From: doyle+@pitt.edu (Howard R Doyle)
Newsgroups: sci.med
Subject: Re: baboon heart recipient
Date: 11 Sep 92 23:19:14 GMT
Organization: Pittsburgh Transplant Institute

In article <1992Sep11.184630.27650@cgrg.ohio-state.edu> djh@osc.edu (David Heisterberg) writes:
>I read that the 35 year old man who received the baboon heart has died
>after 10 weeks.  I hope at least some of that time passed comfortably.
>The WSJ also reported in a sentence or two that he had AIDS, and that
>there was some controversy over this.  Otherwise I've seen very little
>coverage of this, typical, I guess.  I think this was pretty remarkable
>work, on both the medical team and patient's parts.  Is there anyone
>involved, or otherwise knowlegeable who can comment of the successes,
>failures, decisions, surprises, etc. involved in this case?  Thanks.
>-- 


As you pointed out in a later post, it was actually a liver transplant and not
a heart transplant what was performed on this man. A formal report will be
submitted to Lancet in the very near future, so it is still too soon to go
into great detail over the airways, whether the net (*particularly* the net) 
or the traditional media. However, I'll try to summarize what happened and
where we stand.

The operation took place on June 28th. The patient was a 35 year old man
with end-stage liver disease (cirrhosis) due to hepatitis B. A lot has been
said about him having AIDS, and the ethical and scientifical implications
of this in the context of a xenotransplant. We  refused to make any comments
at the patient's request. The report will certainly have all the clinical
information pertaining to this case, but in the meantime I can tell you that
he certainly did not have AIDS.

The operation went initially better than any of us had anticipated. The 
transplanted liver worked immediately, and the patient woke up and was taken
off the mechanical ventilator 17 hours after the procedure. He was started
on a solid diet after about a week, and would have been ready to go out of
the ICU then, but we were just too nervous to send him to the floor (being
that none of us had really done this before).

For about a month his hospital course was pretty unremakable. Had it not been
for the fact that he was requiring dialysis he would have been discharged
(if we had gotten over our apprehension). The transplanted liver, originally
about 600 cc (or the size of a small child's liver) grew almost enough to
fill out the space that a normal human liver would occupy. More importantly,
there seemed to be no problem regarding the metabolic products of the baboon
liver (clotting factors, complement, and the like). When looked at it in some
detail it seems that the recipient does acquire the metabolic make-up of the
donor.

What was even more encouraging (downright amazing), was that rejection was not
the tremendous problem some of us had anticipated. That is not to say he had
no rejection during all this, but it was very simple to control.

All in all, his post-transplant course was not very different from that of a 
patient that has received a human organ. It was not a bed of roses during his
last three weeks of life, but liver transplantation is not a trivial procedure
in the best of circumstances.

Things went really sour nine days before his death. He developed severe sepsis
following a cholangiogram, and had to be put back on mechanical ventilation.
His liver function deteriorated after this, and things looked all in all pretty
grim at the time. However, a week later he seemed to be recovering. His liver
function had improved significantly, he was wide awake, his renal function
was coming back, and his need for mechanical ventilation was down to very
little. On Sunday (Sept 6th) I thought he was going to be ready for extubation
(come off the ventilator) the next day. Around 3 o'clock that afternoon he 
sustained a large subarachnoid hemorrhage. Probably an aneurysm, but we will
have to wait for the final neuropathology to settle that. He was brain dead
in a matter of minutes.

Before we can begin to digest all the lessons that we learned from this 
experience, we will need to wait for the final results of the autopsy. But 
it is clear to us that we were painfully close to succeeding, which is indeed
remarkable given the nature of the procedure, and the fact that it was our
first attempt with a baboon liver. We believe this is a viable alternative to
the current organ shortage crisis, and we plan to continue the program.

I have learned other things as well. I had never before had the opportunity
to meet a man that could be accurately described as having heroic proportions.
It was an honor to take care of him.

________________________________

Howard Doyle
doyle+@pitt.edu


Newsgroups: sci.med