View
43
Download
0
Category
Preview:
DESCRIPTION
Dr.G ü l Dabak Istanbul Kartal Ko s uyolu Y u ksek I htisas Teaching Hospital for Cardiovascular Diseases and Surgery Pulmonology Unit. Lung Transplantation Experience in Turkey. Turkish Thoracic Society Annual Congress , 12 April 2012. Conflict of interest. - PowerPoint PPT Presentation
Citation preview
Dr.Gül DabakIstanbul Kartal Kosuyolu Yuksek Ihtisas Teaching
Hospital for Cardiovascular Diseases and SurgeryPulmonology Unit
Dr.Gül DabakIstanbul Kartal Kosuyolu Yuksek Ihtisas Teaching
Hospital for Cardiovascular Diseases and SurgeryPulmonology Unit
Lung Transplantation Experience in Turkey
Lung Transplantation Experience in Turkey
Turkish Thoracic Society Annual Congress, 12 April 2012
Conflict of interestConflict of interest
• European Respiratory Society (ERS) and Turkish Thoracic Society (TTS) have been sponsors to the speaker during her trainings abroad.
• ERS short –term training fellowship (2008,Vienna,AUSTRIA)
• TTS training fellowship (2010,Newcastle-UNITED KINGDOM)
• European Respiratory Society (ERS) and Turkish Thoracic Society (TTS) have been sponsors to the speaker during her trainings abroad.
• ERS short –term training fellowship (2008,Vienna,AUSTRIA)
• TTS training fellowship (2010,Newcastle-UNITED KINGDOM)
IntroductionIntroduction
• Heart-lung and lung transplantations in the world
• Initial attempts in Turkey • Change of regulations concerning ‘lung
transplantation’• The first successful lung transplantation in
Turkey• Current state in Turkey
• Heart-lung and lung transplantations in the world
• Initial attempts in Turkey • Change of regulations concerning ‘lung
transplantation’• The first successful lung transplantation in
Turkey• Current state in Turkey
Heart-lung and lung transplantations in the world
Heart-lung and lung transplantations in the world
Experimental lung transplantation
Experimental lung transplantation
Vladimir P Demikhov, end of forties!
Vladimir P Demikhov, end of forties!
Clinical lung transplantationClinical lung transplantation
James D Hardy (1918-2003)Mississippi University,USA
James D Hardy (1918-2003)Mississippi University,USA
Initial case !!!Initial case !!!
11 June 1963• Recipient: John Russel
– Sentenced to death in 1957– Left-sided central lung Ca, poor lung functions– Chronic glomerulonephritis
• Donor : Death after MI and pulmonary edema • Good lung functions after the transplant• Exitus due to renal failure on the 18th
postop. day.
11 June 1963• Recipient: John Russel
– Sentenced to death in 1957– Left-sided central lung Ca, poor lung functions– Chronic glomerulonephritis
• Donor : Death after MI and pulmonary edema • Good lung functions after the transplant• Exitus due to renal failure on the 18th
postop. day.
Gilbert Massard, 2012 ERS Strasbourg Tx Kursu
……First hope !……First hope !1963-1969: 23 cases of lung transplantation
• The only successful case
• (14-11-1968)
Belgium, Derom
Patient alive till 10th postop. month
1963-1969: 23 cases of lung transplantation
• The only successful case
• (14-11-1968)
Belgium, Derom
Patient alive till 10th postop. month
Wildevuur & Benfield, Ann Thorac Surg 1970;9:489-515
Dr. Christian BarnardGrote Schuur Hospital,
South Africa
3 December 19673 December 1967
Heart tx,heart-lung txHeart tx,heart-lung tx
• The first successful heart tx in the world by Dr. Christian Barnard, 100 heart tx in the world in the following year
• One-yr survival is 30% in 1970’ ies!• In 1979 cyclosporine was introduced.
Endomyocardial biopsies were done and survival increased to 60%.
• Actual survival rate is 90%.
• The first successful heart tx in the world by Dr. Christian Barnard, 100 heart tx in the world in the following year
• One-yr survival is 30% in 1970’ ies!• In 1979 cyclosporine was introduced.
Endomyocardial biopsies were done and survival increased to 60%.
