This dual procedure is especially helpful for patients with metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease. MASLD happens when fat builds up in the liver, often without symptoms. It's mostly caused by obesity — defined as a body mass index (BMI) of 30 or higher. In advanced stages, MASLD can lead to serious liver damage that requires a transplant.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (01:09) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"Metabolic-associated steatotic liver disease is the most common liver disease, not only in the United States but worldwide," says Dr. Heimbach.

As obesity rates rise, so does the need to treat patients with MASLD.

"When we have excess fat that builds up in the liver, this can lead to inflammation and scarring and even advanced liver disease," she says.

It won't cause complications for everyone, but, for some, it can progress to cirrhosis.

"When a patient develops cirrhosis, they can then need a liver transplant," Dr. Heimbach says.

And having extra weight can be a reason patients might not be eligible for transplant. At Mayo Clinic, the approach is to help patients with obesity as well as transplant.

"We consider both liver transplant and what's called a sleeve gastrectomy, which is a type of weight-loss operation that can be used as a tool to help patients be successful in managing not only their liver disease with a liver transplant, but their obesity with the sleeve gastrectomy," Dr. Heimbach explains.

The procedures are done simultaneously with multiple teams working together. Dr. Heimbach says it's about providing patients the care they need.

"I'm excited about what transplant offers to all of our patients, which is to be able to return to the life that they had before they got sick. And for patients who were carrying extra weight, not only are they healthy again, but now they're able to really fully enjoy and be fully participating in their life," she says.

Additional Resources:

• Study finds long-term health benefits from bariatric surgery and liver transplant

The post Mayo Clinic Minute: Dual procedure combines liver transplant, bariatric surgery appeared first on Mayo Clinic News Network.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:00) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Imagine if your one life could help save the lives of many. Organ donation has the power to transform a single act into the gift of life for countless people in need.

"This tremendous gift of organ donation can make a new life possible for patients who are waiting for transplant, and there is a critical shortage of available donor organs," says Dr. Heimbach.

The need for living organ donors

As the need for kidneys and livers grows, living donation is becoming an increasingly important option for patients waiting for a transplant.

"The primary benefit of living donor transplant is to be able to go ahead to transplant sooner, so patients don't continue to wait on the list, become more sick, have a risk of dying on the list," she says.

Whether you consider being a living or a deceased donor, it's important to ask questions and plan ahead. 

"It's very important to make your wishes known, talk it through with your family and recognize that all of this is possible because of this remarkable altruism," Dr. Heimbach says.

If you want to be an organ donor, you can sign up for your state's donor registry, mark your choice on your driver's license when you get or renew it, and make sure your family knows you want to be an organ donor. 

Read more about living donor transplants.

Related posts:

• Mayo Clinic Minute: Liver transplant for patients with advanced colorectal cancer
• Mayo Clinic Minute: What to expect as a living kidney donor

The post Mayo Clinic Minute: Become an organ donor and save lives appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Heavy rain and wind didn’t deter a group of Mayo Clinic Transplant Center staff on Monday, June 17 who joined a group of bicyclists raising awareness about the need for living organ donation.

A half-dozen Mayo staff pedaled from southwest Rochester to the Mayo Building in a show of support for “The Organ Trail,” a long-distance bike ride focused on bringing attention to the need for living kidney donors. Husband-and-wife duo Mark and Lynn Scotch founded the nonprofit series of long-distance bike rides following their own experiences as living kidney donors. Mark is also a living liver donor. The Rochester stop is part of a 1,173-mile, 3-week long ride that kicked off in their hometown of Plover, Wis. Mark does the cycling and Lynn helps support the team on the road.

Among those joining in the bike ride was Mayo Clinic Transplant Center Director Julie Heimbach, M.D. Standing before a row of journalists at a media availability, Dr. Heimbach explained why living donation is so critically important.

“At Mayo Clinic, we are all-in on living donation. We definitely believe it is the best way to get people off dialysis, potentially even having a transplant before they need to go on dialysis,” Heimbach said. “We are one of the largest living donor kidney programs in the country. And we’re so delighted to be able to support your ride.”

Dr. Heimbach presented both Mark and Lynn Scotch with gifts, including a Mayo Clinic cycling jersey for Mark Scotch.

