Story by Camille Bautista-Fryer; First published in NewYork-Presbyterian's blog Health Matters
In a rare procedure last year, a multidisciplinary transplant team at NewYork-Presbyterian/Columbia performed the state’s first heart, double lung, and liver transplant.
Clad in a bright red “Birthday Queen” sash and surrounded by balloons, Nadine Davis rang in her 50th birthday with a joyous serenade from a group of nurses at NewYork-Presbyterian/Columbia University Irving Medical Center.
Nadine hadn’t envisioned that she’d be celebrating her milestone birthday from a hospital bed, but suffering from pulmonary arterial hypertension, heart failure, and congestive liver cirrhosis, she was hospitalized as she waited for a triple-organ transplant.
On April 30, 2024, just nine days after her birthday, she received news of the greatest gift: there was a match from a single donor. Soon, she would be the first patient in New York State to receive a rare heart, liver, and double lung transplant.
“It was not an easy road,” Nadine says. “Even when I didn’t believe in myself, my nurses, doctors, and the whole staff at NewYork-Presbyterian were rooting for me. I fought with everything that I have, and I’m grateful that I get another chance.”
“What makes NewYork-Presbyterian special is that you can’t have a successful triple transplant unless you have excellence in so many different areas. From nursing and pharmacy to social work and psychiatry, this is a massive team effort,” says Dr. Jennifer Haythe, Nadine’s cardiologist. “It’s a very high-level, complicated execution. It’s like an orchestra, and when it works, it’s beautiful. In this case, it came out flawlessly.”
‘Surviving on a Tightrope’
Since childhood, Nadine struggled with shortness of breath, coughing through the night after playing outside, she says.
Around 2009, doctors diagnosed her with pulmonary arterial hypertension (PAH), a condition where pressure in the arteries of the lungs becomes elevated, leading to difficulty breathing and eventually, heart failure. She managed the condition with medication, but as her disease progressed, she was referred to Dr. Jennifer Haythe, director of the Adult Pulmonary Hypertension Program at NewYork-Presbyterian/Columbia University Irving Medical Center, in 2012.
Dr. Haythe continued to treat her with oral medications for two years, until her condition advanced and she needed continuous intravenous medication, which she remained on for 10 years.
“I couldn’t go swimming because I’d get my IV line wet. I couldn’t walk three blocks, sometimes I couldn’t even go from my room to the bathroom next door because it was hard for me to breathe,” Nadine says.
Several complications arose: an IV-line infection led to endocarditis, an inflammation of the inner lining and valves of the heart, and eventually, a leaky valve. Separately, surgeons implanted a pacemaker to address a heart block, a heart rhythm disorder that disrupted how Nadine’s heart was beating.
“We dug our heels in, and we knew that the key would be close communication and teamwork. There were a lot of issues that required a group of multidisciplinary physicians from infectious disease and electrophysiology to the critical care team in the ICU to try to figure out the best way to bridge her through this course,” Dr. Haythe says.
“The hardest thing for me was knowing that she was very, very sick, and my goal was to never have her be lost. And that was becoming increasingly challenging over the years as her disease progressed and her options were very limited.”
By 2023, Nadine developed heart failure, and soon after, liver cirrhosis as a result of heart failure causing congestion in the organ. Dr. Haythe referred her to Dr. Selim Arcasoy, medical director of the Lung Transplant Program at NewYork-Presbyterian/Columbia.
“From the moment I met her, I was worried that she would eventually progress to needing a lung transplant, as this is the natural course of pulmonary hypertension,” says Dr. Haythe. “By this point, she had end-stage lung, heart, and liver disease and needed all three organs. But she was surviving on a tightrope where she was so good about managing her fluids, weight, salt intake and medication, so we needed to time everything to bring her to transplant at the right moment.”
A New Lifeline
The team had never performed a triple-transplant involving a heart, lung, and liver, but had a wealth of experience in complex transplant surgeries.
“As a high-volume center, NewYork-Presbyterian has done different combinations of multi-organ transplants, giving us the unmatched skill, team collaboration and surgical and medical integration to do this transplant,” says Dr. Tomoaki Kato, clinical director of transplant services at NewYork-Presbyterian/Columbia and chief of the Division of Abdominal Organ Transplant and Hepatobiliary Surgery.
They listed Nadine for transplant in January 2024. Preparation for the procedure started months before the organs became available, with teams conducting huddles to map out the surgical strategy.
Three months later, Nadine visited the hospital for pneumonia. Her condition was so precarious that Dr. Haythe knew it was time to admit her for the long-haul and wait for a potential organ donor.
She had been in the hospital for a month when Nadine received the life-changing call from Dr. Haythe.
“I thought, ‘Am I dreaming?’ I started screaming. It was too good to be true,” Nadine says.
On April 30, 2024, Nadine’s 14-hour, triple transplant began with Dr. Philippe Lemaitre, surgical director of the Lung Transplant Program at NewYork-Presbyterian/Columbia and Dr. Koji Takeda, surgical director of heart transplantation and mechanical support at NewYork-Presbyterian/Columbia, scrubbing in together to explant and implant the lungs and heart.
Dr. Kato then performed the liver transplant, and Nadine was left on respiratory support with extracorporeal membrane oxygenation (ECMO), to allow her new lungs to recover gently.
“Altogether it went really flawlessly, and I was amazed to see how the teamwork resulted in this great success,” Dr. Kato says.
Related:
- From NYP Advances — Transplant Team Performs New York’s First Heart-Lung-Liver Transplant
- A Look Inside the 24-hour Dance of a Split-Domino Heart Transplant
- Changing the Future of Living Liver Donation: A Conversation about Columbia’s All-Robotic Approach
- State of the Union: Lung and Chest Care Today