Dual Organ Transplant Program

What is a dual organ transplant?

Some patients have not only one but two organs that have failed or are likely to fail. When this happens, they may  need a dual organ transplant. With extensive experience performing liver, kidney and heart transplants, our surgeons at Children’s Hospital Colorado understand that it can be better for the patient, their recovery and their chance of success to have simultaneous organ transplants.

Who we treat at the Dual Organ Transplant Program

There are several reasons a patient might need a dual organ transplantation. A few diseases that may make a candidate eligible for simultaneous transplantation include:

• Autosomal recessive polycystic kidney disease (ARPKD) for liver and kidney transplant
• Congenital heart disease (with Fontan physiology characterized by low cardiac output and elevated central venous pressure) for liver and heart transplant
• Alagille syndrome for heart and kidney transplant
• Methylmalonic acidemia for heart and kidney transplant

Patients who already had a heart transplant and now need a liver or kidney transplant may also qualify for a dual organ transplant if their heart needs to be replaced as well.

Patients sometimes recover function in other organs after receiving a single-organ transplant, so transplant programs must carefully gauge whether to list a patient for a multi-organ transplant or a single-organ transplant. Dual organ transplants are only performed when the team of medical and surgical experts think the child will not get better or survive with the transplant of only one organ. As an experienced team, we only recommend dual organ transplant in rare cases when severe disease affects both organs.

Why choose Children’s Hospital Colorado for dual organ transplantation?

Dual organ transplant is most likely to be successful at a hospital that performs a high volume of solid organ transplants with excellent outcomes. Children’s Colorado is one of those hospitals. We have an integrated Solid Organ Transplant Program where team members who care for different transplanted organs work together to coordinate care and address every aspect of a patient’s treatment.

Dual organ transplantation requires a well-organized multidisciplinary team. Our heart, liver and kidney transplant teams collaborate to create the detailed preparation and coordination plans necessary to successfully perform dual organ transplantation. Our expert transplant teams have the experience needed to receive the organs and perform the surgeries with precise timing, accurate testing and the right medications to prevent organ rejection. As more children with complex medical conditions are living healthy, full lives, we are proud to take the next step in transplantation by offering multiple organ pediatric transplants.

Expertise in continuous renal replacement therapy (CRRT)

Continuous renal replacement therapy (CRRT) can help stabilize fluid overload due to poor urine output, electrolyte imbalances and acid–base and metabolic dysregulation, which can worsen during a liver transplant. Our expertise in intra-operative CRRT is unparalleled and involves a large team of providers, including anesthesiologists, surgeons, nurses, nephrologists and CRRT specialists. We’ve had great success with our simultaneous liver-kidney transplants with 100% patient and graft survival. Our work in this field contributes to the success of dual organ transplants and has even been documented as the largest published case series of CRRT in the pediatric liver transplant population to date.

Important things to know about a dual organ transplant

Children who need combined organ transplantation are listed on both organ waiting lists. In most cases of multi-organ transplantation, the organs are transplanted from the same donor. Receiving organs from the same donor instead of from different donors reduces the level of the patient’s immune system response and lowers the risk that their body will reject the organs.

Every dual transplant operation has multiple variables. For a combined liver-kidney transplant or heart-kidney transplant, we transplant the kidney second. Depending on how the patient is doing with their first organ transplant, we can perform the kidney transplant on the same day, or we can put the kidney on a pump and transplant it the following day.

What to expect before a dual transplant procedure

Parents or caregivers can prepare their child by regularly attending medical appointments and meeting with our transplant psychology team and child life specialists. The multidisciplinary team works together to coordinate care leading up to the transplant — this may require extra visits to the hospital for laboratory testing and imaging and may involve admission to the hospital for a period of time.

Preparation for the procedure depends on which organs are going to be transplanted. During these preparatory visits, your child’s nurses, doctors and surgeons will give you specific instructions on how to prepare for the operation.

What to expect after a dual organ transplant

At Children’s Colorado, the typical hospital stay for a dual organ transplant can be several weeks. Immediately after the transplant, your child will stay in the pediatric intensive care unit for several days for close monitoring. Their care team will perform frequent labs to check on organ function, and they will do regular ultrasounds to make sure the fluids in the new organs are moving as expected. It can take some time for one or both of the new organs to work well, but most children start to feel better within several days.

After your child becomes more stable, we transfer them to the inpatient floor where the team will work on feeding, medications and preparing them and your family for discharge. Parents can expect their child to be carefully watched in the inpatient setting for at least two weeks.

Once your child is ready to go home, they will need to return to the hospital twice a week for several months to meet with their transplant teams (surgeon, physician, transplant coordinator, transplant pharmacist, transplant psychologist). Kids can typically return to regular activities, including school, about six weeks after surgery. Even as they return to their daily life, your child will continue to see the transplant team frequently throughout the year to maintain ideal health.

Our goal is for your child to return to their regular life without significant limitations, like enjoying school, playing sports and eating a normal diet. Our transplant team recommends few daily life restrictions, and we encourage shared decision-making about returning to school, day-to-day activities, sports and travel. There are also many successful professional athletes and public figures who have received organ transplants and are living very active and healthy lives as adults.

If you plan to travel internationally with your child, please consult with their doctor about any additional vaccinations they might need, and make sure that they’ll be able to access adequate health care facilities if needed. The best way to optimize the success of your child’s transplant is by leading a healthy lifestyle and following the prescribed medication regimen.

Long-term care for transplant recipients

Recipients of dual organ transplants will need to be on life-long medication therapy. Some of the most important medications are immunosuppressants — medications that prevent the immune system from rejecting the transplanted organs. Common side effects of immunosuppressants may include weight gain, increased blood pressure and increased risk of infection. Your healthcare team will work with you to adjust your child’s medications to minimize any side effects while keeping their transplanted organs healthy.

As your child grows, they will eventually transition to adult care and become responsible for their own health care decisions. Our programs, such as the Improving Pediatric to Adult Care Transitions (ImPACT) Program and the Adult Congenital Heart Disease Program, help make the transition to adult care as smooth as possible and ensure that they continue to get great care throughout their lifetime.