• Actual survival rate is 90%.
Heart-lung Tx: Initial attemptHeart-lung Tx: Initial attempt
• Denton A. Cooley, Houston, TX,USA
• 15 September 1968
• Denton A. Cooley, Houston, TX,USA
• 15 September 1968
Heart-lung Tx: Initial successHeart-lung Tx: Initial success1981
• Bruce Reitz, Norman Shumway, Stanford• PPH
1981• Bruce Reitz, Norman Shumway, Stanford• PPH
The first successful single lung transplantation
The first successful single lung transplantation
Toronto 07 November 1983,
Cooper
The first successful double lung transplantation
The first successful double lung transplantation
• Toronto, 1986Patterson
• Emphysema• Heart-lung technique,en bloc,heart
trimmed off– CPB– Tracheal anastomosis
• Toronto, 1986Patterson
• Emphysema• Heart-lung technique,en bloc,heart
trimmed off– CPB– Tracheal anastomosis
History in Turkey History in Turkey
• 1998 Prof.Dr. Öztekin Oto, Dokuz Eylul University,pediatric heart-lung
• 2004-2007 Prof. Dr. Göksel Kalaycı,Istanbul University Istanbul Medical Faculty , double lung tx in adults. (3 cases)
• 2008 Ege University Eisenmenger case, heart-lung • 7 March 2009 Doç Dr. Cemal Asım Kutlu, Istanbul Sureyyapasa
Teaching Hospital for Pulmonary Diseases and Thoracic Surgery,single lung tx in adult
• 8 April 2009 Prof. Dr. Mustafa Özbaran,Ege University, bilateral pediatric lung tx
• Aralık 2012 Doç. Dr. Cemal Asım Kutlu, Istanbul Kartal Kosuyolu Yuksek İhtisas Teaching Hospital for Cardiovascular Diseases and Surgery retx;
• 14 March 2012 Doç. Dr.Adnan Sayar, Yedikule Teaching Hospital for Pulmonary Diseases and Thoracic Surgery ,single lung in adult
• 26 March 2012 Doç. Dr. Cemal Asım Kutlu, Kartal Kosuyolu Yuksek İhtisas Teaching Hospital for Cardiovascular Diseases and Surgery, single lung tx
• 1998 Prof.Dr. Öztekin Oto, Dokuz Eylul University,pediatric heart-lung
• 2004-2007 Prof. Dr. Göksel Kalaycı,Istanbul University Istanbul Medical Faculty , double lung tx in adults. (3 cases)
• 2008 Ege University Eisenmenger case, heart-lung • 7 March 2009 Doç Dr. Cemal Asım Kutlu, Istanbul Sureyyapasa
Teaching Hospital for Pulmonary Diseases and Thoracic Surgery,single lung tx in adult
• 8 April 2009 Prof. Dr. Mustafa Özbaran,Ege University, bilateral pediatric lung tx
• Aralık 2012 Doç. Dr. Cemal Asım Kutlu, Istanbul Kartal Kosuyolu Yuksek İhtisas Teaching Hospital for Cardiovascular Diseases and Surgery retx;
• 14 March 2012 Doç. Dr.Adnan Sayar, Yedikule Teaching Hospital for Pulmonary Diseases and Thoracic Surgery ,single lung in adult
• 26 March 2012 Doç. Dr. Cemal Asım Kutlu, Kartal Kosuyolu Yuksek İhtisas Teaching Hospital for Cardiovascular Diseases and Surgery, single lung tx
First lung transplantationProf. Dr. Göksel Kalaycı
Istanbul Medical Faculty 11.10.2004
First lung transplantationProf. Dr. Göksel Kalaycı
Istanbul Medical Faculty 11.10.2004
First caseFirst case
• RECIPIENT:44 yr, male,IPF• On oxygen for the last year • Significant functional deterioration in
the last 6 months• On CIPAP for the last one month• PABs:115 mmHg, GFR:47
ml/dak,elevation in hepatic enzyme levels
• RECIPIENT:44 yr, male,IPF• On oxygen for the last year • Significant functional deterioration in
the last 6 months• On CIPAP for the last one month• PABs:115 mmHg, GFR:47
ml/dak,elevation in hepatic enzyme levels
DONORDONOR
• 28 yr female,smoking (+)• AC-PCV , 100% FiO2, 5 cm H2O PEEP,
P insp:20 cmH2O PaO2: 480 mmHg• Roentgenogram: Normal • Bronchoscopy: Normal
• 28 yr female,smoking (+)• AC-PCV , 100% FiO2, 5 cm H2O PEEP,
P insp:20 cmH2O PaO2: 480 mmHg• Roentgenogram: Normal • Bronchoscopy: Normal
Donor lungDonor lung
Explanted lungs of the recipient
Explanted lungs of the recipient
Perioperative periodPerioperative period
• Cardiopulmonary by-pass:3 hr 50 min.