The event featured another special surprise. Katelyn Thompson brought her 3-year-old son Cooper Thompson to welcome the cyclists to campus. Cooper received a kidney transplant thanks to Lynn Scotch donating a kidney to a stranger on his behalf.

"We were so astonished when we learned things like 13 people die every day in this country waiting for a kidney transplant. I guess we just thought everybody that needed an organ got one. And that's sadly not the case at all,” Lynn Scotch said. “So we figured if we don't know this, there must be lots of other people that don't know this and might step forward as well. And so began our journey.”

To learn more about becoming a living donor, visit the Mayo Clinic Transplant Center website.

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In addition to celebrating 60 years as a leader in organ transplant practice, Mayo Clinic is also celebrating a record year in the number of transplants performed. Mayo Clinic, as the largest integrated transplant center in the country represented by sites in Arizona, Florida and Minnesota, performed a collective 1,987 organ transplants in 2023. Transplant volumes not only exceeded previous records held by Mayo Clinic, but also those of other national transplant programs. Since the organ transplant practice began with the first kidney transplant on Nov. 25, 1963, more than 31,000 lifesaving organ transplants have been performed at Mayo Clinic.  

"As we celebrate the 60^th anniversary of Mayo Clinic's transplant programs, we are also celebrating a record number of transplants," says Julie Heimbach, M.D., chair of the Transplant Center at Mayo Clinic in Rochester, Minnesota. "Working together across our three destination transplant centers, we have made remarkable progress in patient care which has led to excellent post-transplant outcomes for patients. We have also developed innovative patient care protocols that make transplantation possible even for the most complex patients. We remain focused on the primary value of Mayo Clinic, which is that the needs of the patient come first."

Each of Mayo Clinic's three destination campuses has a large volume and highly successful transplant program. Altogether, Mayo Clinic currently has the largest liver, kidney and heart transplant programs in the country.

This success can be attributed to several factors, including consistent communication and collaboration between sites, as well as collective expertise-sharing best practices. Each site's transplant program continues to push the limit on ways to increase the availability of organs for transplantation while providing high-quality patient care.

“When others say no, we say yes," says Bashar Aqel, M.D., chair of the Transplant Center at Mayo Clinic in Arizona. "It is not easy at all to become a Category of One. With a passion to do more, to be better every day and unparalleled teamwork, we have achieved that distinction."

While performing more organ transplants in 2023 than in any previous year, team physicians and researchers continue to look to the future of organ transplants. The Transforming Transplant strategic initiative aims to transform the field through research and innovation by redefining standards of care for patients in organ failure. The Transplant Specialty Council and Transplant Research Center also are making plans to begin a Transplant Outcomes and Policy Initiative — a structure to invest in data science and build expertise in policy development — in 2024.

“Transplant is a highly complex clinical practice that requires a high degree of coordination throughout the patient journey," says Burcin Taner, M.D., chair of the Transplant Specialty Council and Transplant Center at Mayo Clinic in Florida. "The growing volume of transplants at Mayo Clinic is the ultimate testament that our patients trust our collective expertise. Our successes will spring us to the future in which we envision Mayo Clinic playing an even bigger role in shaping the future of organ transplant globally.”

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Mayo recognizes 60 years of transplant innovation

Charlotte Markle, 81, is among the world's longest-surviving kidney transplant recipients. Her transplant at Mayo Clinic was over 57 years ago on March 2, 1966.

It followed Mayo Clinic's first kidney transplant on Nov. 25, 1963, which was Mayo's first solid organ transplant of any kind. Charlotte is Mayo's longest-surviving transplant recipient.

She attributes her place in medical history to her loved ones and her care team.

"I thank my husband and my family and the doctors that I had," says Charlotte, who is from Oconomowoc, Wisconsin. "Without them, I wouldn't be doing as well as I am."

Transplant innovation begins

Marking its 60^th anniversary this month, the Mayo Clinic Transplant Center is the largest integrated transplant center in the U.S. Mayo's program includes transplant practices at its campuses in Rochester, Minnesota; Jacksonville, Florida; and Phoenix. Since the program began, Mayo Clinic has performed more than 31,000 solid organ transplants.

"What started at Mayo Clinic in Rochester in 1963 has become a world-renowned transplant program," says Burcin Taner, M.D., director of Mayo Clinic Transplant Center in Florida.

