13-hour lifesaving heart/liver transplant performed on pulmonary atresia patient

A 28-year old man from Georgia, David Krech, is recovering from a rare, lifesaving heart/liver transplant on October 15 at the University of Maryland Medical Center. The 13-hour operation followed a five-month journey as he awaited a suitable heart and liver donor.

The journey began in early May. Dr. Raul Santos, Krech's physician in Thomasville, Ga., believed that the young man would not survive much longer without a heart and liver transplant. He contacted the University of Maryland Medical Center's heart transplant program for help.

Erika Feller, M.D., assistant professor of medicine at the University of Maryland School of Medicine and the medical director of the medical center's heart transplantation program, spoke with Dr. Santos and they arranged to immediately fly Krech to Baltimore on a medevac flight.

He arrived at the medical center on May 6, within 36 hours of their initial conversation. "He was very sick when he arrived. We admitted him right away and began therapy to keep his heart working. A few days later, we listed him for a heart/liver transplant," says Dr. Feller.

As they began to wait for a transplant, Krech's parents, Lavinia and Bill, rented a home in Baltimore's Federal Hill neighborhood a few miles from the hospital. They even brought the family dog up from Georgia. Krech eventually got strong enough to leave the hospital—but he needed to stay on intravenous medicine 24-hours a day to keep his heart going.

When a suitable donor heart and liver became available five months later, he underwent the double transplant on October 15 and was discharged from the University of Maryland Medical Center on November 5.

"The heart transplant was challenging because David had undergone several previous heart surgeries," says Bartley P. Griffith, M.D., professor of surgery at the University of Maryland School of Medicine and chief of cardiac surgery at the medical center, who performed the heart transplant. "We are very pleased at his recovery. In fact, the day after surgery, he was sitting up in a chair, which was quite amazing," adds Dr. Griffith.

Krech was born with a rare form of congenital heart disease called pulmonary atresia. It means that the pulmonary valve does not form properly and blood from the right side of the heart cannot get into the lungs to pick up oxygen. He also had a ventricular septal defect, which is a hole in the wall that separates the right and left ventricles of the heart. He had surgeries at age 10 and 11 to replace defective valves. Those valves were replaced again in 2007.

"The previous operations were a stop gap measures, not a cure. The transplant is a cure," says Dr. Feller.

Krech also needed a new liver because his liver had become scarred as a result of the poor functioning of his heart over many years. His doctors said that his liver was not strong enough to support a transplanted heart.

"A combined heart/liver transplant requires precise teamwork between the cardiac surgeons and the liver surgeons. Each organ depends on the other to function. The result for David has been quite dramatic and therefore very rewarding for us," says Benjamin Philosophe, M.D., Ph.D., associate professor of surgery at the University of Maryland School of Medicine and director of the Division of Transplantation at the University of Maryland Medical Center. Dr. Philosophe and transplant surgeon Sameh A. Fayek, M.D., an assistant professor of surgery, performed the liver transplant.

"I am very grateful to the person who donated my new heart and liver and I am looking forward to being able to resume a normal life," says Krech. "I've been in school at Southwest Georgia Technical College studying early childhood education and I'd like to transfer to a four-year college and eventually teach kindergarten or first grade."

According to his mother, Lavinia Krech, David looks very different now than before his transplant. "I didn't know he had such a beautiful complexion. Because of his heart problems, his skin color was always sort of gray. When he came out of the transplant, his cheeks were actually pink." She added, "We are so indebted to everyone here and thankful that everything fell into place beautifully so that he could get better."

This was the third combination heart/liver transplant performed at the University of Maryland Medical Center. The first two were in 2007. So far in 2010, 12 other heart/liver transplants have been performed in the United States at seven other hospitals.

"This is a great example of the extraordinary teamwork among our physicians and their dedication to helping patients with the most complex medical problems," says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the School of Medicine.

Krech will continue to stay in Baltimore for a few more months as he continues to recover from his transplant before returning home to Georgia.


University of Maryland Medical Center


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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