Lung Transplantation: The Indian Experience and Suggested Guidelines Part II A: The Technique of Lung Transplantation

Abstract

Background: A series of lectures and workshop on lung and heart–lung transplantation were organized by the Departments of Cardiology and Cardiothoracic Surgery at All India Institute of Medical Sciences, New Delhi, and the Department of Heart and Lung Transplantation at Apollo Hospitals, Chennai. The 1st day workshop on preoperative workup part was published as Part-I in this journal in August 2018. The hands-on cadaveric workshop conducted on May 20, 2018, forms the basis of the first section of the second part (Part II a) which deals with the technique of lung transplantation. The techniques of lung transplantation and Indian scenario are also reviewed. Methodology: The technique practiced by the transplant team at Apollo Hospitals, Chennai, was used for the demonstration of donor lung, heart–lung block harvest and implanting lungs, heart–lung block, while also discussing other possible techniques. Human cadavers were used, and live high-definition audio–video transmission to the lecture hall was made. Results: Accurate figures regarding lung transplantation in India are still not available. However, as per the Indian Society for Heart and Lung Transplantation, current data suggest that overall, about 1050 heart transplants and 310 lung transplants have been done in India. Of these, it is anticipated that national data regarding number of single-lung transplants, double-lung transplants, and heart–lung transplants will be available soon. The Department of Heart and Lung Transplantation at Apollo Hospitals, Chennai, has performed a total of 69 hearts and 149 lungs in 119 patients in various combinations: isolated heart transplants (40 patients), double-lung transplantation (DLT) (43 patients), single-lung transplantation (7 patients), heart and DLT (27 patients), en bloc heart and liver transplantation (1 patient), and combined heart–lung and kidney transplantation (1 patient). While the survival data for India are not currently available, our 3-year survival for DLT is 76.2%. Conclusions: While the surgical technique demonstrated is used in most of our cases, at times, different techniques have had to be adopted based on challenges confronted on the operating table. However, we have found that developing surgical protocols and maintaining consistency in the operative techniques translates into good surgical outcomes.