In October, Mayo Clinic performed its first minimally invasive, robotic-assisted kidney transplant, which also was the first one performed in Minnesota.

These medical bookends, six decades apart, mark significant steps in transplant innovation, says Julie Heimbach, M.D., director of Mayo Clinic Transplant Center in Minnesota.

"It reflects the spirit of innovation and of recognizing serious and complex disease and how Mayo can contribute to moving the field forward," Dr. Heimbach says.

In 1963, options to care for people with kidney failure were few. Access to hemodialysis, which can replace kidney function temporarily, was limited. Kidney transplantation was a clinical research option in its infancy in the U.S., following the first successful kidney transplant between identical twins performed in Boston in 1954 by a team that ultimately was awarded a Nobel Prize.

Anti-rejection medication to keep the transplant recipient's immune system from attacking the donated organ was in its early stages but necessary for all transplant recipients except identical twins.

"There were just remarkable hurdles that needed to be overcome," Dr. Heimbach says. "Even very young people were dying of kidney failure. It was one surgical and medical innovation on top of another that allowed this progress to be made."

'My only option was a transplant'

Tired. That's how Charlotte, a Waukesha, Wisconsin, native, remembers feeling in her youth. But she recalls serious health problems striking almost overnight in her early 20s. Nausea led Charlotte, a newlywed at the time, to believe she may be pregnant. Before she could see her physician, she began having convulsions. Her local doctors could not determine her problem, and she was flown to Mayo Clinic.

Her Mayo team ultimately diagnosed irreversible chronic kidney failure.

Kidney function is necessary to live. These two bean-shaped organs remove waste from the blood by producing urine. They also play a role in controlling blood pressure, fluid balance, red blood cell counts, metabolic balance and bone health. Each healthy kidney is about the size of a person's fist. They sit in the abdomen along each side of the spine.

Living well with one healthy kidney is possible; that fact makes living kidney donation an option.

Dialysis to clear waste from the blood is a treatment for kidney failure, preceding transplant, but Charlotte had difficulty tolerating those treatments. "My only option was a transplant," she says.

While a kidney transplant was rare in 1966, so was a patient airplane transfer between medical centers. "Nothing was common back then," Charlotte says with a chuckle.

Donor testing of healthy and willing candidates to identify a matching blood and tissue type for the needy transplant recipient was also in its early stages in the 1960s. One of Charlotte's five older brothers, Roland, was identified as her living donor candidate, and Charlotte recalls learning, "We were about as close to being twins as we could be."

'She is an inspiration'

Thomas Schwab, M.D., a retired Mayo Clinic transplant nephrologist, was in eighth grade when Charlotte underwent her kidney transplant. By the time he joined the Mayo staff in 1986 and assumed some of her transplant care, Charlotte already had had her kidney for over 20 years.

"Charlotte's story and outcome is a true inspiration to our transplant teams and especially to those patients in need of a kidney transplant," he says.

Caring for Charlotte has been a privilege, says Dr. Schwab. "It's a reason to get up every morning if you can help patients have an outcome like Charlotte has had."

Watch: Dr. Thomas Schwab talks about transplant recipient

Journalists: Broadcast-quality sound bites with Dr. Schwab are available in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Name super/CG: Thomas Schwab, M.D./Nephrology/Mayo Clinic.

Charlotte has adhered faithfully to her anti-rejection drug regimen. "I do follow doctor's orders," she says. Any side effects from her medical program have been few, and her transplanted kidney function is remarkably normal for a donated kidney that is more than 90 years old, Dr. Schwab notes.

"A kidney transplant is not a sprint. It's a marathon. It requires paying attention to your health and following the program we recommend. But you're not out there alone. We have an entire team of doctors, nurse coordinators and surgeons that help along the way," Dr. Schwab says.

"Over the years, our record of steadily improving patient outcomes shows that research by Mayo Clinic and colleagues worldwide have developed a recipe for long-term success of our transplant patients."

Pioneering medicine, then and now

Dr. Schwab calls Charlotte a "transplant pioneer" who accepted an opportunity with many unknowns at the time — so was her surgeon, George Hallenbeck, M.D. He led the pioneering team who performed Mayo's first kidney transplant in 1963. Dr. Hallenbeck's innovative efforts were not limited to transplant medicine. He was part of the Mayo aeronautical research team that designed the antigravity suit, called the G-suit, a garment developed during World War II that pilots and astronauts wear to keep from blacking out during high acceleration force.

