http://newpaper.asia1.com.sg/news/story/0,4136,199814,00.html?
FIRST DOUBLE ORGAN TRANSPLANT
Pastor stable but still weak
Operation a joint efforst between surgeons from two S'pore medical insitutions
By Ng Wan Ching
April 24, 2009
TNP GRAPHICS: CELESTINO GULAPA
A PASTOR who needed both a new heart and a liver urgently is alive today thanks to a historic double transplant by surgeons from two Singapore medical institutions.
The intricate 13-hour operation on 7 Apr is a first for Singapore and, possibly, South-east Asia.
It was a collaborative effort between surgeons at the National Heart Centre (NHC) and the Singapore General Hospital (SGH).
NHC surgeons did the heart transplant and SGH surgeons carried out the liver transplant.
The recipient, a Singaporean church pastor, who is in his 50s, was recently moved from the intensive care unit to a high-dependency ward. It is understood he is in a stable condition.
We are not naming the patient out of consideration to his wife and family. His wife told The New Paper that she did not want her husband to be disturbed now as he still needs a lot of rest.
Said his son: 'My father has a weakened immune system right now and is susceptible to infections which could prove fatal.'
The family asked that there be no visitors until he is fully recovered.
The medical institutions declined to comment.
No information was available on whether his transplanted organs came from the same donor.
But news of the ground-breaking operation had earlier appeared on the Internet, with two churches posting it on their weekly updates to members.
Members informed
In one, a local church said: 'This past week, Pastor ... underwent a double transplant of heart and liver.
'And in order to support him, we organised a prayer meeting to pray. We are thankful to God that God answered our prayers and now, he is recuperating well. Let us pray for his continued recovery.'
A church in the US posted this item on 12Apr: 'We received news from Singapore that Pastor ... was admitted to the Singapore General Hospital for a double transplant (heart and liver).... an unusual and radical operation. He is now in stable condition though still heavily sedated. The recovery will be long and difficult. Let us remember Pastor ... and his family in our prayers.'
The pastor himself blogged about his condition before the operation on 7 Apr.
He wrote: 'I just got news early this morning that there is a potential heart-cum-liver donor for me. If all goes well, the transplant might take place this very day.'
The pastor was working at a church in Singapore until a few years ago when he retired due to ill health.
He suffers from a condition called familial amyloidosis - a rare form of inherited amyloidosis.
Chances: 1 in 100,000
This genetic defect is estimated to occur in about one out of every 100,000 Caucasians in the United States, but there is a higher incidence in certain geographic, ethnic and family groups.
For instance, it is more common among those of Portuguese descent.
The liver of such patients produce abnormal proteins. These proteins are deposited throughout the body and eventually affects the nerves and organs such as the heart.
The heart then becomes very big and has difficulty functioning.
This was what had happened to the pastor.
Liver transplant surgeon Dr K C Tan from Gleneagles Medical Centre said that in such situations, it is useless to do just a heart transplant.
The liver will continue to deposit the amyloids (abnormal protein) and will destroy the heart again.
He said: 'You have to transplant both the heart and liver.'
He did the world's first such transplant in the early 1990s in Harefield Hospital, on the outskirts of London, with heart surgeon Professor Sir Magdi Yacoub.
In that operation, the heart was transplanted first by Prof Yacoub, followed by the liver transplant carried out by Dr Tan.
'The heart is already diseased and has poor heart function,' said Dr Tan. 'To operate on another organ with poor heart function is very risky. That's why we transplant the heart first.'
Since that time, such operations have become more common.
'The reason Singapore has not had such an operation before could be due to the difficulty in getting cadaveric donor organs.
'You need both the heart and the liver,' he said.
The success rate of such operations is quite good, he said. But much depends on the condition of the patient and how far his disease has progressed.
'If the transplant takes place at a late stage of his disease, the damage that has been done to his nervous system cannot be reversed. But I would say the success rate for such operations is about 75 per cent,' said Dr Tan.
The good news is that a recipient of two organs from the same donor has a much lower incidence of organ rejection.
Nobody knows why this is so, said Dr Tan.
'Usually there is no need for so much anti-rejection drugs to be given to a recipient of both the heart and liver organs. Somehow, they have better tolerance,' he said.
Spin-off op
There's now an operation that has spun off from this, called domino transplant, he said, which is taking place in the West.
'The liver that is taken from the patient with familial amyloidosis can be given to, say, an elderly liver cancer patient.
'The liver from the patient with familial amyloidosis actually looks normal. It only produces this abnormal protein,' said Dr Tan.
If the liver cancer patient is already 60 or 65 years old, chances are he won't be able to get a donor liver.
But he can use the liver from the patient with familial amyloidosis.
'The symptoms from this condition takes a long time to manifest, at least 20 to 25 years, or even more. By that time, the liver cancer patient would most probably have died from other causes,' said Dr Tan.
It could not be verified if the pastor's previous liver was used in the same way here.
--------------------------------------------------------------------------------
How the world's first heart-and-liver transplant was done in the 1990s
Heart surgeon Professor Sir Magdi Yacoub and liver transplant surgeon Dr K C Tan performed the operation.
The heart was transplanted first as it was already diseased. It's risky to operate on another organ when there's poor heart function.
