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Lung Transplantation Experience in Turkey

Dr.G ü l Dabak Istanbul Kartal Ko s uyolu Y u ksek I htisas Teaching Hospital for Cardiovascular Diseases and Surgery Pulmonology Unit. Lung Transplantation Experience in Turkey. Turkish Thoracic Society Annual Congress , 12 April 2012. Conflict of interest.

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Lung Transplantation Experience in Turkey

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  1. Dr.Gül Dabak Istanbul Kartal Kosuyolu Yuksek Ihtisas Teaching Hospital for Cardiovascular Diseases and Surgery Pulmonology Unit LungTransplantationExperiencein Turkey Turkish Thoracic Society Annual Congress, 12 April 2012

  2. Conflict of interest • European Respiratory Society (ERS) and Turkish Thoracic Society (TTS) have been sponsors to the speaker during her trainings abroad. • ERS short –term training fellowship (2008,Vienna,AUSTRIA) • TTS training fellowship (2010,Newcastle-UNITED KINGDOM)

  3. Introduction • Heart-lung and lung transplantations in the world • Initial attempts in Turkey • Change of regulations concerning ‘lung transplantation’ • The first successful lung transplantation in Turkey • Current state in Turkey

  4. Heart-lung and lung transplantations in the world

  5. Experimental lung transplantation Vladimir P Demikhov, end of forties!

  6. Clinical lung transplantation James D Hardy (1918-2003) Mississippi University,USA

  7. Initial case !!! 11 June 1963 Recipient: John Russel Sentenced to death in 1957 Left-sided central lung Ca, poor lung functions Chronic glomerulonephritis Donor : Death after MI and pulmonary edema Good lung functions after the transplant Exitus due to renal failure on the 18th postop. day. Gilbert Massard, 2012 ERS Strasbourg Tx Kursu

  8. ……First hope ! 1963-1969: 23 cases of lung transplantation The only successful case (14-11-1968) Belgium, Derom Patient alive till 10th postop. month Wildevuur & Benfield, Ann Thorac Surg 1970;9:489-515

  9. 3 December 1967 Dr. Christian Barnard Grote Schuur Hospital, South Africa

  10. Heart tx,heart-lung tx • The first successful heart tx in the world by Dr. Christian Barnard, 100 heart tx in the world in the following year • One-yr survival is 30% in 1970’ ies! • In 1979 cyclosporine was introduced. Endomyocardial biopsies were done and survival increased to 60%. • Actual survival rate is 90%.

  11. Heart-lung Tx: Initial attempt Denton A. Cooley, Houston, TX,USA 15 September 1968

  12. Heart-lung Tx: Initial success 1981 Bruce Reitz, Norman Shumway, Stanford PPH

  13. The first successful single lung transplantation Toronto 07 November 1983, Cooper

  14. The first successful double lung transplantation Toronto, 1986 Patterson Emphysema Heart-lung technique,en bloc,heart trimmed off CPB Tracheal anastomosis

  15. History in Turkey • 1998Prof.Dr. Öztekin Oto, Dokuz Eylul University,pediatric heart-lung • 2004-2007Prof. Dr. Göksel Kalaycı,Istanbul University Istanbul Medical Faculty , double lung tx in adults. (3 cases) • 2008 Ege University Eisenmenger case, heart-lung • 7 March 2009Doç Dr. Cemal Asım Kutlu, Istanbul Sureyyapasa Teaching Hospital for Pulmonary Diseases and Thoracic Surgery,single lung tx in adult • 8 April 2009 Prof. Dr. Mustafa Özbaran,Ege University, bilateral pediatric lung tx • Aralık 2012Doç. Dr. Cemal Asım Kutlu, Istanbul Kartal Kosuyolu Yuksek İhtisas Teaching Hospital for Cardiovascular Diseases and Surgery retx; • 14 March 2012Doç. Dr.Adnan Sayar, Yedikule Teaching Hospital for Pulmonary Diseases and Thoracic Surgery ,single lung in adult • 26 March 2012Doç. Dr. Cemal Asım Kutlu, Kartal Kosuyolu Yuksek İhtisas Teaching Hospital for Cardiovascular Diseases and Surgery, single lung tx

  16. First lung transplantationProf. Dr. Göksel KalaycıIstanbul Medical Faculty 11.10.2004

  17. First case • RECIPIENT:44 yr, male,IPF • On oxygen for the last year • Significant functional deterioration in the last 6 months • On CIPAP for the last one month • PABs:115 mmHg, GFR:47 ml/dak,elevation in hepatic enzyme levels

