ANKARA BILKENT CITY HOSPITAL

Ankara Bilkent City Hospital Lung Transplant Center is one of the three centers licensed by the Ministry of Health, where active lung transplantation is performed in our country. It is the only center that includes independent Heart-Lung Transplant Service (24 beds) and Heart-Lung Transplant Intensive Care (15 beds) units, where lung transplant patients are followed up and treated.Having a detached service and intensive care unit as a lung transplant center has increased the safety and quality of this difficult and complicated work we do. Our hospital is one of the two hospitals where four organ transplants are performed in our country. Our center has continued its activities uninterruptedly with a high success rate since 2013, when it performed its first lung transplant.

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Communication:

Our center continues its activities in Ankara Bilkent City Hospital, Cardiovascular Tower. There are Lung Transplantation Polyclinic and Organ Transplant Coordinator in the Thoracic Surgery polyclinic in B1 floor, E2 block.

Organ Transplant Coordinatorship can be reached at 0 312 5526000 (central), 221503 (internal).

What is Lung Failure?

The term lung failure is used for cases where patients have respiratory distress and become oxygen dependent despite all medications and surgical treatment. Many diseases such as malignant lung cancer and many diseases such as COPD can cause this condition.The most common respiratory distress due to non-pulmonary causes is heart failure. Apart from this, neuromuscular diseases (such as ALS), clotting in the lung vessels and in many connective tissue diseases respiratory distress can be seen.

What is Lung Transplantation?

Lung transplantation is performed in lung failure as in other (Heart, Liver, Kidney, Pancreas, etc.) organ failures. It is the final surgical treatment method accepted in the world in cases of lung failure where patients become oxygen dependent and suffer from severe respiratory distress despite all drug and surgical treatment.It is the process of surgically removing the incompetent lungs and then transplanting the healthy lungs to the recipient. It is performed only in cases of lung failure caused by benign diseases of the lung.Lung transplantation is not performed in cases of lung failure caused by cancer. Lung transplantation is not preferred in cases of respiratory failure caused by non-pulmonary diseases (rheumatological diseases, etc.), but it should be evaluated on a case-by-case basis.

In Which Diseases Is Lung Transplantation Performed?

COPD is the most common cause of lung transplantation all over the world and in our country. The second most common cause is Interstitial Lung Diseases (Lung Fibrosis-Hardening).Cystic Fibrosis, Bronchiectasis, Bullous Lung, Idiopathic Pulmonary Arterial Hypertension, Silicosis and hundreds of benign diseases that lead to lung failure are candidates for lung transplantation.Dozens of diseases have been defined under the title of Interstitial Lung Diseases. Although the cause of this group of diseases is not clear, many reasons such as occupational exposure, smoking, pet nutrition, and drugs are blamed.
Lung transplantation is also performed in pediatric cases at Ankara City Hospital. Cystic Fibrosis is the most common cause of lung transplantation in pediatric cases in our country and in the world. The Children's Hospital, which is part of our hospital, provides services in all sub-branches.

Who Cannot Have Lung Transplantation?

Lung transplantation is the most difficult and complex transplantation among all organ transplantations, and it has been accepted as one of the largest surgical applications among thousands of procedures defined by the Ministry of Health. Such a major surgical procedure poses a serious risk for elderly patients.In our center, we do not perform lung transplantation for patients aged 65 and over. In cases with lung cancer or other organ cancer, secondary organ failure (heart failure, kidney failure, liver failure, etc.), situations with active viral, fungal or bacterial infection (HIV, Hepatitis B, C, Tuberculosis, Resistant microbial growths) lung transplantation is not performed.Lung transplantation is not performed in patients with bleeding-coagulation disorder, patients with a previous lung removed, patients with coronary artery disease in the angiography and obese people (BMI>35). Apart from these situations, many medical reasons that emerge as a result of detailed medical examinations may prevent lung transplantation.

How Can I Apply for Lung Transplantation? How Does the Process Work?

