Majority of people recover from COVID-19 Pneumonia, but they develop secondary infections post recovery. There are patients who develop lung damage gradually, they remain on oxygen and have to be on follow up for years. However, many others see a saturation drop even after the ventilator support and ECMO is given in such a circumstance.
Many patients who have had severe lung damage and they continue to be on bridge support, especially the ones on ECMO support. These patients are the ones who are considered for double lung transplant because they have incurred irreversible lung damage.
"Though it is a small fraction of people from all those who have recovered from COVID-19 requiring double lung transplant due to severe damage to the lungs. The ECMO support is being given for 4-6 weeks and if that doesn't work, we undertake double lung transplant because that is the only resort. Even after the transplant, these patients are supposed to be on a lot of medications and there is about 50 percent survival rate of upto five years, even in the western countries," said Dr Anantha Subramanian, pulmonologist, Kauvery Hospital.
He added that it is usually being done in people who are younger and can benefit from the same. Patients who have other organ damage due to COVID-19, are not considered for the double lung transplant.
Moreover, there is an increase in the number of registrations for double lung transplant who are looking for donors as more number of people have recovered from COVID-19. However, a proper healthy lung for transplantation is also a challenge.
Dr Suresh Rao, Co-Director of Heart and Lung Transplantation Programme & Mechanical Circulatory Support, MGM Healthcare says that the dual lung transplant is challenging because even after the registration for the transplant, we receive it only after a month or more. "In such conditions, the patient would have become more sick. We used to get dual lung donations from the other cities but post lockdown, that is also an obstruction. Since, only about 20-30 percent of the total number of brain dead cases we receive have healthy dual lungs for transplantation, the availability is a major concern," he says.
He added that secondary infections should be prevented and a close follow-up of the patient post COVID-19 recovery is necessary.
Doctors say that there is an increase in the cases of post COVID-19 cases, with higher intensity and more cases of fibrosis, when pulmonary rehabilitation is also not an option.
"Elderly patients suffering from chronic diabetes, on immunosuppressive drugs, and other comorbidities can develop lung fibrosis and even the ECMO support is given as a bridge if they can benefit from lung transplant. The selection of candidates for dual lung transplant is also very difficult as there can be secondary infections and rejection post transplantation procedure also. The pulmonary rehabilitation is also important post COVID-19 recovery to ensure that the lung condition does not worsen," said Dr S Suresh, Consultant Pulmonologist, Gleneagles Global Health City.