Amid the growing need for additional transplant services in the state, Keck Medicine of USC has opened a new location in Las Vegas that will provide specialized care for patients in Las Vegas and surrounding communities who need a liver or heart transplant.  

The clinic is the first in Nevada to offer in-state heart transplant services. 

“Organ transplantation offers patients new hope and may extend lives,” said Marty Sargeant, MBA, CEO of Keck Medical Center of USC. “We are proud to bring our lifesaving care and clinical expertise to Nevada and look forward to working with local physicians, patients, families and the community to promote optimal health for patients in need.” 

Patients who undergo transplantation through Keck Medicine have access to a multidisciplinary team of specialists including USC Transplant Institute surgeons, physicians, nurses, social workers and counselors, specially trained dietitians and pharmacists, and a dedicated transplant coordinator to manage care throughout all phases of transplantation.  

When patients visit the Las Vegas location, they will first undergo a transplant evaluation, which may include medical imaging and diagnostic tests conducted by other local medical providers, to determine if they are candidates for transplantation.  

Upon completing evaluation and if matched with an appropriate organ donor, patients may undergo transplantation at Keck Hospital of USC in Los Angeles and return for post-surgical follow-up care at the Las Vegas location. 

Excellence in heart transplant care 

The USC Heart Transplant Program provides expert care for heart failure and other serious conditions that may require a heart transplant. The program’s one-year survival post-transplant outcomes exceed the national average, according to the Scientific Registry of Transplant Recipients (SRTR), which gathers national organ transplant data.  

“As a pioneer in heart transplantation with some of the best post-transplant outcomes, Keck Medicine is often able to successfully treat patients who traditionally might not have been considered candidates for transplant,” said Raymond Lee, MD, surgical director of the USC Heart Transplant Program and mechanical circulatory support with Keck Medicine. 

The transplant program offers patients access to state-of-the-art care, including noninvasive heart transplant rejection testing, which helps reduce the need for invasive biopsies.  

“Our new clinic addresses an important need for increased access to specialized and compassionate care for patients in need of a heart transplant in Las Vegas and the surrounding communities,” said Ajay Vaidya, MD, medical director of the USC Heart Transplant Program and cardiologist with Keck Medicine. 

Advanced liver transplant care 

The USC Liver Transplant Program has been a leader in liver transplantation for more than 25 years. In January 2024, Keck Hospital outperformed other medical centers as the only liver transplant program in Southern California to receive a 5-tier rating from the SRTR, recognizing Keck Hospital’s one year organ survival rate.  

The transplant team, which treats all types of liver disease and conditions, specializes in several types of liver transplantation, including deceased-donor, transfusion-free and living-donor liver transplants, when a portion of the liver from a healthy person is removed and transplanted into the patient. 

“Our extensive experience and advanced care capabilities support our goal of providing patients with the best possible outcomes and greatest chance of survival after transplantation,” said Jeffrey Kahn, MD, medical director of the USC Liver Transplant Program and hepatologist with Keck Medicine.  

“As a leader in liver transplantation that treats some of the most complex cases, we understand the importance of easily accessible care. We are excited to work closely with Las Vegas patients in their home city to help guide them through their transplant journey,” said Aaron Ahearn, MD, PhD, surgical director of the USC Liver Transplant Program and hepatobiliary and pancreatic surgeon with Keck Medicine. 

The new clinic is located at 2911 N. Tenaya Way, Suite 106, Las Vegas, NV 89128. 

For more information on services and treatment offered at the transplant clinic, please click here. You can learn more about the USC Transplant Institute here.  

Keck Medicine’s growing local presence 

In addition to the new transplant care clinic, Keck Medicine has provided health care to the members and families of the Culinary Workers Union in Las Vegas since 2019. Keck Medicine provides primary care, including internal medicine and pediatric care, and physical therapy at two Culinary Health Center locations across the Las Vegas Valley.

Keck Hospital of USC performs some 300 liver and kidney transplants each year, and provides ongoing care to thousands of post-transplant patients on an outpatient basis. During the peak of the COVID-19 surge in Los Angeles, Keck Medicine of USC physicians implemented a new protocol to monitor and manage the care of liver and kidney transplant recipients who developed COVID-19, including monoclonal antibody therapy for eligible patients.

