TORONTO — A Toronto teen with cystic fibrosis has been given a second chance at life with a first-of-its-kind triple-organ transplant.
In August, Reid Wylie underwent a 17-hour operation to replace his failing lungs, liver and pancreas at Toronto General Hospital, freeing him from using an oxygen tank and allowing him to eat meals without taking daily handfuls of pills to digest his food and insulin shots to control his diabetes.
A number of triple transplants have been performed using various organs, but this is believed to be the first in the world to replace the lungs, liver and pancreas in a single 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. This 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.
"I couldn't walk longer than maybe 20 minutes, slowly, without getting out of breath," said Wylie.
Now, he can breathe.
"That's the best part. I can just breathe and I don't wake up gasping for air. I can basically do anything. I've been going to the gym a lot. I just finished playing basketball with some friends."
Dr. Cecilia Chaparro, a TGH respirologist who has treated Wylie for more than two years, said the teen has undergone a complete transformation.
"He was close to dying if he had not had this opportunity," Chaparro said of the donor organs that were virtually a perfect tissue match for Wylie.
"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 immunosuppressive drugs to prevent organ rejection. But because his new lungs, liver and pancreas don't contain the CF gene, they are not subject to the ravages of the disease.
Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program, called the operation a "medical tour de force, a huge accomplishment."
The double-lung transplant was the first to be done, and that surgery alone took 10 hours, led by Dr. Tom Waddell, who had been on call when the donor organs became available.
"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.
"When you see a patient who needs a lung transplant, a liver transplant and a pancreas transplant, you usually have to say which one takes precedence, because sometimes you can't get them all done.
"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 that sudden rush 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, activity of the heart.... Patients can have a heart attack at this stage.
"In this case, Reid sailed right through it. The organs 'pinked up' nicely, very quickly. In a surgeon's world, that's what we are looking for."
The teen's mother has a hard time believing her son is the same boy who just four months ago was in hospital for several weeks every six months getting IV antibiotics for severe lung infections.
"He was sick all the time," said Toni Emerson, a single mom whose older son is not affected by CF. "The worst part of it was he couldn't make plans.
"He could wake up in the night and be coughing and all of a sudden he wasn't just coughing up mucus, he'd be coughing up a cup of blood. And then it would become an emergency."
Since the transplant, she said her son can make plans with friends and look towards finishing high school.
"There's such a difference that I can barely compare the two," said Emerson, who is relieved and grateful to the unidentified donor who has given her child a new future.
"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."
