Children's Hospital Colorado has performed its first dual heart and liver transplant, joining a small group of U.S. hospitals that have completed this complex procedure in pediatric patients. According to the hospital, only 38 other pediatric heart and liver dual organ transplants have been done in the United States.
The medical team at Children's Hospital Colorado spent years preparing for such a case by developing collaboration between specialties including surgery, cardiology, and hepatology. Their preparation proved essential when 11-year-old Gracie Greenlaw required the procedure.
Gracie was born with hypoplastic left heart syndrome (HLHS), a condition where her heart had only one functioning chamber. She underwent three surgeries before age three to help her heart function but later developed complications affecting her liver, which are known long-term effects for HLHS patients.
In response to these chronic outcomes, Children's Colorado established the Fontan Multidisciplinary Clinic in 2016 as part of its Single Ventricle Program. The clinic aims to provide comprehensive care for patients with single ventricle diagnoses such as HLHS and related conditions.
Dr. Kathleen Simpson, a cardiologist involved in Gracie’s care, explained: "The Fontan is a lifesaving surgery, but the longer someone lives after the procedure, there is an increased chance of developing comorbidities. Our care team worked to keep her healthy and living a typical day-to-day life as long as possible before we determined a dual organ transplant would give her the best long-term quality of life."
Gracie also suffered from plastic bronchitis—a rare condition causing airway blockages—which worsened over time along with her liver function. After being placed on the waitlist for a dual organ transplant in April, she received both organs within one month due to an organ donation.
A multidisciplinary team prepared extensively for the operation because of its complexity. Dr. Matthew Stone and Dr. Emily Downs performed the nine-hour heart transplant first while the donor liver was preserved using a TransMedics Organ Care System until it could be transplanted by Adams and Dr. Kendra Conzen during an additional seven-hour surgery.
After more than a month recovering in the cardiac progress care unit, Gracie was discharged home and has since returned to school and daily activities with ongoing follow-up appointments.
Dr. Duncan Wilcox, Surgeon in Chief at Children’s Colorado, stated: "This procedure showcases the expertise, talent and level of care Children's Colorado provides to our patients, including those with complex medical needs. As the top-ranked pediatric hospital in Colorado and the Rocky Mountain region, we are proud of our leading-edge transplant care and look forward to supporting more patients who need dual organ transplants in the future."
