Thoracic Surgery

Dr. Jeffrey B. Matthews

Jessica Donington, MD, MSCR
Professor of Surgery
Chief, Section of Thoracic Surgery
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Maria Lucia Madariaga, MD

Testing Convalescent Plasma in the Age of Pandemic

Maria Lucia Madariaga, MD, did not let the fact that she was our newest thoracic surgeon stop her from plunging headfirst into the fight against COVID-19. Dr. Madariaga joined the University of Chicago Medicine in February 2020 and by the end of March had launched a clinical trial to study whether blood plasma transfusions from people who have tested positive for the virus and recovered are a viable treatment for critically ill patients with COVID-19.

An extra boost from plasma

Plasma is the fluid in which blood cells are suspended. When someone is infected with a virus, the body’s immune system produces proteins called antibodies that can seek out and neutralize the virus. Transfusing plasma containing these antibodies to severely ill patients could give their immune systems extra resources to fight off the infection.

After a patient recovers, the antibodies stay in the blood and can provide immunity; however, it is not yet known how long a patient will be immune following recovery from COVID-19. Donating plasma for the trial is similar to donating blood.

A single plasma donation from one patient can help multiple recipients.

The first step

Dr. Madariaga’s clinical trial recruited qualifying convalescent plasma donors from among current UChicago Medicine patients and other Chicagoans. Those plasma donations are being used to treat patients currently hospitalized at UChicago Medicine.

The initial study investigated the safety and feasibility of identifying donors, collecting plasma donations and administering transfusions. Further study of the effectiveness of such a treatment will require additional trials. As the COVID-19 pandemic spread, hospitals around the world began testing convalescent plasma as a potential treatment.

Cross-disciplinary collaboration under one roof

“A major barrier to widespread study in the United States has been that it requires broad cross-disciplinary collaboration,” said Dr. Madariaga. “At UChicago Medicine, we are really fortunate that we have all the teams required to perform a convalescent plasma trial under one roof—the Biological Sciences Division, Blood Donation Center, Department of Medicine, Transplant Institute and Department of Surgery.”

A promising turnaround

Edgardo Diaz, 30, was one of the recipients of donor plasma—and it was not his first time in the hospital for a procedure of this gravity. Just a year earlier he had undergone a successful lung transplant at UChicago Medicine, but he recently returned to the medical center in critical condition with COVID-19.

Diaz’s lung transplant surgeons included Tae H. Song, MD, also a member of our cardiothoracic faculty. The team knew Diaz’s transplant disqualified him from most trials, but because he had severe and possibly life-threatening COVID-19, he met the FDA criteria for the convalescent plasma trial. Running out of time and options, Diaz’s doctors invited him to participate.

Within hours after receiving the convalescent plasma on April 25, Diaz’s 104-degree fever started going down. Days later, his breathing and kidney function improved. Nine days after receiving the plasma, Diaz tested negative for COVID-19. He was released from the hospital May 1 and continues to test negative for the virus.

Now that he’s home, Diaz said he feels “even better than I did before I had COVID-19.” He’s been able to resume his workouts, and has returned to his job.

Maria Lucia Madariaga, MD

Seeing patients safely home

“It’s a pretty safe therapy,” Dr. Madariaga said of convalescent plasma, adding that early reports she’s seen nationwide about treating COVID-19 patients with plasma have shown very few side effects. “We have given it to high-risk, immunocompromised patients, and it still seems safe.”

“This trial is just the first step,” she said. “One of the best parts of this experience was meeting so many fantastic people who were motivated to work together and get this trial off the ground.

“I am especially grateful for the support from the Department of Surgery leadership and the brilliant work done by our Thoracic Surgery team who launched our idea into reality.”

Maria Lucia Madariaga, MD
Assistant Professor of Surgery

Maria Lucia Madariaga, MD

Parts of this article were previously published on the UChicago Medicine website on April 13, 2020, and were written by Matt Wood; and on the UChicago News website on June 29, 2020, and were written by Jamie Bartosch.

faculty listing

Professor of Surgery
Jessica Donington, MD, MSCR, Professor of Surgery; Chief, Section of Thoracic Surgery
Mark K. Ferguson, MD, Professor of Surgery

Assistant Professor of Surgery
Maria Lucia Madariaga, MD, Assistant Professor of Surgery

faculty honors

Jessica Donington, MD, MSCR, was honored as a Distinguished Leader in Program Innovation by the Biological Sciences Division. This award recognizes outstanding faculty leaders who have developed innovative programs that have improved the quality of the division and/or the medical center.

