Doctors have successfully completed the first double lung transplant in Canada for a man whose lungs were devastated by COVID-19.
Tim Sauve, 61, became ill with COVID-19 in December when he noticed himself getting dizzy at home in Mississauga, Ont. In a matter of days he ended up in hospital, unable to breathe.
“I was put on 100 per cent oxygen at that moment, and after that there was no turning back, they could not lower my oxygen” Sauve told CTV News’ chief medical correspondent Avis Favaro. “At that point it got very, very serious.”
Sauve was transferred to the intensive care unit (ICU) at Toronto General Hospital in January with acute respiratory distress syndrome – or lung failure – caused by COVID-19. At that time, he was also put on extracorporeal membrane oxygenation (ECMO) which is a treatment that pumps the blood outside the body into an artificial lung to become oxygenated and then cycles it back into the patient, basically providing heart-lung bypass support.
“He had really no prospect of recovery as far as we could tell, things looked pretty dire and it looked quite unlikely that he would be able to pull through,” said respirologist and member of the Toronto General Hospital lung transplant program Dr. Stephen Juvet to CTV News.
Sauve’s other organs were not failing, but there was little chance his lungs would recover, which is why doctors offered him a chance at survival with a transplant.
Dr. Marcelo Cypel, a thoracic surgeon at the University Health Network told CTV News that Sauve had such intense scarring in his lungs from the disease and with two and a half months with no improvement in the ICU, his medical team felt “his only chance of surviving was by a lung transplantation.”
In mid-February, Sauve became the first COVID-19 patient in Canada to receive a double lung transplant.
Cypel said it was a close call. “I don’t think if we didn’t get lungs for him for another five to seven days, probably he would not be a candidate anymore.”
Sauve said he feels like “a million dollars” after the operation. He’s lost 30 pounds and says “everyone” was surprised at his quick recovery.
Approximately 40 lung transplants have been performed for COVID-19 patients globally, a procedure that is considered high-risk with life-long medications necessary to prevent organ rejection.
The rise in variants of concern in Canada and their tendency to infect a younger cohort of patients means that lung transplants for severe COVID-19 cases could become more common.
Dr. Shaf Keshavjee, surgeon-in-chief at University Health Network in Toronto and director of the Toronto Lung Transplant Program said it’s a watch and wait situation.
“We had a meeting with the other transplant centres in Canada, and they’re sort of looking and waiting, watching what to do…knowing that they’re very difficult and high-risk transplants to do,” he said.
But lung transplants for COVID-19 patients means adding even more people to the already long transplant lists, diminishing the odds for people already waiting – and doctors can’t reliably predict whose lungs will recover on their own.
“When do you resort to transplant is really answering the very difficult question: When is the lung irreparably damaged?” Keshavjee said. He added that in the past, ECMO could keep a patient alive for “four to six weeks” but now works for six to seven months.
“We’ve seen lungs recover in three, four or five months, they get off ECMO and go home to their lives, so when do you jump to transplant? How do you know that the lung is irreparably damaged – a lot of lungs can look really bad on CT scans and X-rays and recover,” he said.
In Sauve’s case, his lungs started to heal “in the wrong way” and he developed severe scarring and fibroids, Keshavjee said. “That’s when we started to have the discussion that “you know, your only way out of this is with a transplant.”
Sauve is hoping to return home in a few months, but issued a stark warning from his hospital bed after his family all contracted COVID-19. His future father-in-law, 80-year-old Juanito Teng died, but his partner Julie Garcia and her son did not become ill at all.
“It’s an opportunity for me to tell people, don’t take your guard down for one minute,” Sauve said. “It is so powerful, and it’s so quick. It’s unbelievable. I don’t wish this upon anyone ever.”