A lung transplant is a useful treatment for respiratory disease that has curtailed the lung function severely. In such patients, a lung transplant can increase longevity and also help improve quality of life. However, lung transplant surgery is a complex procedure needing cutting edge facility and care.
Severe, end-stage lung disease is a strong indication for a lung transplant. The procedure should be considered when all other treatment modalities have failed and also in people whose lung disease is so severe that they can no longer live and breathe comfortably.
We have the most experience in India with lung transplants. We have evolved a program of intense evaluation of donors especially with respect to latent TB which is a very important problem in our country.
Lung Transplant Evaluation
The process of evaluation involves four sequential steps:
- Screening – Includes review of the medical records sent by the primary physician or the patient.
- Consultation – Includes assessment by the surgeon and the pulmonologist to determine if the patient is within the window of safe transplant and to educate the patient and family regarding transplantation.
- Evaluation – Includes a battery of testing to confirm end stage lung disease and to ensure that the patient will benefit from transplantation.
- MDT discussion – Multidisciplinary team will review the data of the evaluation to confirm that lung transplantation is the right treatment option.
Who Will Benefit From Evaluation?
- End stage lung disease (COPD, Interstitial Lung Disease, Bronchiectasis, Cystic Fibrosis)
- Primary and secondary irreversible pulmonary hypertension
- Unable to complete a 6 min walk test, or less than 300 m covered, or desaturation (< 88%)
- Breathless at rest or requiring oxygen
- Increasing Pulmonary Hypertension on Pulmonary Vasodilators
- RV dysfunction on RV echo
Once the donor organ becomes available it will be evaluated by our team. If it passes the criteria set by our team, the organ will be accepted for transplantation. Single lung, double lung or combined heart-lung transplant will be done depending on the disease of the patient. Usually patients with bronchiectasis, cystic fibrosis and pulmonary hypertension will benefit from a double lung transplantation. The transplantation will be performed under general anaesthesia. The surgery usually takes anywhere between 6 to 10 hours depending on whether it is single or double lung and if complication occurs. Immediately after the surgery, the patient will be admitted in a dedicated heart and lung transplant unit for recovery.
Post Transplant Care
The transplant team will continue to care for you indefinitely. The purpose of the follow up care includes monitoring of the recovery process and early identification of infection, rejection and intolerance to medications. It includes scheduled visits of once a month in the first year along with blood tests, x-ray and lung function studies. The infectious disease and endocrinology consultants, physical therapist and dietician will continue caring for you during this phase to achieve a safe recovery.