An Extraordinary Transplant Triple Play

uch_026630-1

By Dianna Douglas

Darryl Williams got winded while running an annual 10K race in Oak Park in 1995. Puzzling, since he was in excellent shape. Over the next five years, he had irregular heartbeats and felt strange sensations in his chest. But none of the treatments his doctors tried made a difference.

Allen Anderson, associate professor of medicine and director of the Advanced Heart Failure Program, met Williams in 2000. The arrhythmia was becoming life-threatening. Anderson diagnosed Williams with sarcoidosis of the heart, an inflammatory disease, and began to treat him with medication.

Williams was determined to get better. He followed his doctor’s orders and took his medications, even when they had toxic side effects. “We were able to control it for 10 years,” Anderson said. “He did his part as well, by taking care of himself.”

But Williams’ sarcoidosis continued to grow. The disease, which affects about 18 people per 100,000 annually, spread to his liver. Soon his ailing heart and liver put serious strain on his kidneys. Anderson decided that his only hope was a new heart, liver and kidney. “He was in heart failure and liver failure. He was critically ill. He was going to die.”

The criteria to be considered for a three-organ transplant are stringent. “We have to be very careful about patient selection,” Anderson said. A heart, liver and kidney transplant is a massive surgery. “We have to pick patients who have a good chance of survival.”

Williams’ case was the subject of many multidisciplinary meetings, with hematologists, surgeons, nutritionists, psychiatrists, social workers, infectious disease specialists. “The fundamental question is: are you going to commit organs to this person?” said John Renz, professor of surgery and director of the Liver Transplant Program. “You have to look at all aspects of a patient. And you have to feel that you are committing that precious resource well.”

After multiple screenings, the team was convinced. At 55 years old, Darryl Williams didn’t have any other health problems that would complicate his recovery. He was always careful to follow his doctors’ instructions, and would likely keep taking his medications after a transplant surgery. And, as important as anything, he had a large family and community of friends to support him through the ordeal.

After three months of waiting in the hospital for the transplants, Williams was rolled into an operating room.

“It’s an extraordinary surgery,” said Valluvan Jeevanandam, professor and chief of cardiac and thoracic surgery. “People don’t do well after any open heart surgery without a good functioning liver,” he said. “The liver has to filter out toxins and promote coagulation. Similarly, a new liver won’t do well without a good heart.”

He compares multi-organ heart transplants to “walking a tight rope without a net under you.”

There are other pressures, too. After leaving the deceased donor, the heart is only good for about five hours. A liver can be transplanted for 18 hours, and a kidney can sometimes be good for up to 48 hours. So, the heart goes in first.

“From a technical point of view, all three surgeries have to be perfect,” Jeevanandam said. “The challenging thing is sewing in all three organs in an environment hostile to any transplant procedure.”

The heart transplant was over in about four hours, but the heart was struggling. “We had to maintain his heart until he could get his liver,” Jeevanandam said. The surgeons used inotropes to stimulate the heart and a balloon pump to keep oxygen flowing.

Then Renz and the liver transplant team took over.

“When the new liver went in, the heart got better and better,” Renz said. “I think a real key to the success of this operation was the seamless integration of the OR nurses, OR support staff and our anesthesia team led by Drs. Irene White, Geraldine Diaz and Mark Nunnally.”

By the time it was Yolanda Becker‘s turn to bring in a kidney transplant team, Williams had been in the operating room for almost 17 hours. Becker is a professor of surgery and director of the Kidney and Pancreas Program, and has done hundreds of kidney transplants, including many multiple organ transplants. She said that sometimes it’s best for a heart transplant patient to recover before attempting to put in a kidney.

But the donor kidney was aging, and the patient was limping along. The surgery teams, nearing exhaustion, didn’t want to have to discard the donor kidney. And none of his physicians wanted Williams to have a new heart and liver without a new kidney.

“I decided that we would not wait until the patient got stable,” Becker said. She recalls Jeevanandam telling her that if they were going to attempt the kidney transplant, it needed to be done quickly.

Becker and the kidney transplant team worked at breakneck speed. The surgery is normally three to four hours. But in this case, a mere 36 minutes passed between the incision and the reperfusion.

After 19.5 hours on the operating table, Williams became the 10th person in the United States – and the fourth at the Medical Center – to have a successful heart, liver, and kidney transplant.

Jeevanandam said it takes an entire university committed to interdisciplinary programs to pull off a triple transplant. But he saved his sincerest words of praise for the organ donor, whom he called the biggest hero in the surgery: “It’s incredible how many people can be affected from this gift,” he said.

Williams says he feels better than he has in years. He’s looking forward to spending some time with his wife, their Jack Russell terrier, and his children and grandchildren. “My immediate goal is to get my strength back, and try to recapture some of my life,” he said.

Anderson, his heart failure specialist, believes that Williams will have no limitations after getting rehabilitated, and notes that sarcoidosis rarely recurs in transplanted organs. Williams will be able to travel, exercise, and do the daily activities he wants to do. “There’s a good chance that he will have a normal life,” Anderson said.

About Rob Mitchum (526 Articles)

Rob Mitchum is communications manager at the Computation Institute, a joint initiative between The University of Chicago and Argonne National Laboratory.

%d bloggers like this: