Double win for University of Colorado Hospital transplant patient

Combined heart and kidney transplant is a first in Colorado.
November 19th, 2015

On Feb. 24 of this year, Samuel Johns was popping Tums for a bout of stubborn indigestion as he prepared to leave home to work his job as an elevator mechanic with Schindler Elevators in Lakewood. When he became light-headed and dizzy a short time later, he headed to the ED at St. Anthony’s Hospital. There he flat-lined after suffering a massive heart attack.

Johns, now 53, survived the event, but it left both his heart and kidneys irreparably damaged. He is now on the road to recovery, thanks to a double heart and kidney transplant performed at University of Colorado Hospital (UCH) Nov. 7 – the first in Colorado. Johns received his new heart in a six-hour procedure that was followed by a break of equal length to make sure the organ was working well. A second team then transplanted a healthy kidney.
Surgeons at UCH begin transplanting a donor heart in Samuel Johns Nov. 7. Photo: Michael Mazzanti.
The double procedure required careful coordination between the cardiac and kidney transplant teams, as well as cardiothoracic surgery, pharmacy, social work, and other providers, said UCH cardiologist Amrut Ambardekar, MD, medical director of the Cardiac Transplant Program. He noted that both Peter Kennealey, MD, surgical director of the Kidney and Pancreas Transplant programs at UCH; and Natasha Altman, MD, an assistant professor of Cardiology with the CU School of Medicine who specializes in heart failure, had experience with double heart-kidney transplants at other institutions.

After a six-hour period to ensure the new heart was working well, the kidney transplant team began work on Johns. Photo: Dan Weaver.

“We thought, ‘Why send the patient somewhere else?’ We have to try,” Ambardekar said.

The effort was rewarded. Johns left UCH Nov. 17 to return to his home in Littleton to recuperate with the help of his wife Lori and daughters, Sara, 20, and Melissa, 14.

“The patient has done exceedingly well and his case is a glowing example of how the multidisciplinary approach to organ transplantation works so well at the University of Colorado Hospital,” Kennealey said in a press release.

Lengthy struggle

Johns FamilyJohns recovers at UCH with (from left) wife Lori and daughters Sara and Melissa. Photo courtesy Samuel Johns.
The nine-month struggle came without warning, Johns said from his hospital bed in UCH’s Cardiac Intensive Care Unit (CICU) just hours before he was discharged. There is a history of cardiac problems on both sides of his family – his father suffered a fatal heart attack – but he says he had no prior heart problems. His life changed with the February attack, however.

The half-hour of CPR delivered by rescuers who saved his failing heart that day left him with broken ribs, he said. The hospital implanted an arterial stent and Johns went home 12 days later with a life jacket fitted with an alarm and electrical paddles to shock his heart in an emergency. He was supposed to wear the jacket for 40 days; the alarm went off 15 hours after he put it on.

Back at St. Anthony’s, Johns had a defibrillator implanted to control violent bouts of ventricular tachycardia (VT) that set his heart racing uncontrollably. He endured dialysis at UCH to treat kidney damage caused by severely diminished blood flow from his heart. His heart-pumping function was only a third of normal, said Ambardekar.

Last resort

Ambardekar prescribed heart and kidney medications, but they failed to restore Johns to health. By September, the only remaining option was to place him on transplant lists for both a heart and a kidney – preferably from the same donor.
Amrut Ambardekar, MD, medical director of the Cardiac Transplant Program at UCH
Amrut Ambardekar, MD, medical director of the Cardiac Transplant Program at UCH, was part of the large team that coordinated and performed the double transplant procedure.
“Often the kidneys will recover with medication treatment, but with the lack of blood flow and so many episodes of VT, he had suffered multiple insults,” Ambardekar said. “Even with several months of treatment, the kidneys couldn’t get better.”

During the wait for a donor, Johns wore a fanny pack that delivered regular infusions of Dobutamine, a drug used to improve blood circulation. Fatigued and short of breath, he couldn’t work or do much to help Melissa or Lori, who he said he held down three jobs to keep the family afloat financially.

On Nov. 6, the hospital called to say that organs from a single donor had arrived – news that was simultaneously welcome and anxiety-producing.

“I was very stressed out because it all became a reality just that quick,” Johns said.

Around midnight on Nov. 7, cardiothoracic surgeon Ashok Babu, MD, began the heart transplant. He finished up at 6 a.m. Following the break to ensure the heart was pumping adequately, Kennealey and his team transplanted Johns’s donor kidney in a two-and-a-half-hour procedure.

Road to recovery

By 7 p.m. that evening, Johns was dimly aware that Lori, Sara, and Melissa, all of whom had spent the night at the hospital, were there to welcome him back to the world. Late the next morning, he breakfasted on an omelet and had lasagna that evening.
Samuel Johns
Just 10 days after the transplant procedure, Johns was awaiting discharge from the Cardiac Intensive Care Unit at UCH.
“I’ve been eating good ever since,” he said.

He’ll be eating healthy from now on, Johns added. He acknowledged that 20 years of traveling around the metro area repairing elevators didn’t encourage good dietary choices and may have contributed to his heart problems. His last physical before the heart attack, which produced a “clean bill of health,” was four years ago. Prior to his illness, he weighed 260 pounds, 80 of which he’s lost.

“I’ve learned a lot about diets,” he said. “I’ve learned it the hard way.”

Johns went home with a long list of medications, including immunosuppressants, antibiotics, and drugs to control his blood pressure. He’ll be back for weekly visits for a month and will begin cardiac rehabilitation after his sternum heals, either at UCH or a community facility, Ambardekar said. Both the cardiology and nephrology teams will follow Johns’s progress, Ambardekar added.

On Nov. 18, Johns was back at UCH, not for treatment, but for media coverage of his case. His sights aren’t set on celebrity but rather on getting back to work.

“This has been very stressful for my wife,” he said, adding his employer has held his job for him. He is grateful for the second opportunity granted by the donor and the providers who cared for him.

“I got great care here,” he said as he spent his last few hours in the CICU. “All of the physicians, nurses, and educators have been excellent. I couldn’t wish for better.”

About the author

Tyler Smith is a freelance writer based in metro Denver.