In the early days of kidney transplantation, living donor surgeries were sometimes more extensive than for recipients. Donor surgery required a lengthy incision around a third of the body, and sometimes a rib needed to be removed, Dr. Schwab explains.

Since 1999, living kidney donation surgery at Mayo has been performed with laparoscopic techniques, using smaller incisions to insert surgical instruments and a special camera to remove the donor's kidney. This minimally invasive approach shortens recovery and increases the rate of living kidney donation, which may be arranged in weeks to months compared with an average four- to six-year wait for a deceased donor kidney.

Even into the 1970s, many patients' kidney transplants did not survive one year. Today, one-year survival rates for kidney transplants are over 98%, making it the treatment of choice for patients with kidney failure who are eligible for surgery.

October's robotic-assisted kidney transplant was yet another Mayo milestone. While most kidney transplants are done via open surgery with a 4- to 8-inch incision on the lower abdomen, a robotic-assisted transplant allows the surgeon to make a significantly smaller incision using robotic instruments to complete the transplant, allowing shorter recovery time for the recipient.

Mayo also is focused on research and innovations to expand the kidney donation eligibility pool by helping organs from deceased donors remain viable longer while awaiting transplant. Medical research is being conducted to identify organ failure earlier to delay or prevent the need for a transplant. Mayo transplant experts are developing new practices to help organs last longer after transplantation. In the future, bioengineering of new organs may be possible.

"Our mission is that no patients should die awaiting transplant," says Bashar Aqel, M.D., director of Mayo Clinic's Transplant Center in Arizona.

'I owe all that to Mayo Clinic'

Family and faith have comforted Charlotte during her kidney transplant journey. She recalls praying in the hospital chapel with her mother. "I'm just a strong believer that everything we were doing was the right thing and that everything would turn out," says Charlotte. "I owe all that to Mayo Clinic."

For Charlotte, it's hard to believe how far transplant medicine has come, including a surgeon controlling a robotic instrument to perform the procedure. "It's really something," she says. It pleases her to know that today's female transplant patients may consider pregnancy, which Charlotte and her husband, David, were advised against in the 1960s and 1970s.

Charlotte expresses deep gratitude for her good health during a more than 50-year marriage and a 40-year career as a hospital dietary aide. A widow, she enjoys time with her extended family and quilting and crafting with her sole surviving sibling, her sister, Sharon.  

Emotion tugs at her voice when Charlotte speaks of Roland, who, years after donating a kidney, died awaiting a heart transplant. "My brother would be very proud of me," she says.

To future organ donors and recipients, Charlotte has a message: "I wish them all the best and good meaningful years like I have had."

Related content:

• Four ways organ transplants are being transformed to save more lives
• Bianca's transplant journey  
• Regenerative medicine paves the way for heart transplant
• New heart, new start for Gregg Bohlig 

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ROCHESTER, Minn. — While 2021 proved to be a record-breaking year for organ donation in the U.S., many people are still hesitant to register to become a donor. Nationwide, only about 48% of people are registered to be organ donors, according to LifeSource. That's despite surveys showing that 95% of people in the U.S. support organ donation.

April is National Donate Life Month. Here are five reasons to consider checking the box to become a donor:

1. The need is tremendous

More than 106,000 people in the U.S. are waiting for a lifesaving organ transplant, according to the Organ Procurement and Transplantation Network. Every nine minutes, another name is added to the waiting list. Sadly, an average of 17 people die every day waiting for a transplant.

2. One donor can save many lives. 

A single organ donor can save up to eight lives. Tissue donors can help heal up to 75 people. People who donate their corneas can restore sight to two people. People are eligible to donate across the age spectrum.

"Because the liver continuously regenerates, livers from older donors — even into age 80 and beyond — may be eligible to donate," says Julie Heimbach, M.D., director of Mayo Clinic's William J. von Liebig Center for Transplantation and Clinical Regeneration in Minnesota.

3.  More diverse donors are needed. 

More donors from all backgrounds are needed. But it is especially important for more people from diverse backgrounds to sign up to be organ donors.

