Highly specialized: Stanford leads in en-bloc heart-liver transplantations
by Roxanna Van Norman
March 22, 2023
Stanford Health Care's multidisciplinary team helps give another chance at life closer to "normal" for Christopher
In the months leading up to his surgery, Christopher Bowers prepared himself mentally and physically for when he would get the call from Stanford Health Care for a new donor heart-liver. At 47, he had managed a lifetime of health complications due to being born with a rare congenital heart condition.
"I spent several months before the surgery doing exercise routines, Qigong, and meditation, preparing mentally and physically," said Christopher, who was on the waiting list for a heart-liver transplant at the hospital. "I felt like that is part of what helped me get through this [process]."
When he finally got the news from Stanford, Christopher was nervous, but the meditation and exercises helped him to be ready – and so was a specialized team of cardiologists, adult congenital heart specialists, transplant surgeons, and health care experts.
"Stanford's rich history and experience in complex surgeries provide better options for patients like Christopher," said Joseph Woo, MD, professor and chair of cardiothoracic surgery and the Norman E. Shumway Professor at the Stanford School of Medicine. "The team made sure he and his family received the best care with optimal outcomes."
On July 16, members of Christopher's team performed a rare en-bloc heart and liver transplant with a pulmonary artery reconstruction*. The surgical team included cardiac transplant surgeon John W. MacArthur, MD, and liver transplant surgeons Clark Bonham, MD, and Carlos Esquivel, MD, PhD.
The successful 15-hour operation offers Christopher, father of a 3-year-old, the potential for a life of better health after one marked by numerous health struggles.
"It's a whole mix of feelings," Christopher said of his emotions following the surgery. "It's gratitude and excitement to potentially have a life that might be a little closer to normal or one that isn't ruled by my poor health."
Transplants at Stanford
The complex double organ surgery builds on Stanford's success with heart-liver transplants over the years.
"Patients come from all over the United States for our specialized care and expertise in transplantation, especially when they require multi-organ transplantation to address complex adult congenital heart disease," said MacArthur, assistant professor of cardiothoracic surgery. "We were glad Christopher entrusted us with his care."
Stanford is among the top ten medical centers in the nation for the most heart-liver transplants over five years between 2017 and 2022, according to the Organ Procurement and Transplantation Network.
Christopher's care team also included transplant cardiologist Jeffrey Teuteberg, MD, the section chief of heart failure, cardiac transplantation, and mechanical circulatory support in the Advanced Heart Failure Program and professor of medicine at the Stanford School of Medicine.
Care for complex cases
Getting the right kind of care is critical for such patients. Christopher was born with a single ventricle, giving him only one functioning pumping chamber (ventricle) of the heart. Specifically, he had a double inlet left ventricle, a defect that affects the valves and chambers of the heart and results in a small and poorly functioning right ventricle and an overworked left ventricle.
From the time he was six weeks old, Christopher had several major surgeries, including the Fontan circulation procedure as a baby, a reconfiguration of the blood circulation to ensure proper blood flow. Like many patients with congenital heart disease, he underwent more corrective heart surgeries in his childhood and teen years.
While not curative, the success of these operations has allowed many patients to survive into adulthood.
Such was the case for Christopher who was able to lead a normal life for many decades – a testament to how far the field of congenital heart disease has come, said Christiane Haeffele, MD, MPH, an adult congenital cardiologist on his care team and a clinical assistant professor of medicine. "Fifty years ago, someone with his anatomy would not have survived past infancy," she said.
"Prior to his deterioration that led to his transplant evaluation, Christopher had obtained his master's in social work, and he and his wife, Jen, were raising their son," said Haeffele. "Our challenge now is to help our single ventricle patients continue to have full, active lives. For some, this will mean the possibility of a transplant."
Rare and highly specialized
Stanford is the only comprehensive care center for adults with congenital heart disease (ACHD) in northern California accredited by the Adult Congenital Heart Association (ACHA). That combination is linked to superior outcomes, according to George Lui, MD, the medical director of Stanford’s Adult Congenital Heart Program and a member of Christopher’s care team.
Before arriving at the hospital, Christopher had developed progressive heart failure despite receiving the best medical treatments in recent years. His previous history of heart surgeries, pacemaker replacements, and weakening of the heart over time was further complicated by the decline in his kidney and liver functions.
Because of the complexity of his case and a diagnosis of cirrhosis of the liver, Christopher's doctors raised the potential of a heart-liver transplant as an option. They recommended Stanford, which has a high volume and expertise in transplanting adults with congenital heart disease.
"The American Heart Association and American College of Cardiology recommends patients with complex congenital heart disease receive medical care in highly specialized programs," said Lui, such as Stanford's Adult Congenital Heart Program. Up until the end of 2021, Stanford has performed 29 adult combined heart-liver transplants, with 76% of the cases related to congenital heart disease as the primary diagnosis.
Major surgeries needing multi-organ transplants are technically complex and physically demanding, an operation only a few centers have the expertise to achieve. Stanford has a long tradition of pioneering heart procedures and multi-organ transplantations, including the first adult heart transplant in the United States and the world's first heart-lung transplant. Since its first adult heart-liver transplant procedure, Stanford has continued to deliver exceptional and personalized care to this patient population.
Additionally, the collaboration between Stanford Health Care and Stanford Medicine Children's Health positions the adult heart transplant program and the Adult Congenital Heart Program as the premier care center for patients with congenital heart disease in the United States.
"It's a process, and it's a long process," said Christopher, who noted that the transplant team helped to guide him and his wife through the evaluation and waiting period process. The team also encouraged him and his wife to lean on friends and family, to seek out community resources, and join transplant support groups.
His wife, Jen, added, "Everybody at Stanford was hands down amazing. Every single person – from people who took care of the building to making food in the cafeteria to checking our Covid vaccination records every time I came in – everybody was just wonderful."
Christopher was discharged from the hospital one month after the surgery and is home in Sonoma, Calif., where he recently started cardio rehabilitation. He is slowly easing back into basic day-to-day activities and focusing on spending time with his son. "My understanding is that I've done really well, and I'm grateful for that," he said.
Jen recalled a conversation with Dr. MacArthur, immediately after surgery. "I said, thank you. I can't believe you did it. Christopher’s doing so well,' and he said: 'I knew we were going to be able to do it.'"
* Pulmonary artery reconstruction involves the repair of the damaged arteries in the lungs.