Rare Flu Leads to Rare Lung Transplant for Omaha Native
MADISON - Tyler DeGand was a healthy 14-year-old boy.
Then, suddenly, in March of this year, he wasn't.
Infection with a rare strain of influenza B sent this football-loving, vigorously healthy Nebraska native through a six-month roller coaster of life-threatening complications. Very quickly, it looked like Tyler was headed for a short life while stranded on a mechanical ventilator.
Today, however, he is looking forward to going home with normal lung function, thanks to the generosity of a donor family and a team of University of Wisconsin transplant surgeons and pulmonologists led by Dr. Nilto De Oliveira and Dr. Keith Meyer. On October 7 Dr. De Oliveira transplanted a new set of lungs into Tyler, giving him a new shot at a normal, healthy life.
"The surgery couldn't have gone better," says Dr. De Oliveira, whose team spent more than eight hours transplanting the new lungs into Tyler's chest. "It's extremely rare to transplant lungs into a patient at such a young age unless they have cystic fibrosis, but it's also extremely rewarding. His quality of life is dramatically improved."
Tyler's terrible illness ravaged quickly. A severe Staph infection settled into his lungs and blood stream shortly after the influenza infection had caused so much damage that he couldn't walk from his father's parked car to the entrance of his local Urgent Care Clinic for a medical evaluation just four days after his influenza symptoms (sore throat, fever, and headache) had started.
Tyler had an endotracheal tube placed in his windpipe and received artificial ventilation later that day, and the doctors were hard pressed not to lose him. He was emergently transferred on the same day to Omaha Children's Hospital, where signs of the evolving Staph infection were diagnosed. He quickly became so ill that other organs started to fail, especially his kidneys.
Months later, after Tyler was stabilized and his other organs had regained their function, it became clear that his lungs had been completely ravaged. With virtually no chance of recovering some of his lost lung function, he was facing the prospect of spending the rest of his life on a ventilator.
When Tyler's old lungs were removed and UW Lung Transplant Team doctors and lung pathologists examined his lung tissues and the CT scans performed just before his transplant, they were amazed at the extent of the very severe damage that had occurred. Some of the damage was still ongoing, and they realized that Tyler had no chance of coming off his ventilator without a lung transplant.
Chris DeGand, Tyler's father, says he couldn't believe how quickly his son's health degenerated. "He was so strong and such a healthy kid," says Chris. "Watching him go through this was brutal - he would take two steps backwards and not be able to recover the ground he lost as he got more and more ill through March and April."
Dr. Meyer speculates that the virus set everything off by causing severe damage to bronchial tubes and other tissues throughout Tyler's lungs. The Staph pneumonia, a relatively common complication of influenza infections, settled into the damaged lung and spread to Tyler's blood stream. This made him go into shock and caused much more damage to the lungs and other organs in Tyler's body.
"The influenza was very much what started this, and the Staph infection poured oil on a burning fire," says Dr. Meyer, the medical director of lung transplantation at UW Hospital who became directly involved in Tyler's care after surgery. "It triggered a cycle that wouldn't go away and got worse and worse."
Because Nebraska Medical Center has no lung transplant program, Tyler's doctors in Omaha had suggested he get listed for a set of lungs with UW's program, as other young patients from Nebraska have done over the years. Tyler was transferred to the American Famly Children's Hospital in Madison, where his condition was stabilized. Because Tyler was so ill, it took only seven weeks to find a donor whose lungs were a good match, giving him a second chance at life.
Today, Tyler is off the ventilator, talking up a storm, and no longer needs an oxygen tank. He's moving around UW Hospital, waiting to be discharged so he can return to Omaha, where he's looking forward to beginning high school.
UW doctors have told him that he can expect to resume most normal activities (no contact sports, unfortunately), but he will have to be monitored closely for signs of organ rejection or signs of various lung infections that can complicate a lung transplant. Tyler's immune system is suppressed by medications that Tyler must take for the rest of his life to keep his new lungs from being rejected.
Dr. De Oliveira notes that lung transplants remain among the riskiest transplant procedures, and long-term survival rates at five years after transplant are around 50 percent for many of the diseases for which lung transplants are performed.
Survival rates at some transplant centers such as UW are better, especially for younger patients like Tyler. Many centers will not perform lung transplants on mechanically ventilated patients. Over the past 15 years, however, UW has performed transplants on many stabilized patients with severe lung damage who could not get off their ventilators. These carefully selected patients have survival outcomes that are no worse than patients who were not on artificial ventilation when they received their transplants. Some UW lung transplant recipients continue to enjoy excellent lung function nearly 20 years after their transplants.
Tyler recalls battling feelings of self-pity as his health deteriorated, but his attitude is nothing but optimistic now.
"I can really feel the difference." he says. "Now I appreciate all the little things - like how I don't have to fear a flight of stairs anymore."
Date Published: 10/19/2009