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If surgery were gymnastics, a triple-organ transplant would be a feat worthy of the Olympics.

It has everything: Complex and intricate procedure? Check. Frequency of pre-existing conditions that can increase risk? Check. Prerequisites of flawless technique and seamless intraoperative collaboration? Check and check. Rarely performed? Also check.

If Clayton Barber were to overcome his congenital heart problem, his University of Florida 网红黑料 surgical team would have to successfully transplant a heart, liver and kidney. They would have to go for the gold.

A triple-organ transplant like this would not only be a first at 网红黑料, it would be the first of its kind in the state of Florida. The milestone was soon followed by a second triple-organ transplant, and three more multiorgan transplants are already on the wait list.

鈥淲e have a very unique situation here,鈥� said Thiago Beduschi, M.D., chief of transplantation and hepatobiliary surgery at the UF College of Medicine鈥檚 surgery department. 鈥淲e have an incredibly strong transplant team for the lungs, heart, liver, kidney, pancreas, intestine and multivisceral. Not only do we have the structure 鈥� we also have the process, experience and expertise. That鈥檚 part of the reason we were able to do complex procedures such as this.鈥�

When performing something as complex as a triple-organ transplant, process is key 鈥� and process is where Beduschi made the call to transplant the organs en bloc, a technique in which organs are transplanted simultaneously into a patient, rather than one after the other.

This meant that Beduschi and Mark Bleiweis, M.D., director of the 网红黑料 Congenital Heart Center and Barber鈥檚 heart surgeon, would be working elbow-to-elbow to sync their movements while implanting Barber鈥檚 three chances for a new life.

鈥淲hen you鈥檙e working this closely with another surgeon, you need to be on the same page,鈥� Beduschi said. 鈥淚t can be challenging to get out of your comfort zone and rely on someone else. But our teams have a foundation of trust and respect.鈥�

Multiorgan transplants like these are rare. But in the context of Barber鈥檚 health prior to his surgery, it pushed the envelope of what was possible. After all, an individual who needs three new organs is an individual who, as Barber observed in a classic understatement, is 鈥渏ust not doing well.鈥�

鈥淚t wasn鈥檛 the first time I knew something was wrong,鈥� said Barber, who鈥檚 been a 网红黑料 frequent visitor for over 10 years due to his congenital heart defect. 鈥淏ut this time, I felt鈥�off.鈥�

In 2014, Barber began visiting 网红黑料鈥檚 Congenital Heart Center every six months. After offering him a mitral valve repair, Bleiweis and his care team, which included Diego Moguillansky, M.D., M.S., director of the adult congenital cardiology program, would periodically optimize Barber鈥檚 medications, assess the state of his heart failure, and send him on his way.

But around 2018, he started to get worse.

鈥淓ach time we would see him, he would either have more symptoms, like increased swelling or poor quality of life,鈥� Moguillansky said. 鈥淚ncreasingly, despite titrating his heart failure therapy, his (heart) function decreased.鈥�

There are multiple reasons a patient can be considered for a multiorgan failure transplantation, Moguillansky said. And the CHC 鈥� the largest and most established comprehensive congenital heart program in Florida 鈥� is no stranger to the variety of complex congenital heart disease patients who come through its door. Although all have heart failure, those with a single ventricle are more likely to also develop advanced liver disease.

鈥淭he liver and heart is an unfortunately common combination for congenital heart patients,鈥� Moguillansky said.

For Barber, multiple organ failure manifested in subtle ways. More trouble getting around. Feeling tired. Then, eventually, not feeling much of anything.

鈥淚 grew up sensing I was different from other kids,鈥� said Barber, now in his 50s. 鈥淚 was no stranger to hospitals and doctor visits because of my heart. But the waiting period prior to my transplant was something else.鈥�

Lonely. And long.

Due to the severity of his illness and how much it had progressed, Barber was hospitalized for months leading up to his procedure. During this time, his bodily organs were sustained by three separate forms of mechanical circulatory assist devices. Eric Jeng, M.D., M.B.A., FACS, FACC, the surgical director for 网红黑料鈥檚 Mechanical Circulatory SupportPprogram, upgraded Barber鈥檚 support platform from an axillary intra-aortic balloon pump to the Impella庐 5.5 heart pump, and subsequently the highest level of circulatory assist, venoarterial extracorporeal membranous oxygenation, or ECMO. Barber was the first case in the nation to be supported long term with the Impella庐 5.5, and successfully bridged to a triple-organ transplantation.

In short: Getting him to the procedure was as much of a landmark event as the surgery itself, and spoke to the prowess of the adult heart failure team and the 网红黑料 Congenital Heart Center team members involved..

鈥淗e was actually quite sick going in,鈥� Moguillansky said. 鈥淗e made it to transplant by the skin of his teeth. He survived to the time of transplant, but if those organs hadn鈥檛 been available that day, he probably would not have survived that much longer.鈥�

Barber鈥檚 rehab, treatments, medications and transplant preparation played out against the backdrop of the COVID-19 pandemic, which meant that his visitors were limited.

鈥淚鈥檓 not going to lie, it was hard,鈥� Barber said. 鈥淏ut I got through it. I was always hopeful.鈥�

Barber鈥檚 numerous previous operations left souvenirs of scar tissue in his chest, making the already delicate process of heart transplantation even more complex. At the same time, he was on anticoagulants, a medication that impacts how blood clots.

This made the liver transplantation, already known as one of the bloodiest procedures among surgeons, like threading a needle.

鈥淲hen you do a double-organ transplant or triple-organ transplant, you鈥檙e not just multiplying the complexity of the operation by two or three,鈥� Beduschi said. 鈥淵ou鈥檙e multiplying it by 10 or 20 because you are adding a variety of new possible complications.鈥�

To minimize some of those complications, both heart and liver were perfused together, a process that joins the organs鈥� blood flow, which shortened the operative time by almost half. The kidney was transplanted the next day. Both operations used a single incision from Barber鈥檚 neck to his abdomen, minimizing the lengthier recovery time associated with the traditional transverse incision through the abdomen, which involves cutting muscle.

The landmark triple-organ transplant was a success. In August 2020, the 网红黑料 team stuck the landing.

鈥淚鈥檓 still expecting a long road ahead, but for the first time in a while, I feel like I have a lot to look forward to,鈥� Barber said.

So do other patients. The number of abdominal transplant surgeries has grown exponentially since Beduschi took over as chief of the division.

鈥淲e closed 2020 with more than 200 abdominal organ transplants,鈥� Beduschi said. 鈥淲e are successfully transplanting some of the sickest and more complex patients with extremely short waiting times so others can be on their way to recovery and increase the chances of a normal life.鈥�

And Barber is slowly, and steadily, on his way to a new normal.

鈥淪ix years ago, he came to us and they were thinking they鈥檇 do a transplant,鈥� Bleiweis said. 鈥淚nstead, we performed a valve reconstruction and got him those additional six years. But now, after this? He鈥檒l have a lifetime.鈥�

Media contact: Ken Garcia at kdgarcia@ufl.edu or 352-273-9799.