To avoid heart rejection, surgeons "replaced" a woman's healthy liver
Surgeons have performed a simultaneous heart and liver transplant on a woman with a coronary artery dissection. The report on the successful operation was published in The Journal of Heart and Lung Transplantation.Surgeons at the University of Washington Medical Center reported the first operation to perform simultaneous transplantation of two organs at once to prevent the high risk of rejection of the donor heart. The surgery was successful and confirmed the theory that a donor liver can provide reliable immune protection in a subsequent heart transplant.
Adriana Rodriguez, 31, suffered a coronary artery dissection after giving birth to her third child. Such ruptures, caused by stress and hormonal changes during pregnancy, often occur after childbirth, and in many cases are treated with medication without serious consequences, doctors explain.
In Adriana's case, the dissection progressed to serious heart failure, and the patient's life could only be kept alive with the help of a ventilator. The only possible treatment was a heart transplant. But, as the doctors calculated, after pregnancy there was a 99% chance of rejection of the transplant.
Pregnant women are more likely to be highly sensitized (hypersensitivity to foreign substances - note "Hitech"), because when they carry a child, their body produces antibodies against paternal antigens. They don't attack the fetus, but after transplantation they will start attacking the transplanted organ - sometimes within minutes.
Doctors suggested an alternative treatment that included not only a heart transplant, but also replacing a healthy liver with a donor liver. Surgery to transplant these two organs at the same time (HALT) has been done before, but only in cases of both heart and liver failure. A 2021 study found that patients who undergo such surgery experience "profound immunologic protection."
Adriana's surgery lasted 17 hours. During that time, surgeons transplanted her with a new heart and liver, while her own liver was removed and implanted into another patient. Researchers monitored antibodies in Rodriguez's body daily, and it wasn't until 65 days later that the reaction to the donor organs completely disappeared. Further observations confirmed the success of the transplant, although doctors still do not understand how liver transplantation protects against heart rejection.