Adriana Rodríguez, a 31-year-old Washington resident, qualifies for a heart transplant, yet voluntarily undergoes a groundbreaking two-for-one procedure, swapping her perfectly functioning liver.
In a rare occurrence, when a patient’s heart and liver are both replaced with organs from a donor, it signifies a critical issue with both organs. Adriana Rodriguez, a 31-year-old resident of Washington state, met all the criteria for a heart transplant, while her liver was functioning properly. Nevertheless, surgeons made a groundbreaking decision to perform a simultaneous heart and liver transplant, which had never been done before.
Researchers from the University of Washington School of Medicine in the US, led by cardiologist Shin Lin, made this historic decision due to the high likelihood that Adriana’s immune system would reject any foreign tissue. Her antibody levels against organ donors’ antigens were the highest ever observed. Finding a compatible heart alone was nearly impossible, as she would have needed a donor with an identical immune profile.
The only viable option was a heart-after-liver transplant (HALT), where a new heart would be accompanied by a liver. Since Adriana’s own liver was functioning normally, it was transplanted into a second recipient in a HALT domino (HALT-D) procedure.
In 2021, cardiovascular surgeon Richard Daly and his team reported positive long-term outcomes of HALT in patients with end-stage heart and liver disease, compared to heart transplants alone. The reason why a donated liver reduces the chances of heart rejection remains unclear. Livers are resilient organs, capable of withstanding antibody attacks better than most transplanted tissues. Its large surface area may divide the body’s immune response, allowing other transplanted organs to integrate successfully.
Despite the uncertainties, Lin believed that HALT-D offered the best chance of saving Adriana’s life. His unwavering conviction convinced the surgical team to proceed with the procedure. Adriana, alive and well, owes her life to Dr. Lin’s determination, as stated by cardiothoracic surgeon Jay Pal.
Adriana’s search for a new heart began shortly after giving birth to her third child, when pregnancy hormones caused a tear in one of her heart’s arteries, resulting in severe heart failure. After failed attempts to wean her off life support and allow her heart to recover, Adriana was connected to a machine that oxygenated and circulated her blood. However, her chances of finding a compatible heart were nearly impossible due to her highly sensitized immune system from her recent pregnancy.
Based on Daly’s research findings, Lin considered HALT as a potential solution. On January 14, 2023, Adriana received the news she desperately awaited—a suitable heart and liver had become available.
It took a little over two months for Adriana’s immune system to stabilize after the surgery. Assessments of her antibodies indicated that the transplanted liver played a significant role in controlling her overactive immune response.
The future for both the patient and the procedure remains uncertain. The scarcity of compatible organs has prompted researchers to seek better ways of procuring tissues that are less likely to be rejected. In the meantime, HALT-D could serve as an option for cases where the prospects for the recipient are grim.
Six months after the operation, Adriana expresses deep gratitude for the exceptional care she received. She appreciates the doctors and surgeons who worked tirelessly to save her life, the nurses who went the extra mile to make her comfortable, and all the individuals involved in her case whom she didn’t have the opportunity to meet.
This remarkable case study was published in The Journal of Heart and Lung Transplantation.
Image Credit: Shutterstock