University of Chicago surgeons perform heart-liver-kidney transplant
May 11, 1999
On Friday, May 7, 1999, after 11 weeks of waiting, 64-year-old Kent Slater of Rockford, Michigan--father of four and grandfather of nine--received a new heart, liver, and kidney at the University of Chicago Hospitals.
This is believed to be only the second time this combination of organs has ever been transplanted. In the first attempt, performed at the University of Pittsburgh in 1989, the patient survived for four months.
All three organs came from the same donor, who was infected with hepatitis C, a chronic viral infection of the liver. No other information about the donor is available.
Because of his multiple medical problems, Slater was turned down by several other cardiac transplant programs.
He was a "logistical nightmare," said Allen Anderson, MD, assistant professor of medicine and director of the heart-failure program at the University of Chicago. Getting the go-ahead from his insurance company, making and keeping him healthy enough to undergo the operation, and coordinating the different surgical teams all provided multiple challenges.
So did the wait for suitable organs. Slater suffered from heart failure, which required transplantation within a few months. He also suffered from a hepatitis C infection, probably acquired during previous bypass surgery. The hepatitis had damaged his liver; the heart failure led to his kidney failure.
Because he was an older, very complex patient, with hepatitis, Slater was considered an extremely high-risk patient and was only eligible to receive organs from donors with hepatitis C. He had been waiting in the hospital for donor organs since February 12, 1999.
The transplant operations, which went smoothly, began at about 8:30 a.m. The cardiac team, led by Valluvan Jeevanandum, MD, associate professor of surgery and section chief of cardiac surgery at the University of Chicago, performed the heart transplant first.
At 3:30 p.m., a second surgical team, led by Michael Millis, MD, associate professor of surgery and director of the liver transplant program, and David Cronin, MD, PhD, assistant professor of surgery, began the liver operation, which lasted until 7:30 p.m. Once the liver transplant was completed, the same team performed the kidney transplant, which lasted until nearly 10 p.m.
Slater has recovered very well and was already awake, alert, and breathing on his own by Saturday. On Monday, just 60 hours after his 14-hour surgery, he sat up in a chair and walked a few steps. He is currently listed as in serious condition and is well enough to be transferred out of the intensive care unit. The transplanted organs all appear to be working normally.
"A multi-organ transplant like this is a lot like a relay race," said Jeevanandum, who has performed more than 600 heart transplants. "To make it work, each team not only has to run a perfect race, but they also need to make a smooth hand-off to the following team. For example, we had to transplant the heart in such a way that it could immediately withstand the stresses of major abdominal surgery, the liver transplant. In this case, each team seems to have 'nailed' their leg of the race."
"I think we were all a little stunned by how smoothly it went," said Millis, who has performed more than 1,000 liver transplants. "It added some tension at first, knowing that we were performing a multiple-organ transplant on a man who had just had a heart transplant, but the heart remained strong and steady throughout."
Despite a splendid start, Slater still must clear several hurdles. In the first few days after a transplant physicians are most concerned that the new organs continue to function normally and receive adequate flow through the newly connected blood vessels that supply them.
A week after the operation the first signs of rejection can appear, as the body's immune system recognizes the transplanted organs as foreign tissue. The drugs that patients receive to suppress this immune response leave the patient more susceptible to infections.
There is no mention in the medical literature of any previous heart-liver-kidney transplant and the United Network for Organ Sharing, which coordinates organ allocation nationwide, has records of only the one previous attempt, in 1989. Heart-liver transplants have been performed only about a dozen times in the United States, including three times at the University of Chicago Hospitals. All three of those patients are alive, at home and doing well.
(Note added May 26, 1999: Slater has recovered well and is being discharged from the Hospital 19 days after his surgery on Wednesday, May 26, 1999. He will stay with his wife at a nearby apartment and receive regular medical attention until he is well enough to return to his home in Michigan.)
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