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Heart-lung transplantation is indicated for patients with end-stage heart disease and lung disease. Given the complexity involved in the surgery and the post operative challenges, appropriate patient selection is key. Our study describes characteristics and short term outcomes in patients undergoing combined heart and double lung transplant (CHLTx) at our center. This is a retrospective study of patients who underwent CHLTx at our center in South India, from June 2021 to June 2022. CHLTx was performed on 14 patients during the study period. The majority of the patients were male (57%) with a mean age of 37.8 years (range 16-71 years). The most common indication for CHLTx was congenital heart disease (35.7%), followed by idiopathic pulmonary arterial hypertension (28.6%), Group 3 pulmonary hypertension due to interstitial lung disease (ILD, 21.4%) and ILD with ischemic heart disease in 14.2% patients. The mean 6MWT distance was 208 metres. Two patients were on pre-operative ECMO support but none required it post-operatively. No mortality was reported at 6-months. Post-operative sepsis was reported in 35.7% patients. Post-operative anastomotic complications developed in 14.2% patients, and both patients were managed with airway stenting (narrowing and dehiscence respectively). Overall, rejection was detected in 30.9% of 42 surveillance biopsies (at 1,3 and 6 months). Of these, 84.6% (n=11) were for grade 1 antibody-mediated rejection (AMR) and 2 biopsies showed acute cellular rejection (ACR). One patient was noted to have both AMR and ACR. The episodes of rejection correlated with high dd-cfDNA and dd-cfRNA levels along with high donor-specific antibodies. Combined HLTx is a viable option in patients with end stage heart and lung failure with acceptable outcomes, despite the challenges of a low-middle income country. [ABSTRACT FROM AUTHOR]

Tracheal dehiscence remains one of the feared complications after a heart-lung transplant because of its high mortality and morbidity despite surgical repair. Although it is very rare, treatment options are mainly focused on surgical re-exploration and patch repair. We present a case of partial anastomotic dehiscence 1 month after a combined heart-lung transplant. A 24-year-old gentleman, with a negative cross-match for donor-specific antibodies, underwent a combined heart-lung transplant for idiopathic pulmonary arterial hypertension and severe right ventricular dysfunction. His postoperative course was uncomplicated with no primary graft dysfunction, infection or airway complication. He was discharged on postoperative day 19. A routine CT chest before the 1st-month surveillance biopsy post-transplant showed a rent at the anterior tracheal anastomotic site (Figure 1A) with minimal bilateral pneumothoraces. Bronchoscopy showed partial dehiscence from 11 o clock to 2 o clock (25%-50% of circumference) in the cartilaginous part of the tracheal anastomotic site (Figure 1B). A covered metallic tracheobronchial Y stent measuring 18mm x 60 mm was inserted via a flexible bronchoscope under fluoroscopic guidance to stimulate neo-epithelization (Figure 1C). Bronchial washings for cultures were negative. Transbronchial lung biopsy was negative for acute cellular and antibody-mediated rejection. He was initiated on antibiotic and mucolytic therapy along with serial clean-up bronchoscopies and steroid reduction. Follow-up CT scan showed healed dehiscence and resolution of pneumothoraces. The Y stent was removed after 8 weeks of placement with the healed anastomotic area (Figure 1D). Twice monthly follow-up bronchoscopies for 3 months did not show any recurrence. Bronchoscopic metallic stent placement is a viable option for small tracheal dehiscence post-combined heart-lung transplant without the high risk of postoperative morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Lung transplantation (LTx) has come as hope for select patients with post-COVID acute respiratory distress syndrome (ARDS). It has a different phenotype with unique challenges. We aimed to bring out our experience with and outcomes of LTx for post-COVID ARDS., Methods: This study is retrospective case series from a single center in India. All the patients with post-COVID end stage lung disease (ESLD) who underwent bilateral LTx between 1st May 2020 and 30th August 2021 were included. LTx was performed following no improvement with optimal medical management with adequate time provided for recovery. Information relating to demographics, comorbidities, pretransplant status, perioperative parameters, gross and histopathological findings of explanted lungs, posttransplant morbidity, and mortality were analyzed., Results: This study included 23 patients. The median age of the patients in this study was 42 years and 20 participants were men (87%). The mean duration of intensive care unit stay was 15.83 ± 6.61 days. Mortality was observed among 8 participants (34.78%). Mean survival time was 34.54 weeks. Among the 8 patients who expired, the cause of death was sepsis for 6 patients (75.0%), neurologic cerebrovascular accident for 1 patient (12.5%), and cytomegalovirus for 1 patient (12.5%). All the deaths were reported in primary graft dysfunction grade 2 & 3 category. No rejections were observed on first and third month surveillance biopsies., Conclusions: LTx is the definitive option for survival in select patients with severe post-COVID-19-associated ESLD. This study brings out various challenges involved in such phenotypes and also observations in postoperative recovery., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Lung transplantation (LTx) is the definitive treatment for select progressive end-stage lung disease patients despite being on optimum medical therapy. Asian countries like China, Japan and India have started LTx programmes despite various odds and challenges. Some of these challenges seem to be unique to developing countries. We have elaborated the challenges of LTx in India and their proposed solutions and shared our experience in setting up a successful LTx programme., Competing Interests: Conflict of interestThe authors declare no competing interests., (© Indian Association of Cardiovascular-Thoracic Surgeons 2021.)

