- Complex conditions may affect multiple organs, requiring evaluation at an advanced transplant center.
- Duke Health is among the top multi-organ transplant centers in the nation by volume.
- Duke's multidisciplinary transplant team collaborates to provide patients world-class care. Early referral to Duke gives patients more options.
A 45-year-old Louisiana man had lived with cardiomyopathy and an implantable cardioverter defibrillator (ICD) due to a mutation in the lamin A/C (LMNA) gene for eight years, but by 2025, his arrhythmias continued to worsen despite maximal medical therapy. The patient was admitted to an ICU in his community, where they suspected an underlying viral infection had resulted in pneumonia and aggravated his heart condition.
As it became obvious the patient required advanced care, his hospital contacted Duke Health. “The patient presented with ICD shocks and ventricular arrhythmias,” says Duke advanced heart failure specialist Karen Flores Rosario, MD, who specializes in genetic cardiomyopathies. “With his genetic condition, and by the time of our evaluation at Duke there were no ablation options that could cure the arrhythmia, so they were looking at heart transplant.”
In addition to his heart condition, the patient also showed liver damage. “Anti-arrhythmic drugs are used universally, but unfortunately, for this patient, these medications potentially contributed to drug-induced liver injury,” Flores explains.
“If we did a heart transplant alone, the liver may not tolerate it, and he could have a poor outcome,” says transplant cardiologist Adam D. DeVore, MD, MHS. “On the other hand, undergoing two organ transplants is incredibly taxing on the body and increases the risk of postoperative complications. It’s a difficult decision that’s different for every single patient.”
How did the Duke Transplant team treat this patient’s heart and liver?
The patient was transferred to Duke via air ambulance in an ICU-to-ICU transfer. After thorough evaluation, the multidisciplinary Duke Transplant team recommended a combined heart/liver transplant. The patient spent two months in the Duke ICU recovering from his illness before he received his transplant in November 2025, with heart surgeon Jacob N. Schroder, MD, and abdominal transplant surgeon Meera Gupta, MD, MSCE, performing the procedure.
“The patient did surprisingly well,” said Flores. “The heart and liver need fine-tuning to ensure perfusion, and fortunately, that happened pretty early. He was able to leave the hospital one month after his surgery.”
Fewer than 100 combined heart/liver transplants are performed annually in the U.S., and Duke is among the top multi-organ transplant centers in the nation by volume.
Early referral can be key to strong outcomes, Flores says. “Patients with recurrent heart failure or decompensation are at risk. If patients are receiving guideline-directed medical therapy but still have poorly controlled blood pressure or can’t tolerate the medications, that’s a good point to consider whether the patient needs to see an advanced heart failure specialist.”
Early referral also gives patients more options. “When we meet patients earlier, we can build a relationship before they’re sick enough for transplant,” Flores says. “This gives us time to improve modifiable risk factors so that when the time comes, those factors aren’t barriers to transplant.”
The patient shares his experience of multiorgan transplant in this Duke Health Blog story.