Reducing rejection by reversing order of heart-liver transplant

Apr 27, 2021 | Jennifer O'Hara | @jenohara

For heart-liver transplants, the liver and heart must come from the same donor, and some patients wait years to receive both organs. Also, antibodies from the donor can increase chances of the receiving patient rejecting the heart.

But Dr. Sudhir Kushwaha, a Mayo Clinic cardiovascular transplant surgeon, says when a liver transplant is also involved, it sort of gives the heart protection. Now, he says, Mayo is introducing an innovative approach by transplanting the liver before the heart.

"When we looked back, at our experience with our combined heart-liver patients, we made the observation that those patients really have zero rejection," says Dr. Kushwaha. "With that in mind, we thought, well, what's going on here? There must be some biological process."

“The antibodies seem to bind in the liver in a way that doesn't harm it — the same as it does in other organs — and it really does sort of sponge up the antibodies against that specific donor,” says Dr. Richard Daly, a Mayo Clinic cardiovascular transplant surgeon.

In this Mayo Clinic Q&A podcast, Drs. Kushwaha and Daly discuss in detail this reverse transplant protocol and the research learning process of the past decade. They also discuss why some patients need this double organ transplant and they describe how the surgeries are closely choreographed with Mayo Clinic's liver transplant teams.

To practice safe social distancing during the COVID-19 pandemic, this interview was conducted using video conferencing. The sound and video quality are representative of the technology used. For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was recorded prior to COVID-19 or recorded in an area not designated for patient care, where social distancing and other safety protocols were followed.