Approximately 60% of people on the waitlist for a transplant are people of color. While organs are not matched based on race and ethnicity, people will generally have a better chance of matching with someone from a similar racial or ethnic background.

Fewer diverse donors means people of color can end up waiting longer for a lifesaving transplant.

4. Healthy people also can consider becoming a living donor.

People who are healthy have the option of becoming a living donor. With living kidney donation, which is the most common type of living-donor transplant, donors give one of their two healthy kidneys to the recipient. People who are healthy and have excellent kidney function only need one kidney to live a normal, active lifestyle.

Another option is to become a living-liver donor. A portion of the donor's liver is removed and given to the recipient. The donor's liver grows back to its original size within a matter of weeks.

People can donate to a relative, friend or acquaintance, or a stranger as a nondirected donor.

5. Thanks to medical advances, organ donors are saving more lives.

Recent research and technical advancement are helping ensure more organs are getting to the people who desperately need them. Among the major advances is perfusion technology, which allows more time between organ retrieval and transplant. Antiviral drugs can also be used to help eliminate the hepatitis C risk for people accepting an organ from an infected donor.

Several Mayo Clinic transplant experts can talk about the importance of organ donation, including:

• David Douglas, M.D., director of Mayo Clinic's Transplant Center in Arizona.
• Julie Heimbach, M.D., director of Mayo Clinic's William J. von Liebig Center for Transplantation and Clinical Regeneration in Minnesota.
• Juan Carlos Leoni Moreno, M.D., a cardiologist at Mayo Clinic's Transplant Center in Florida.
• C. Burcin Taner, M.D., director of Mayo Clinic's Transplant Center in Florida.
• Timucin Taner, M.D., chair of the Division of Transplantation Surgery at Mayo Clinic in Minnesota.

###

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contacts:

• Heather Carlson Kehren, Mayo Clinic Public Affairs, newsbureau@mayo.edu
• Tia Ford, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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Jaleezia Gibson, a 19-year-old college student and track athlete from Pennsylvania, was in her dorm room at Minnesota State University, Mankato, when she began feeling poorly. After two days of nausea and vomiting, she called 911. Soon thereafter, she was airlifted to Mayo Clinic from the Emergency Department at Mayo Clinic Health System in Mankato. She had severe liver failure. And COVID-19. 

Dr. Julie Heimbach, chair of the Division of Transplant Surgery at Mayo Clinic in Rochester, says the team had to make the difficult decision as to whether to proceed with a liver transplant when Jaleezia, who was gravely ill, was infected with COVID-19.

"Jaleezia's kidneys had shut down, so she was on hemodialysis. She was on a ventilator that was breathing for her and in a coma because of her liver failure," says Dr. Heimbach. "We had to make a decision very quickly with little data to guide us, but our teamwork, especially with infectious diseases, critical care, hepatology, anesthesia, and transplant surgery, made it possible for us to proceed despite her COVID-19 diagnosis."

In doing so, Jaleezia is thought to be the first patient at Mayo Clinic to undergo a liver transplant while infected with COVID-19.

After two months of recovery and therapy, the young sprinter not only survived, but also her determination and strength inspired the teen's health care team. Dr. Heimbach calls Jaleezia's journey to recovery "remarkable."

Watch: College athlete overcomes COVID-19 with liver transplant.

Journalists: Broadcast-quality video natural sound pkg (2:52) is available in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Read the script.

My body would just feel like it was just shutting down. So I called 911. And then they came, took me to the ambulance and then the helicopter," says Jaleezia.

"Do you have to go pack up your dorm when you leave here," asks Shanna Britt, who is one of the first therapists who worked with Jaleezia.

"Miss Gibson came to us with severe liver failure and her diagnosis also, unfortunately, included that of COVID," says Dr. Heimbach.

"And here's the parallel bars, my first time."

"We had a little bit of an audience."

"I know. We did a lot, especially because for a while there, too, you were so weak that we didn't do a whole lot. And then all of a sudden you just took off."

"I've been doing boxing, stairs, the bike, squats, balancing, strengthening ― all strengthening stuff to make my legs (and arms) stronger."

