Lung transplantation is a life changing decision and for those carefully selected patients with end stage lung disease has become an accepted therapy for those who have not benefited from available therapies. The treatment is highly successful, with more than 80 percent of patients surviving the first year and greater than 50% of patients surviving beyond five years. The quality of life of long-term survivors is excellent, with the majority returning to productive activities. These results are possible because of the development of specialized care teams and the application of rigorous patient-care protocols, both in the hospital and for the long term.
The lung transplantation service at Amrita Institute of Medical Sciences is a multidisciplinary integrated service which drives it strength from the blessings of Mata Amritanandamayi and the skills and expertise of its core lung transplant team which are fortunate to have trained in internationally reputed lung transplant units in the World. The world class support facilities including an ECMO, blood transfusion, pathology, microbiology, infection control, radiology services, intensivist services allows us to expect the best possible outcomes for our patients.
Indications for Lung Transplant
In general we consider lung transplantation in persons with end stage lung disease who are less than 60 years of age for a double lung or heart-lung transplant, and less than 65 for a single lung transplant. However, there is no absolute age contraindication and we consider patients based on his/her physiologic age rather than strict chronologic age. Long-term survival does favor younger patients as co-morbid illnesses increase with the ageing process.
The following lung conditions will be considered
- Obstructive Lung Disease
- Alpha-1 Antitrypsin deficiency
- Obliterative Bronchiolitis
- Suppurative Lung Disease
- Cystic Fibrosis
- Interstitial Lung Disease
- Idiopathic pulmonary fibrosis
- Eosinophilic granulomatosis
- Occupational lung disease
- Hypersensitivity pneumonitis
- Drug toxicity
- Vascular Lung Disease
- Idiopathic pulmonary hypertension
- Eisenmenger’s pulmonary hypertension
- Chronic pulmonary emboli unsuitable for PTE
Contraindications to Lung and Heart-Lung Transplantation
- Absolute Contraindications
- Malignancy – within two years. For extracapsular renal, breast stage 2 or higher, colon Duke stage B or higher, or melanoma stage III or higher, wait 5 years.
- Irreversible secondary organ failure unless considered for a combined transplant.
- AIDS (HIV infection currently under re consideration)
- Hepatitis B/C- if antigen positive and histological evidence of disease
- Continued abuse of alcohol, tobacco or other drugs
- Psychiatric history likely to result in non-compliance and or persistent non-compliance with medical therapy.
- Relative Contraindications
- Coronary artery disease-must be able to revascularize, if for lung transplant only
- Intubated and ventilator dependent-if unable to ambulate
- Obesity BMI >30
- Chronic renal impairment with GFR <50ml/min, unless candidate for combined renal transplant
- Diabetes with end organ damage
- Severe osteoporosis (bone mineral density > 2 sd's less than predicted for age)
- Active peptic ulcer or diverticulitis
Decision regarding the utility of the donor lung will be made by the harvesting team and anaesthetic team based on standard criteria from individuals between the age of 18-64 preferentially. These may include brain dead donors or Donation after Cardiac Death(DCD) donors. When possible the ischaemic time will be maintained to within 6 hours, however marginal donors may be considered at the discretion of the harvesting team.