Heart and Heart-lung Transplantation: Indian Scenario

Lung Transplantation for Pulmonary Artery Hypertension

This manuscript discusses the role of lung transplantation in patients with pulmonary hypertension. The indications and timing for referral to a transplant unit and timing for wait-listing for lung transplantation are discussed. The type of transplantation—isolated (single or double) lung transplantation and situations when combined heart and double lung transplantation is indicated—will be elaborated. Escalation of medical therapy with the need and timing for bridging therapies such as extracorporeal membrane oxygenation until an appropriate organ becomes available will be discussed. Challenges in the postoperative period, specific to lung transplantation for pulmonary artery hypertension, will be reviewed. The outcomes following lung transplantation will also be considered in greater detail.

The evolution of lung transplantation in India and the current scenario

Lung transplantation has come of age in India. This article aims to trace the evolution of lung transplantation in India from its humble beginnings in 1999 to the current scenario spanning a period of 22 years. Right from the passing of the Act legalising deceased organ transplantation, its amendments and rules—to the development of transplant regulatory bodies—both at national and state levels, the journey thus far has been chronicled. Description of the initial cases at sporadic centres which has now proliferated to many centres now across many states has been elaborated on. The impacts on evolution of lung transplantation by the governmental transplant organisations, non-governmental organisations, and the medical professional societies are described. Publications related to lung transplantation from India are mentioned. Situations specific to India, current scenario of lung transplantation, and future directions are discussed. A brief mention of our experience with lung transplantation has also been made.

Exploring new frontiers: Organ transplant anaesthesia or bariatric anaesthesia

Unlike previous years, Anaesthesiology today is a major speciality encompassing many areas of modern medicine. Advent of various surgical sub-specialities resulted into the emergence of anaesthesia sub-specialities, as every group of surgery has specific need. Choosing the best-suited speciality is a complex matter. For that, one needs to have an idea about each one of them. A postgraduate anaesthesiology student does not have adequate exposure to choose the speciality. This article will give an overview of two important sub-specialities i.e., Organ Transplant Anaesthesia and Bariatric Anaesthesia.

Opportunities and challenges for thoracic organ transplantation in government institutions

The first successful heart transplant in India was performed by Panangipalli Venugopal on 3 August 1994 at the All India Institute of Medical Sciences, New Delhi. Twenty-five years later, only seven government institutions are performing heart transplants and only one government hospital has an established heart transplant program in India. Only one lung transplant has been performed in a government institution all over the country. This article reviews the history and current status of thoracic organ transplant in India. The authors discuss the factors responsible for the dismal progress of thoracic organ transplant in government hospitals, opportunities available in government institutions for widening the scope of transplant program, and the steps taken by the Government of India to improve healthcare in the country.

Early experience with pediatric cardiac transplantation in a limited resource setting

BACKGROUND

Pediatric heart transplantation is a now a well-established and standard treatment option for end stage heart failure for various conditions in children. Due to logistic issues, it is not an option for in most pediatric cardiac centres in the third world.

AIM

We sought to describe our early experience in the current era in India.

METHODS

This is a short term retrospective chart review of pediatric patients who underwent heart transplantation at our centre. Mean/Median with standard deviation /range was used to present data.

RESULTS

Twenty patients underwent orthotopic heart transplant between January 2016 and June 2019. The median age at transplant was 12.4years (range 3.3 to 17.3 years). The median weight was 23.2kg (range 10-80kg). The mean donor/recipient weight ratio was 1.62± 0.84. The mean ICU stay was 12.1days. The mean follow up post transplant was 2.03± 0.97years (range 10 days-3.57years). The 1 month and the 1 year survival was 100%. Biopsies were positive for significant rejection in 7 patients (35%). At the time of last follow-up, 3 patients (15%) had expired. The major post transplant morbidities were mechanical circulatory support (n=3), hypertension with seizure complex (n=3), post transplant lympho-proliferative disorder (n=1), pseudocyst of pancreas (n=1), coronary allograft vasculopathy (n=3) and systemic hypertension (n=7). All surviving patients (n=17) were asymptomatic at last follow up.

CONCLUSION

The results suggest acceptable short term outcomes in Indian pediatric patients can be achieved after heart transplantation in the current era. Significant rejection episodes and coronary allograft vasculopathy need careful follow up.