Two-stage procedure improves chance of long-term survival

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Kathryn Holleman
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ST. LOUIS - Washington University surgeons performed the first combined heart-kidney transplant at Barnes-Jewish Hospital June 2 and 3 on Jonathan Sadowski, 20, of O’Fallon, MO. Sadowski was discharged from Barnes-Jewish Hospital June 14.

The success of the procedure opens the door for other patients in the area with both heart and renal (kidney) failure to have transplants, according to Gene Ridolfi, Barnes-Jewish Transplant Center director. Barnes-Jewish is currently the only hospital in the St. Louis region performing heart transplants.

“Traditionally, patients with heart failure were disqualified as candidates for transplant if they also had renal failure,” said Ridolfi. “However, data has shown that for certain patients, like Jonathan, transplanting a donor kidney at the same time as the heart results in an increased chance of long-term survival for the patient.”

Sadowski was on the waiting list for the combined transplant for about two and a half weeks before donor organs became available. He was hospitalized at Barnes-Jewish with end-stage heart and renal failure for most of that time, spending about a week in the cardiac intensive care unit. While in the hospital, he underwent daily kidney dialysis treatments.

The transplant was performed in two stages, with Washington University heart transplant surgeon I-wen Wang, MD, PhD, performing the five-hour heart transplant in the evening on June 2. In that operation, Dr. Wang removed Sadowski’s diseased heart and implanted the new heart.

“The donor heart was beautiful, very healthy,” Dr. Wang said.

Sadowski was then taken to the cardiothoracic surgery intensive care unit to be stabilized and his new heart monitored to make sure it functioned properly. During that time, a special pump, provided by Mid-America Transplant Services, the area’s organ procurement organization, cooled the donor kidney and continually flushed it with a preservation fluid in order to keep it in the best possible condition.

At about 7:30 a.m. on June 3, Sadowski was wheeled back to the operating room where Washington University transplant surgeon Jason Wellen, MD, implanted the donor kidney in a four-hour operation. The new kidney began producing urine as soon as it was connected to Sadowski’s blood vessels, according to Dr. Wellen.

“The entire heart and kidney transplant was extremely successful,” Dr. Wellen said. “We’re very pleased with the outcome.”

The heart transplant was Sadowski’s second. He was born with a severe heart defect - left hypoplastic heart syndrome – and received his first transplant in Virginia when he was less than two months old.

Sadowski had a normal, active childhood and adolescence, and loved to play both ice and roller hockey, he said in a recent interview. He graduated from Francis Howell High School, where he played on the school’s hockey team, and was working for Schnucks when he fell ill about a year ago.

Doctors found that he had developed transplant coronary artery disease, a rapidly progressing form of heart disease, and anti-rejection medication plus his failing heart had caused irreversible damage to his kidneys.

While the failure of two organs might have automatically ruled him out as a candidate for transplant just a couple years ago, physicians now look at multi-organ transplants as an option for patients such as Sadowski – who is young, otherwise healthy and likely to benefit long-term from the procedure, said Dr. Wellen. In addition, new anti-rejection medications and regimens have lowered the risk of patients developing organ damage or transplant coronary artery disease.

The Barnes-Jewish Transplant Center expects to evaluate several such patients for combined heart and kidney transplants each year.

However, only a handful of transplant centers across the country have the depth of specialized resources and personnel available to be able to perform such a complex procedure and then provide ongoing care, said Dr. Wang.

“We’re lucky here at Washington University and Barnes-Jewish to have the resources and the multi-disciplinary teams to be able to do procedures such as this and then provide the long-term transplant care that results in outstanding outcomes,” he said.