Key to the success of the pulmonology and lung surgery program, ranked 37th in the United States in the U.S. News & World Report’s 2020-21 Best Hospitals survey, is the interdisciplinary nature of its members. This variety in expertise — which includes thoracic surgeons, pulmonologists, intensivists, ECMO specialists and nurses — helped the team evaluate the patient’s progression.
“Our team works from a multidisciplinary perspective,” said Andres Pelaez, M.D., medical director of the lung transplant program and an associate professor of medicine in the UF College of Medicine. “We witnessed the way in which the virus had completely destroyed his lungs, and while his frailty was initially significant, we saw how determined he was and knew he could benefit from lung transplantation as we watched him become less frail over time.”
Despite the patient’s improved strength, he began to show signs that the lung damage was permanent. He needed increased levels of ECMO, and imaging showed signs of advanced chronic lung disease.
“We concluded that we were dealing with a situation that was not reversible,” Machuca said. “These were signs that our window of opportunity was quickly closing.”
Life changed for the patient when, after 33 days at UF Health Shands Hospital and more than three months on ECMO, donor lungs became available. Due to the limited size of the patient’s chest cavity, Machuca performed a lobar transplant, resizing the donor lungs to ensure a perfect fit.
“This treatment brings much-needed hope that other selected patients struggling with coronavirus or its aftereffects can have a second chance,” Machuca said. “But this disease and its impact on the body certainly require further understanding.”
While a lung transplant might be an option for those whose lungs are severely damaged by COVID-19, Machuca cautions that the evaluation for transplant candidacy should still be performed on a case-by-case basis. Expertise and experience with end-stage lung disease in a multidisciplinary setting are a necessity.
“A lung transplant is a major, complex surgery, and the aftermath requires the patient to make lifestyle changes,” Machuca said. “You need to be sure that this kind of a procedure is not just the patient’s only option but their best option.”
The patient is recovering steadily and has been disconnected from ECMO, demonstrating the resilience the team said he’s displayed from the beginning.
“Over the past several years, the advanced lung services at UF Health have increased in national prominence, as evidenced by both our U.S. News rankings and the amazing results for lung transplantation as measured by UNOS,” said UF Health Shands CEO Ed Jimenez. “It’s no surprise that UF Health teams would be one of the few centers nationally that took this on and gave this man new hope.”