"Having to recover from a transplant, essentially, you know, just with your family, I know by your side on the phone, but not able to be with you, you know, taking the steps with you down the hall, that all has to be with physical therapy. They have been remarkably supportive for her, and really the whole team that has helped her to recover. It's been fantastic," says Dr. Heimbach.

"You just did stairs without a handrail. And we're over here like on the verge of tears because we're just so happy and excited for you," says Shanna.

"And, really, the personal fortitude that it takes and the attitude that it takes is remarkable and inspiring," says Dr. Heimbach. "And Miss Gibson is very remarkable. And her attitude is so impressive. And it really speaks to the fact that she has been able to recover so quickly and is pushing herself to be where she is today. And to be honest, she actually had liver disease, and she was functioning at a very high level without even knowing it. So I have an expectation that she has unlimited potential in the future." 

"Right here, she's walking for the first time without a walker or anything around the nursing unit," says Shanna. "I think I could speak for all the therapists in our office that worked with Jaleezia, as she was honestly the shining light and a lot of our lives during this time because she was just so positive."

"All of us are really hoping that you can get back to that high-level sprinting, and considering in the last month the amount of progress that you made, I really do think that it's possible. It's going to take a while for you to get that endurance back. But otherwise, I think hope's is just that she's happy and healthy, and lives an awesome life ― and hopefully you will call us in a few years and let us know how she's doing."

"I will. I'm looking forward to gaining my strength back to be able to run again and eventually make the Olympics or something," says Jaleezia.

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date. 

For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

Learn more about: tracking COVID-19 and COVID-19 trends.

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Organ donation often is referred to as the gift of life. In the U.S., 100,000 people are waiting for an organ transplant, according to the United Network for Organ Sharing. Unfortunately, many may never get the call saying that a suitable donor organ has been found. It's estimated that every day in the U.S., 20 patients die because of the lack of donor organs. While organ donation is often thought of as something done after death, living donation is possible with some organs including kidney and liver.

On the next Mayo Clinic Radio program, Mollie Luhman, a living kidney donor, and Dr. Mark Stegall, a surgeon at Mayo Clinic who helped perform the transplant, will share their story. Also on the program, Dr. Michael Zaccariello, a psychologist at Mayo Clinic, will help explain why attention deficit hyperactivity disorder (ADHD) is on the rise. And Dr. Donald Hensrud, a preventive medicine specialist at Mayo Clinic, will discuss nutrition do’s and don’ts.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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When doctors said there was nothing they could do for his end-stage liver disease, Danny Willis refused to give up. He obtained a lifesaving transplant at Mayo Clinic. And even a near-fatal setback after that couldn't stop him from reclaiming his health.

Danny Willis isn't a big fan of superheroes, yet the former Mayo Clinic patient boasts a large Superman tattoo on his neck. The tattoo represents a death-defying fight Danny waged for years and ultimately won. He not only survived severe liver failure by undergoing a liver transplant at Mayo Clinic, but he also overcame mucormycosis, a deadly fungal disease that cost him part of his lung, kidney, leg and shoulder.

Danny committed to getting the tattoo just months before coming to Mayo Clinic's Rochester campus. While hospitalized near his home in Owensboro, Kentucky, and facing a grim prediction that he likely wouldn't survive the night, Danny made a promise to his distraught best friend.

"It took everything I could to say to him that I'm going to make it through this," Danny says. He also told his friend, "And after I get through it, I'm going to get Superman tattooed on my neck."

When Danny regained his health, he debated the body art. "I wanted to be a minister, and I was like, 'Should I get a neck tattoo?' I said I was going to, but I didn't know. And I asked for a sign."

The next day, the owner of a local tattoo studio called him. The owner had heard about Danny's pledge to his friend, and he offered to ink Danny for free.

"Now people come up and ask me all the time, 'Why would you get a Superman tattoo?'" says Danny, who is pursuing that career in the ministry. "And I get to tell them my story."

Gravely ill and out of options

The person Danny was at the beginning of his story bears little resemblance to the person he is today. Morbidly obese and working 80 to 90 hours a week, Danny had poor nutrition and little time to exercise. His weight caused numerous health concerns. In 2012, he was diagnosed with advanced cirrhosis.

"I honestly look back at the other part of my life as if I was someone else," he says. "The wrong decisions I made had me where I was dying."

Danny says his weight prevented him from being placed on the transplant list, and his doctor didn't give him much hope.

