Man Undergoes Rare, Successful Triple Organ Transplant in Long Island
Fewer than 80 triple organ transplants have been attempted in the United States, and for the first time, the rare procedure was successfully performed on Long Island. As CBS News reports, a beloved husband now has a new heart, liver and kidney.
“Miracles exist”
Sergio Arias Cestoni, 47, had to stop working at his Long Island factory when his three organs began failing. He spent months at Northwell hospitals, waiting, hoping and praying. “Get two, it was hard. Get three, it’s gonna be worse. But it happened. Miracles exist,” Cestoni said.
The triple match came from a single unidentified donor. “To have all three be a match for him is indeed a miracle,” said Dr. Nabil Dagher, with the Northwell Health Transplant Institute. It took rotating teams of medical experts to complete the 14-hour surgery. “It’s definitely not another day in the office, not a regular day,” Dr. Ahmed Fahmy said. “Moments like this are very rewarding to the team.”
“It was really a highlight of my career to be a part of this operation,” anesthesiologist Dr. Donnie Isseroff said.
The Rarity and Importance of Triple Organ Transplants
A triple solid organ transplant includes three organs — some combination of lung, heart, liver, kidney, pancreas — from the same donor implanted simultaneously. One of the most common forms of triple solid organ transplant involves a heart, a liver and a kidney, according to Bashar A. Aqel, M.D., a transplant hepatologist and Transplant Center medical director at Mayo Clinic in Arizona.
Rationales for a single donor providing all organs for a multiorgan transplant include facilitating logistics and ensuring the greatest chance of a positive outcome, says Dr. Aqel. “If someone has multiorgan failure, you can’t transplant one organ to that recipient,” says Dr. Aqel. “The transplant would have a high failure risk. If individuals needing a heart transplant also have poorly functioning livers and kidneys, they won’t make it out of surgery if you perform a heart transplant only.”
Transplant specialists place patients in need of triple transplant on the standard transplant waitlist, specifying a requirement for same-donor multiple-organ transplant. Heart or liver disease severity determines triple transplant organ allocation. Most frequently, a patient’s progressing heart disease drives specialists’ consideration of triple transplant. Often, advanced-stage heart failure damages an individual’s liver and kidneys. The converse also is true: Kidney or liver disease can precipitate heart failure.
Though patient ages vary for triple transplant, eligible patients often are children and young adults. “Triple transplant’s complexity calls for robust clinical status,” says Dr. Aqel. “Selection is crucial, especially as recovery is challenging. You almost need a perfect patient.”
He says no formal triple transplant eligibility criteria exist. Determining eligibility is complex, with criteria accompanying each organ the patient will receive. At Mayo Clinic, organ-specific selection committees assess eligibility and consider the disease involved. Each committee makes a recommendation in a joint meeting of all selection committees, putting all expertise together to determine how to proceed.
Dr. Aqel indicates that triple transplant provides hope for life rather than acceptance of death from the disease involved. “Patients who need triple transplants have limited options,” says Dr. Aqel. “In the absence of the transplant option, the prognosis is extremely poor and the odds of surviving the disease processes are slim to none.”
“Try to honor my donor”
Since the successful procedure, Cestoni has had to stick to a regiment of dozens of daily pills, but that will be scaled back as there has been no organ rejection. “I can feel my heart now beating more strong,” Cestoni said. “I feel excellent, very different.”
Cestoni says when he first started the transplant process in November, he could only walk a couple of blocks. Now, he walks 30 minutes a day. He hopes to resume college courses. “College, my life with my wife, with my parents, brothers, my community,” he said. Cestoni only dreamed this day would come. “I feel so proud to get all these organs and try to honor my donor,” Cestoni said.
April is Donate Life Month, so it seems like the perfect time to be highlighting this important event. Says Dr. Aqel, “Triple transplant gives patients their lives back and is the ultimate representation of the gift of life.”
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