Combined heart-liver transplant in UMCG – a first in the Netherlands

In a first for the Netherlands, a 35-year-old patient from the UMCG was the first to receive a new heart and a new liver at the same time. A large team of heart surgeons, liver surgeons, and other specialists performed the unique transplant, which took almost 24 hours in total. The patient is doing well and has started her rehabilitation. This transplant was made possible by combining years of expertise in the field of congenital heart defects and all the expertise of the UMCG Transplantation Centre (GTC). Several patients are on the waiting list at the UMCG for the same combined transplant.

Congenital heart defects

The patient had a serious congenital heart defect: the right part of her heart was missing. Since birth, she has been operated on her heart numerous times at the UMCG. This condition also overloads the liver. In almost all patients with this condition, it leads to cirrhosis of the liver between the ages of 30 and 40. As a result, patients suffer from frequent fluid retention and shortness of breath, which means that they have to be admitted to hospital regularly. Eventually, the liver stops functioning. There is no further treatment for these patients and many of them die in the short term. Several hundred people in the Netherlands have this rare heart condition. This combined transplant offers prospects for a number of them.

Second lease of life

The liver of the 35-year-old UMCG patient also deteriorated rapidly in the past year. She often had to be admitted to the UMCG this year. ‘I have been a regular at the hospital all my life,’ she says. ‘Because of my heart defect, I don’t know any different. Despite this, I was able to lead a fairly normal life in my childhood and teenage years. I could go out, go to college. But now that my liver was causing so many problems in recent years, leading a normal life had become increasingly difficult. I was able to do less and less. With these organs, I have been given a second lease of life. I am extremely grateful. I’m thankful that the doctors can do this, but I am also very grateful to the donor. I have very mixed feelings that I get a new future because someone else has passed away.’

UMCG Heart Centre and Transplantation Centre

It is no coincidence that this special transplant took place in the UMCG. The UMCG’s Centre for Congenital Heart Defects (CCH) has more than 75 years of experience in caring for heart patients, who are often treated by the UMCG from childhood to adulthood. In addition, the UMCG is the transplantation centre of the Netherlands for adults and children, and has a very successful liver transplant programme. Heart and liver transplant specialists have joined forces to give patients for whom a combined transplant is the last resort a future again.

Very complex operation

It took seventeen medical specialists and more than 30 support staff, spread over three shifts, to perform the operation that lasted almost 24 hours. First, the heart was transplanted and then the liver. ‘Actually, everything about this operation was complicated,’ says one of the heart surgeons. ‘This patient’s heart was very abnormal, but its ‘connections’, such as the arteries and veins, were too. So now we had to connect a normal heart to the abnormal connections. But connecting the liver was also complex, as was having vital functions taken over by the heart-lung machine.’ During the heart transplant, the liver was connected to a perfusion machine so that the storage time of the liver outside the body could be safely extended by almost seven hours until the liver transplant.

Preparation

Years of preparations preceded the combined transplant. The heart surgeons and liver surgeons wrote protocols together and worked out the operation to the most minute detail. There was a lot of contact with foreign experts from the United States and other countries who have already carried out this operation. Any risks and bottlenecks of the surgery and the subsequent period were thoroughly analysed in advance. The selection of patients - who is eligible for this transplant? - was also made very carefully.

Because every patient is anatomically different due to the congenital condition, a personal surgery plan is made for each individual patient in addition to the protocols and preparations. When the suitable donor organs become available, the surgeons on duty can perform the surgery according to that plan.

Faith

The patient was also awaiting the transplant. ‘My liver was getting worse, and obviously, my heart was already bad. I could hardly do anything, and was constantly tired. And then your doctors say: there might be another way out, something new, something we’ve never done before. I didn’t even have to think about it. I didn’t have much choice either. It was this, or... well, nothing. I had a lot of faith in the doctors. And I also have a lot of faith in my new heart. I can look ahead again. Now I still have to regain my strength, but I look forward to being able to lead a much more active life again soon. Longer walks, but also long, active trips. My dream is to see the Northern Lights. That will take a while. First, I have to get fit again with physiotherapy and exercise every day. I have had to sit on the bench for far too long.’

Innovative transplantation centre

The various transplant programmes of the UMCG Transplantation Centre have been successful for many years. For example, in 2022, 48 lung transplants and 12 heart transplants have been performed in both adults and children. The liver transplant programme also achieved a record number of 87 liver transplants last year, 25 of which were in children. The GTC’s strength also lies in bringing together these years of expertise and experience. Groningen has an extensive track record of new transplant types and combinations. In addition to this heart-liver transplant, several combined transplants were performed this year, such as heart-lung transplants. This also involved patients with congenital heart defects. In the Netherlands, these combined transplants are only performed at the UMCG.