Simultaneous heart and liver transplantation was performed for the first time in our country at the Institute of Cardiology in Warsaw. A 51-year-old patient with a genetic defect causing damage to the heart muscle was operated on.
“This is another pioneering operation of this type in our center, in 2017 we performed the first simultaneous heart and kidney transplantation” – said the director of the Warsaw Institute of Cardiology, Prof. Tomasz Hryniewiecki. Such transplants are performed by few centers in Europe and around the world.
The operation took place on August 30, 2018 and lasted 7 hours (from 19.00 pm to 12 am the next day). The patient, Marek Wlaź, who underwent the procedure, said that XNUMX days after the procedure he felt well and hoped that he would return to the physical fitness that would allow him to function normally.
Simultaneous heart and liver transplantation was performed by cardiac surgeons of the Institute of Cardiology in Warsaw, Prof. Mariusz Kuśmierczyk, Dr. Jerzy Lichomski and Dr. Mateusz Kuć. It was also attended by prof. Krzysztof Zieniewicz and dr hab. Krzysztof Dudek from the Department and Clinic of General, Transplant and Liver Surgery, Medical University of Warsaw. They were the ones who performed the liver transplant.
Head of the Department of Cardiac Surgery and Transplantology, Institute of Cardiology in Warsaw, prof. Mariusz Kuśmierczyk admitted that for such a difficult procedure, it lasted quite short. Everything was well organized. “At one point in the operating room, there were 20 people at the same time, including doctors of various specialties,” he added.
The expert explained that the heart was transplanted first, and then the ECMO extracorporeal blood oxygenation pump was connected. It was only during the operation of this pump that the surgeons from the Medical University of Warsaw transplanted the liver.
«We were not sure how the new, transplanted heart would behave after the transplantation of the liver, which initially releases all the toxins produced by the so-called cold ischemia, that is, from its collection to implantation. We were afraid that this new heart would not be damaged »- explained Prof. Kuśmierczyk.
ECMO (Extracorporeal Membrane Oxygenation) was disconnected from the patient on the second day after heart and liver transplantation, when doctors made sure that both organs were functioning well.
The operated patient – Mr. Marek Wlaź said that he had no doubts as to whether he should undergo surgery. «There was no other option, even for a moment I didn’t have the thought to withdraw from this idea. There was only one way ahead of me »- he added.
Wlaź said that he could function well for many years, but at some point his health deteriorated with each passing month. “At the end of June this year, I was able to walk 400 m, and before the operation even 100 m was a big challenge for me,” he said.
Prof. Mariusz Kusmierczyk explained that the patient had been waiting at the Warsaw Institute since March 2018 for a suitable donor from whom the heart and liver could be collected. «He had heart failure and we were afraid that something could happen to him at home. We also wanted to be sure that he was well prepared for this difficult operation, that he had no infection and that his kidneys were working properly »- he added.
Simultaneous transplantation was necessary in this patient because of a genetic storage disease, which causes a lack of certain enzymes in the liver and the deposition of substances damaging the heart muscle. “If we only transplant the heart in such a situation, the liver still does not produce these enzymes and the new heart will be damaged” – explained prof. Kuśmierczyk.
The specialist said that in the future there will be an increasing need for simultaneous heart and liver transplants, as there are more and more patients at an early age with the so-called single-chambered heart. “Poland is the second country in the world, after the United States, in which most newborns with underdevelopment of the left ventricle are operated on” – emphasizes prof. Kuśmierczyk.
After three or four operations, cardiac surgeons in such children rebuild the heart in such a way that it is single-chamber, i.e. there is one chamber, while the other one does not work, and the blood flow to the lungs is hydrostatic (only the force of gravity works – ed.).
«This, in turn, can lead to cirrhosis of the liver over time, so a patient with single-chamber heart failure should have a heart and liver transplant. The liver itself and the heart itself cannot be transplanted, because the results of such procedures are generally bad »- emphasized prof. Kuśmierczyk.
Prof. Hryniewiecki pointed out that the Institute of Cardiology in Warsaw is one of the two most important heart transplant centers in the country and is constantly expanding therapeutic options for the largest possible group of patients who have heart failure and failure of other organs, kidneys or liver.