Now, a new study shows that as a result of these efforts, the number of hospitalizations and deaths for patients managed with the new protocol dropped by 18%. For those who received the drug therapy, the number of hospitalizations were halved, and deaths reduced to zero.

“We took a very proactive approach in managing our at-risk patients that resulted in significantly improved outcomes,” said Aaron Ahearn, MD, PhD, a liver, kidney and pancreas transplant surgeon with Keck Medicine, who also is the principal investigator and corresponding author of the study.

Quick response to an urgent problem

Early in the pandemic, Keck Medicine physicians realized that COVID-19 was much more lethal for transplant recipients than the general population. By December 2020, the height of the Los Angeles outbreak, they were treating 20 or more COVID-positive liver or kidney transplant recipients per week, many of them gravely ill.

“We were overwhelmed with cases and realized we needed to do something quickly to help these patients,” said Ahearn.

Ahearn and his colleagues assembled a multidisciplinary team consisting of transplant, infectious disease, nephrology, hepatology and family medicine specialists to devise a new patient protocol that included:

• Creating a database to track COVID-19 outcomes.
• Educating staff on identifying and monitoring COVID-19 symptoms.
• Creating a triage system to determine the severity of the disease and appropriate level of care.
• Providing telehealth visits by internal and family medicine doctors.
• Giving all recent transplant recipients a home pulse oximetry monitor to track their oxygen levels.

Additionally, eligible patients who tested positive for COVID-19 were offered monoclonal antibody therapy, which the U.S. Food and Drug Administration had approved in November 2020 for emergency use to treat COVID-19. Monoclonal antibodies have been found to be effective for treating mild to moderate COVID-19 disease soon after infection.

Patients who tested positive for COVID-19 within the previous 10 days with symptoms not severe enough to be hospitalized were eligible for the drug therapy. All patients who met this criterion were offered a single outpatient infusion of one of two monoclonal antibody therapies.

How the study was conducted

For the study, the physicians conducted a retrospective review of all liver and kidney transplant recipients who tested positive for COVID-19 and were seen at Keck Hospital from Feb. 1, 2020 to Feb. 28, 2021, a total of 226 patients. They reviewed patient demographics, COVID-19 treatments, hospitalizations and survival rates.

When comparing the outcomes of all patients before and after the protocol was implemented, the study authors found the total rate of hospitalization dropped from 54% to 35% and deaths from 20% to 9%.

They also discovered that the protocol was even more effective for patients who were identified early in their disease course and were therefore eligible for monoclonal antibody therapy.

A total of 34 (17 liver or combined liver/kidney transplant recipients and 17 kidney transplant recipients) received the drug therapy. For this group, COVID-related hospitalizations fell from 32% to 15% and death from 13% to zero.

Additionally, none of the patients had a major adverse reaction to the therapies.

Ahearn believes these results have important implications for the continued treatment of liver and kidney transplant recipients in the age of COVID-19.

“While all patients benefitted from our change in protocol, those who received the monoclonal antibodies benefitted the most,” he said. “Our study strongly suggests that these therapies can reduce disease progression in liver and kidney transplant recipients with COVID-19 and should be considered for all patients.”

Other authors in the study include Thin Thin Maw, MD, a nephrologist with Keck Medicine; Rishi Mehta, MD, a clinical assistant professor of medicine (clinician educator) at the Keck School of Medicine of USC and the associate medical director of inpatient operations at the Keck School; Juliet Emamaullee, MD, PhD, a transplant surgeon with Keck Medicine; Jim Kim, MD, a kidney and pancreas transplant surgeon with Keck Medicine; Emily Blodget, MD, MPH, an infectious disease specialist with Keck Medicine; Jeffrey Kahn, MD, a hepatologist with Keck Medicine; Linda Sher, MD, a hepatobiliary and pancreatic surgeon with Keck Medicine; and Yuri Genyk, MD, a hepatobiliary and pancreatic surgeon with Keck Medicine and division chief of hepatobiliary, pancreas and abdominal transplant surgery at the Keck School.

Living donor transplants, where donors either donate one of their two kidneys or part of a liver to a patient, allow patients in need to receive an organ sooner, improving their chance of survival. Yet nationally, living donor transplants make up only approximately 30% of kidney transplants and 5% of liver transplants.