• Bilateral sequential single lung implantation
-16 units of blood were transfused, PAP ort. 22 mmHg
• Cardiopulmonary by-pass:3 hr 50 min.
• Bilateral sequential single lung implantation
-16 units of blood were transfused, PAP ort. 22 mmHg
First case- early postop. periodFirst case- early postop. period
First case-prognosisFirst case-prognosis
• Postop. 11. day-DIC ,multiorgan failure and exitus
• Pathology-Postmortem biopsy: Akut alveolar
damage
• Postop. 11. day-DIC ,multiorgan failure and exitus
• Pathology-Postmortem biopsy: Akut alveolar
damage
The 2nd caseThe 2nd case
• RECIPIENT:33 yr male, DIF• PABs:45 mmHg• GFR:44 ml/dak• DONOR: 54 yr male• AC-PCV, Pinsp:20 cm H20 ,% 100
FiO2, PEEP=5 cm H20 and PaO2: 540 mmHg
• RECIPIENT:33 yr male, DIF• PABs:45 mmHg• GFR:44 ml/dak• DONOR: 54 yr male• AC-PCV, Pinsp:20 cm H20 ,% 100
FiO2, PEEP=5 cm H20 and PaO2: 540 mmHg
Perioperative periodPerioperative period
• Bilateral sequential single lung tx• 6 units of blood were transfused
intraoperatively• Total CPB time: 3 hr 8 min
• Bilateral sequential single lung tx• 6 units of blood were transfused
intraoperatively• Total CPB time: 3 hr 8 min
Postop days 0 and 1Postop days 0 and 1
The 2 nd case-Postop. Day 1The 2 nd case-Postop. Day 1
• 6 units of blood transfused• Progressive hypotension• Exitus
• 6 units of blood transfused• Progressive hypotension• Exitus
The 3rd caseThe 3rd case
• 20 yr male• IPF• PAP:110 mmHg • Bilateral sequential single lung
transplantation on CPG by-pass
• 20 yr male• IPF• PAP:110 mmHg • Bilateral sequential single lung
transplantation on CPG by-pass
The 3rd case-postop. phaseThe 3rd case-postop. phase
The 3rd case- early postop. periodThe 3rd case- early postop. period
The change of regulations concerning lung transplantation
2007-2008
The change of regulations concerning lung transplantation
2007-2008
Sureyyapasa Lung Transplantation Study Group (SATCAG)
Sureyyapasa Lung Transplantation Study Group (SATCAG)
• Co-ordinator:April 2007• Application for change of regulations: May
2007• Change of Tx regulation:May 2008• ‘Scientific Council’ membership:July 2008• Visit by ‘Scientific Council’ :November
2008• Certification for tx:December 2008
• Co-ordinator:April 2007• Application for change of regulations: May
2007• Change of Tx regulation:May 2008• ‘Scientific Council’ membership:July 2008• Visit by ‘Scientific Council’ :November
2008• Certification for tx:December 2008
• Meetings on a weekly basisSeminarsLiterature reviewInvited speakers Practical workLogistic problems Legislative issues
Certificate of tx
• Meetings on a weekly basisSeminarsLiterature reviewInvited speakers Practical workLogistic problems Legislative issues
Certificate of tx
Cardiovascular surgeons
Thoracic surgeons
A 01-01
SATCAG
Op.Dr. Şenol ÜrekGöğüs Cerrahisi
Op.Dr. Erdal TaşçıGöğüs Cerrahisi
Dr. Oral AkınGöğüs Cerrahisi
Uz.Dr. Abdullah HelvacıAnesteziyoloji ve Reanimasyon
Op.Dr. Ahmet ÖzsoyK.V. Cerrahi
Uz.Dr. Burhan MeydanAnesteziyoloji ve Reanimasyon
Uz.Dr. Gül DabakGöğüs HastalıklarıDoç. Dr. Ferda Aksoy
Patoloji
Uz. Dr. Naim Ulusanİnfek. Hast. ve Kl. Mikrobiyoloji
Op.Dr. Çağatay TezelGöğüs Cerrahisi
Belma ErdoğanKoordinatör
Burcu KutluPsikolog
Dr. Tuğba CoşgunGöğüs Cerrahisi
Doç. Dr. Cemal Asım KutluGöğüs Cerrahisi
Doç. Dr. Attila SaygıGöğüs Hastalıkları
1963 1983
