First Series of Combined Heart & Lung Transplantation from India

Abstract

This study analyses the data of patients undergoing Combined heart and lung transplant(CHLTx) with primary pulmonary hypertension(PPH),advanced lung diseases with right ventricular failure and uncorrected congenital heart diseases which are not uncommon in India unlike the developed countries. Single centre retrospective study of patients who underwent thoracic organ transplantation from April 2017 to October 2019. 107 patients underwent CHLTX,double lung and single lung transplantation. 17 patients underwent CHLTx . Primary etiology was congenital heart disease in 6 (35.3 %), PPH in 6(35.3 %), followed by Group III PH, in 5 (29.4 %) {ILD with severe PH in 4 (30%) and bronchiectasis with severe PH in 1 (7%)}. Post operatively primary graft dysfunction(PGD) was observed in 5 (29.4 %) patients. 2 (11.76 %) had Grade 3 and 3 (17.64 %) had Grade 2 PGD. Post-op ECMO was used in 4 (23.5%) cases. 30 day mortality was observed at n = 3 (17.64 %). 4 (23.5 %) had gram negative sepsis of which 3 (17.64%) expired. For CHLTx in Eisenmenger syndrome with no clear guidelines about the timing,often patient's symptoms and degree of cyanosis are the deciding factors. With well developed congenital cardiac surgery services in developed countries, patients requiring CHLTx for Eisenmenger are rare. However, in India it's not uncommon. The criteria to decide between double lung transplantation vs CHTLX in the other two groups were made with ECHO and right heart catheterisation results. In cases where the results were ambiguous, Cardiac MRI was used to decide between CHTLX vs only lung transplantation. Patients with Right ventricular EF < 25% on Cardiac MRI were advised to undergo CHLTx. Our early experience in CHLTx proves encouraging for patients with end stage cardiopulmonary disorders in India. Cardiac MRI plays a vital role in deciding between CHLTx vs only lung transplantation. Further follow up of the patients is required to establish long term outcomes and complications following combined heart lung transplant.