Each year Keck Hospital of USC assesses some 250 potential living kidney donors and 150 potential living liver donors, typically family or loved ones of the person needing the transplant. Approximately 30% of these donors are rejected due to obesity-related conditions such as high blood pressure, Type 2 diabetes and fatty liver disease. These medical issues may make the surgery less safe for them and can potentially adversely affect the organ they hope to donate.

To improve the health of would-be donors, the USC Transplant Institute of Keck Medicine of USC is launching a unique living donor wellness pilot program that will help donation candidates make sustainable lifestyle changes.

“Keck Medicine wants to creatively and effectively provide the needed support for these donors to not only become healthy for surgery, but for the rest of their lives,” said Jim Kim, MD, director of the program and of kidney and pancreas transplantation at Keck Medicine.

The long-term aspect of the program is crucial. “Without interventions, some of these would-be donors themselves will need a liver or kidney transplant themselves one day,” Kim added.

The program also aims to reduce health disparities in the local community. Keck Medicine serves a large Latinx population, and many of those wishing to become a living donor are Latinx.

“Our efforts are even more crucial because the Latinx community has disproportionately higher rates of obesity and diabetes than other population groups,” said  Helen Hyosun Han, MD, a transplant hepatologist at Keck Medicine and medical director of Keck Medicine’s Living Donor Liver Program.

Participants in the donor wellness program will receive access to nutrition consultations and a registered dietitian, lifestyle redesign coaching with an occupational therapist and fitness support. Participants will also receive a wellness starter kit with additional resources such as:

• Personalized meal plans, a body weight scale and a sports water bottle.
• A wearable fitness tracker and a blood pressure monitor.
• Access to the Mindful USC mobile app, which includes guided meditations.
• A wellness journal.

Participants will be regularly monitored by the transplant team to determine if and when they are healthy enough to donate. Once a participant becomes a donor, the team will monitor them for two years post-surgery to encourage ongoing healthy lifestyle habits.

The pilot program plans to enroll up to 20 participants in the first year. To be eligible for the program, candidates must be:

• Eighteen years or older.
• Financially and psychologically suitable for organ donation.
• Medically determined to have a fatty liver, prediabetes and/or metabolic syndrome (a cluster of conditions that increase the risk of heart attack, stroke and Type 2 diabetes).

 To learn more about the USC Transplant Institute, please click here.

When examining data from the last two decades of all liver transplant recipients in the United States, Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine, and his colleagues discovered that during the entire study period of 2002-2018, Black patients had, on average, a 15% higher chance of dying after a liver transplant than white or Hispanic patients. And from 2017-2018, they had a 60% higher chance of dying after a liver transplant than white recipients of liver transplants. The survival gap between Black patients and white patients increased with the number of years post-transplant.

The findings persisted even after the researchers statistically adjusted the results for a number of demographic and health factors, including where a patient lived, their insurance type, if they had diabetes and severity of liver disease.

Additionally, the study found that Black recipients had a higher severity of liver disease at the time of transplant and tended to die more often from acute or chronic organ rejection than white patients.

“We were very surprised by these results because almost 20 years ago, a landmark study showed that Black patients who underwent liver transplants had lower post-transplant survival rates than white and Hispanic patients, and since then, the field has made numerous interventions to try to narrow the gap,” said Lee. “It is eye-opening that not only does this disparity still exist, it’s gotten worse.”

In comparing the results of the new study with the landmark one of 20 years ago, researchers discovered that the survival gap initially narrowed between 2002-2009, was unchanged in 2010-2013, and then worsened from 2013-2018.

When searching for the reasons behind the study findings, researchers discovered two modest — but significant — factors in the disparity between the outcomes of Black and white patients.

The first was alcohol-associated liver disease — liver damage as the result of heavy alcohol consumption before the transplant.

“The proportion of alcohol-associated liver disease among Black liver-transplant recipients almost doubled from 2002-2005 to 2014-2018, outpacing a 36% relative increase in the disease among white liver-transplant recipients,” Lee said. In addition, Black liver-transplant recipients with alcohol-associated liver disease had a lower survival rate than white liver-transplant recipients with alcohol-associated liver disease.

The second biggest factor was the type of insurance the patient had. Black recipients were more likely to be insured through Medicaid rather than private insurance when compared to white patients. Liver recipients with private insurance had higher survival rates than those with Medicaid.

