UW Medicine reports history making heart-liver transplant for Bellingham woman

UW Medicine doctors in Seattle are reporting a history-making case in which a patient received two donor organs, a heart and a liver.

The procedures were done together, doctors said, to prevent the extremely high likelihood that 31-year-old Adriana Rodriguez of Bellingham would reject a donor heart transplanted alone.

“There are no words to express my gratitude for my exceptional care — to the doctors and surgeons brainstorming on how to save my life, to my nurses for going the extra mile to make me feel comfortable, and to everyone working on my case who I didn’t get to meet,” Rodriguez said in a UW Medicine news release.

She has recovered well since the procedures performed Jan. 14, said Dr. Shin Lin, a cardiologist at the UW Medicine Heart Institute. Doctors officially listed Rodriguez for a heart transplant Jan. 5.

Rodriguez’s need for a heart transplant stemmed from a spontaneous tear within her coronary artery that occurred on Dec. 7.

Two weeks earlier, Rodriguez had given birth to her third child at PeaceHealth St. Joseph Medical Center in Bellingham.

Lin is the lead author of the paper describing the novel approach, which is newly published in The Journal of Heart and Lung Transplantation.

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Lin said doctors seldom perform heart-liver transplants on one recipient, according to the release. In fact, this was the first such case for UW Medicine surgeons.

Why Rodriguez’s case was unparalleled

Doctors said Rodriguez’s case was unprecedented in two ways: She received a donor liver only to lessen the chance her body would reject the donor heart she needed. A second patient who had advanced liver disease received Rodriguez’s healthy liver as part of a domino-like transplant.

“She met all criteria for transplant, but her antibodies were the highest we’ve ever seen,” Lin said in the release. “Finding an immunologic match for her heart alone was going to be like trying to win the lottery. Essentially, she would have needed the donor to be her immunologic twin.”

Rodriguez’s doctors treated the coronary artery dissection with an aortic balloon pump to help her heart circulate blood. Then they transferred her to UW Medicine, where doctors found her dissection had caused widespread, permanent damage to her heart.

In the month that followed, Rodriguez’s team removed the balloon pump and tried other ways to restore her heart’s pumping function.

“The dissection injured her heart a lot. We attempted to remove her from support over time to see if her heart was recovering, and she continued to fail that,” Dr. Jay Pal, a cardiothoracic surgeon, said in the release. “We went through a variety of support strategies to try to help her heal.”

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“Pregnant women are more likely to have high sensitization because when they carry a child, their body develops antibodies against antigens that come from the father,” Lin noted, according to UW Medicine. “These antibodies don’t attack the fetus, but if you transplant that person, those antibodies will attack the transplanted organ — sometimes within minutes.”

More on the surgery

On Jan. 14, organ-procurement agency LifeCenter Northwest notified UW Medicine that two organs had become available from a deceased donor. This set in motion a carefully orchestrated, 17-hour sequence at UW Medical Center-Montlake.

“There was concern that this was an unproven treatment in a complex patient. But there were no other ideas or techniques that would allow this young mother to be free from ECMO and leave the hospital,” Pal said in the release. “Dr. Lin’s unyielding belief that HALT-D would be successful convinced us. Ultimately, Adriana is alive and doing well because of his conviction.”

Exactly why a donor liver would protect a donor heart is still a bit of a medical mystery, Dr. Daniel Fishbein, a heart failure specialist on Rodriguez’s team, suggested.

“I think we don’t fully understand the science of transplant immunology,” Fishbein said, according to UW Medicine. “We can learn a lot from patients like this. We need to understand the magic so we can hopefully, someday, repeat it with medications instead of an organ.”