How SA’s lung transplant team defied global fatality rates during Covid

The state’s only two lung transplant doctors – a husband and wife team – decided to divide to conquer “huge” international fatality rates of up to 45 per cent during Covid.

Staring down a 45 per cent fatality rate for lung transplant patients who contracted Covid, South Australia’s only two doctors in this field decided to divide and conquer.

Professor Mark Holmes, who established and heads up the statewide lung transplant unit based at the Royal Adelaide Hospital, and his wife, Professor Chien-Li Holmes-Liew, split their clinical service in two to best support their severely immunocompromised patients.

Prof Holmes-Liew said the Covid’s arrival in Australia left her “pretty stressed about how we would manage”, as at the time, their unit still had the same number of resources as when it was first set up 20 years ago.

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Nurses Mary Young and Laura Sadler with Professor Chien-Li Holmes-Liew of South Australia's lung transplant unit, which is based at the Royal Adelaide Hospital.

“We decided I would manage all of Covid and (Prof Holmes) would manage everything else,” Prof Holmes-Liew said.

“I read all the data that was available internationally and the mortality rate was up to 45 per cent, which was absolutely huge.

“I learnt rapidly based on international experience what would lead to a better outcome for our patients and we set up a streamlined process, which I oversee pretty obsessively.”

The result has been zero Covid fatalities from the 32 of SA’s 130-odd lung transplant recipients who contracted it. Not one of them spent a single day in ICU either, Prof Holmes-Liew said.

Her process began with emailing the state’s entire lung transplant population with information on what to do as Covid began its spread and who to call if they needed help.

“We also admitted all (the patients who contracted Covid), as one of the risks is they can get worse very early and very quickly without warning at home,” she said.

“We were given one clinical nurse, Mary Young, to act as the single point of contact for the patients – she is one of the shining lights of the service. Together, we update the protocol. I gave medical advice and drove the decisions being made on the ward.

“After the patients leave hospital, … Mary calls every day and if there are any red flags, we intervene rapidly.”

Professors Chien-Li Holmes-Liew and Mark Holmes made the tough call to take their daughter out of school for a term early in the pandemic, to ensure they could keep helping patients.

While vaccination helped these patients, it didn’t offer the same level of protection as the general population. Wearing masks and avoiding crowded places “came naturally before Covid” to them and was now crucial, Prof Holmes-Liew said, while “a drug that helps prevent’ Covid” named Evusheld, is being rolled out in lung transplant and other immunosuppressed cases.

“We are very heavily invested in our patients (for whom the pandemic) has been very difficult,” she said.

“We used to tell them to travel, go to work, see your friends – that’s why we transplanted you, so you can live as normal a life as possible. But now, they have to be extra careful.”

It has been a challenging time for Prof Holmes-Liew and her husband too – as the only lung transplant doctors in SA, they made the tough call to take their seven-year-old daughter out of school for a whole term early in the pandemic.

“If we got Covid, there would be no one to look after the transplant patients,” she said.

A third doctor has now joined the SA lung transplant unit, which is one of the only lung transplant satellite centres in the world.

Prior to its establishment, SA patients would need to spend months away from their loved ones in Melbourne or Sydney completing their workup (pre-transplant testing) and waiting for a suitable donor to be found.

Now, patients do their workup at the Royal Adelaide Hospital and don’t fly interstate until organs become available and they can be transplanted. The SA team then resumes their post-surgery care.

Double lung transplant recipient Flynn O’Malley was recovering from his second operation when the pandemic hit. Picture: Brenton Edwards

Double lung transplant recipient Flynn O’Malley said it was “incredible to be able to stay in my home state with friends and family, and with the clinicians we’d gotten to know so well” up until his operations in Melbourne in 2015 and 2020.

The 23-year-old’s recovery from the second transplant – which became necessary after workplace fire damaged his first set of transplanted lungs – coincided with the onset of Covid, making 2020 a difficult year for him.

“I was very cautious, I don’t think I caught up with my mates for a good year,” he said. “I’m certainly not miserable though – I’m living. (And) I’m forever grateful for both transplants.”