Milan, 18 Jan. (Adnkronos Salute) — The first living lung transplant in Italy has been performed in Bergamo. The protagonist of the operation, carried out yesterday, January 17 at the Papa Giovanni XXIII hospital, is a 5-year-old boy from another region, who received the organ from his father. After giving his son the marrow to treat the thalassemia that afflicts the baby since birth, the father chose to deprive himself of a part of the lung to save the child’s life.»This is a very rare case, with very few precedents in Europe», underline the Bergamo Asst.
The child — explains a note from ‘Pope John’ — suffers from thalassemia or Mediterranean anemia, a blood disease that has made it necessary to have a bone marrow transplant, performed in another Italian hospital. The donation of the marrow from the father, with the consequent transfer of the parent’s immune system to the child, however, produced the so-called graft host disease (GvHd), a serious complication that is observed in patients undergoing allogeneic transplantation. In summary, donor cells ‘attack’ the recipient’s organs and tissues because the new immune system does not recognize them as its own. A form of rejection that has caused the child an extremely serious and irreversible damage to lung function, so much so that it requires lung transplantation.
Father and son remain hospitalized and their prognosis is still reserved.The doctors, however, say they are «confident about the post-operative course, also because in this case the risk of rejection, particularly high for lung transplantation from cadavers, is very low when the immune system recognizes the new organ as its own». It is above all for this reason that, when a hospital from outside the region asked Pope John’s willingness to accept the child for a lung transplant, the surgeons of Bergamo proposed the living donation to the family.
«The extreme rarity of these cases, and the technical limitations of living transplantation, in the case of the lung do not make it an easy therapeutic option — specifies Michele Colledan, director of the Department of Organ Failure and Transplantation and of the General Surgery Unit 3, abdominal transplants of the Asst Pope John XXIII — For this reason, unlike what happens for other organs, It is not usually considered an option within everyone’s reach, able to contribute effectively to the elimination of waiting lists.However, the intervention marks an important step for our hospital in a path of growth of transplant activity almost forty years. A path undertaken thanks to the pioneering of Lucio Parenzan in pediatric cardiac surgery and that has led us, also thanks to Giuseppe Locatelli, to the specialization in congenital and acquired child pathologies and that, in the last 20 years, has been strengthened by aiming at a high-level clinical activity on the lung, even in adults «.
The whole procedure lasted 11 hours, describe the territorial social-health company. For the double removal and transplantation, two adjacent surgical rooms were used and worked in parallel. While the father underwent the removal of the right pulmonary lobe, in the next room the preparation phase of the son began. The entire intervention was guided and coordinated by Colledan, who also performed the transplant on the child. The collection from the father was performed by Alessandro Lucianetti, director of General Surgery 1, thoracic abdominal.Cardiac Intensive Care Anaesthetists, Paediatric Cardiac Surgeons and Perfusionists have arranged to support cardiocirculatory functions with Ecmo, the ‘heart-lung machine’. The two collection and transplantation teams were assisted by anesthesia and resuscitation and by the technical and nursing staff, for a total of several dozen operators involved. The study and management of patients before and after surgery were followed by the Paediatrics, Pulmonology, Paediatric Intensive Care and Adult Intensive Care teams.
The National Transplant Center has granted the Bergamo hospital a special authorization to perform the operation. Living lung donation is in fact a possible option, but adopted so far only in rare cases and in very few countries in the world — remarks the Asst — especially in Japan and North America, due to its extremely complex application. The known cases in Europe are few: a living transplant results in Germany in 2012; The EuroTransplant database, which connects some Central European countries, records two cases in the last 10 years.
«An appreciation goes to all the staff who managed the double intervention — comments Maria Beatrice Stasi, director general of Pope John XXIII — Such complex and delicate clinical cases are possible thanks to an extraordinary organizational effort.Several dozen professionals, each in his role, contributed in all phases, in the departments, in the operating rooms, in the laboratories, in the offices and offices of the technical and administrative staff. It is thanks to this teamwork that our hospital, a large public company, achieves and maintains cutting-edge clinical standards, not only at national level».
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