"He said, basically, that I was terminally ill, and there's nothing he could do for me," Danny says.

Then Danny heard that Mayo Clinic sometimes could help patients other facilities could not. A call was made, and Danny got an appointment at the Mayo Clinic Transplant Center. In late November 2012, Danny headed to Rochester. "It was a shot in the dark," he says.

He was very sick when he arrived for his appointment, according to Julie Heimbach, M.D., a surgeon in the Liver Transplant Program.

"He had obesity-related liver disease, which is the most common type of liver disease in the U.S.," Dr. Heimbach says.

"My youngest son was only 9 at the time. I wanted to raise my son and see him grow into a man." — Danny Willis

But Danny's weight made him a candidate for Mayo Clinic's obesity-related liver transplant protocol. Offered at only a handful of hospitals in the nation, this protocol combines a weight-loss program with a sleeve gastrectomy surgery that's done in tandem with a liver transplant.

The sleeve gastrectomy surgery reshapes the stomach from a round bag into a small, slender tube that restricts the amount of food a person can ingest, resulting in more durable treatment for obesity.

Transplant success, devastating infection

After being accepted into the protocol, Danny got to work.

"For about a month, I didn't do anything but eat apples and drink water. I was doing everything I could. I wanted to live," says Danny, who stayed at Rochester's Gift of Life Transplant House prior to his transplant. "My youngest son was only 9 at the time. I wanted to raise my son and see him grow into a man."

Despite Danny's efforts, his liver disease worsened. In 2013, he was admitted into intensive care at Mayo Clinic Hospital — Rochester, Saint Marys Campus. In the ICU, Danny slipped in and out of consciousness. "The last time I went into the hospital, I don't really remember much else until I started getting better," he says.

During that time, Danny required varying levels of life support. More than once, he was sedated and connected to a ventilator to help him breathe. Danny says he was perilously close to being disconnected from life support. But on May 23, 2013, a donor liver became available, and Danny underwent a transplant.

After surgery, Danny's medical team waited for him to regain function. When two weeks passed with little progress, Danny's physicians discovered that he'd contracted the fungal infection called mucormycosis.

People who have organ transplants tend to be susceptible to this infection, as are individuals who have Type 1 diabetes, blood cancers and low white blood cell counts. It develops when patients breathe in fungal spores present in the environment. The infection can affect the lungs, gastrointestinal tract, skin, brain and other organ systems, says Paul Deziel, a physician assistant who runs Mayo Clinic's Outpatient Transplant Infection Disease Clinic.

"Most of the time, when this infection is acquired in the presence of immunosuppression, the patient would not survive. It's quite a miracle that he did." — Julie Heimbach, M.D.

Among transplant patients who develop mucormycosis in only one body system, the survival rate is about 52 percent. When the infection spreads to multiple areas, the survival rate decreases dramatically. Danny's infection was widely disseminated, affecting his lungs, kidneys and muscles.

While it's likely that Danny had contracted the infection before his transplant, it only became evident afterward that it was spreading, and it required aggressive treatment.

Surgical removal of the infected tissue is the only way to get rid of the infection. In Danny's case, this included removing parts of his right lung, kidney, right shoulder muscle and left thigh muscle. After that surgery, Danny had daily infusions of antifungal medication for six months. He'll have to take an oral antifungal medication for the rest of his life. Given the seriousness of Danny’s infection, his outcome is remarkable, according to Dr. Heimbach.

"Most of the time, when this infection is acquired in the presence of immunosuppression, the patient would not survive," she says. "It's quite a miracle that he did."

Danny remained hospitalized through the end of the summer. After that, he was transferred to an inpatient rehabilitation facility for two months to regain his strength and learn how to walk again. In October 2013, Danny was able to go home.

Highly motivated and completely changed

Several factors played into Danny's ability to overcome the infection, including his state of mind.

"He got the transplant and got a really good functioning liver," Dr. Heimbach says. "In addition to that, he didn't give up on himself. Even though he had to have multiple surgeries and a long rehab when he wasn't feeling good, he had to get up and move. And he had the strength and the motivation to do that."

Danny's motivation came in the form of his youngest son, Kage. During the moments he felt closest to death, Danny says he'd close his eyes and picture his son. "He was the only one who believed I was going to live."