For the study, researchers analyzed data from the United Network for Organ Sharing registry, which tracks all organ transplants in the United States. They studied the post-transplant life expectancy of approximately 47,000 Black, Hispanic and white liver transplant recipients between 2002 and 2018, the last year for which adequate survival data is available. Black patients were identified as non-Hispanic Black and white transplant recipients as non-Hispanic white.

Lee hopes the study will encourage further research into how issues such as alcohol use and social determinants of health affect organ transplant outcomes.

“Our findings are a huge wake-up call that physicians and other health care professionals need to do better in delivering equitable care,” said Lee. “Hopefully we can begin to invest in interventions that acknowledge previously undiscovered causes of inequity that will successfully narrow the disparity gap in liver transplant survival rates.”

Norah Terrault, MD, a Keck Medicine gastroenterologist and division chief of gastroenterology and liver diseases at the Keck School of Medicine of USC, and Jennifer Dodge, MPH, an assistant professor of research medicine and population and public health sciences at the Keck School, were also study authors.

However, once lung transplant recipients leave the hospital, they may experience complications, such as an infection or organ rejection, that can result in unplanned hospital readmissions and other poor outcomes.

One of the many challenges patients face is managing their health from home and adhering to medication schedules.

To provide another layer of support for lung transplant recipients, the Keck Medicine of USC lung transplant team launched a two-year observational pilot study to monitor patients post-discharge using Bluetooth-enabled devices and computer tablets. The devices measured blood pressure, heart rate, weight, blood glucose, oxygen saturation and pulmonary function.

The researchers discovered that monitored patients had 44% fewer hospital readmissions and spent 54% fewer days in the hospital when they were readmitted.

“This study is significant because it is the first to use Bluetooth technology to comprehensively monitor transplant patients,” says Felicia Schenkel, MSN, lung transplant manager and lead author of the study. “Lung transplant recipients are a high-risk patient population, and we’re happy to see that this program worked so well to improve patients’ lives.”

The study appeared in the American Journal of Transplantation.

Twenty-eight lung transplant patients received the two-year remote tracking and 28 matched control patients did not. With the exception of remote monitoring, all patients received the same level of post-surgical care, which included regular in-person visits and lung function check-ups. The two groups of patients were also similar in respect to demographics, diagnosis and pre-transplant clinical characteristics.

Monitored patients used computer tablets to report symptoms, track appointments and medication compliance, conduct videoconferences with staff and access educational videos along with other materials.

Patients were asked to measure their vital signs and report symptoms daily for the first three months and after that time, three times a week. The results were sent in real time to the transplant team and triggered alerts if out of normal range.

Patients with high compliance rates on reporting vital signs and symptoms received incentives such as badges and humorous memes. Patients with marginal compliance received encouraging reminders and periodic calls from the transplant team.

At the end of the two years, the tracked patients were readmitted to the hospital 66 times versus 112 for the control group. They were less likely to be admitted for infections and non-organ rejection/non-infection causes such as shortness of breath or hypertension. They also had a lower but not statistically significant readmission for organ rejection and for death.

In addition, when monitored patients were readmitted to the hospital, they spent an average of 12 fewer days per patient per year compared to the control group (approximately 10 days versus 22). Hospital costs were also dramatically cut by 48%, translating to a $132,000 reduction in hospital charges per patient per year.

The at-home tracking worked for two reasons, according to Schenkel. “With constant monitoring, we were able to react to data sooner and take intervening steps before a patient’s condition worsened,” she says. “In addition, because we incentivized data reporting, patients were more likely to check in with us about their health and report symptoms.”

Post-surgical remote monitoring is now standard protocol for all lung transplant recipients at Keck Medicine. The department averages between 30 – 40 lung transplants per year.

In the future, study authors hope other medical teams will follow their lead.

“Real-time remote monitoring of patients is not only beneficial to lung transplant patients but can easily be transferred to other types of transplant or critical care patients,” Schenkel says. “This program should be a model for how telemedicine can be used in the future, especially as the need for remote monitoring technology has increased due to the COVID-19 pandemic.”

Other Keck Medicine authors of the study include Mark L. Barr, MD, co-director of the USC Transplant Institute; Sivagini Ganesh, MD, MPH, medical director of the lung transplant program; Maria Bembi, RN, lung transplant coordinator; Roya Sadeghi, RN, lung transplant coordinator; Jeremy O’Connor, MSW, LCSW, cardiothoracic transplant social worker; Marian Duong, RD, cardiothoracic transplant dietitian; Jaynita Patel, MS, RD, clinical dietitian; and Tammie Possemato, project manager.

