Despite liver transplant, extracardiac manifestations of TTR (especially neurological) progress after transplant; this is due, in part, to the “seeding” effect of amyloid fibrils, in which the liver responds to the presence of any TTR fibrils in the body by producing new wild-type TTR fibrils.15 Presently, many patients need to take RNA silencers or TTR stabilizers after heart-liver transplant to decrease progression of extracardiac amyloidosis. This evidence concerns the gene TTR and amyloidosis.