Patients under the age of 65 who have respiratory distress, have become oxygen dependent, and have a benign lung disease, should apply to a Chest Diseases Specialist or Thoracic Surgeon Specialist in the province where they are located and get an opinion on whether they can be transplanted.They must then apply to a lung transplant center. If there is no reason for rejection at the first examination in our center, we hospitalize our patients who are candidates for lung transplantation in our clinic for a week and perform their examinations.In these examinations, we seek answers to the questions of whether there is an obstacle for lung transplantation and what the risk factors are.Afterwards, the file containing all the examinations is discussed at the Lung Transplantation Council and the patient is placed on the Lung Transplant Waiting List if appropriate.

It will make our work easier for our patients, who come to the first examination, to come with a file illuminating their situation.It is important to come with previous tomography CDs, Pulmonary Function Tests (blowing tests), hospitalization epicrisis, heart ECO report, angio report, if any, and lung biopsy report in order to get an idea at the first examination.

What is the Waiting List and how long is the Waiting Time in our Country?

Our patients, who are found to have no obstacle to lung transplantation, are recorded in the Organ Transplant Waiting List of the Ministry of Health. After this stage, the waiting period for the appropriate organ will begin. This period varies according to the patient's blood type, the lung volume (size) between the recipient and the donor, and the urgency. This period can sometimes be months or even years.Due to the shortage of donors in our country, the waiting period is long in our country. The Covid-19 pandemic has also caused this period to be extended. Due to the long waiting period, it will be the right decision for our patients to apply to lung transplant centers early.

The lung is the organ with the shortest cold ischemia time (the time it takes for the organ to be transferred to the recipient after removal from the donor) among all organ transplants. Patients registered on the waiting list must come to our hospital as soon as possible (within 1 hour at the latest) after the organ is found. For this reason, our patients who live outside of Ankara and are on the waiting list in our hospital should settle in Ankara.

What is a donor lung (appropriate organ) and how is it obtained?

Living donor and cadaveric (organs of brain-dead patients) donors are used in organ transplants all over the world and in our country. Live donor transplants are possible in liver and kidney transplants and are frequently performed in our country.However, lung and heart transplants are performed with cadaveric donors. The dependence of lung transplantation on a cadaveric donor reduces the annual number of lung transplantations.After the donor is presented by the Ministry of Health, firstly, the blood group compatibility is sought, then the size compatibility of the lung between the donor lung and the recipient is sought. Apart from this, many criteria play a role in organ acceptance.

Living donor lung transplantation is frequently performed in some countries where donor shortages are at an acute stage.In this sense, our center has completed the infrastructure process to start living donor lung transplantation and is in an effort to start this practice as soon as possible.

Surgery Process and Intensive Care

Lung transplantation is applied in the form of bilateral and unilateral lung transplantation. The operation that we often do and want to do is bilateral lung transplantation.First, one side is transplanted, and then the other side is transferred, and in this way, a double lung transplant is performed.There are also cases where we perform unilateral lung transplantation for medical reasons. Lung transplant surgery takes an average of 12-18 hours.During the lung transplant surgery, a heart-lung pump device (ECMO) is used to meet the patient's oxygen needs.After the operation, the patient is taken to the intensive care unit and then slept for an average of 24-48 hours. Depending on the adaptation process of the newly transplanted lung, this period may sometimes be longer. The average intensive care unit stay is 10 days.

Length of Hospital Stay and Follow-up

The average hospital stay (from the day of surgery) is 30 days. During this period, many issues such as surgery and healing process, many problems related to the adaptation process of the lung, drugs to be used and education, rehabilitation and infections are struggled.All our patients who have had a lung transplant should never break their ties with the transplant center and should not disrupt their routine follow-ups.There is always a possibility that the transplanted lung will be rejected, so immunosuppressive drugs are used.These drugs should be used for life and the blood level should be checked regularly.Regular checks for rejection of the transplanted lung are required.The lungs are the only organs open to the outside environment with the trachea among the transplanted organs, which means that they are open to infections. For this reason, transplant patients should pay attention to hygiene and preventive measures (such as masks) for life.

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Figure-1,2: Removed end-stage lungs and donor lungs prepared for transplantation

25.07.2023