An Omaha man is recovering well today after undergoing an historic operation at The Nebraska Medical Center on May 18. David Gildea was the first patient at the medical center to receive a combined heart and kidney transplant.
“This is an exciting milestone for our transplant program,” said John Um, M.D., heart transplant surgeon at The Nebraska Medical Center. “This is a vital treatment option for patients in our region who have advanced heart failure and renal disease.”
Before transplant, Gildea had end-stage heart disease and his kidneys were barely functioning, requiring daily dialysis.
“Medically speaking, he was about as sick as a person can get,” said Clifford Miles, M.D., nephrologist at The Nebraska Medical Center.
Even at a medical center which routinely handles complex cases requiring multi-disciplinary care, Gildea’s case necessitated a remarkable amount of highly specialized expertise; bringing together experts from five different medical specialties.
“Very few heart transplant programs in the world will perform a multi-organ transplant for an extremely sick patient, said Eugenia Raichlin, M.D., cardiologist at The Nebraska Medical Center. “The care for this patient required the skills of an experienced and sophisticated team of transplant surgeons, hematologists and renal and cardiovascular disease specialists.”
Dr. Raichlin adds that advanced renal disease in the presence of severe heart failure has traditionally been a reason to exclude heart failure patients from a heart transplant. “Patients in this particular condition have faced insurmountable odds,” said Dr. Raichlin. “With simultaneous heart and kidney transplantation, we are able to offer more of the high-risk heart disease patients a reason for hope.”
Surgery began at 5:30 p.m. on Tues., May 18 and continued until 1:00 a.m. the next morning. The patient’s heart was transplanted first, followed immediately by the kidney.
“Once we were confident that the new heart was working well, we knew the patient could tolerate the kidney transplant,” said Dr. Um.
An Uncommon Operation
A combined heart and kidney transplant is not a common procedure. Data from the United Network of Organ Sharing (UNOS) shows there were only a total of 60 combined heart and kidney transplants performed in the nation last year in comparison to 362 combined liver and kidney transplants and 16,831 isolated kidney transplants.
“This is not a technically difficult operation,” said Michael Morris, M.D., kidney transplant surgeon at The Nebraska Medical Center. “The reason these operations are relatively rare is because there are not many robust heart transplant programs in the nation. The fact that The Nebraska Medical Center can now perform these transplants is a huge credit to the growing success of our heart transplant program.”
The Nebraska Medical Center transplant team anticipates there will be a growing need for combined heart and kidney transplants. According to Dr. Miles, many patients who suffer from long-term heart failure also have significant renal disease. The two problems often co-exist because a weakened heart cannot pump blood sufficiently to the kidneys or because the kidneys have been damaged by other cardiovascular conditions such as hypertension or diabetes.
At age 61, David Gildea says he had been in great shape until recently, eating well and exercising every day since his teenage years.
“For more than forty years, I ran about two to three miles a day and lifted weights,” said Gildea. But one day, about a year ago, he says he couldn’t find the energy to run. “I was alarmed,” he said. He quickly got worse. “I had a hard time doing anything. It would take me a few hours to get dressed every morning.”
“He was exhausted just walking from the bedroom to the living room,” said Gildea’s girlfriend, Karen Rech. “It was to the point that every time he moved, I was in constant fear of losing him.”
A biopsy revealed amyloid (pronounced AM’-i-loyd) protein deposits in Gildea’s kidneys and heart. His physician suspected Gildea had amyloidosis, a rare blood disease affecting only eight of every one million people. People who have the disease have abnormal deposits of amyloid in their tissue or organs. Harm results when the deposits cause the organs to malfunction. The disease is rapidly disabling and life-threatening. In Gildea’s case, his heart and kidneys were affected.
“I had never heard of amyloidosis,” said Gildea. “I was told it was a very rare disease, and that most people don’t survive it.”
Dr. Raichlin had trained at the Mayo Clinic in Rochester, Minn., a center which specializes in amyloidosis, and knew about an aggressive treatment for the disease – a multi-organ transplant followed by a blood stem cell transplant.
“I knew our medical center had the expertise to help this patient,” said Dr. Raichlin. “Plus, we had to act quickly; David didn’t have a lot of time. I suggested this innovative treatment.”
Immediately following his heart and kidney transplant, Gildea said he felt like a new person. “I wasn’t short of breath when I went for a walk. I had stamina again.” His friends said they also noticed he could think more clearly.
Another Transplant to Come
As amyloidosis is normally a fatal disease, Gildea will require high-dose chemotherapy followed by an autologous blood stem cell transplant to halt the progression of the disease towards his transplanted organs. Edward Faber Jr., DO, MS, hematopoietic stem cell transplant specialist at The Nebraska Medical Center plans to prepare Gildea for this treatment over the next three months.
“Many patients with amyloidosis have advanced organ disease or are too old to benefit from this type of intensive treatment,” said Dr. Faber. “Usually, heart and kidney failure from amyloidosis are contraindications to this type of therapy, but Gildea is now eligible for the treatment due to the successful combined heart and kidney transplant.”
Gildea will receive an autologous blood stem cell transplant, which means that he will have his own blood stem cells collected and stored in liquid nitrogen. He then will receive high-dose chemotherapy to damage the blood stem cells which are causing the amyloidosis. After chemotherapy, Gildea’s stored blood stem cells will be reintroduced to replace the damaged blood stem cells.
Gildea Continues Positive Attitude
“Although I was deeply concerned when I was first diagnosed, a positive attitude has gotten me through the tough times,” said Gildea. “As the father of severely handicapped 29 year old twins, I have had a lot of hard days in my life. I know I still have a long road ahead with my treatment. My goal has always been to not complain.”
Before he went into the transplant operation, Gildea says he was asked, “How can you be so calm?” His response, “I know the outcome.” This is the kind of attitude that will help Gildea through the next steps of his treatment.