  18. DONOR 28 yr female,smoking (+) AC-PCV , 100% FiO2, 5 cm H2O PEEP, P insp:20 cmH2O PaO2: 480 mmHg Roentgenogram: Normal Bronchoscopy: Normal

  19. Donor lung

  20. Explanted lungs of the recipient

  21. Perioperative period Cardiopulmonary by-pass:3 hr 50 min. Bilateral sequential single lung implantation -16 units of blood were transfused, PAP ort. 22 mmHg

  22. First case- early postop. period

  23. First case-prognosis Postop. 11. day -DIC ,multiorgan failure and exitus Pathology -Postmortem biopsy: Akut alveolar damage

  24. The 2nd case RECIPIENT:33 yr male, DIF PABs:45 mmHg GFR:44 ml/dak DONOR: 54 yr male AC-PCV, Pinsp:20 cm H20 ,% 100 FiO2, PEEP=5 cm H20 and PaO2: 540 mmHg

  25. Perioperative period Bilateral sequential single lung tx 6 units of blood were transfused intraoperatively Total CPB time: 3 hr 8 min

  26. Postop days 0 and 1

  27. The 2 nd case-Postop. Day 1 6 units of blood transfused Progressive hypotension Exitus

  28. The 3rd case 20 yr male IPF PAP:110 mmHg Bilateral sequential single lung transplantation on CPG by-pass

  29. The 3rd case-postop. phase

  30. The 3rd case- early postop. period

  31. The change of regulations concerning lung transplantation 2007-2008

  32. Sureyyapasa Lung Transplantation Study Group (SATCAG) • Co-ordinator:April 2007 • Application for change of regulations: May 2007 • Change of Tx regulation:May 2008 • ‘Scientific Council’ membership:July 2008 • Visit by ‘Scientific Council’ :November 2008 • Certification for tx:December 2008

  33. Meetings on a weekly basis Seminars Literature review Invited speakers Practical work Logistic problems Legislative issues Certificate of tx SATCAG Cardiovascular surgeons Thoracic surgeons A 01-01

  34. Uz.Dr. Gül Dabak Göğüs Hastalıkları Uz.Dr. Abdullah Helvacı Anesteziyoloji ve Reanimasyon Doç. Dr. Ferda Aksoy Patoloji Uz. Dr. Naim Ulusan İnfek. Hast. ve Kl. Mikrobiyoloji Uz.Dr. Burhan Meydan Anesteziyoloji ve Reanimasyon Op.Dr. Erdal Taşçı Göğüs Cerrahisi Dr. Oral Akın Göğüs Cerrahisi Doç. Dr. Cemal Asım Kutlu Göğüs Cerrahisi Doç. Dr. Attila Saygı Göğüs Hastalıkları Op.Dr. Şenol Ürek Göğüs Cerrahisi Op.Dr. Çağatay Tezel Göğüs Cerrahisi Dr. Tuğba Coşgun Göğüs Cerrahisi Op.Dr. Ahmet Özsoy K.V. Cerrahi Belma Erdoğan Koordinatör Burcu Kutlu Psikolog

  35. Kidney Liver 1975 Lung 2009 Heart 1989 Lung 2004 Heart-lung 1998 1983 1963 Liver 1967 Heart 1967 Heart-lung 1981

  36. The first successful lung transplantation in Turkey

  37. The first successful single lung transplantation in Turkey (07.03.2009)

  38. A single lung transplantation for silicosis: The first successful lung transplantation case in Turkey Sureyyapasa Lung Transplantation Study Group Turkish J Thorac Cardiovasc Surg 2011;19(3):455-462

  39. E. Ü 34 yr male Dental technician Dyspneic for the last 11 years On oxygen for 6 months Silicosis Initial hospitalization: November 2008 Jan 2009, Tx candidate 07 March 2009, Tx

  40. 6March 2009 Saat 23.30

  41. 6 a.m.

  42. The first successful bilateral lung transplantation08.04.2009

  43. 6 wk postop.

  44. 8 April 2009

  45. N. T. 51 yr male Mine worker and baker Dyspneic for the last 5 years On O2 for 6 months DİF Initial evaluation: Feb. 2009 March 2009, Tx candidate 15 November 2009 , Tx.

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