Heart, liver transplant marathon a success
It is a tale of give and take on a grand scale. The dedication and skill of 68 medical staff over 20 hours of painstaking surgery has given Hong Kong its first combined heart and liver transplant.
The recipient is a 27-year-old woman who received the heart and liver of a brain-dead donor. At the same time she donated her failing but still useful liver to a 62-year-old man with liver cancer. The historic procedures - the city's first combined heart and liver transplant with a sequential liver transplant - took place at Queen Mary Hospital on Friday. Both organ recipients are in satisfactory condition in intensive care wards.
Professor Lo Chung-mau, head of the University of Hong Kong liver transplant team at Queen Mary Hospital, said: 'The female recipient is conscious and can speak, with stable blood pressure; the male recipient has started to regain consciousness. The patient asked me to convey thanks to the donor and his family.' The woman has a hereditary condition - familial amyloidotic polyneuropathy - and would have died within a few years if she had not received the transplants. One of her relatives died from heart problems because of the condition.
At 3pm on Thursday, Queen Mary Hospital in Pok Fu Lam was informed that a young man had been confirmed brain-stem dead after a stroke in Queen Elizabeth Hospital, Yau Ma Tei. His heart and liver were available for donation and suitable for the woman. Three hours later, at 6pm, both she and the man agreed to the transplants.
About 6.30am on Friday, the donor organs were picked up from Queen Elizabeth Hospital, setting in motion a remarkable 20 hours. The woman first underwent a heart transplant, then a liver transplant. Her liver was then transplanted into the man.
'The challenge was that we needed to ensure the heart transplanted to the female patient was functioning before we went ahead with the liver transplant,' the professor said.
Despite a hospital mortality rate for combined liver and heart transplants of about 10 per cent - higher than the 7 per cent mortality rate for heart-only transplants and 2 per cent for liver-only transplants - the transplant team believed it was worthwhile proceeding because the woman was displaying symptoms of heart failure.
The operation required the participation of four cardiac anaesthesiologists, five cardiac surgeons, six liver anaesthesiologists, seven liver surgeons and 46 nurses, making it one of the largest performed in Queen Mary's operating theatre. 'When I walked into the operating theatre and saw a crowd of medical teams ready for this, I was so touched and impressed that we were co-operating to do our best,' Lo said. 'This was an unforgettable experience due to the teamwork and co-operation to make this surgery possible.'
Sylvia Wong, operations manager for operating theatre services, said the transplants threw up some manpower challenges. She said: 'Apart from the two liver transplant surgeries, we needed to ensure patients in line for other surgery were not affected.'
Some nurses cancelled days off and some worked extra hours so that they would be able to help, she said.
Queen Mary Hospital said the woman's was the fifth known case involving this type of heart problem, although many cases may have gone unreported because patients were unaware they suffered from her condition.
The two recipients are expected to be discharged from hospital in two weeks. It is understood the donor's kidney was given to a patient at another hospital.
The combined heart and liver transplant was the first one done in Hong Kong. Singapore did a similar operation a few years ago. A Queen Mary Hospital spokesman said the experience would help save four to five patients a year requiring similar multi-organ transplants.
By July this year, there were 1,640 patients waiting for kidney transplants, 100 waiting for livers, eight for hearts, and 13 for full lung transplants, Hospital Authority figures show.
Professor Fan Sheung-tat, the University of Hong Kong's head of surgery, said he hoped that the Hospital Authority would now provide more resources to the transplant team.