~ECMO used successfully as bridge while patient was waiting for lung transplants~

~Apollo Hospitals has given a new lease of life to most number of patients using ECMO machine, including India’s longest patient on ECMO for 46 days prior to a successful transplant

The Apollo Hospitals Group today demonstrated its leadership in the field of organ transplants with the announcement of the first Double Lung Transplant during the COVID pandemic in India. The patient was a 39-year-old whose lung condition deteriorated significantly in the months before the transplant when the country was in lockdown due to the pandemic. He was put on ECMO or Extra Corporeal Membrane Oxygenation to support his heart and lungs till donor lungs were available. The double lung transplant surgery took place successfully on July 29, 2020 at Apollo Hospitals, Chennai, and after a robust recovery, the transplant recipient was discharged on August 27, 2020.

Dr. Prathap C Reddy, Chairman, Apollo Hospitals Group said, “Our transplant program has come a long way since its inception in 1995. This double lung transplant during COVID times is an exemplary achievement and has only been possible due to our relentless focus on adopting the latest medical advances and technology to reinforce our leadership position in the healthcare space. Our transplant journey has seen numerous milestones and firsts that are testament to our continuing efforts to be a leader in organ transplant surgery, not just in India but globally. From the first successful paediatric liver transplant, first successful adult cadaveric transplant, first successful liver transplant for acute liver failure, first combined liver-kidney and other simultaneous multi-organ transplants, it is a long list! Our transplant team has led the way and laid down benchmarks for organ transplants in India over the years, and I am sure that they will continue to do so going forward. I am proud to say that today with over 90% success rates for multiple transplants in India, Apollo Hospitals organ transplant center is a beacon of quality and hope for patients not just from India, but from across the world.”

Ms. Preetha Reddy, Vice Chairperson, Apollo Hospitals Group said, “The successful double lung transplant during the COVID pandemic is a feather in our transplant program’s cap! Since its inception, our organ transplant programme has evolved and expanded, building on the Apollo Group’s talent and infrastructure, to facilitate new locations while continuing to deliver clinical expertise employing state-of-the-art technology. The successful transplant and recovery also brings into focus our pioneering success in the use of ECMO to support the heart and lungs until transplant or recovery. The confidence to have performed the transplant during the pandemic came from the highest standards of excellence in Infection Control Protocols and Best Practices that we follow. Today, the Apollo Hospitals group has the largest solid organ transplant programme in India with over 3500 transplants performed to date with success rates comparable to the best in the world.”

Ms. Suneeta Reddy, Managing Director, Apollo Hospitals Group said, “As a pioneer, Apollo Hospitals has continued to invest in the best of technology to support our organ transplant program. There are nearly 2 million people on the organ transplant waiting list around the world. The demand for organs is increasing with advances in transplant medicine leading to successful outcomes for patients with end-stage disease and giving them the gift of life. As awareness about donation grows and researchers find ways of improving the viability of organs, we are also keeping a close eye on the future where research is taking place in areas such as building organs using bioprinting, fighting rejection rates, and technologies to repair and replace cells and tissues, with a long term horizon. Today, we follow gold standards in organ transplantation to ensure results that are among the best in world.”

The successful double lung transplant was a result of the gold standard followed in clinical organ retrieval, preservation and transport with a dedicated team coordinating the complex logistics required to ensure timely transfers, a team keeping the recipient prepped and ready, and the transplant surgery performed by some of the finest and experienced transplant surgeons in the country supported by specialists from a variety of fields, transplant coordinators, social workers, psychiatrists and anaesthesiologists.

Dr. T Sunder, Senior Consultant Cardiothoracic Heart and Lung Transplant Surgeon, Apollo Hospitals, Chennai said, “Performing a transplant surgery during a pandemic presents many medical and logistic challenges to ensure safety of recipients, family members and healthcare personnel. Safety is ensured safety via strict protocols that mandate all transplant patients to be received and managed only in dedicated areas that do not have any COVID patients. The staff looking after them are assigned to only the transplant patients and all are checked for COVID status. Post-operatively, all parameters of the recipients are passed on to the treating doctors in real time via encrypted software and only if a physical examination is mandated is access to a patient given. A dedicated post-operative transplant care medical team does not cross over and examine other patients further ensuring safety. Limiting physical contact with the recipient has been a feature of our transplant team since the inception of Apollo Hospitals’ transplant program. This has helped us in maintaining excellent long term outcomes with low infection rates.”

The number of patients waiting for a lifesaving organ transplant far exceeds the number of available donor organs, and the need for organ transplants is increasing. When the patient condition deteriorates while waiting for a donor organ, ECMO or Extra Corporeal Membrane Oxygenation comes to the rescue. Similar to the heart-lung bypass machine used in open-heart surgery, the ECMO machine pumps and oxygenates a patient’s blood outside the body, giving rest to the heart and lungs.  ECMO acts as a bridge to recovery and bridge to transplant.

