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Asia's First Combined Heart, Liver Transplant

Ruzanna Harutyunyan's picture

The Outram Campus saw yet another landmark transplantation when a multi-disciplinary team from the National Heart Centre (NHC) Singapore’s Heart/Lung Transplant Unit and Singapore General Hospital’s (SGH) Liver Transplant Service successfully performed the first-ever combined heart and liver transplant in Asia, two weeks ago.

Mr Lau Chin Kwee, 57-year-old Singaporean was diagnosed with a rare genetic condition known as Familial Amyloid Polyneuropathy (FAP) where a single gene mutation caused the liver to produce abnormal proteins known as amyloids. These proteins affect the nerves and the organs impairing the functions of these organs over time. As liver is the source of the mutant protein, liver transplantation is recommended as a potential curative treatment.

Mr Lau was referred to SGH Liver Transplant Service in September 2006 to be considered for liver transplantation. However, before consideration for liver transplant, his heart needs to be assessed if it was also affected by the disease and if so, he may need heart transplant too. Clinical evaluation of his heart in January 2008 confirmed that it was also affected by the disease. The NHC Heart Transplant team then found him suitable for heart transplant. Mr Lau was placed on the waiting list for combined heart and liver transplant in November 2008.

Mr Lau underwent a combined heart-liver transplantation when suitably matched organs from a deceased donor under HOTA became available in early April 2009.

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The complex surgery requires seamless interface and co-ordination between the heart and liver transplant teams, for both the donor and the recipient. The timing between the recovery and transplantation of individual organs is crucial as it would affect the viability of the organs.

In preparation for the surgery and with oversight by Dr C Sivathasan, the two teams discussed potential problems, technical challenges; and realignment of the sequence of operating procedures in heart transplant followed by liver so as to ensure that the entire surgery can proceed smoothly.

The operation proceeded with heart transplant followed by liver. The entire operation including the pre-transplantation preparation took about 12 hours. The heart transplantation led by Dr C. Sivathasan, Dr Lim Chong Hee and Dr Lim Yeong Phang was completed within 3.5 hours. The liver transplantation led by Dr Tan Yu Meng, Dr Cheow Peng Chung and Dr Alexander Chung took another 5 hours. The anaesthesiology team was led by A/Prof Hwang Nian Chih and Dr Lai Fook Onn.

Mr Lau is recovering well and is expected to be discharged from the hospital soon.

With the concentration of 35 clinical specialties on Outram Campus with SGH as the anchor hospital, this medical campus has seen close to 5,000 people who benefited from various transplant programmes involving kidney, bone marrow, heart, liver, lung, skin grafts and cornea. The various national transplant programmes are possible with the strong collaboration of myriad specialists working in multi-disciplinary teams, including Visiting Consultants from the private sector. Besides physicians and surgeons involved in direct patient care, other specialists include anaesthesiologists, intensivists, infectious disease physicians, radiologists, psychiatrists, endocrinologists, histopathologists, nurses, medical social workers, transplant coordinators, dieticians, occupational therapists, physiotherapist, perfusionists and pharmacists.