After Heart Transplant, Surgeon Returns to Operating Room

By In the Loop • February 27, 2020

After a heart transplant in 2018, Dr. Robert Montgomery, a surgeon at NYU, turned to an experimental protocol at Mayo Clinic. The new drug eliminated his tremors and allowed him to return to surgery.

When he was just 29, Robert Montgomery had a defibrillator placed in his chest to guard against the symptoms of familial dilated cardiomyopathy, a genetic form of heart disease.

Montgomery was no stranger to the condition, The Wall Street Journal reports. It had taken the life of both Montgomery's father and a brother. Not only did he worry he'd suffer the same fate, he also feared the disease and his defibrillator might keep him from his dream of becoming a surgeon. "It wasn't clear back then whether the device would interfere with operating-room equipment," he says.

The defibrillator saved Montgomery's life "many times." What it didn't do was stand in the way of him becoming a surgeon. He's currently director of New York University's Langone Transplant Institute in New York City. "Surgery is so important to me," Dr. Montgomery tells the paper. "The operating room is the place where I feel kind of the most at home. I fought really hard to become a surgeon … and stay in the game and now I had this second challenge and it was really important that I overcome that."

That second challenge was a heart transplant in 2018 that was necessary after "a series of cardiac arrests and life-threatening arrhythmias." Just two weeks after his heart transplant — performed by colleagues — the Journal reports that Dr. Montgomery "returned to work part-time. Three months later, he resumed seeing patients."

The only side effect was a tremor caused by the immunosuppressant drug he was taking to keep his body from rejecting his new heart. "Most people learn to live with it," Dr. Montgomery tells The Wall Street Journal. "Unless your profession is a watchmaker or a surgeon. Then it becomes an important thing."

Dr. Montgomery needed a way to keep the tremor at bay. He found that in an "experimental protocol" at Mayo Clinic, where heart transplant patients are being treated with a different anti-rejection drug called rapamycin, the paper reports.

Developed by Mayo cardiologist Sudhir Kushwaha, M.D., the rapamycin protocol has a simple goal: improve the long-term survival rates of heart transplant patients like Dr. Montgomery. And it seems to be working. "His research shows that if patients switch to rapamycin within six months of their transplant, their survival rate is nearly double that of those on the standard drug," according to the article. Other benefits are "a lower likelihood of developing cancer as well as improved kidney function." And importantly for Dr. Montgomery, "tremors aren't a side effect."   

So last June, Dr. Montgomery began a two-month transition to rapamycin. When he was done, not only was his tremor gone but he was feeling well enough to assist on a surgery. Four months later, he assisted colleagues at NYU on two separate kidney transplants, according to The Wall Street Journal. And earlier this month, Dr. Montgomery took the lead on performing his first kidney transplant since undergoing his own heart transplant in 2018.

Dr. Montgomery says he didn't take part in the experimental protocol entirely for himself. He also did it to show other transplant patients that they, too, can return to their normal ways of life after transplant. "That's really important to me, to serve as sort of an example," he tells the paper. "Transplant patients don't want to be marginalized. They want to really be able to turn that page and really get back to their lives."

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