After her mother died of heart failure, Anissa Swanigan began experiencing rapid heartbeats and was told to chalk it up to anxiety. With a pregnancy a year later, she was told she had hypertrophic cardiomyopathy, a congenital disease that results in a thickening of the heart muscle.
Memphian Anissa Swanigan, pictured at the Gift of Life Transplant House in Rochester, Minn., is the second person ever to have a heart and liver transplant done in reverse – liver before heart.
(Photo courtesy of Mayo Clinic)
“I could barely walk from my garage to the driveway. Things were bad,” she said.
In 2009, Swanigan had a right heart catheterization to determine how well the organ was performing. When the diagnosis came in, she said, she was “devastated, shocked. I tried not to think about it. You’re praying; you’re hoping that somebody made a mistake.”
She would need a heart transplant. A subsequent life-threatening liver disease would require a liver transplant as well.
The want of a second opinion took her to the Mayo Clinic. Since August 2012, Swanigan has been a regular visitor to the hospital in Rochester, Minn., and she has been living there since February.
To further complicate matters, Swanigan is “highly sensitized,” meaning antibodies in her body would fight certain proteins on the cell surfaces in the donor heart and rejection of that organ would almost be a given.
“Not everybody has significant antibodies to other people, but we can develop these kinds of antibodies, especially if we’ve had blood transfusions or in women that have had children, or sometimes we just don’t know why,” Richard Daly, cardiovascular surgeon and team lead on Swanigan’s surgery, said by phone. “Some people have antibodies to a large portion of the population, and when that occurs, if somebody has antibodies to 80 or 90 percent of the population then, of course, getting a donor is much, much more difficult.”
In any multiple organ transplantation involving the heart, it is the first to be transplanted, which reduces the amount of time the organ is outside of the body. To combat Swanigan’s sensitivity, however, the liver would be transplanted first in an effort to soak up and reduce the majority of the antibodies and mitigate the chance that her body would immediately reject the heart. It would be only the second time such a reversal of transplantation had ever been done; the first was at the Mayo Clinic in 2011.
On Mother’s Day weekend, a donor became available. A team of surgeons and nurses worked for 12 to 14 hours to complete the process.
“The choreography of the transplant had to be very precise so that we were ready to put the liver in as soon as the organs arrived, and simultaneously getting ready so that as soon as the liver was in we could start putting the heart in,” Daly said.
For the 41-year-old Swanigan, the lead-up to the surgery may have been the most difficult part of her ordeal. There is the waiting and the wondering – an organ donor can come at any time, day or night, and both organs had to come from the same donor. But she is also the mother of two boys – Siddiq, 5, and Ilyas, 4 – home in Memphis with family. She hasn’t held them since April; they talk on the phone and visit via Skype.
“We hug the computer when we want to give each other a hug,” she said by phone from Rochester. Too young to understand what’s going on, she said, “They just know that Mama was sick.”
Swanigan, who was scheduled to return to Memphis this month, said she looks forward to “being with my kids, just a normal day with my kids, being able to run and play with them, take them to the park, just simple things.”
Daly said that she can expect a normal life as a transplant patient.
“Patients are generally better after transplant because they’re dying from an organ that’s failing. … Transplant improves their quality of life and their prognosis,” he said, though he’s quick to point out that “transplant doesn’t cure you; transplant is like a new disease, a disease called ‘transplantation.’ We do that when the prognosis and quality of life for transplantation is better than the disease that the patients have.”
Swanigan can look forward to a lifetime of immunosuppression medicines and their side effects, and regular doctor visits and testing. But she can also look forward to a life with Siddiq and Ilyas, and hopefully getting back to her job teaching in the business department at Southwest Tennessee Community College. She said she also would like to work with an organization that advocates for others suffering from heart disease.
Daly hopes that one day there will be a way to artificially replicate the transplant reversal he and his team performed on Swanigan. In the meantime, though, both are passionate about the importance of organ donation, and urge everyone to agree to it.
“We’re in a situation where we’re watching people die and we don’t get a chance to do transplants for them,” Daly said.
Swanigan is living proof as to the positive results. She’s up and about and exercising, ready to return home.
“I feel great. I’m truly blessed.”