UPMC Transplant Surgeons Perform Rare Heart-Liver Transplant in 18-Year-Old Young Man

While organ transplantation has become routine and widespread during the last 50 years with ever-increasing efficacy and good long-term outcomes for the majority of patients, some forms of solid organ transplantation remain relatively rare. Combined heart-liver transplantation is one of those rarities.

The world’s first successful combined heart-liver transplant was performed in Pittsburgh at UPMC Children’s Hospital in 1984 by pioneering transplant surgeon and researcher Thomas E. Starzl, MD, PhD, and colleagues. That first case, in a young, 6-year-old girl from Texas, led to numerous other medical discoveries and laid the foundation for hundreds more procedures to be performed with increasing efficacy and long-term quality of life.

However, combined-heart liver transplants remain a rare phenomenon. Since 2010, only a little more than 400 have been performed in the United States, the vast majority of which have occurred in patients older than 18.

In February 2022, a multidisciplinary transplant team at UPMC, including David J. Kaczorowski, MD, surgical director of the Advanced Heart Failure Center at the UPMC Heart and Vascular Institute, Mary Keebler, MD, director of the section of heart failure and pulmonary hypertension and the medical director of advanced heart failure at UPMC, and Christopher B. Hughes, MD, FACS, surgical director of liver transplantation at the Thomas E. Starzl Transplantation Institute, performed a successful heart-liver transplant in an 18-year-old male.

“This was an interesting case in that we had an 18-year-old patient who began to have unexplained abdominal pain but had otherwise been in good, healthy condition,” says Dr. Kaczorowski. “Initially, it was thought the abdominal pain could be related to a muscular injury due to intense physical activity, but later was thought to be related to a gall bladder issue, which his local doctors removed. Further testing, however, revealed significant impairment of his heart function, which was when he was referred to our center for evaluation and treatment.”

The patient’s condition upon arrival at UPMC was poor, and he was found to be in decompensated heart failure with impaired renal function. The patient’s liver function was also significantly compromised and deteriorating. Dialysis allowed for the patient’s renal function to recover, but unfortunately, the heart failure was still present, and further testing determined that he had developed cirrhosis of the liver.

“We had a very young patient, in prior good physical condition, with a rapid decline in heart and liver function. He was a reasonable candidate for a heart transplant, but he also would need a liver,” says Dr. Kaczorowski. “So, we put him on the list for a transplant and began the waiting process for organs.”

The exact cause of the patient’s heart failure remains unclear but has been attributed to non-ischemic cardiomyopathy of unknown etiology. The effects of the heart failure caused the initial abdominal pain, kidney failure, and subsequent liver dysfunction and cirrhosis.

Because of how ill the patient was and the extent of his heart failure, he remained in the hospital for more than two months on mechanical circulatory support using the percutaneous Impella® heart pump device to support his heart function while waiting for potential donor organs.

After 77 days, organs became available and were transplanted into the patient sequentially by Dr. Kaczorowski, Dr. Hughes, and the rest of the surgical transplantation team. He was released from the hospital to his home 10 days after the procedure, having recovered quite well and expeditiously following surgery.

At his four-month post-transplantation follow-up, the patient was doing well and free from signs of organ dysfunction or rejection.

“It’s very rare that you see a healthy, vital young person decompensate so quickly and be in dire need of a new heart and liver,” says Dr. Kaczorowski.

The patient’s initial presentation and symptoms were quite atypical of decompensating heart failure and concomitant organ dysfunction.

“That he’s done so well in the immediate follow-up period is promising, and he’ll continue to be followed very closely by our cardiology and hepatology colleagues over the long term.”

Transplantation medicine and patient outcomes have progressed exponentially over the last four decades since Dr. Starzl and colleagues performed the first heart-liver transplant in Pittsburgh. All of the dedicated heart, liver, transplant, and research teams at UPMC and the University of Pittsburgh continue to build upon and propagate that pioneering work in transplantation medicine into the 21st century.

For more information or to refer a patient to the UPMC Heart and Vascular Institute, please email HVIReferral@upmc.edu.

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