The world’s first transplant of lung tissue from living donors to a patient with severe lung damage from COVID-19 was successfully wrapped up by a team of doctors in Japan on Thursday.
The recipient, identified only as a woman from Japan’s western region of Kansai, is recovering after the nearly 11-hour operation on Wednesday, Kyoto University Hospital said in a statement. It said her husband and son, who donated parts of their lungs, are also in stable condition.
According to the university statement it was the world’s first transplant of lung tissue from living donors to a person with COVID-19 lung damage. With transplants from brain-dead donors in Japan are still rare, living donors are considered a more realistic option for patients.
“We demonstrated that we now have an option of lung transplants from living donors,” Dr. Hiroshi Date, a thoracic surgeon at the hospital who led the operation, said at a news conference. “I think this is a treatment that gives hope for patients” with severe lung damage from COVID-19, he said.
Kyoto University said dozens of transplants of parts of lungs taken from brain-dead donors to patients with COVID-19-related lung damage have been carried out in the United States, Europe and China.
Lung transplantation is used to treat a variety of end-stage lung diseases; however, patients with acute lung injury due to infectious causes are generally not considered for transplantation. Although sporadic cases of lung transplantation for COVID-19-associated acute respiratory distress syndrome (ARDS) have been reported, insufficient data are available to inform selection criteria for potential recipients, the optimal timing of transplantation, and outcomes after transplantation.
Additionally, several unaddressed concerns limit the use of lung transplantation as a therapy for patients with severe ARDS secondary to COVID-19.
Although several organs can be affected by COVID-19, the lungs are the primary site of disease. A significant proportion of patients with SARS-CoV-2, ranging from 6% to 10%, can progress to ARDS and require mechanical ventilation. Furthermore, the mortality of patients with COVID-19-associated ARDS requiring mechanical ventilation can exceed 20–40%. Given the millions of active cases combined with the increase in COVID-19 case numbers due to second waves of the pandemic in many countries, the number of patients who require prolonged mechanical ventilation and extracorporeal support, and the cumulative number of deaths from COVID-19-associated ARDS, are expected to rise or remain high. Hence, it is important to consider lung transplantation as a life-saving therapy for patients with COVID-19-associated ARDS when medical therapy fails.
The woman contracted COVID-19 late last year and developed breathing difficulties that rapidly worsened. She was placed on a life support machine that works as an artificial lung for more than three months at another hospital because her lungs were so severely damaged.
Even after she was free of the virus, her lungs were no longer functional or treatable, and the only option for her to live was to receive a lung transplant, the university said.
Her husband and son volunteered to donate parts of their lungs, and the surgery was conducted at Kyoto University Hospital by a 30-member team headed by Dr. Date. Her husband donated part of his left lung, and son gave part of his right lung. She is expected to be able to leave the hospital in about two months and return to her normal life in about three months, the university said.