Coronavirus Milan, 18 years old with “burned” lungs saved with a record transplant

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An 18-year-old from Milan, severely affected by the Coronavirus, after spending more than two months in Resuscitation was saved by doctors with a bilateral lung transplant – the first case in Europe – performed on May 18 at the Policlinico in Milan. In fact, the virus had burned his two organs, making them unable to breathe in a few days.

The nightmare started on March 2, with a sudden high fever. The case of the boy, who is called Francesco to protect his privacy, is very rare, given that Covid-19 in the vast majority of adolescents only causes mild symptoms. Instead, he, 18 years old, healthy, tall, with no pre-existing diseases, found himself in 4 days in very serious conditions in intensive care at the San Raffaele hospital, in the new intensive care unit set up to cope with the wave of Covid patients from the height of the emergency. Two days later he was intubated.

From the beginning, the family had been informed by health professionals that only a miracle he could have saved the 18-year-old, and a chain of solidarity had started among the acquaintances to ask for prayers for him.

On March 23, given the new worsening of his conditions, The doctors of the Cardiac Surgery Intensive Care Unit of Irccs in Via Olgettina connected it, in a pharmacological coma, to the Ecmo life-saving machine. His lungs were hopelessly compromised. In mid-April, the first glimmer of hope: in a confrontation with the experts of thoracic surgery and lung transplants of the Polyclinic, directed by Mario Nosotti, it was decided to attempt the path of transplantation. Doctors were aware that this path had hitherto only been attempted in China, where the spread of Covid-19 began. It was a leap into the void, they say.

The machine of the National Transplant Center started up: after the positive evaluation, Francesco was placed on the national urgent waiting list on 30 April. A few days later the notification of an available donor arrived, but almost immediately the cold shower: not suitable. Meanwhile Francesco continued to deteriorate and his reservations – comments Nosotti – seemed to be nearing the end. Just under two weeks ago, the long-awaited turning point: a pair of suitable organs was identified, donated by a person who died in another Region and negative to the coronavirus, and the collection and transport to Milan was immediately arranged.

In the meantime – continues Nosotti – colleagues from San Raffaele they faced the delicate phase of patient transport in our operating room dedicated to Covid operations. A transplant is always a delicate operation, but even more so when all the operating room staff heavily protected by virus protection devices, including even ventilated helmets, which hinder the movements and fatigue the experts in an important way: So much so that we had planned a change of surgical team, as well as anesthesiological and nursing team at regular intervals, in order to allow colleagues to catch their breath.

The intervention was complex even for serious damage caused by coronavirus: The lungs, in fact, appeared wooden, extremely heavy and in some areas completely destroyed. A widespread damage to the lung alveoli, now unable to perform their function, with notes of extensive septal fibrosis, was then confirmed under microscopic examination. The surgery ended perfectly, and after about 12 hours the extracorporeal circulation was disconnected: something not entirely common, especially considering that the patient had been connected to Ecmo for two months.

Today, the Polyclinic informs, Francesco awake, collaborator, follows physiotherapy and is slowly weaned from the respirator. Now he will have to undergo a long rehabilitation, not so much for the coronavirus infection (from which he has now recovered), but for the 58 days he spent stuck in bed, intubated and assisted by the machines. A similar intervention took place in Austria on the same days (in Vienna last week). But it was a practically unexplored road, if not in a few rare cases in China.

In addition to the technical skills – says Nosotti, director of the School of Specialization in Thoracic Surgery at the University of Milan – I must underline the obstinacy and courage of the colleagues of San Raffaele who, instead of surrendering, have involved us in a solution never attempted before in the western world. Our experience is inspired by that of Professor Jing-Yu Chen of the Wuxi hospital in China, whom we personally know and with whom we discussed some technical aspects, since for obvious reasons he found himself facing the problem before us. The 18-year-old from Milan becomes a pioneer patient from many points of view, if one thinks that, among other things, hyperimmune plasma was also used in the delicate post-operative management.

May 28, 2020 | 10:27

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