Worldwide, lung transplantation has been a therapeutic option for select end-stage lung disease patients who are on optimized medical regimens, but the underlying clinical condition continues to progress. For any successful lung transplantation program, it is important to have a robust donor lung management program. Lungs are commonly affected by the various factors related to trauma or neurogenic in brain stem death donors. This article would focus on the basic protocols to optimize donor lungs which would help in increasing donor pool. It would also elaborate COVID-specific points for donor lung evaluation. This article would also describe the criteria for ideal as well as marginal donor lungs. A comprehensive literature search was performed using PubMed to review various articles related to donor lung management., Competing Interests: None

Background: Lung transplantation (LT) has emerged as a definitive cure for a plethora of end-stage lung diseases (ESLDs). With improvements in immune-suppression protocols, the posttransplantation survival rates have gone up., Aim: The study reported the initial experience of the India's single largest lung transplant program on clinicopathological profile, procedures, challenges encountered, and outcomes., Settings and Design: A retrospective analysis was done from data available at three centers of Institute of Heart and Lung Transplant, Gleneagles Global Hospitals across Chennai, Bengaluru, and Mumbai., Materials and Methods: A total of 132 patients underwent lung (single or bilateral) or combined heart and lung transplant between April 2017 and March 2020. All the participants had 30 days' follow-up. Postoperative complications, graft rejection, and 30-day mortality were reported. Kaplan-Meier survival analysis and logistic regression analysis were performed., Statistical Analysis Used: Kaplan-Meier survival and binary logistic regression was performed., Results: Interstitial lung diseases, 65.91%, were the most common diagnosis. Bilateral LT (81.3%) was the most common type of LT performed. Grade III primary graft dysfunction was observed in 16 (12.1%). Distal airway stenosis (21.97%) was the most common complication followed by anastomotic stenosis (14.30%). Gram-negative bacterial sepsis (52%) was the leading cause of death. Cumulative probability of survival at 1 month was 0.85 (95% confidence interval [CI] 0.80-0.92), and at 1 year, it was 0.78 (95% CI, 0.72-0.86)., Conclusion: This study establishes the fact that despite multiple challenges, LT is a viable option for selected patients with ESLDs in India and should encourage early referrals to a transplant center., Competing Interests: None

The science of lung transplantation has evolved from an experimental procedure, to be accepted as a legitimate mainstream therapy for patients with end-stage pulmonary disease. Now lung transplantation offers patients with end-stage lung disease acceptable quality of life and matches a 5-year survival rate of other solid organ transplants. In the present report, we present our initial experience in performing two single lung transplantations done in our centre.

We encountered a 46-year-old immunocompetent male patient who presented with a right upper lobe collapse on a chest x-ray. A flexible bronchoscopic examination revealed an endobronchial mass emanating from the right upper lobe and obstructing the right mainstem bronchus. Bronchial washings and biopsy of the lesion were consistent with cryptococcal infection. The response to oral diflucan therapy was suboptimal. Subsequently, the patient underwent a successful bronchoscopic resection of this mass with the placement of an endobronchial stent. We report this rare case of endobronchial cryptococcal infection treated with a combination of an antifungal agent and bronchoscopic debulking.