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…