Organ Transplant

ATTR amyloidosis is a rare condition that causes a protein to build up in the body, causing damage to some organs. Sometimes, this damage is very serious. It may cause an organ to stop working well. When this happens, doctors may suggest an organ transplant.¹

Why an organ transplant might be needed

ATTR amyloidosis is a complex disease. It involves a protein called transthyretin (TTR). The liver makes all the TTR protein in the body.^1-3

In people with ATTR amyloidosis, this TTR protein becomes unstable. It changes shape and folds incorrectly. These misfolded proteins stick together and form clumps called amyloid deposits. These deposits can build up in different parts of the body. They often gather in the heart, nerves, and kidneys. This buildup makes the organs stiff. It stops them from working the way they should. This process causes the symptoms of amyloidosis.^1,2

Over time, the amyloid buildup can cause severe damage and may cause organ failure. Organ failure is life-threatening. If an organ fails, new medicines may not be enough. A transplant may be the best option. A transplant replaces the damaged organ with a healthy one from a donor.²

Liver transplant

A liver transplant may seem strange because ATTR amyloidosis most often affects the heart or nerves; however, the liver is the source of the problem.³

The liver produces the TTR protein. In the type of ATTR passed down in families (called hereditary ATTR, or hATTR), the liver makes a faulty, unstable TTR protein. A liver transplant removes the organ that is making this faulty protein.³

The new, healthy donor liver makes normal, stable TTR protein. This stops the body from making new amyloid deposits. A liver transplant can stop the disease from getting worse. It is a treatment that targets the cause of the disease.³

A liver transplant is a major surgery. It has serious risks. Also, the transplant does not remove the amyloid that is already built up in other organs. Damage in the heart or nerves may not get better. Sometimes, it can still get worse, especially in the heart.^2,3

Doctors usually consider liver transplants for younger people with hereditary ATTR. They often must have early-stage nerve damage. They cannot have severe heart damage. People who get a liver transplant must take medications for the rest of their lives, which help stop the body from rejecting the new organ.^2,3

Newer medicines are now available to treat ATTR amyloidosis. These drugs can stabilize the TTR protein or stop the liver from making it. Because of these new drugs, liver-only transplants for ATTR are done less often. Your doctor can explain if a liver transplant is a good option for you.^1-3

Heart transplant

ATTR amyloidosis often causes serious heart problems. This is called amyloid cardiomyopathy (ATTR-CM). Another name for it is cardiac amyloidosis. The amyloid deposits make the heart muscle thick and stiff. The heart cannot pump blood well. This can lead to heart failure.^1-3

If heart failure becomes very advanced, a heart transplant may be needed. This surgery removes the damaged heart and replaces it with a healthy donor heart.²

A heart transplant can save a life and improve a person’s quality of life. But a heart transplant does not cure ATTR amyloidosis. Your liver still makes the unstable TTR protein. This means new amyloid deposits can form. They can start to build up in the new, healthy heart.²

Because of this, doctors must also treat the source of the TTR protein. After a heart transplant, people must take TTR stabilizer drugs. These drugs help stop the protein from misfolding. This helps protect the new heart.^1-3

In some cases, doctors may suggest a combined heart and liver transplant. This is a very large operation. It replaces the damaged heart and stops the source of the faulty TTR protein. This is only an option for a small number of people.⁴

A heart transplant is a complex surgery. Your medical team will do many tests. They must decide if you are healthy enough for the surgery. Talk to your doctor about all the risks and benefits.⁴

Talk to your doctor

In ATTR amyloidosis, organ transplants are used when the disease causes severe organ failure. A liver transplant removes the source of the faulty TTR protein. A heart transplant replaces a heart that is badly damaged by amyloid.^2-4

Deciding on a transplant is a big decision. It depends on your health, your age, and the type of ATTR you have. Your healthcare team is the best source of information. Talk with them about all your treatment options.