The compassionate support he received from his Mayo Clinic care team also was instrumental in his recovery.

"I saw good people in the church and in the hospital while I was sick and getting better afterwards, and that's who I wanted to be." — Danny Willis

"I was there by myself, and the people in the hospital were all the support I had. They were amazing," Danny says. "I remember waking up and one of the nurses was just standing in the room, watching me, because she cared. There was a nurse practitioner who would come in and change my wound vac every day. She was the one who was in charge of me, and I remember when I sat up in bed for the first time, she cried. She became part of my family."

While Danny has made an about-face in his lifestyle — he eats well, joined a gym and now carries just 200 pounds on his 6-foot-4-inch frame — he says the ultimate credit for his remarkable survival and recovery rests with God. "He's the one," Danny says, "that got me through this for real."

Bearing witness to the kindness of his Mayo Clinic health care providers and others convinced him to pursue the ministry.

"I saw good people in the church and in the hospital while I was sick and getting better afterwards, and that's who I wanted to be," he says. "I didn't want to be tough any more. In fact, it was the opposite. I have a kind heart toward everyone. We should extend our love to those who are hard to love. I was once hard to love, and it was through other people showing me love that made me want to love."

HELPFUL LINKS

• Learn more about liver disease.
• Read about Mayo Clinic's Liver Transplant Program.
• Explore Mayo Clinic.
• Connect with others talking about transplants on Mayo Clinic Connect.
• Request an appointment.

The post Sharing Mayo Clinic: Facing death and fighting back appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Obese patients who underwent a life-saving liver transplant and weight-loss surgery at the same time were better able to keep the weight off long term and had fewer metabolic complications than those who lost weight on their own before undergoing a liver transplant, Mayo Clinic research shows. The findings were recently published in Hepatology.

“This study shows that the combined approach of liver transplantation and weight-loss surgery is safe and effective over the long term,” says senior author Julie K. Heimbach, M.D., a transplant surgeon and division chair of Transplant Surgery at Mayo Clinic.

As obesity rates in the U.S. have soared, so have the number of people diagnosed with nonalcoholic fatty liver disease – a range of liver diseases that affects people who drink little to no alcohol and results in too much fat stored in liver cells. An estimated 80 to 100 million Americans have been diagnosed with this chronic liver disease. Historically, severely obese patients who are unable to lose the necessary weight have been denied access to a liver transplant because obesity can increase surgical risks and is a potential risk factor for post-transplant complications. In other instances, the transplants are performed without addressing a patient’s weight problem, which can lead to liver disease in the future and jeopardize the success of the transplant.

The study involved a total of 49 adults with a body mass index of more than 35 kg/m2 who were referred to Mayo Clinic for a liver transplant since 2006. Of those patients, 36 were able to lose enough weight to achieve a BMI of less than 35 kg/m2 and underwent a liver transplant alone. Overall, there were 29 patients who were unable to lose sufficient weight prior to transplant and thus underwent a combined liver transplant and sleeve gastrectomy, with 13 of them being at least three years or more from the time of the surgery, which was the focus of the study. Sleeve gastrectomy is a type of weight-loss surgery that reduces the size of the stomach by about 80 percent.

Researchers found that, while patients who underwent the liver transplant alone experienced significant weight loss before surgery, they steadily gained weight afterwards. The percentage of total body weight gained ended up being higher among those patients who had the liver transplant alone compared to those who underwent both a liver transplant and sleeve gastrectomy. Three years after surgery, patients who had the liver transplant alone maintained a weight loss of a median of 3.9 percent of their total body weight compared to 34.8 percent for patients who had the transplant and weight-loss surgery. In addition, those patients who had the dual surgery were less likely to have high blood pressure, insulin resistance and fatty liver. They needed less medication to lower blood pressure and cholesterol.

“Obesity-related liver disease is one of the most common and rapidly increasing reasons that people need a liver transplant. Even though most obese people will not need a transplant, for those who develop advanced liver disease, we need to have an approach that treats not only the liver disease but the cause of the liver disease,” says Dr. Heimbach.

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Media contact:

• Heather Carlson Kehren, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

The post Liver transplant, weight-loss surgery combination benefits obese patients in long term appeared first on Mayo Clinic News Network.