The Bluetooth devices were provided by ActiCare Health.

Delaney, a high school teacher and marathon runner, had initially gone through the screening process to donate to a friend. When his friend’s condition improved, he offered to give part of his liver to a stranger in need.

“When you do a loving act, the act itself is its own reward,” says Delaney. “Anything worthwhile in life is difficult. So no, it’s not an easy thing to step forward and donate, but the level of satisfaction you get is life-changing.”

Shaw, who was on the national organ registry wait list for three years, found even routine tasks like grocery shopping exhausting.

“I’m eternally grateful,” says Shaw. “I’m excited just to get back out into the world. I want to try new things. I want to say yes to everything.”

Whether it’s a friend, relative or like Delaney, an altruistic person willing to donate to a stranger, being matched with a living donor means a patient can have a transplant before they develop liver disease complications that may be fatal.

“Every year, hundreds of people die waiting for an organ,” says Yuri Genyk, MD, director of the liver transplant program at Keck Hospital, and Delaney’s surgeon. “Living donors are the only way we can narrow the gap between the need and availability of organs.”

Shaw is a typical example. She was at the stage where she needed a liver transplant, but she was not sick enough to receive one from the national organ registry of deceased donors.

“Without a living donor, she would have had to wait for the progression of the disease, with multiple hospitalizations and complications,” says Genyk. “She would be at high risk for developing fatal complications and not surviving on the wait list.” 

How the Transplant Works

At Keck Hospital, donor and recipient surgical teams work simultaneously in side-by-side operating rooms to remove a portion of the healthy liver from the donor and immediately transplant it into the person in need. The donor surgery takes 4-to-5 hours; the recipient surgery takes about 9-to-10 hours to remove the diseased liver, transplant the donated one and then connect all of the various blood vessels and bile ducts.

“Donors completely recover after the operation,” says Genyk. “They eventually return to their studies, occupation, hobbies and physical activities.”

And they’ve given the recipient another chance at life.

Keck Medicine of USC is one of the few institutions in the nation that does living-donor liver transplants. Both donor and patient are assigned an entire team, not just for the surgery, but for the entire journey, from screening through long-term recovery.

“Many people aren’t aware that the liver regenerates,” says Navpreet Kaur, MD, the transplant surgeon who performed Breana’s operation. “Within two months, the liver will grow to almost its full size and potential in both the donor and recipient, and will be completely grown within a year. ”

Becoming a Donor

Most people receive an organ from a family member or friend, but anyone could be a match. The screening process starts with a simple blood test.

In the case of Delaney, through his friend’s experience, he realized there were many more people experiencing liver disease. “They have a disease that’s out of their control. Their life is dependent on someone coming forward. If I were in that situation, I’d hope that someone would do that for me.”

He says that it’s made him appreciate the gift of health. Before this operation, he had never spent the night in a hospital. And yet, “I’d do it again in a heartbeat if I could,” says Delaney. “What greater gift is there in life than to do something to benefit someone else, whether it’s a family member or a stranger?”

To learn more about becoming a living donor in Southern California, visit the transplant institute of Keck Medicine of USC and complete the living donor interest form here.

For more information on the liver and liver transplant, please visit Donate Life. 

More Living Donors Needed

Every year, hundreds of people die waiting for an organ transplant. According to the United States Department of Health and Human Services Organ Procurement and Transplantation Network (OPTN):

• Nearly 114,000 people are on the national organ transplant waitlist. Of those, more than 13,000 are on the waitlist for a liver.
• In 2018, nearly 5 percent of liver transplants were made possible thanks to living donors who stepped forward to save lives.

Assessing the Need

To assess a patient’s need for a transplant, patients are assigned a MELD (Model of End-Stage Liver Disease) score from 6 to 40. At MELD 40, you have a 90 percent of chance of dying within three months.

In some parts of the country, people can receive a deceased-donor liver via the national organ registry with a MELD score of 28. According to the National Liver Review Board, in Southern California it’s 35.

Living donors can change this equation.

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Editor’s Note: Link to electronic press kit with video and photo assets: LINK