History of Medicine: First Pediatric Heart Transplant
James Lovette was born in a Colorado hospital with a very serious heart condition known as “single ventricle.” The life-threatening condition affects the cardiac chambers that the heart uses to pump blood through the body. In 2015, it is possible to repair such defects with multiple open heart surgeries known as a “staged reconstruction” of the heart. However, back in 1984, the condition was fatal.
At that time heart transplantation was truly in its infancy. Only a few heart transplants had been performed in children, and survival rates were not encouraging. In 1967, three days after South African surgeon Dr. Christiaan Barnard had performed the first adult heart transplant, Dr. Adrian Kantrowitz had performed the first pediatric heart transplant in a New York baby, who lived just 6 hours. In 1984, London surgeon Dr. Magdi Yacoub performed a heart transplant in a 10-day old baby, and this child survived 18 days.
In short, the odds were not in James’ favor. With no one to turn to, his parents brought him to Columbia in New York City and urged Dr. Eric Rose to take his case.
Columbia’s adult heart transplant program had begun in 1971 under the leadership of Keith Reemtsma, MD, who was conducting pioneering research in cross-species transplantation and critical immunosuppressive drugs. His team had begun performing adult transplants at Columbia in 1977, and he had recruited Dr. Rose and pediatric cardiologist Dr. Linda Addonizio to establish a pediatric program.
Dr. Rose and his team were hopeful, but uncertain about performing the transplant in young James. They were less worried about the surgery itself and far more concerned with the James’ response to the new organ. Until then, every time a heart had been transplanted, the patient’s immune system had rejected it as a foreign invader.
The game changer was a new drug. Columbia was one of only a few centers in the United States to begin trials of cyclosporine, the revolutionary immunosuppressant drug that was the first to successfully tamp down a body’s immune response to prevent organ rejection. It gained FDA approval at the end of 1983, just before James Lovette’s condition became so dire.
Young James had the right team and the right medications, but much still remained uncertain. Heart transplant surgery was incredibly risky, and yet the alternative was certain death, for without a new heart, James would not survive. Fortuitously for him, a donor heart became available just in time.
The operation took place on June 9, 1984. Dr. Rose wore magnifying glasses in order to better see the tiny heart during the surgery. Afterwards, the team improvised as best they could, titrating doses of cyclosporine to prevent his body from rejecting the heart. And it worked.
As the years went by, James was in medically uncharted territory. He struggled with his health for decades, surviving a bout of Hodgkin’s Lymphoma and, eventually, a second heart transplant. Nevertheless, his transplant at age four, which enabled his survival till early adulthood, was a huge success. His parents were able to watch him graduate from college and receive a master’s degree. Sadly, James passed away in his sleep during his first week of medical school. Dr. Rose said that his former patient “was a wonderful kid. He lived an interesting and full life. He would have been a fine physician.”
In addition to saving the life of one young boy, that 1984 surgery was a pivotal milestone for the field of transplant surgery. It paved the way for improvements in surgical technique and immunosuppressant drugs, which were instrumental in the evolution of cardiac transplantation to what it is today – a lifesaving option for over 5,000 people each year.
In 2014, Columbia surgeons used 3D printing to help perform surgery on a newborn. Read the story here.
Learn more about pediatric heart transplants at Columbia.
Read more about the history of heart transplantation.
Check out other interesting stories in our "History of Medicine" series: