Gabrielle Cotty is simply Gabby to her family and friends. But to the world of medicine, she is a pioneer — one of only 250 people nationwide to ever receive heart and liver transplants simultaneously.
Cotty, 24, who lives in Nesconset with her family, received the organs in May during a 12-hour operation at the Montefiore Einstein Center for Transplantation in the Bronx. For Cotty, her lifesaving operation took place in a year marking two significant anniversaries for transplant medicine: the 55th anniversary of the first liver transplant and the 50th anniversary of the first transplanted heart. The first simultaneous heart and liver transplants took place 16 years after the first heart transplant.
Today, a double-organ transplant is still rare. Cotty’s surgeons had to choreograph every step in advance. Even where the surgeons and nurses stood in the operating room had to be “blocked out” like in a theater production, said Dr. Milan Kinkhabwala, the center’s director of abdominal transplantation.
“Gabby’s case was extraordinarily complex and required a lot of pre-planning to make sure it went smoothly,” he said. “During the surgery, we had two separate transplant teams working simultaneously for some portions, and at other times they worked individually.”
The recovery process is long, but Cotty has astounded her doctors.
“She’s a trouper,” said Dr. Jacqueline Lamour, also one of Cotty’s physicians. “She bounced back really quickly.”
Cotty has been recuperating at home since June and now is getting ready to see her friends again at Maryhaven Center of Hope in Yaphank, said her mother, Kathi Cotty. At the center, which serves those with special needs, she takes part in community service activities and likes to do arts and crafts, her mother said.
For Cotty, who has an intellectual disability, getting back to her daily routine comes after years of living with a heart defect that triggered a liver condition.
Cotty was born with a heart that had just one ventricle — not two, a right and a left, like a normal heart. The right ventricle pumps blood into the lungs; the left into the circulation through the aorta.
To override the defect, Cotty had to have three open-heart surgeries before she was 5. The surgeries, though, could never cure Cotty’s heart defect, said Lamour, who also is director of advanced cardiac therapies at Montefiore’s Children’s Hospital.
One of the operations, called the Fontan procedure, allowed Cotty to lead a near-normal life for more than 20 years, Lamour said. Developed by the late French pediatric heart surgeon Dr. Francois Marie Fontan, the procedure involves moving around what Lamour described as the heart’s “plumbing,” basically allowing a heart with only one ventricle to function as if there were two. In essence, the Fontan procedure separates the flow of “red blood” from “blue blood” — oxygenated from deoxygenated.
“That worked really well for Gabby until a year ago,” Lamour said. “But because the physiology has been changed from the way nature designed it to be, the liver is under higher pressure.”
Over time, Lamour said, “the liver gets congested and becomes scarred. And when you have scar tissue in the liver, you leak protein.”
The leaking protein, she said, was a sign that Cotty’s liver was failing.
To her doctors, it was clear the time had come to replace both organs.
In April, Cotty was admitted to Montefiore’s Children’s Hospital and put on the transplant list. Although in her 20s, she remained a pediatric patient because of her medical history. She waited only 25 days before a matching heart and liver were found, her mother said.
Like her doctors, Cotty’s family is amazed by how well she is doing.
“She’s doing very well, ” Kathi Cotty said. “She takes several medications three times a day. But no one would ever guess she had such a serious operation.”
Cotty’s most potent medicine, her mother said, has been the big doses of encouragement from her dad, John, and large extended family of her four siblings and their children.
And now, Cotty is ready to return to the center and all her friends.
“She likes it there,” her mother said, “and she’s really looking forward to going back.”