Can one surgery save both heart and liver? How Children’s Hospital Colorado pulled off a medical first

Children’s Hospital Colorado has completed its first pediatric dual heart and liver transplant, marking a regional milestone in complex organ transplant surgery. Only 38 such procedures have been performed nationwide to date, placing the hospital among a highly specialized cohort of pediatric centers capable of multi-organ transplants.

This dual transplant was performed on 11-year-old Gracie Greenlaw, who had been living with hypoplastic left heart syndrome (HLHS) and developed progressive liver failure due to long-term complications following the Fontan procedure. A combined surgical and clinical team drawn from 25 multidisciplinary specialties executed the procedure in two stages across 16 hours, involving cardiology, hepatology, anesthesia, and transplant surgery specialists.

Beyond its immediate clinical significance, the case represents a major strategic and reputational leap for Children’s Hospital Colorado. The successful surgery signals the institution’s readiness to take on highly complex, resource-intensive cases with long perioperative timelines, increasing its regional draw and potentially enhancing its referral footprint across a seven-state area.

Why does pediatric dual organ transplant remain so rare, and what does this case signal for future practice?

Pediatric heart and liver transplants remain among the most technically challenging procedures in modern medicine, often requiring close coordination across disciplines that rarely interact with such intensity outside of combined cases. Only 38 pediatric dual transplants of this kind have been documented in the United States, and the pool of eligible patients is small. Moreover, the logistical complexity is immense: both organs must come from the same donor, survive time-sensitive transportation and preservation constraints, and be surgically implanted without triggering rejection or failure cascades.

Children’s Hospital Colorado has been preparing for years for this milestone. The presence of the Fontan Multidisciplinary Clinic, which was established in 2016 as part of the broader Single Ventricle Program, has enabled longitudinal care planning for complex heart disease patients like Gracie. This program positioned the hospital to identify candidates early and coordinate preemptively for organ failure trajectories not uncommon in Fontan survivors.

According to Dr. Megan Adams, surgical director of the Pediatric Liver Transplant and Kidney Transplant Programs, this outcome reflects years of groundwork to elevate the hospital’s transplant program into a regional center of excellence. The fact that the surgery succeeded with minimal post-operative complications and a one-month inpatient recovery timeline further validates the institution’s readiness to expand such capabilities.

How does the Fontan procedure contribute to long-term liver disease in pediatric cardiology patients?

The Fontan procedure, which is part of a three-stage palliation approach for children with single-ventricle heart defects such as HLHS, has significantly improved survival into adulthood. However, it does not normalize physiology. The Fontan circuit relies on passive blood flow through the pulmonary circulation, often leading to chronic venous congestion, low cardiac output, and hepatic congestion.

Over time, these hemodynamic stresses can cause liver fibrosis, cirrhosis, and even hepatocellular carcinoma in some patients. Gracie’s care team, led by cardiologist Dr. Kathleen Simpson and hepatologist Dr. Dania Brigham, had been monitoring for these sequelae. When Gracie developed worsening plastic bronchitis alongside liver decompensation, the team made the call to list her for a combined heart-liver transplant—a decision informed by preemptive scenario modeling across a broad surgical and clinical team.

What logistical and technical strategies helped make the dual transplant viable?

Timing, organ preservation, and surgical choreography played a critical role. Once Gracie was listed in April, a compatible donor match arrived within a month—a remarkably short wait given the dual organ requirement. The team sequenced the heart transplant first due to the shorter viable window for cardiac tissue. That portion of the surgery, led by Dr. Matthew Stone and Dr. Emily Downs, took nine hours.

The liver, preserved using the TransMedics Organ Care System, remained viable during that time. This device mimics physiologic liver function, allowing more time than traditional cold storage. Dr. Adams and Dr. Kendra Conzen then completed the liver transplant in a subsequent seven-hour procedure, with ongoing anesthesiology support throughout the 16-hour total surgery time.

This case also underlines the importance of intraoperative communication across disciplines. Unlike most surgeries, where individual teams rotate in sequence or work on separate anatomical domains, this transplant required close handoffs and coordinated management of hemodynamics, volume status, and coagulopathy across overlapping organ systems.

What precedent does this set for future complex pediatric transplant cases in the U.S.?

Children’s Hospital Colorado now joins a small cohort of institutions capable of offering such dual-organ procedures at scale. This includes prominent names such as Texas Children’s Hospital, Lucile Packard Children’s Hospital at Stanford, and Children’s Hospital of Philadelphia. For patients in the Rocky Mountain and surrounding states, this opens a new frontier of access without needing to travel cross-country.

Strategically, this capability could also affect referral patterns, payer recognition, and research collaborations. The hospital may now attract more complex congenital heart disease patients with systemic complications, as well as potential industry partnerships for transplant device trials or organ preservation technologies.

Clinically, the Fontan-associated liver disease population is growing. With many patients now reaching adolescence and adulthood, there is rising demand for coordinated cardiac and hepatic care—and an increasing need to rethink transplantation models that address systemic rather than single-organ failure.

What are the long-term considerations for the patient and hospital following this transplant?

Seven months post-surgery, Gracie is reportedly thriving—back in school and living a more typical life. Like all pediatric heart transplant recipients, she will eventually require a re-transplant due to graft longevity limits. However, the liver transplant is expected to last a lifetime, barring complications.

Children’s Hospital Colorado will now have to maintain a rigorous follow-up and care coordination structure to support her long-term health. It also places pressure on the transplant team to monitor emerging complications, immunosuppressive load, and comorbidity development over time.

From a hospital operations standpoint, this milestone could justify further investment in transplant infrastructure, surgical training pipelines, and research fellowships focused on dual-organ and pediatric multiorgan failure pathways. It also elevates the institution’s competitive positioning in the academic and clinical pediatric transplant space.

What are the key takeaways from Children’s Hospital Colorado’s first pediatric dual organ transplant?

• Children’s Hospital Colorado has successfully completed its first pediatric heart and liver transplant, a rare procedure with only 38 such cases reported nationally.
• The patient, 11-year-old Gracie Greenlaw, suffered from hypoplastic left heart syndrome and liver failure due to Fontan-associated complications.
• Years of multidisciplinary planning and care coordination positioned the hospital to execute this high-risk, high-reward surgery.
• The heart transplant was completed first, followed by liver transplant using a TransMedics Organ Care System for prolonged viability.
• This case positions Children’s Hospital Colorado as a regional leader in complex pediatric transplant care across a seven-state catchment.
• The procedure may shift referral patterns and open doors to broader research and technology partnerships.
• Fontan-associated liver disease is becoming an emerging frontier for dual-organ transplant strategies as the congenital heart population ages.
• Gracie’s recovery reinforces the viability and necessity of such procedures in extending both lifespan and quality of life for complex congenital cases.