Complex transplant performed on patient with Scleroderma in Chennai

CHENNAI: Scleroderma is a common autoimmune disease that causes inflammation and fibrosis in various organs of the body. In one such case of inflammation in the lungs due to Scleroderma in a 53-year-old female, the lung capacity was reduced permanently.

In order to treat the same, the patient underwent lung transplantation at a private hospital in the city.

The inflammation led to Interstitial Lung Disease (ILD) that caused subsequent scarring of the walls of the air sacs and reduced lung capacity and function. The patient had developed pulmonary hypertension which leads to high pressure inside blood vessels in the lungs and worsens breathlessness and heart failure.

The patient was diagnosed with ILD five years ago and was being managed with medications. She was evaluated by experts at the Kauvery Hospital and was added to the transplant list. She was awaiting a suitable donor for nine months and remained on oxygen support.

Dr Srinivas Rajagopala, Senior Consultant in Pulmonology, and Director of Transplant Pulmonology & Lung Failure Unit said, “The transplant was medically complex and required optimisation and careful planning. Several centres abroad do not accept scleroderma patients because of the concern of aspiration due to poor movement of the oesophagus which can cause permanent damage to the lung graft. Since the patient was immunologically sensitized, she had antibodies (anti-HLA) against potential donor lungs and it could lead to rejection."

He added that virtual and actual cross-match was obtained at the time of donor availability to avoid antibody-donor lung reactions. A bilateral lung transplant with central ECMO support was done on the patient by Dr Kumud Kumar Dhital, Program Director with the able support of lead anaesthetist and intensivist Dr Pradeep Kumar. She was weaned off the ventilator support within 24 hours and oxygen support by 4th-day post-transplant. She is able to walk normally and was discharged home on the 12th postoperative day.