The Barcelona de Vall d’Hebron hospital has been the first to make a pediatric and liver transplantation

The Vall d’Hebron University Hospital has been the first in Spain that makes a Pediatric and liver pediatric transplantation simultaneously. More than 30 professionals participated a few months ago in a 16 -hour surgery in which the heart was first transplanted and then the liver. In the success of this intervention, a new technology has been key, Hope, which means hope in English and acronym for hypothermic oxygenated perfusion.

This technique circulates an oxygenated solution at a very low temperature through the donor’s liver to preserve it better. Allows Keep the organ out of the body beyond the limit of 8 hours, helping to reduce ischemic damage due to lack of oxygen and improving its viability between removal and liver transplant, while the cardiac surgery equipment performs the heart transplant without going counterreloj.

Live with a heart with a single ventricle

This cardiohepatic transplant has allowed a 16 -year -old boy, who He was born with a single ventricle, Recover his life, which was in danger from a terminal failure of the heart and liver. This organic dysfunction is common in patients who have gone through Fontan surgery to save a type of congenital heart disease. The technique, devised by Dr. Francis Fontan in 1970, is a palliative surgery that allows living children born with a single ventricle, a serious malformation that prevents normal blood circulation. It is the last of three interventions that are carried out in the first years of life – before a Glenn procedure and a banding -, to redirect venous blood towards the lungs without going through the ventricle, which improves the oxygenation and quality of life of the patients. “This is done by connecting the veins that carry oxygen -poor blood directly to the lungs, eliminating the dependence of the defective ventricle,” simplifies Dr. Raúl Abella, head of the Pediatric Cardiac Surgery Service of the Vall d’Hebron University Hospital. Fontan surgery is performed in the first years of life and with it the blood circulation routes adapt to allow blood to reach the lungs, since the heart cannot do it normally. “We disconnect the cava from the heart to connect them to the pulmonary artery,” Describe.

The palliative surgeries that these patients receive when they are small allow them to reach adulthood and have a good quality of life. But despite being an effective solution, it is not definitive, they require constant medical controls and the long time can cause heart failure, pulmonary hypertension or liver problems.

«The modified circulation in this type of surgery can also affect the blood flow to the liver, causing a blood stagnation in the liver vein. This causes chronic congestion that can evolve to liver fibrosis, cirrhosis and other liver disorders, ”explains Dr. Jesús Quintero, head of the Hepatology and Pediatric hepatic transplantation of the Vall d’Hebron University Hospital. These patients may present signs such as alterations in liver functions, malformations in the blood vessels of the liver and, in more serious cases, liver failure. “This is the case of the boy we have operated, up to 13, led a normal life: I went to school, played and played sports,” he says. «But in the last two years he no longer left home. As a result of a slow blood flow, he retained liquids, swollen and tired. She had a home teacher, she followed a diet made to measure by the Vall d’Hebron nutrition team and came to the Polivalent Pediatric Day Hospital every 15 days to receive treatment and a transfusion of albumin, the blood protein, ”adds Lis Vidal, advanced practice nurse of the Hepatology and Pediatric hepatic transplantation of the Vall d’Hebron Hepatology Hospital.

These patients, in addition to the heart and liver – can develop liver fibrosis and cirrhosis – can also have problems in the intestine, such as this patient, and a 5 % Develop cancer. This is the case of a girl who received a double heart transplant and liver successful months before this adolescent patient. The girl’s intervention went well, but during the postoperative period she developed a liver lymphoma that she could not overcome.

High complexity surgery

Thanks to the advances in the treatments of cardiac pathologies in pediatric age, there are more and more adults with congenital heart disease. Patients with Fontan surgeries require multidisciplinary monitoring, since, being a palliative procedure, over time organs deteriorate. The doubly transplanted young man had the intestines and the liver affected when he needed the heart transplant. The intestines do not condition surgery, but the cirrhotic liver, yes. That is why the double simultaneous transplant was chosen. Like the rest of the transplanted people, the first months will be at home and the next year will return to school to study 1st of Baccalaureate and prepare to enter the double degree of physics and mathematics.

The surgery was performed with the ‘exvivo’ Hope perfusion technique, which offers three advantages: it improves the initial liver conditions, gives margin to the surgical equipment for heart transplant and allows you to change extracorporeal circulation support to reduce bleeding.