15 specialties, 4 liver transplants and 1 life saved: Inside a rare surgery at Children's Hospital Colorado

Every April, the healthcare industry recognizes National Donate Life Month, celebrating the field of organ transplantation and raising awareness about the need for more donors. This year's awareness month holds more meaning than ever for Children's Hospital Colorado, where a multidisciplinary team of experts from 15 different specialties and departments recently performed an exceedingly complex surgery to save one transplant patient's life. 

The 18-year-old patient, who lives in Montana, first underwent a liver transplant at the Aurora-based hospital about 10 years ago.

"There was a complication of that transplant that required an immediate retransplant because he got pretty sick," Michael Wachs, MD, chief of abdominal transplant surgery and hepatobiliary surgery at Children's Hospital Colorado, told Becker's

Surgeons transplanted a suboptimal liver into the patient as a temporary treatment to keep him alive. Several months later, the patient received a third transplant and faced complications that required an interventional radiologist to place a stent in both his hepatic artery and hepatic vein to promote better blood flow into and out of the liver. 

"That solved things for quite awhile. It wasn't until he was 17 years old that the stent put into the hepatic artery clotted off, and he developed a very severe infection," Dr. Wachs said. The patient was hospitalized several times starting in late 2021, and his care team quickly realized he needed another transplant to survive. 

"Because the first three had happened in such a short order and he had done so well for such a long time, we felt that he deserved an opportunity at a fourth transplant," Dr. Wachs said. "We just had to go about trying to figure out the best way to make that happen."

The case was far more complex than a traditional liver transplant for several reasons. The first challenge was finding a good organ donor match. Because the patient had undergone three prior transplants and numerous blood transfusions, his immune system developed a sensitivity to a protein found on many people's tissues. Second, the stent in the patient's hepatic vein was only a couple centimeters from where the vein empties out into the heart. 

"It was clear we were going to have to remove that stent and then sew the liver above where that scar tissue was," Dr. Wachs said. "There was a chance that we were going to have to do that with open heart surgery and have the cardiac surgeons involved as well."

The transplant team and cardiac surgery teams worked together to map out the procedure and landed on two possibilities the care team had to be ready for: a cardiopulmonary bypass or a venous bypass, to bypass the liver itself. 

Surgeons also knew they'd have to perform dialysis in the operating room, as the patient had developed some renal insufficiency as a result of his infection. 

"We had done dialysis during some liver transplants, but this was gonna be a tough one because of the potential for cardiopulmonary bypass," Dr. Wachs said.

Due to the intricacies of the case, a multidisciplinary team at Colorado Children's spent several months planning out the transplant while they waited for a viable donor match. 

"All of those things — getting the plan and the coordination in place, having multiple people from all the different programs available at the spur of the moment because we couldn't predict when the organ was gonna get here — that took a lot of planning and preparation," he said. "It really involved pretty much every hospital department that I can think of including the administration which helped facilitate all of this communication."

Surgeons performed the transplant on July 12, 2022. Dr. Wachs said the procedure — one of the more difficult operations he's ever performed — was as straightforward as it could've been. The patient did not have to go on venous or cardiopulmonary bypass and has not experienced any complications since the surgery. 

"He left the hospital and as far as I know is getting back to normal life," Dr. Wachs said. 

Dr. Wachs said he felt an overwhelming sense of relief after the successful procedure and commended his colleagues for the incredible amount of teamwork and collaboration needed to perform the surgery. 

"We have a pretty incredible group of people that work with us as part of the transplant program — surgery is just a very small part of it," he said. "Children's Hospital is the kind of place where everybody seems happy to come to work. We're doing things for children that deserve to be cared for. … I just feel proud to be part of it." 

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