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Lung Transplanta tion

Lung Transplanta tion. Sina Ercan, M.D. Yeditepe University Department of Thoracic Surgery. Organ Transplantation. Organ transplantation is often the only treatment for end state organ failure, such as liver , lung and heart failure.

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Lung Transplanta tion

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  1. Lung Transplantation Sina Ercan, M.D. Yeditepe University Department of Thoracic Surgery

  2. Organ Transplantation • Organ transplantation is often the only treatment for end state organ failure, such as liver, lung and heart failure. • The procurement of organs for transplantation involves the removal of organs from the bodies of deceased persons. This removal must follow legal requirements, including the definition of death and consent.

  3. Organ Transplantation • Organ Tx saved 350.000 patients’ lives in the USA up to date • Currently 91.000 patients are on the waiting lists • 18 patients are dying each day while waiting for a suitable organ • Dividing the organs (Liver lobes or one of pair organs) did not suffice to meet the numbers • Only solution is more donors

  4. History Non Hearth Beating Donor First Human Lung Transplant JD Hardy et al. JAMA 1963;186:1065-74 The first lung donor was a NHBD who died from myocardial infarction! The receiver lived 18 days J.D. Hardy Jackson, MS

  5. 40 Tx around the world in next 15 years all died • Mostly within 2 weeks due to primary graft failure, sepsis or rejection • Early use of high dose steroids interrupted bronchial healing and caused dehiscence

  6. Cyclosporine’s discovery was a turning point in immunosuppression and eliminated the need for early high dose steroid use • With carefull patient selection in 1983 Dr Cooper and his Lung Tx team from Toronto transplanted a single lung to a 58y/o man with IPF and reported in 1986

  7. Lung Transplant Organizations and Registries

  8. <ISHLT • Formed in 1981 by 15 cardiologists and cardiac surgeons • Today: >2500 members from >45 countries, representing 14 disciplines involved in the management and treatment of end-stage heart and lung disease • This multinational, multidisciplinary mix is one of the biggest strengths of the Society and provides an exceptional environment for networking and information exchangingSpecialties: Anesthesiologists Nurses Health care managers Basic scientists Pathologists Transplant coordinator Cardiologists Perfusionists Immunologists Pharmacists Tissue engineers Cardiothoracic surgeons Ethicists Pulmonologists

  9. Organ Exchange Institutions • United Network for Organ Sharing (United States of America) • Eurotransplant (Austria, Belgium, Germany, Luxembourg, The Netherlands, Slovenia) • UK Transplant (United Kingdom, Ireland) • Scandia Transplant (Sweden, Norway, Denmark, Finland) • Australia and New Zealand Cardiothoracic Organ Transplant Registry

  10. EUROTRANSPLANT • Eurotransplant region: Austria, Belgium Germany, Luxembourg, the Netherlands, Slovenia and Croatia • To produce its services, Eurotransplant manages the following three core processes: • Allocation • Algorithm development, • Registry

  11. EUROTRANSPLANT • Population served 124.5 million • Number of new patients on waiting list9,300 • Number of transplanted organs6,600 (kidney, liver, pancreas, heart, lung) • % of organs exchanged cross-border 20% (outside Eurotransplant: 2%

  12. Lung Tx in the USA • UNOS (United Network for Organ Sharing) • First computerized organ matching system in 1977 • UNOS officially formed in 1984 • National Organ Transplant Act also accepted in 1984: • Organs can not be bought and sold • National Organ Procurement and Tx Network (OPTN) to be formed • UNOS became the first and only OPTN in 1986

  13. UNOS • Non-profit and donation accepting federal organization • Enhances organ distribution and supports organ transplantation • Forms the necessary policies for application • Supports and improves organ donation

  14. Lung Tx in the USA Lung Tx performed in 66 centers in 11 regions

  15. Organ Matching Criteria • Medical urgency • Tissue typing • Blood group • Waiting time • Lung size • Immunity status • Geographic distance

  16. Organ Shortage • 15% - 25% of multiorgan donors have suitable lungs • Increasing donor age • Increased waiting time • Waiting list mortality 10% - 30%

  17. Lung Tx in the USA

  18. Lung Allocation System • 2004 OPTN / UNOS • Lung Allocation System • Rather than a simple wait list, a system allocating the organs based on a) To give the organ to the one needs most b) to the one that will benefit the most • >12 y/o patients (Children <12 y/o are prioritized) • 0 – 100 lung allocation score • Lab results • Test results • Diagnosis • Besides the ABO group and geographic distance, LAS is also effective in organ distribution • Effect of waiting time is very limited

  19. Lung Tx in the USA

  20. Current Status in Pediatric Lung Tx Candidates

  21. Current Status in Adult Lung Tx Candidates

  22. ABD’de Akciğer Transplantasyonu

  23. ABD’de Akciğer Transplantasyonu

  24. ABD’de Akciğer Transplantasyonu

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