Doctors from the UW Medicine Heart Institute in Seattle, USA, reported a case that went down in the history of medicine. A patient received two organs from donors, a liver and a heart, to avoid the very high possibility that her body would reject a transplanted donor heart alone.
In doing so, they tested the concept that a donated liver could confer powerful immune protection in a subsequent heart transplant. The case has been reported in The Journal of Heart and Lung Transplantation.
Adriana Rodriguez, 31, is the patient who underwent a double transplant on January 14 of this year. According to the doctors, she recovered well. Rodriguez required a heart transplant after suffering a spontaneous coronary artery rupture on December 7, 2022. Two weeks earlier, the patient had given birth to her third child.
Doctors also noted that heart and liver transplants are rarely performed on recipients. This is an unprecedented case in two respects: Rodriguez received the liver from a donor only to alleviate the near-certainty that her body would immediately reject the donor heart she desperately needed. Moreover, his healthy liver was transplanted into a second patient who had advanced liver disease.
“She met all of the criteria for transplantation, but her antibodies (to organ donor antigens) were the highest we’ve ever seen. Finding an immune match just for her heart would be like trying to win the lottery. The basis for the donor to be her immune twin.
It is believed that there are hormonal changes and stresses during pregnancy that can make coronary arteries vulnerable to these tears. At best, the exfoliation heals without doing much damage to the heart and the patient goes home to take medication and get better. This patient had acute heart failure, said Dr. Daniel Fishbein, a heart failure specialist on Rodriguez’s team, in a statement.
Doctors found that the rupture caused widespread and permanent damage to the heart.
On December 14, the patient was connected to an extracorporeal membrane oxygenation (ECMO) system. This machine pumps blood and oxygenates it, temporarily resting the patient’s heart and lungs. On January 5 of this year, Rodriguez officially entered the transplant list.
With each transplant, doctors measure the recipient’s potential antibodies to assess the likelihood of rejection of the donor organ. A person whose levels are high is described as “hypersensitive.”
Rodriguez’s assessment indicated that she had a higher probability of organ rejection out of 99% of potential donors.
“Pregnant women are more likely to have hypersensitivity because when they carry a baby, their bodies develop antibodies against antigens that come from the father. These antibodies don’t attack the fetus, but if you transplant that person, those antibodies will attack the organ,” cardiologist Shen Lin said. Transplanted – sometimes within minutes.
In an effort to solve the problem, the doctor found a 2021 observational study that showed “profound immune protection” with a heart transplant protocol after liver transplantation among seven highly sensitive patients who needed both organs.
Although the data set was small and Rodriguez didn’t need a liver, Lin thought it was his best chance of survival. He proposed the idea to the team, with one modification: Rodriguez’s healthy liver would be transplanted into another patient who needed the organ.
Many colleagues immediately opposed this approach. There was concern that this was an unproven treatment in a complex patient. But there was no other solution that would allow this young mother to be discharged and discharged from the hospital.
On January 14, UW Medicine was notified by LifeCenter Northwest’s organ-purchasing agency that there were two members. In the transplant process, doctors first removed Rodriguez’s liver and placed it on ice, then transplanted it with a donor liver.
The patient then received the donated heart while her liver was transplanted to another person in an adjacent operating room.
“We look at (Rodriguez’s) antibodies almost every day. Just 65 days after transplantation, the antibodies against the donor’s organs were completely gone. That’s when I felt like I could finally breathe easy. That means it was an absolute success.”, the cardiologist assessed.
It is not yet known exactly how the donor liver protects the transplanted heart.
“I don’t think we fully understand the science of transplant immunology. We can learn a lot from patients like this. We need to understand the magic so that one day we can replicate it with drugs instead of organs,” Fishbein asserts.
Six months into the double farming, Adriana Rodriguez thanked:
“There are no words to express my gratitude for my extraordinary service. (…) I pray that no other woman will go through this, but I hope this situation of mine will benefit and bring hope.”
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