Domino Transplant

Provided by Science Daily

Sep. 18, 2013 — Tiffany Schwantes was going to die without a new liver. The 31-year old mother of two suffered from an aggressive form of liver cancer and, because of organ allocation rules, she could not be placed high enough on the liver transplant list to receive a new liver in a timely manner. Surgeons at Houston Methodist Hospital and her oncologist at the University of Texas MD Anderson Cancer Center determined that the only way to save her life was a domino transplant.

This is a rarely performed and complicated procedure that would allow her to receive a new liver from a living donor,” said R. Mark Ghobrial, M.D., director of the Center for Liver Disease and Transplantation at Houston Methodist Hospital.

The majority of patients with her type of cancer, cholangiocarcinoma, never receive a transplant, but Schwantes’ case was different.

“She was young and her tumor was responding to chemotherapy for a sustained duration,” said Milind Javle, M.D., an MD Anderson GI oncologist. “Because of her positive response to treatment I was able to refer her to the Houston Methodist liver transplant team.”

Tiffany was on what is called the ‘out-of-criteria’ list. Her liver was not sick enough for her to receive one from the normal donor pool where recipients are chosen by their degree of illness, said Howard Monsour, M.D., chief of hepatology at Houston Methodist Hospital. “If we would have waited for her liver to deteriorate, her cancer would have spread and she would have never made it.”

Meanwhile, 60-year old Vernon Roberson was suffering from amyloidosis, a genetic blood disease that attacks and destroys organs such as the heart, liver, kidneys, etc. He was progressively getting worse and was in need of a heart and liver transplant. When the organs became available this past July, surgeons asked him if he would be okay with donating his liver to Schwantes.

“I told them if I can save someone’s life, I am all for it,” Roberson said.

“While the diseased liver was not working for Mr. Roberson, we determined it was a viable organ for Tiffany,” Ghobrial said. “It will take her 20 to 30 years to develop amyloidosis, if at all, and if that occurs she can get another liver transplant. This was really the only option for saving her life.”

Ghobrial says more precision is necessary for this surgery than a standard liver transplant because blood flow to the organ must be preserved to keep it viable for the recipient. During a normal procedure, the liver is removed and discarded.

The 12-hour plus procedure involved a large transplant team that included four liver surgeons, two cardiac surgeons, two anesthesia teams, a perfusion team, transplant coordinators and at least 10 nurses.

“This is the first domino transplant we have ever done at Houston Methodist Hospital. It’s a very rare procedure, but I think the shortage of organs will cause us to look at doing more in the future,” Ghobrial said.

“There’s been a national push to use more of these so-called ‘marginal’ organs,” Monsour said. “We have a great joint program with MD Anderson where they are referring more of these patients like Tiffany to us for evaluation. I think if we can catch these cancers early, I believe we can save many more lives by performing domino transplants.”

Roberson is on the road to recovery in Houston and Schwantes is back home in Alabama enjoying life with her husband and children.

“This is a wonderful example of collaboration between different institutions to provide innovative approaches to betterment of human life,” Ghobrial said. “Thinking outside the box, we all helped prolong the life of a young wife and mother. That’s what makes this job so great.”

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