In August, Reid Wylie underwent a 17-hour operation to replace his failing lungs, liver and pancreas at Toronto General Hospital. The procedure freeing him from using an oxygen tank and enabling him to eat meals without having to take handfuls of pills to digest his food and insulin shots to control his diabetes.
A number of triple transplants have been performed involving different organs, but this is believed to be the first in the world to replace the lungs, liver and pancreas in one operation, the hospital says.
Cystic fibrosis, or CF, is a genetic disease that causes the lungs to fill with thick, sticky mucus, making them prone to repeated infections that eventually destroy the respiratory organs. The mucus also blocks tubes that carry digestive enzymes from the pancreas to the small intestine, leading to poor absorption of nutrients. Over time, pancreatic tissue can break down, resulting in diabetes.
“Near the end, I was pretty much only able to walk around a little bit,” the 19-year-old said of the months before the transplant surgery, the last several weeks of which he spent in hospital tethered to an oxygen tank.
Now, he can breathe.
Dr. Cecilia Chaparro, a TGH respirologist who has treated Wylie for more than two years, said the teen has undergone a complete transformation.
“It’s really unreal to see him,” she said.
“He’s able to breathe without oxygen and do all his activities . . . . He’s no longer drowning in secretions. All the medications he was using, all the pancreatic enzymes (and insulin) . . . all of those are gone.”
Wylie will have to take lifelong immuno-suppressive drugs to prevent his body from rejecting the organs. But, because his new lungs, liver and pancreas don’t contain the CF gene, they are not subject to the ravages of the disease.
“The lungs are the most vulnerable and the most difficult part of the operation to do, and they have less time to be able to sit outside the body,” explained Keshavjee, who was not involved in the operation.
“But he was in a situation where he needed the lung and the liver for sure and would not survive either of those operations without doing them at the same time,” he said. “If we did lung, he would die of liver failure after. And if we did liver, he probably would not get through the lung transplant.”
Once Waddell’s team completed their work and Wylie was stable, a second team led by Dr. Mark Cattral stepped in to perform the liver transplant and had to decide whether to attempt replacing their young patient’s pancreas at the same time.
After assessing Wylie’s vital signs, Cattral got the green light from the anesthesia team to proceed. The decision was made to transplant the liver and pancreas as a whole unit, including the connecting vessels between the two organs.
One of the critical moments in that seven-hour portion of the operation came when surgeons unclamped the blood vessels to the liver to restore blood flow throughout the body, because the sudden rush of blood can cause instability in the heart.
“This is the part that gives us grey hair,” said Cattral. “Your eyes are on the monitors, watching the blood pressure, the activity of the heart . . . . Patients can have a heart attack at this stage.
“I have to pinch myself every once in a while.”
As for Wylie, he’s happy to feel “more normal” and hopes the success of his triple transplant means others with CF will benefit in the future.
“It’s hard to put into words. It feels like I have a second go at life.”