Children's Hospital Colorado (Children's Colorado) has completed its first-ever dual heart and liver transplant, marking a major milestone for the hospital. The complex procedure involved dozens of specialists working across 25 multidisciplinary care teams. Nationwide, only 38 pediatric patients have previously received both a heart and liver transplant.
"Performing Children's Colorado's first-ever heart and liver dual organ transplant is an amazing accomplishment for our Pediatric Transplant Program," said Dr. Megan Adams, surgical director of the Pediatric Liver Transplant and Kidney Transplant Programs. "Thanks to years of dedication and a team committed to being the trusted leaders in pediatric transplant across our seven-state region, we're grateful to provide this level of care to even more kids who need complex organ transplants to treat life-threatening illnesses and help them live healthy and happy lives."
Care teams at Children's Colorado had spent years preparing for the possibility of a dual heart and liver transplant. Close coordination among specialists in surgery, cardiology, hepatology, and other fields, along with strong backing from hospital leadership, ensured the team was ready when 11-year-old Gracie Greenlaw and her family needed help.
Gracie was born with hypoplastic left heart syndrome (HLHS), a condition in which her heart developed with only one functioning pumping chamber. Before turning three, she underwent three major surgeries, the Norwood, the Glenn and the Fontan, to allow her heart to circulate blood effectively. Although many children with HLHS now survive into adulthood, the condition and its treatments can lead to serious long-term complications, including liver damage and liver failure.
To address these ongoing challenges, Children's Colorado established the Fontan Multidisciplinary Clinic in 2016 as part of its Single Ventricle Program. The clinic focuses on caring for patients with HLHS and other single ventricle conditions, such as tricuspid atresia and unbalanced common atrioventricular canal, by providing coordinated, whole-patient care.
Through this program, Gracie received continuous monitoring and treatment for both her heart and liver. Her care team included experts like cardiologist Dr. Kathleen Simpson and hepatologist Dr. Dania Brigham, who worked together to manage her condition until a transplant became the best option.
"The Fontan is a lifesaving surgery, but the longer someone lives after the procedure, there is an increased chance of developing comorbidities," Simpson said. "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."
For years, Gracie lived with plastic bronchitis, a condition that causes thick, protein-like material to build up in the airways. Over the past year, her symptoms worsened, and signs of liver failure began to appear. Her medical team concluded that moving forward with a dual transplant was necessary, and she was placed on the transplant waitlist in April.
In preparation, dozens of specialists met regularly to plan for the surgery. They carefully accounted for the challenges of transplanting two organs at once, including differences in blood volume needs and electrolyte management during the operation.
Less than a month after joining the waitlist, compatible donor organs became available, made possible by another family's decision to donate. Because the heart can only remain viable for a short time, the surgical team began with the heart transplant. Dr. Matthew Stone, surgical director of the Pediatric Heart Transplant Program, and congenital heart surgeon Dr. Emily Downs led the nine-hour procedure.
While the heart surgery was underway, the donor liver was maintained on a TransMedics Organ Care System -- a specialized device designed to replicate normal liver function. This technology preserved the liver and allowed the heart surgeons the time they needed to complete their work. Dr. Adams and transplant surgeon Dr. Kendra Conzen then performed the liver transplant, which took an additional seven hours. Throughout the process, close coordination with anesthesiology teams was essential to protect Gracie's health.
The surgery was successful. Gracie left the cardiac progress care unit just over a month later. Seven months after the transplant, she continues to attend monthly follow-up visits, but she has returned to school and is back home with her dogs.
Like other pediatric heart transplant recipients, Gracie will need another heart transplant later in life. Her transplanted liver, however, is expected to last for the rest of her lifetime.
"This procedure showcases the expertise, talent and level of care Children's Colorado provides to our patients, including those with complex medical needs," said Dr. Duncan Wilcox, Surgeon in Chief. "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."