Jessica Donington, MD, MSCR, and Mark K. Ferguson, MD, were named 2020 Top Doctors by Chicago magazine.

Mark K. Ferguson, MD, successfully completed the third edition of Difficult Decisions in Thoracic Surgery: An Evidence-Based Approach.

Maria Lucia Madariaga, MD, was founder and leader of the UChicago Medicine Convalescent Plasma Project. This National Institutes of Health–sponsored effort, which was a collaboration with UChicago Medicine’s antibody laboratory, collected plasma from more than 100 recovered COVD-19 patients for transfusion into severely ill COVID-19 patients. She now heads the Convalescent Plasma Working Group.

select publications

Brownlee AR, Donington JS. Update on Lung Cancer Screening. Semin Respir Crit Care Med. 2020; 41(3):447-452. doi: 10.1055/s-0039-3400480.

Brownlee AR, Mitzman B, Cyzman R, Ferguson MK. Outpatient Thoracoscopic Mediastinal Biopsy: A Safe and Cost Effective Approach [published online ahead of print, 2020 Jun 3]. Ann Thorac Surg. 2020; S0003-4975(20)30792-X. doi: 10.1016/j.athoracsur.2020.04.056.

Catenacci DVT, Chase L, Lomnicki S, et al. Evaluation of the Association of Perioperative UGT1A1 Genotype-Dosed gFOLFIRINOX With Margin-Negative Resection Rates and Pathologic Response Grades Among Patients With Locally Advanced Gastroesophageal Adenocarcinoma: A Phase 2 Clinical Trial. JAMA Netw Open. 2020;3(2):e1921290. Published 2020 Feb 5. doi: 10.1001/jamanetworkopen.2019.21290.

Edwards JG, Chansky K, Van Schil P, et al. The IASLC Lung Cancer Staging Project: Analysis of Resection Margin Status and Proposals for Residual Tumor Descriptors for Non-Small Cell Lung Cancer. J Thorac Oncol. 2020; 15(3):344-359. doi: 10.1016/j.jtho.2019.10.019.

Ferguson MK, Mitzman B, Derstine B, et al. A Morphomic Index Is an Independent Predictor of Survival After Lung Cancer Resection. Ann Thorac Surg. 2020;109(3):873-878. doi: 10.1016/j.athoracsur.2019.10.064.

Lee P, Goldman J, Donington JS. Lung Cancer: Advances in Diagnosis and Management. Semin Respir Crit Care Med. 2020; 41(3):333-334. doi: 10.1055/s-0040-1709995.

Madariaga ML, Lennes IT, Best T, et al. Multidisciplinary selection of pulmonary nodules for surgical resection: Diagnostic results and long-term outcomes. J Thorac Cardiovasc Surg. 2019 Sep 24. pii: S0022-5223(19)32014-8.

Madariaga MLL, Geller A, Lanuti M, et al. Pulmonary Artery Resection During Lung Resection for Malignancy. Ann Thorac Surg. 2019 Dec;108(6):1692-1700.

Madariaga MLL, Troschel FM, Best TD, et al. Low thoracic skeletal muscle areap morbidity after pneumonectomy for lung cancer. Ann Thorac Surg. 2020 Mar;109(3):907-913.

Milner R, Donington J, Matthews JB, Posner M, Turaga K, Angelos P. Is it ethically appropriate to continue surgical clinical trials during the COVID-19 pandemic? Surgery. 2020; 168(1):1-3. doi: 10.1016/j.surg.2020.04.024.

Tam V, Tong B, Gorawara-Bhat R, Liao C, Ferguson MK. Gender Bias Affects Assessment of Frailty and Recommendations for Surgery. Ann Thorac Surg. 2020; 109(3):938-944. doi: 10.1016/j.athoracsur.2019.06.066.

Udelsman BV, Soni M, Madariaga ML, et al. Incidence, aetiology and outcomes of major postoperative haemorrhage after pulmonary lobectomy. Eur J Cardiothorac Surg. 2020 Mar 1;57(3):462-470.

residents & fellows

View the Cardiothoracic Residents and Fellows here.