The liver was then transplanted.
FIRST DOUBLE ORGAN TRANSPLANT
Pastor stable but still weak
Operation a joint efforst between surgeons from two S'pore medical insitutions
By Ng Wan Ching
April 24, 2009
TNP GRAPHICS: CELESTINO GULAPA
A PASTOR who needed both a new heart and a liver urgently is alive today thanks to a historic double transplant by surgeons from two Singapore medical institutions.
The intricate 13-hour operation on 7 Apr is a first for Singapore and, possibly, South-east Asia.
It was a collaborative effort between surgeons at the National Heart Centre (NHC) and the Singapore General Hospital (SGH).
NHC surgeons did the heart transplant and SGH surgeons carried out the liver transplant.
The recipient, a Singaporean church pastor, who is in his 50s, was recently moved from the intensive care unit to a high-dependency ward. It is understood he is in a stable condition.
We are not naming the patient out of consideration to his wife and family. His wife told The New Paper that she did not want her husband to be disturbed now as he still needs a lot of rest.
Said his son: 'My father has a weakened immune system right now and is susceptible to infections which could prove fatal.'
The family asked that there be no visitors until he is fully recovered.
The medical institutions declined to comment.
No information was available on whether his transplanted organs came from the same donor.
But news of the ground-breaking operation had earlier appeared on the Internet, with two churches posting it on their weekly updates to members.
Members informed
In one, a local church said: 'This past week, Pastor ... underwent a double transplant of heart and liver.
'And in order to support him, we organised a prayer meeting to pray. We are thankful to God that God answered our prayers and now, he is recuperating well. Let us pray for his continued recovery.'
A church in the US posted this item on 12Apr: 'We received news from Singapore that Pastor ... was admitted to the Singapore General Hospital for a double transplant (heart and liver).... an unusual and radical operation. He is now in stable condition though still heavily sedated. The recovery will be long and difficult. Let us remember Pastor ... and his family in our prayers.'
The pastor himself blogged about his condition before the operation on 7 Apr.
He wrote: 'I just got news early this morning that there is a potential heart-cum-liver donor for me. If all goes well, the transplant might take place this very day.'
The pastor was working at a church in Singapore until a few years ago when he retired due to ill health.
He suffers from a condition called familial amyloidosis - a rare form of inherited amyloidosis.
Chances: 1 in 100,000
This genetic defect is estimated to occur in about one out of every 100,000 Caucasians in the United States, but there is a higher incidence in certain geographic, ethnic and family groups.
For instance, it is more common among those of Portuguese descent.
The liver of such patients produce abnormal proteins. These proteins are deposited throughout the body and eventually affects the nerves and organs such as the heart.
The heart then becomes very big and has difficulty functioning.
This was what had happened to the pastor.
Liver transplant surgeon Dr K C Tan from Gleneagles Medical Centre said that in such situations, it is useless to do just a heart transplant.
The liver will continue to deposit the amyloids (abnormal protein) and will destroy the heart again.
He said: 'You have to transplant both the heart and liver.'
He did the world's first such transplant in the early 1990s in Harefield Hospital, on the outskirts of London, with heart surgeon Professor Sir Magdi Yacoub.
In that operation, the heart was transplanted first by Prof Yacoub, followed by the liver transplant carried out by Dr Tan.
'The heart is already diseased and has poor heart function,' said Dr Tan. 'To operate on another organ with poor heart function is very risky. That's why we transplant the heart first.'
Since that time, such operations have become more common.
'The reason Singapore has not had such an operation before could be due to the difficulty in getting cadaveric donor organs.
'You need both the heart and the liver,' he said.
The success rate of such operations is quite good, he said. But much depends on the condition of the patient and how far his disease has progressed.
'If the transplant takes place at a late stage of his disease, the damage that has been done to his nervous system cannot be reversed. But I would say the success rate for such operations is about 75 per cent,' said Dr Tan.
The good news is that a recipient of two organs from the same donor has a much lower incidence of organ rejection.
Nobody knows why this is so, said Dr Tan.
'Usually there is no need for so much anti-rejection drugs to be given to a recipient of both the heart and liver organs. Somehow, they have better tolerance,' he said.
Spin-off op
There's now an operation that has spun off from this, called domino transplant, he said, which is taking place in the West.
'The liver that is taken from the patient with familial amyloidosis can be given to, say, an elderly liver cancer patient.
'The liver from the patient with familial amyloidosis actually looks normal. It only produces this abnormal protein,' said Dr Tan.
If the liver cancer patient is already 60 or 65 years old, chances are he won't be able to get a donor liver.
But he can use the liver from the patient with familial amyloidosis.
'The symptoms from this condition takes a long time to manifest, at least 20 to 25 years, or even more. By that time, the liver cancer patient would most probably have died from other causes,' said Dr Tan.
It could not be verified if the pastor's previous liver was used in the same way here.
--------------------------------------------------------------------------------
How the world's first heart-and-liver transplant was done in the 1990s
Heart surgeon Professor Sir Magdi Yacoub and liver transplant surgeon Dr K C Tan performed the operation.
The heart was transplanted first as it was already diseased. It's risky to operate on another organ when there's poor heart function.
The liver was then transplanted.
