By Mary Otto
Washington Post Staff Writer
Tuesday, November 13, 2007
Few patients are good candidates for a combined heart and liver transplant, and few doctors are willing to face the risks the complex surgery involves. As of August, only 53 heart-liver transplants had been performed in the United States in the past 15 years, according to data compiled by the Organ Procurement and Transplantation Network.
In October, Trevanoyn Shelton of Oxon Hill joined that small group. He was medically ideal for the procedure and mentally prepared.
Shelton received donated organs in back-to-back surgeries that lasted a total of 10 1/2 hours. Now he is recovering and says he is feeling better than he has in years.
"I feel wonderful. I'm glad to be here," Shelton said yesterday, appearing with some of his doctors at the University of Maryland Medical Center in Baltimore.
Shelton, 33, suffered from a relatively rare heart condition known as restrictive cardiomyopathy, doctors said.
"His heart muscle became fibrotic and stiff, preventing the heart from filling with blood. As a consequence, the heart couldn't pump the blood forward into his body," said Sina L. Moainie, the cardiac surgeon who led the heart transplant team.
Shelton's malfunctioning heart caused his liver to become congested and fail, said Benjamin Philosophe, head of the medical center's division of transplantation and a member of the liver transplant team. Shelton also suffered from hepatitis B, which had caused fibrosis, or scarring of the liver.
"Mr. Shelton needed both a new heart and a new liver in order to survive," Philosophe said. "Each transplant itself is a major operation, and getting patients through a double transplant procedure of this magnitude is a challenge. The transplanted heart has to be strong enough to withstand the stress of a liver transplant."
Finding a pair of compatible donor organs also was a challenge, said Erika Feller, a cardiologist who worked to get Shelton listed correctly on a national waiting list for organs. Feller is the medical center's medical director for heart transplantation.
The organs Shelton received came from a Maryland donor whose identity was not released.
"I'm sorry someone had to lose their life to give me this opportunity, but I'm thankful," Shelton said.
Doctors believe his heart condition may be hereditary. His mother, Ramonia Shelton, died of a heart ailment five years ago, said his brother, Dwon Shelton.
When Trevanoyn Shelton first visited an Oxon Hill cardiologist this year, he was so weak he could barely walk.
The cardiologist, Cynthia Crawford-Green, saw the seriousness of his condition. "We have to put you in the hospital," she said she told him.
He was first placed at Washington Hospital Center and later moved to the University of Maryland Medical Center. Crawford-Green and Feller formed a close alliance to help Shelton, whom they described as a grateful and cooperative patient in spite of his fragile health.
"When he came to us, he was quite ill," Feller said. "We moved pretty quickly toward a transplant."
Doctors said they were careful to explain the risks of the double transplant to Shelton. The risk of the combined surgery is much higher than that of either surgery alone.
But Shelton, who attended Ballou Senior High School and once enjoyed playing sports, said he was not afraid of the surgery.
"I was kind of excited to find I had a chance to be better off," he said.
The heart transplant was performed first. Luis Campos, a University of Maryland Medical Center transplant surgeon, said performing the liver transplant right after the heart transplant was like sailing in uncharted waters. He was particularly concerned about the risk of excessive bleeding because Shelton had received blood thinners while he was on a heart-lung machine during the heart transplant. Campos's fears were unrealized, however.
"We were able to perform the liver transplant with minimal blood loss and little variation in blood pressure," Campos said.
Shelton has returned home and is slowly rebuilding his strength.
"I want to get as healthy as I can and go out and find employment," he said.
Dwon Shelton, seven years younger, hopes the brothers will play basketball again someday. For now, he's guarded, protective of Trevanoyn.
"I'm watching out for him, looking out for him, making sure everything is okay," Dwon said.