October 31, 2008

Novel transplant provides new heart, kidney, outlook

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Transplant patient Patrice Fisher does her rehab exercises at the Dayani Center. (photo by Joe Howell)

Novel transplant provides new heart, kidney, outlook

Patrice Fisher doesn't take the ongoing shortage of donor organs in this country lightly.

She has been on the kidney transplant list since 2004, and earlier this year the Memphis resident was placed on the heart transplant waiting list.

For Fisher, 29, it was not a matter of getting either a kidney or a heart — she needed both organs to survive, which placed her in a more perilous situation.

In September she became Vanderbilt Medical Center's first simultaneous heart/kidney transplant patient.

Heart/lung transplants are the most common multi-organ procedures at Vanderbilt. Traditionally, patients seeking multiple organs were deemed too risky for transplantation.

“When you have end-stage organ dysfunction in two organ systems, it puts you in a very high-risk category,” said Steven Hoff, M.D., assistant professor of Cardiac Surgery. “The mortality rates are much higher. And in the past a patient who had end-stage renal disease would not typically be a candidate for a heart, and vice versa.

“It would be a little bit different scenario if organ donation was such that we had plenty to go around. Organs for donation are scarce and it doesn't make sense medically or ethically to risk giving an organ to someone who may not do well when you can give it to someone with a better chance of survival.”

Fisher's recent transplant is a sign of Vanderbilt's innovative treatments.

“It is a demonstration that the Vanderbilt Transplant Center is a full service center providing all critical options of transplantation,” said Hal Helderman, M.D., chief of Renal Transplant Medicine.

In 2003 Fisher was diagnosed with end-stage renal failure due to focal segmental glomerulosclerosis or FSGS, one of many diseases that affect kidney function by attacking the tiny units where blood is cleaned.

At 300 pounds Fisher was placed on hemodialysis three times a week to remove waste that accumulated in her blood.

During one of her treatments she went into cardiac arrest, was resuscitated and received an implantable cardiac defibrillator that can shock the heart into a normal rhythm.

Doctors believe that Fisher's congestive heart failure was a result of the volume overload caused by her renal failure. In 2004 she started peritoneal dialysis, which is not as tough on the heart.

Every night she would hook herself up to the machine for 9.5 hours. The dialysis helped her lose more than 150 pounds of excess fluid.

For years Fisher continued this routine while taking care of her 9-year-old daughter and attending school.

After several hospitalizations, she was finally placed on the heart transplant list. Months later her status changed.

“I really was not scared about the whole transplant piece, not until they moved me up on the list in May,” said Fisher. “Once I was placed on both lists, I knew I needed to be healthy enough to receive both organs. I knew I could not get one organ without the other. That scared me.”

Over the summer, Fisher continued her life as normally as she could while waiting for a call from the Vanderbilt Transplant Center.

It came on Sept. 15 at 6:23 a.m.

“I was at the gym walking on the treadmill,” said Patricia Cathey, Fisher's mother. “I looked at the number and realized it was Nashville. They could not locate Patrice, so when I got home I told her.”

During the trip to Nashville, Fisher became uneasy, overwhelmed by the loss associated with her gain.

“It's like all of a sudden I got nervous,” Fisher said. “I knew for me to live, someone else had to die and that really bothered me. It all began to seem so surreal, really like it was a dream.”

The heart was transplanted on Sept. 15 followed by the kidney a few hours later on Sept. 16.

“We typically do the heart first, then the patient is allowed to recover for a short period of time,” said Hoff. “With the current preservation techniques the kidney can be preserved for up to 24 hours, but the heart for only four hours.

Her doctors agree that Fisher's prognosis is excellent. They point to improved outcomes in transplantation at Vanderbilt as well as Fischer's age and overall health.

Fisher's experience with medicine has impacted her life in a major way.

Prior to her heart-kidney transplant, she was studying political science with the hopes of going into politics or law. Now her focus is on nursing.

“Having gone through this, I am looking into the nurse practitioner program at Vanderbilt,” said Fisher, 29. “I think I would be of greater help as a nurse than a politician or lawyer.”