In Rare Cases, Heart and Liver Transplants Are Performed Simultaneously

In rare cases, when a diseased heart and liver are replaced with a donor heart and liver, it is because something has gone wrong with both.

Historic First: Heart and Liver Transplant Together

Adriana Rodriguez, a 31-year-old Washington state resident, qualified for a heart transplant and her liver was alive and well. However, the surgeons replaced it with the historic first.

The Reason Behind the Decision

A team of medical researchers at the University of Washington School of Medicine in the US made this historic decision based on the almost certain likelihood that her immune system would destroy any foreign tissue.

Cardiologist Shen Lin explained, “She met all the criteria for a transplant, but her antibodies (to donor organ antigens) were the highest we have ever seen. Finding an immune match just for her heart would be like trying to win the lottery. she needed a donor who would be her immune twin.”

The Procedure: Post-Liver Transplant Heart Transplant (HALT)

They concluded that her only chance was a liver transplant in a so-called post-liver transplant heart transplant (HALT).

Because her liver was working perfectly, she was transferred to a second recipient as part of the HALT Domino (HALT-D) procedure.

And in 2021, a team led by cardiovascular surgeon Richard Daley reported positive long-term outcomes of HALT in patients with end-stage heart and liver disease compared to heart transplantation alone. It is not clear why a donated liver could reduce the chance of heart rejection, since the liver is a hardy organ, able to withstand antibody attack better than most imported tissues. Its wide surface can divide the body’s defenses, allowing other transplanted organs to take root.

Cardiac surgeon Jay Pal said: “Dr. Lane’s unwavering faith has convinced us that HALT-D will be a success. Ultimately, Adriana is alive and well thanks to his beliefs.”

A Desperate Search for a Compatible Donor

The search for a new heart for Rodriguez began just weeks after she gave birth to her third child late last year. As the pregnancy hormones affected her coronary system, one of her heart arteries ruptured, resulting in catastrophic failure.

“We tried to take her off support over time to see if her heart recovered and she kept failing,” Pal said.

Placed in an oxygen machine that pumps blood through her body, Rodriguez waited for a heart made from tissue close to her own. Although more than a month had passed since her birth, her immune system remained hypersensitive to the new life in which she lived, which reduced her chances of finding a compatible donor to almost zero.

Based on the results reported by Daley, Lin thought HALT was worth a try.

A Ray of Hope: Heart and Liver Become Available

And on January 14, 2023, Rodriguez received the news she desperately needed. A suitable heart and liver became available.

It took Rodriguez’s immune system just over two months to stabilize after the surgery, and her antibody tests showed that her liver played a key role in taming her immune response.

The Future of the Procedure

It is unclear what the future holds for the patient or the procedure. There is a dearth of compatible organs, prompting researchers to look for better ways to supply tissues that are less likely to be rejected. Meanwhile, HALT-D may be an option in cases where the prospects for the recipient are bleak.

Six months after the operation, Rodriguez had nothing but gratitude for the path her surgeons had taken.

This case study was published in the Journal of Heart and Lung Transplantation.

Source: Science Alert