Heart-lung1981
Heart
1967
Liver1967
KidneyLiver1975
Heart1989
Heart-lung1998
Lung2004
Lung2009
The first successful lung transplantation in TurkeyThe first successful lung transplantation in Turkey
The first successful single lung transplantation in Turkey (07.03.2009)
The first successful single lung transplantation in Turkey (07.03.2009)
A single lung transplantation for silicosis: The first successful lung
transplantation case in Turkey
A single lung transplantation for silicosis: The first successful lung
transplantation case in Turkey
Sureyyapasa Lung Transplantation Study Group
Turkish J Thorac Cardiovasc Surg 2011;19(3):455-462
Sureyyapasa Lung Transplantation Study Group
Turkish J Thorac Cardiovasc Surg 2011;19(3):455-462
• E. Ü• 34 yr male• Dental technician• Dyspneic for the last
11 years• On oxygen for 6
months • Silicosis• Initial hospitalization:
November 2008• Jan 2009, Tx candidate• 07 March 2009, Tx
• E. Ü• 34 yr male• Dental technician• Dyspneic for the last
11 years• On oxygen for 6
months • Silicosis• Initial hospitalization:
November 2008• Jan 2009, Tx candidate• 07 March 2009, Tx
6 March 2009 Saat 23.30
6 a.m.
The first successful bilateral lung transplantation
08.04.2009
The first successful bilateral lung transplantation
08.04.2009
6 wk postop.
8 April 2009
• N. T.• 51 yr male• Mine worker and baker• Dyspneic for the last 5
years• On O2 for 6 months• DİF• Initial evaluation: Feb.
2009• March 2009, Tx
candidate• 15 November 2009 ,
Tx.
• N. T.• 51 yr male• Mine worker and baker• Dyspneic for the last 5
years• On O2 for 6 months• DİF• Initial evaluation: Feb.
2009• March 2009, Tx
candidate• 15 November 2009 ,
Tx.
Current state of lung transplantation in Turkey
Current state of lung transplantation in Turkey
Lung tx March 2009-April 2012(Sureyyapasa-Kosuyolu)
Lung tx March 2009-April 2012(Sureyyapasa-Kosuyolu)
• 16 single/double lung tx.1 retx
• 3 cases discharged from hospital, Two still alive, one died probably
due to embolism• Last case extubated, postop. 16 th day
• 16 single/double lung tx.1 retx
• 3 cases discharged from hospital, Two still alive, one died probably
due to embolism• Last case extubated, postop. 16 th day
Istanbul Yedikule Teaching Hospital for Pulmanory Diseases and Thoracic
Surgery
Istanbul Yedikule Teaching Hospital for Pulmanory Diseases and Thoracic
Surgery• Doç.Dr.Adnan Sayar• Single lung tx (14.03.2012)
• Donor: 44 yr male-Intracranial bleeding due to aneurysmal rupture
-52 hr long intubation,paO2 400 mmHg (%100 O2, 5 PEEP)
• Duration of cold ischemia: 5 hr 8 min• Recipient: Emphysema(Alpha 1 AT deficiency), 26
yr male-FEV1: 1.0 %23, FVC: 3.4 %65 DLCO: 14 %40-6mwt: 420m First O2 sat %98, later O2 sat%84
• Doç.Dr.Adnan Sayar• Single lung tx (14.03.2012)
• Donor: 44 yr male-Intracranial bleeding due to aneurysmal rupture
-52 hr long intubation,paO2 400 mmHg (%100 O2, 5 PEEP)
• Duration of cold ischemia: 5 hr 8 min• Recipient: Emphysema(Alpha 1 AT deficiency), 26
yr male-FEV1: 1.0 %23, FVC: 3.4 %65 DLCO: 14 %40-6mwt: 420m First O2 sat %98, later O2 sat%84
Yedikule Teaching Hospital14.03.2012
Yedikule Teaching Hospital14.03.2012
Yedikule Teaching HospitalYedikule Teaching Hospital
Kosuyolu Kosuyolu
• The first successful heart tx in Turkey 7 Sep. 1989
• As of March 2012, 110 tx (no heart-lung tx so far!)