Dr. Madan Kumar K, Senior Consultant Cardiothoracic Heart and Lung Transplant Surgeon, Apollo Hospitals, Chennai and a member of the transplant team said, “Apart from using ECMO as a bridge to recovery as well as for the most number of bridge to lung transplants, with a 75% success rate using this demanding procedure, we also have on record the patient who spent the longest time on ECMO – 46 days – prior to a successful lung transplant. Apollo Hospitals was one of the early pioneers in the use of ECMO and beginning as early as 2010, we have used it in a wide array of situations such as poisoning, trauma, and infections like H1N1. ECMO is also helping to save lives of patients with COVID -19 who have severe acute respiratory distress syndrome as lungs are badly affected, taking over the function of the heart and lungs and allowing those organs to rest and recover.”

Dr. Paul Ramesh Thangaraj, Senior Consultant Cardiothoracic Heart and Lung Transplant Surgeon, Apollo Hospitals, Chennai said, “Organ transplants are among the most challenging, but rewarding procedures. Transplants remove diseased organs and replace them with healthy ones to extend the lifespan of patients suffering from end-stage conditions, giving them a second chance to live their life fully. Apollo Hospitals, Chennai has the capabilities and infrastructure to perform all Solid Organs Transplantation including Liver, Kidney, Heart, Lungs, Pancreas, and Intestine, as well as combined such as Heart-Lungs, Kidney-Pancreas, and other multi-organ transplants. Our transplant centres are equipped with sophisticated technology to ensure the best possible infrastructure for our patients. Our Organ Transplant Surgeons and allied teams work with the organ donor in case of a living donor, and recipient before, during and after surgery to ensure the greatest likelihood of superior results. The successful double lung transplant during COVID period is a testament to our excellence and expertise built over the past decades.”

The Apollo Hospitals Group is at the forefront in laying down the benchmark for accessible and affordable world-class healthcare in India with the best of experienced doctors supported by an infrastructure that consists of the latest and most advanced medical technology available. Apollo Hospitals Group is a leader in the field of organ transplants and is one of the best organ transplant hospitals in India. The first successful paediatric and adult liver transplants in India were performed at Apollo Hospitals in November 1998.

The Apollo Hospitals’ organ transplant team is staffed with some of the finest and experienced transplant surgeons in the country delivering the highest standards from care. Specialists from a variety of fields and a support staff that includes transplant coordinators, social workers, psychiatrists and anaesthesiologists ably support them. Continuous upgradation of surgical technology gives patients a simpler and pain-free surgical and recovery experience. Patients can avail of treatment options and outcomes that are at par with the best available in the world.

The Apollo Hospital Heart and Lung transplant program

The Heart Transplant program started in Apollo quite soon after the passage of the Transplantation of the Human Organs Act in 1994. The first heart transplant was done on Christmas Eve 1995 and was a great success with the patient being one of the longest survivors of heart transplant in India. He had a high quality of life for just under 15 years.

A revival of the program was undertaken in 2006 with the establishment of Tamil Nadu state support in 2009 through the establishment of TRANSTAN (Transplant Authority of TN) and subsequent streamlining of organ allocation.

The team has widened over the years into an interdisciplinary clinical force encompassing cardiologists, pulmonologists, infectious disease experts, critical care doctors, endocrinologists, GI nephrologists with special interest in transplant medicine and a paramedical group of nurses, physiotherapist, dieticians, counsellors and transplant coordinators. The team specializes in end stage heart and lung failure both as outpatient and when patients present in ICU or emergency room as acute problems.

The surgical team has assessed 397 patients and transplanted 220 organs (69 hearts and 151 lungs) in 120 patients. It has the most experience in the country in multi-organ transplantation.  The current survival rates are in line with international rates with a 83% long-term survival and an 75-80% long term survival. Patients are surviving over 10 years post-transplant and doing well currently.

In addition, Apollo Hospitals was the earliest adopter of mechanical circulatory support in India. The LVAD program started about 8 years ago and both the first succesful LVAD to heart transplant bridge operation as well as the first successful ECMO for lung failure and cardiac arrest about 10 years ago was performed. In the last 10 years, the team has done 201 ECMOs for a wide variety of conditions such as acute heart failure and lung failure resulting from infections, poisoning, sudden heart attacks and blood clots to the lungs. The outcome data is shared with ELSO (the primary international ECMO organization) and is on par with international standards.

The motivation is not to just focus on numbers but to ensure that transplants are done appropriately and outcomes are monitored by a monthly audit by independent peer review. The monthly audit has been a feature of both the cardiothoracic and transplant teams for the last 7 years.

Some of the milestones of the Heart and Lung Transplant team:

1. Most number multi-organ transplants in India,
2. First successful bridge to heart transplant (LVAD – Heart TX).
3. Oldest patient to receive a successful heart and lung transplant in India – (age 67) – second oldest in the world currently well and alive 7years post-transplant.
4. Oldest patient to receive a successful lung transplant in India (age 73)
5. Second successful double lung transplant in the world in a patient with Hermansky-Pudlak syndrome.
6. Asia’s first successful en-bloc combined Heart and Liver transplant.
7. Largest ECMO series in India for ARDS.
8. Most number of successful bridge of ECMO to Lung Transplant
9. Longest ECMO to lung transplant bridge in India – 46 days.