Maryland Man Has New Chance at Life after Two Simultaneous Transplants
Transplant surgeons at the University of Maryland Medical Center in Baltimore are the first in Maryland to perform a combined heart and liver transplant. The two organs were transplanted in a 33-year-old man from Oxon Hill, Md., during a ten-and-a-half hour procedure on October 15, 2007. A total of 15 people in two transplant teams participated in this rare combination transplant. Data from the Organ Procurement and Transplantation Network indicate that only 53 of these heart-liver transplants have been performed in the United States since 1992.
The patient, Trevanoyn Shelton, went home from the medical center about two weeks after the surgery and is recovering well. Prior to the lifesaving transplants, he was unable to walk even a short distance without losing his breath. He had waited on the transplant list for about two months before suitable organs became available. Today, he says he feels healthier than he has in years.
Mr. Shelton suffered from a relatively rare heart condition known as restrictive cardiomyopathy, according to Sina L. Moainie, M.D., a cardiac surgeon at the University of Maryland Medical Center who led the heart transplant team. “His heart muscle became fibrotic and stiff, preventing the heart from filling with blood. As a consequence, the heart couldn’t pump the blood forward into his body,” says Dr. Moainie, who is also an assistant professor of surgery at the University of Maryland School of Medicine.
Mr. Shelton’s heart problem contributed to his liver failure. “Blood had filled his liver and that congestion impeded his liver function,” according to Benjamin Philosophe, M.D., Ph.D., head of the University of Maryland Medical Center’s Division of Transplantation and associate professor of surgery at the University of Maryland School of Medicine who was part of the liver transplant team. In addition, he says Mr. Shelton had hepatitis B, which had caused fibrosis, or scarring of the liver.
“Mr. Shelton needed both a new heart and a new liver in order to survive,” says Dr. Philosophe. “Each transplant by itself is a major operation and getting patients through a double transplant procedure of this magnitude is a challenge. The transplanted heart has to be strong enough to withstand the stress of a liver transplant,” says Dr. Philosophe.
Obtaining the two donor organs was equally challenging. Cardiologist Erika D. Feller, M.D., medical director for heart transplantation at the University of Maryland Medical Center and an assistant professor of medicine at the University of Maryland School of Medicine, worked diligently to have Mr. Shelton listed correctly on the national transplant waiting list. “His case was unusual because we had to make sure that a suitable donor liver came with a compatible donor heart,” says Dr. Feller.
Dr. Feller has high praise for Mr. Shelton’s cardiologist in Oxon Hill, Cynthia Crawford-Green, M.D., who was persistent in finding him a medical center with the capability and experience to manage his complex health problems.
During the surgery, the heart transplant was performed first, and then the liver transplant team took over. Luis Campos, M.D., a University of Maryland Medical Center transplant surgeon, says performing the liver transplant right after the heart transplant was like sailing in uncharted waters. “I anticipated that there might be excessive bleeding because the patient needed blood thinners while he was on a heart-lung machine during the heart transplant,” says Dr. Campos, an assistant professor of surgery at the University of Maryland School of Medicine. “But we were able to perform the liver transplant with minimal blood loss and little variation in blood pressure.”
Dr. Feller says she anticipates a good prognosis for Mr. Shelton. “I am optimistic that he will have this heart and liver for many years, based on his age, how well he has done so far, the fact that he does not have other diseases and also based on how we work with patients in our transplant program,” says Dr. Feller.
Even though this type of dual transplant is difficult and rare, surgeons at the University of Maryland Medical Center have a great deal of experience in heart and liver transplantation. In the last year, from November 2006 – October 2007, surgeons at the medical center performed 33 heart transplants and 44 liver transplants.
Bartley P. Griffith, M.D., director of Heart and Lung Transplantation at the University of Maryland Medical Center and professor of surgery and chief of the Division of Cardiac Surgery at the University of Maryland School of Medicine, was a national pioneer in performing dual heart/liver transplants prior to moving to Maryland in 2001. He co-authored one of the first papers describing a heart/liver transplant operation in 1984 in The Lancet.
“The University of Maryland Medical Center has the expertise and willingness to push the envelope to help people even with the most complex health challenges,” says Dr. Griffith.
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