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Double Lung Transplant in Vaping Case a Success

Nov. 12, 2019 — The first double lung transplant done as a result of a vaping injury is a success, with the 17-year-old high school athlete on the road to recovery, doctors at Henry Ford Hospital in Detroit said Tuesday.

Doctors did the 6-hour transplant Oct. 15 after the patient’s situation became more and more critical. Doctors describing the surgery at a news conference Tuesday said the lung injury came entirely from vaping.

“What I saw in his lungs is something I never saw before, and I have been doing lung transplants for 20 years,” said Hassan Nemeh, MD, surgical director of thoracic organ transplant at Henry Ford Hospital. He was one of three surgeons on the transplant team. “This is an evil I have not faced before.”

The patient, previously an active high schooler, is still hospitalized. He is close to being transferred to rehab and is expected to be able to return to school. Nemeh said he hopes the teen will talk about the dangers of vaping. “I would expect him to be an advocate to stop this madness.”

The donor was healthy, Nemeh said, but gave no further details.

The severity of the teen’s condition quickly put him high on the national waiting list, Nemeh said.

The teen was admitted to a hospital on Sept. 5 and needed intubation by Sept. 12. On Sept. 17, he was hooked up to a heart-lung machine treatment called ECMO (extracorporeal membrane oxygenation) to keep him alive. He continued to decline and was transferred to Henry Ford on Oct. 3, then put on the waiting list on Oct. 8.

The family of the teen asked for privacy but asked the medical team to share a statement: “He has gone from the typical life of a perfectly healthy 16-year-old athlete — attending high school, hanging out with friends, sailing and playing video games — to waking up intubated and with two new lungs, facing a long and painful recovery process as he struggles to regain his strength and mobility, which has been severely impacted.”

He turned 17 while in the hospital, doctors said.

Lung Transplants in the U.S.

In 2018, 2,530 lung transplant procedures (including both single and double) were done in the U.S., according to the Organ Procurement and Transplantation Network. No breakdown is available on what percent were double.

There are now 1,422 patients on the waiting list for a lung.

During the procedure, a surgeon removes the diseased lung or lungs and attaches the donor lung or lungs to the airway and the blood vessels that lead to and away from the heart. In some cases, the lungs are transplanted along with a donor heart.

Among the common reasons for a transplant are chronic obstructive pulmonary disease (COPD), lung scarring from pulmonary fibrosis, high blood pressure in the lungs known as pulmonary hypertension, or cystic fibrosis, a hereditary disorder that affects the lungs.

Experts Weigh In

A transplant is called for only when there’s severe lung damage, says Wayne Tsuang, MD, an assistant professor of medicine at Cleveland Clinic and a practicing lung transplant pulmonologist. He was not involved in the Detroit patient’s medical care.

“It would have to be end-stage lung disease, in that all the potential medical treatments were exhausted and the team taking good care of him had no other options to salvage his lungs,” he says.

Among those options are oxygen, prescribing steroids to lessen the inflammation in the lungs, and giving antibiotics if pneumonia sets in.

“There are different criteria for different diseases, but overall, very severe lung disease [has to be present],” agrees Mangala Narasimhan, DO, regional director of critical care medicine and a pulmonologist at Northwell Health, New Hyde Park, NY. She was not involved in the Detroit patient’s medical care.

In general, Tsuang says, 1-year survival is about 85%, while 50% of transplant recipients are alive at 5 years. The range varies greatly and depends on things like other health conditions that may be present.

“The median survival for all adult recipients is 6.5 years,” says Narasimhan, citing 2018 national statistics.

The long recovery includes taking anti-rejection medications for the rest of the patient’s life. Often, that involves a dozen new medications, Tsuang says.

Sources

News conference, Henry Ford Health System, Nov. 12, 2019.

Wayne Tsuang, MD, assistant professor of medicine and lung transplant pulmonologist, Cleveland Clinic.

Mangala Narasimhan, DO, regional director of critical care medicine and pulmonologist, Northwell Health, New Hyde Park, NY.

Organ Procurement and Transplantation Network.

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