• Five lung tx and 2 heart-lung tx candidates on waiting list
• The first successful heart tx in Turkey 7 Sep. 1989
• As of March 2012, 110 tx (no heart-lung tx so far!)
• Five lung tx and 2 heart-lung tx candidates on waiting list
Centers certified for lung transplantation
Centers certified for lung transplantation
CENTER Dr. in charge DATE
Sureyyapaşa Dr. Erdal Taşçı Dec. 2008Istanbul Medical Faculty Prof. Dr. Alper Toker Oct. 2010Goztepe Medical Park Dr. Erkan Yıldırım March
2011 Yedikule Doç. Dr. Adnan Sayar May 2011Sureyyapasa Doç. Dr. CA Kutlu May
2011
GATA Dr. Orhan YücelEge Medical Faculty Doç. Dr. Kutsal Turhan Feb. 2012Marmara Med. Faculty Doç. Dr. B. YıldızeliKosuyolu Doç. Dr. CA Kutlu
CENTER Dr. in charge DATE
Sureyyapaşa Dr. Erdal Taşçı Dec. 2008Istanbul Medical Faculty Prof. Dr. Alper Toker Oct. 2010Goztepe Medical Park Dr. Erkan Yıldırım March
2011 Yedikule Doç. Dr. Adnan Sayar May 2011Sureyyapasa Doç. Dr. CA Kutlu May
2011
GATA Dr. Orhan YücelEge Medical Faculty Doç. Dr. Kutsal Turhan Feb. 2012Marmara Med. Faculty Doç. Dr. B. YıldızeliKosuyolu Doç. Dr. CA Kutlu
The first solid organ transplant in Turkey
(3 November 1975)
The first solid organ transplant in Turkey
(3 November 1975)
“This is a very significant incidence for our country’s medicine. Do disseminate this news, but do not exaggerate anything. Haberal has the capacity to accomplish a lot more.Make sure he is not harmed in any way.“
Prof.Dr. Hüsnü GÖKSEL
“This is a very significant incidence for our country’s medicine. Do disseminate this news, but do not exaggerate anything. Haberal has the capacity to accomplish a lot more.Make sure he is not harmed in any way.“
Prof.Dr. Hüsnü GÖKSEL
Bütün Dünya,Başkent Üniversitesi Kültür Yayını, Nisan 2012;10-11
Contributors to my presentation (in alphabetical order)
Contributors to my presentation (in alphabetical order)
• Doç. Dr.Reşat DABAK• Uzm.Dr.Levent DALAR• Doç.Dr. Figen GÜLEN• Prof.Dr. Axel HAVERICH• Doç Dr. Cemal Asım KUTLU• Prof. Dr. Gilbert MASSARD• Prof.Dr. Alper TOKER• Doç. Dr. Kutsal TURHAN• Doç.Dr.Adnan SAYAR
• With my gratitude…
• Doç. Dr.Reşat DABAK• Uzm.Dr.Levent DALAR• Doç.Dr. Figen GÜLEN• Prof.Dr. Axel HAVERICH• Doç Dr. Cemal Asım KUTLU• Prof. Dr. Gilbert MASSARD• Prof.Dr. Alper TOKER• Doç. Dr. Kutsal TURHAN• Doç.Dr.Adnan SAYAR
• With my gratitude…
Recommended