'History making' dual-organ transplant saves 31-year-old woman

According to the official statement, the dual transplant is based on the immunoprotection concept, which permits a donor's liver to induce immunoprotection on a transplanted heart.

The condition had caused "widespread, permanent damage to her heart"

After being diagnosed with coronary artery dissection on December 7, 2022, Rodriguez required a heart transplant. This condition occurs when an artery within the heart unexpectedly tears, resulting in the formation of a blood clot between the heart's layers.

Initially, at PeaceHealth St. Joseph Medical Center in Bellingham, her doctors employed an aortic balloon pump to address the anomaly. The purpose was to prevent blood clot formation and maintain uninterrupted blood flow.

However, she was eventually transferred to UW Medicine, where it was discovered that the condition had caused "widespread, permanent damage to her heart".

The doctors mentioned that such dissections are thought to be very, very rare in pregnant women. Rodriguez had given birth to her third child at PeaceHealth just two weeks before the diagnosis. 

“There are thought to be hormonal changes and stress in pregnancy that can make the coronary arteries vulnerable to these tears,” Dr. Daniel Fishbein, a heart failure specialist on Rodriguez’s team, said in the statement. 

Fishbein added: “In the best-case scenario, a dissection heals without much heart damage and the patient goes home with medications and gets better. But this patient had terrible heart failure.”

Rodriguez was formally added to the heart transplant waiting list on January 5.

17-hour long surgery  

There are two unique aspects to her medical situation that have never been seen before.

In the first instance, she underwent a liver transplant from a donor to decrease the chances of her body rejecting the crucially needed donor heart. Secondly, her own healthy liver was transplanted into a patient with advanced liver disease.

As per the medical professionals, the precise mechanism by which a donor's liver can potentially provide immunoprotection to sustain a donor's heart remains somewhat of a mystery.

This complicated surgery was proposed by Dr. Shin Lin, a cardiologist at the institute. Lin came across an observational study from 2021 that revealed a “profound immunologic protection” via a heart-after-liver transplant (HALT) strategy in seven highly sensitized patients who needed both organs at the same time.

Dr. Lin was certain that the procedure would be successful, but finding the right donors was challenging.  

“She met all criteria for transplant, but her antibodies (to the antigens of organ donors) were the highest we’ve ever seen. 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,” said Lin. 

Fortunately, on January 14, LifeCenter Northwest notified UW Medicine that a liver and heart had become available from a deceased donor. 

During the surgical procedure, the liver was transplanted first, followed by the heart. Simultaneously, Rodriguez's liver provided another patient with a renewed opportunity for a better life.

Rodriguez expressed her gratitude six months after her successful procedures: "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.” 

"I pray no other woman goes through this, but I hope my situation will benefit them and bring them hope," she said.

The findings are published in The Journal of Heart and Lung Transplantation.

Study Abstract:

In dual organ transplantation, the inclusion of a liver is known to confer immunoprotection to the other graft. In 2021, Daly and colleagues described successful heart after liver transplantation (HALT) in seven highly sensitized patients with end-stage heart and liver disease. Herein, we report taking the next logical step of performing the world's first-ever HALT on a patient solely for high sensitization. Because her normal liver was dominoed into another patient, we call our procedure HALT with domino (HALT-D).