U.k. Girl Recovers After Landmark Surgery to Remove Donor Heart
Hannah Clark was given the donor heart at the age of 2 after suffering severe heart failure, according to a report published today in The Lancet medical journal. Doctors removed the donor heart 10 1/2 years later because of risks posed by immunosuppressant medicines used to prevent organ rejection.
Heart transplantation can be used to save the lives of infants and small children with organ failure due to cardiomyopathy, a disorder of the heart muscle. The condition occurs in 1.2 to 1.4 children in every 100,000, and is 8 to 12 times more common in the first year of life than in subsequent years, the researchers said. The outlook is poor, though it is possible in theory for the patients own heart to recover if he or she lives long enough for this to happen, as was the case with Clark.
“Apart from the overriding human element in this report, Hannahs case has provided many lessons relevant to biology, transplantation, heart recovery and malignant disease,” said Magdi Yacoub, a surgeon at the Heart Science Centre at Harefield Hospital in London, in the study. “We all hope this will stimulate further research and progress in this area.”
The donor organ was grafted on to the girls heart in 1995 and took over many of its functions, allowing her own heart to gradually recover from the muscle disorder, the researchers said.
Complications
To prevent rejection of the new organ, Clark was given immunosuppressant medicines, which can carry side-effects such as an increase in cancerous disease. The patient developed one such complication, a type of malignancy called Epstein-Barr- virus-associated post-transplant lymphoproliferative disorder.
About 4.5 years after the transplant, both organs were functioning normally, so it wasnt considered necessary to carry out the major surgery that removing a donor heart would involve. Clark continued to have problems with cancer, which started to spread and become “extremely serious” by the time she turned eight, according to the report.
Doctors used chemotherapy and multiple courses of drugs to beat the disease. Clark continued to struggle with the malignancy and in 2005 an echocardiogram showed that while her own heart was working normally, the donor heart was weakening because doctors had reduced the immunosuppressant drugs to help her fight the cancer.
This led to symptoms suggesting rejection of the donor heart, forcing her doctors to consider removing the second heart.
Complete Recovery
The surgery took place at Great Ormond Street Hospital in London in February 2006. The team was led by Victor Tsang and Yacoub. The patient didnt take any immunosuppressant drugs after surgery and has made a complete recovery from the cancer, the report said.
Other options such as mechanical hearts suitable for use in children are also being developed, the report said.