Getting Back to the Music Following a Heart-Liver Transplant

A heart-liver transplant is a highly complex operation that is only performed at centers with extensive expertise in multi-organ transplantation. The procedure requires comprehensive medical management, exceptional surgical skills, and precise coordination between transplant teams.

In 2023, only 73 heart-liver transplants were done in the United States. Just three took place in New England—all at Massachusetts General Hospital, a founding member of Mass General Brigham.

One recent Mass General heart-liver transplant patient was Jimmy Nuzzo, a professional disc jockey from Norwalk, Connecticut.

Jimmy, 65, was born with tetralogy of Fallot. This rare heart defect limits oxygen flow to the body. At just three months old, he had surgery to increase blood flow to his lungs. At age seven, he underwent open-heart surgery to repair a heart valve.

Years later, more heart problems emerged. In his late 40s, Jimmy underwent procedures to replace the repaired valve and to install a pacemaker and, later, a defibrillator to treat atrial fibrillation. Finally, when his tricuspid valve started leaking, his doctors at Brigham and Women's Hospital told him it couldn’t be replaced. Instead, he would need a heart transplant.

"When the doctors handed us a pamphlet with the word 'transplant' on it, [my wife] Lisa and I lost it," Jimmy said. "We just cried and cried. It was overwhelming, and we were scared."

A struggle to find a donor match

Soon, the news got even worse. The leaky tricuspid valve was causing fluid to build up in Jimmy's abdomen, putting pressure on his liver. His doctors said the liver would not make it through the stress of a heart transplant—he would need a liver transplant as well. 

With no other options, Jimmy was admitted to Mass General and placed on the national waiting list for a combined heart-liver transplant. Finding a donor was not going to be easy.

"It's not uncommon for patients like this to wait longer because we're looking for a healthy liver and a healthy heart, and both have to be the right size for the body and come from the same donor," liver surgeon Nahel Elias, MD, explained. 

In the meantime, Jimmy got to work. His days at Mass General were filled with walking, riding a stationary bike, and physical therapy to prepare his body for the transplant. 

Gregory Lewis, MD, medical director of the Mass General Heart Transplant Program, led Jimmy's care team. "From the moment we met him, I felt like I was in a good place," Jimmy said. "If not for him, I wouldn't be here today." 

The days and weeks seemed to crawl by. Along the way, there were a few "dry runs"—potential matches that turned out to be incompatible. An on-site social worker and members of the transplant team supported the Nuzzos throughout this period, but the uncertainty took its toll. 

"It was tough on us and the transplant team," Lisa recalled. "After a dry run, the doctors would share our sadness. They felt exactly what we were feeling." 

At last, a match

Six months after being admitted to Mass General, Jimmy finally got the news he had been longing to hear: A compatible donor had been found. Surgery was scheduled for the next day. 

Cardiac surgeons David D'Alessandro, MD, and Asishana Osho, MD, had been collaborating with Dr. Elias and Dr. Lewis' team of transplant cardiologists to identify a suitable donor. Now, they had to work together to perform the complex operation. 

"Transplanting a new heart or liver puts tremendous stress on the body," Dr. Osho said. "With a heart-liver transplant, both organs are working hard to reach their full potential. It takes a massive team effort to support the patient." 

Jimmy's case was particularly challenging. His congenital (present at birth) heart disease made navigating the chest cavity more difficult. Scar tissue from his previous open-heart surgery was another complicating factor. 

Meanwhile, his liver had significant fibrosis (scar tissue), which prevents the organ from functioning normally. It also causes congestion in the liver, which impairs blood flow and causes varices (enlarged veins) in the stomach and duodenum (first part of the bowel). 

"Heart-liver transplants come with significant risks to patients, particularly those with congenital heart disease," said Meaghan Doucette, NP, lead advanced practice provider for the Heart Transplant Program. "It needs to be done by a team with the right training, experience, and resources."  

During the surgery, the cardiac team, led by Drs. D'Alessandro and Osho, first transplanted Jimmy’s new heart. Then, the liver team, led by Dr. Elias, completed the liver transplant.

The operation lasted 21 hours.