He donates a piece of his lung to his 5-year-old son so he can go back to living like a normal child. Ánduel, a 34-year-old Albanian man, emotionally embraces the little boy as he leaves the Papa Giovanni XXIII hospital in Bergamo.
Here, on January 17, “a miracle” took place. The medical team performed the first living donor lung transplant in Italy. Now he is back to breathing independently and will be able to play like a normal child.
Little ‘Mario’ (invented name) was discharged last week, just over a month after surgery. His family moved to Italy in the summer of 2018, when the child was just one year old. Mum arrived first, then dad Ánduel joined them, after having left his job as a construction engineer in Albania.
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Diagnosis of disease and indication for transplantation
The year following their arrival in Italy, Mario’s parents took their son to the Meyer hospital in Florence for some signs of illness. After the tests, the diagnosis of thalassemia or Mediterranean anemia arrives, a blood disorder. In the summer of 2021, a bone marrow transplant is required. Despite the success of the transplant, this very donation of marrow from the father, with the consequent “transfer” of the parent’s immune system to the child, generates the so-called graft versus host disease (GvHD), a serious complication observed in patients undergoing allogeneic transplantation.
It is a complex immune reaction, where the transplanted cells from the donor “attack” the recipient’s organs and tissues, which the new immune system fails to recognize as its own. This disease damages the lungs to the point that the child was completely losing the ability to breathe independently. For him there is no hope of survival, except that of a lung transplant. In the autumn of 2022, the specialists of the Meyer hospital in Florence contacted Pope John XXIII of Bergamo to evaluate and possibly put the child on the list for a lung transplant.
The pre-transplant phase and the intervention
On 1 December 2022 the family arrives in Bergamo. The child is hospitalized in the Pediatrics department, directed by Lorenzo D’Antiga, who is Director of the Integrated Pediatric Pathways Department at the Bergamo hospital. Mario is welcomed by the section of Pediatric Hepatology and Gastroenterology and Transplants, specialized in the management of the pediatric patient undergoing transplantation for any solid organ, except for the heart which is managed in a special department. The child needs continuous high-flow oxygen, i.e. a non-invasive respiratory assistance system, managed also thanks to the experience gained by the nursing staff during the pandemic period.
During the discussion of the multidisciplinary team of pediatric transplants, Michele Colledan, director of the Department of Organ Failure and Transplantation and of the General Surgery Unit 3 – Abdominal Transplants and Professor of Surgery at the University of Milano-Bicocca, highlights the The enormous advantage represented by a transplant with an organ donated by the father, who has already donated the marrow and therefore transferred his immunity to his son. This would have eliminated the risk of rejection.
Although this strategy was already adopted by Pope John for liver transplantation, in the case of the lung this intervention had never been done in Italy and had very few precedents in Europe, due to the great technical difficulty and the rarity of this situation. After detailed discussion and consideration of all aspects, the whole team agrees to this type of approach.
Mario’s parents don’t wait even a moment and say they are immediately ready to do whatever it takes to save their son’s life. The father of the child is then followed by Pneumology, which offers its advice to the transplant team in view of the preparation of the operation on the father. The director Fabiano Di Marco, professor of respiratory diseases at the University of Milan, and his team evaluate the father-donor at a functional, clinical and imaging level.
Throughout the period, the family was welcomed into one of the apartments managed by the ETS ODV Friends of Pediatrics Association, which makes volunteers available for the needs of families who have children hospitalized for medium-long periods. The family spends Christmas at the hospital in Bergamo. On 30 December the family leaves Bergamo and Pope John XXIII waiting to be called back for surgery.
The transplant was performed on Tuesday, January 17, 2023 in two adjacent surgical rooms, which worked in parallel. The operation is guided and coordinated by Michele Colledan, who performs the transplant on the child, while Alessandro Lucianetti, director of General Surgery 1 – Abdominal Thoracic, performs the removal of the right lung lobe from the donor father.
The post-surgery course and the discharge of the child
Immediately after the operation, the father was hospitalized on the first day in the adult intensive care unit, directed by Fabrizio Fabretti. Upon waking up from the sedation, Mr. Anduel immediately asks his wife for news about their son’s health. Given the regular course, he was transferred to Surgery 3 – abdominal transplants, directed by Michele Colledan, to be discharged after about a week.
The child is hospitalized for two weeks in the Pediatric Intensive Care Unit led by Ezio Bonanomi, one of the largest facilities in Italy for beds dedicated exclusively to the pediatric patient and specialized in the management of critically ill children, even in the phases following the transplant . Upon his arrival in intensive care he is still attached to the ECMO (ExtraCorporeal Membrane Oxygenation) extracorporeal circulation system used for the operation. Eight days after the transplant Mario reaches respiratory autonomy with suspension of invasive ventilation. Once the sedation is suspended, the mother has the opportunity to stay with her child day and night. The father was able to see his son again after about a week, that is, after recovering from the operation.
The child is transferred to ordinary hospitalization on 1 February in Pediatrics, in the same ward that followed him in December. He is in excellent general condition. Mario resumes his normal activities without the need for any respiratory support, thanks to the new lung donated by his father, which is perfectly functional. The parents were able to be present in the room to assist the child for the entire period of hospitalisation.
The child’s resignation arrives on Tuesday 21 February, just over a month after the operation. Mario will stay in Bergamo for some time to undergo post-transplant checks. Then he will be able to go home and start a normal life again.
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