UPMC Physician Resources

Archives for Transplantation

2017 Update in Abdominal Transplantation Medicine and Surgery — May 12

UPMC Transplant Services, the UPMC Liver Cancer Center, and the UPMC Center for Liver Diseases will host the 2017 Update in Abdominal Transplantation Medicine and Surgery on Friday, May 12. The conference will be divided into two courses – a liver course and a kidney course and will provide health care professions an overview of current trends, management techniques, and new innovations and research to treat liver and kidney diseases.

Friday, May 12

Registration will begin at 7:30 a.m.

Fairmont Pittsburgh
510 Market St.
Pittsburgh, PA 15222

Liver Topics:

•    Living-Donor Liver Transplant
Presented by: Abhinav Humar, MD

•    The Nuts and Bolts of the Liver Transplant
Presented by: Christopher Hughes, MD

•    Predictors of Mortality on the Liver Transplant Waiting List and Early Intervention
Presented by: Swaytha Ganesh, MD

•    Non-Alcoholic Fatty Liver Disease: Non-invasive Evaluation and Treatment Options
Presented by: Jaideep Behari, MD, PhD

•    Intestinal Rehabilitation and Transplantation Solutions for Complex Gastrointestinal Problems
Presented by: Ruy Cruz, MD

 Kidney Topics:

•    Living-Donor Kidney Transplant
Presented by: Amit D. Tevar, MD

•    Antibodies: HLA Typing, CPRA, Crossmatching, and Antibody-Mediated Rejection
Presented by: Puneet Sood, MD, MPH

•    Kidney Transplantation for the Pediatric Patient
Presented by: Armando Ganoza,

•    Is My Patient a Candidate: Listing Elderly, Obese and Patients with Cancer
Presented by: Christine Wu, MD and Amit D. Tevar, MD

•    Long-term Medical Management of Renal Transplant Patient
Presented by: David J. Levenson, MD

Registration

For more information or to register, please visit UPMC.com/AbdominalTransplantConference2017.

The International Society for Heart and Lung Transplantation (ISHLT) 37th Annual Meeting and Scientific Sessions — April 4-8, San Diego

The UPMC Heart and Vascular Institute and UPMC Cardiothoracic Transplant Department will be well-represented at the International Society for Heart and Lung Transplantation (ISHLT) 37th Annual Meeting and Scientific Sessions in San Diego, Ca. Faculty research will be featured in both oral and poster presentations throughout the conference, including:

 

Tuesday, April 4

ACAD Core ID – ISHLT Academy: Core Competency Course in Infectious Diseases in Thoracic Transplantation and Mechanical Circulatory Support

SESSION 2: This Could Happen to You…Drug Interactions and Toxicity Errors to Avoid with Anti-infectives and Immunosuppression and Cracking the Therapeutic Drug Monitoring Code

Presented by: Christopher R. Ensor

 

Wednesday, April 5

Opening Plenary Session

Co-Chair: Jeffrey J. Teuteberg

 

Symposium: When Should We Call It Quits? The Efficacy of Interventions to Ameliorate Psychosocial Risk Factors

When Do We Call It Quits: Intervention Strategies and Outcomes for Medical Non-Adherence

Presented by: Mary Amanda Dew

 

Are All Substances Made Equal?

Presented by: Andrea DiMartini

 

Oral Session: Cutting Edge Updates in Infectious Diseases

0039 – Clinical Risk Factors for Invasive Aspergillosis in Lung Transplant Recipients: Results of an International Cohort Study

Presented by: C. Aguilar, B. Hamandi, C. Fegbeutel, F. P. Silveira, E. A. Verschuuren, P. Ussetti, P. V. Chin-Hong, A. Sole, C. Holmes-Liew, E. M. Billaud, P. A. Grossi, O. Manuel, D. J. Levine, R. G. Barbers, D. Hadjiliadis, L. Singer, S. Husain

 

Oral Session: Bugs and Devices: A Bad Combination

0047 – Epidemiology of Fungal Infections (FI) in Mechanical Circulatory Support Device (MCSD) Recipients: Analysis of IMACS Registry 2013-2015

Presented by: O. Morrissey, R. Xie, J. Schaenman, S. Husain, M. Mooney, T. Nakatani, R. Kormos, M. Gómez-Bueno, S. Aslam, Y. Pya, M. Hannan

 

Symposium: Thinking Outside the Box: Extra-Pulmonary Management in Lung Transplantation

New Lungs – Old Sinuses: Friends or Foes?

Presented by: Joseph M. Pilewski

 

Mini Oral Session: Allocation, Bridging and Lung Allograft Assessment Strategies

0116 – Mechanical Ventilation and Extracorporeal Membrane Oxygenation (ECMO) as a Combined Bridging Strategy to Lung Transplantation: Significant Gains in Survival

Presented by: A. L. Du, J. Hayanga, J. D’Cunha, M. Tuft, M. Morrell, N. Shigemura

 

Mini Oral Session: The Hardware of MCS

0131 – Association Between the Use of Invasive Hemodynamic Monitoring and Outcomes with Percutaneous Left Ventricular Support: A Call for Standardization?

Presented by: J. J. Teuteberg, W. O’Neill

 

0132 – Analysis of Right Ventricular (RV) Regional and Global Systolic Function by Gated Blood Pool SPECT (GBPS) in Patients Undergoing Left Ventricular Assist Device (LVAD) Implantation

Presented by: C. B. Link, A. Nayak, P. Soman, M. A. Simon, J. J. Teuteberg, L. Lagazzi, A. Althouse, R. Kormos.

 

Poster Session 1: Heart Failure

0563 – Does Heart Failure with a Lower Ejection Fraction Mean Higher Costs? Insights from Data Analytics Across a Large Health Care System

Presented by: C. B. Link, S. Koscumb, P. Lynch, R. Ramani, M. Shullo, O. Marroquin, J. J. Teuteberg

 

0570 – Utilizing Data Analytics to Identify Patients at Highest Risk of Heart Failure Readmission

Presented by: C. B. Link, S. Koscumb, P. Lynch, R. Ramani, M. A. Shullo, O. Marroquin, J. J. Teuteberg

 

Poster Session 1: Junior Faculty Clinical Case Reports

0832 – Complications Following Lung Transplantation in a Patient with Short Telomere Syndrome

Presented by: C. Naik, M. Morrell

 

0847 – Successful Resolution of Refractory Rejection with Cyclophosphamide in a Lung Transplant Recipient Intolerant to Cell Cycle and Proliferation Signal Inhibitors

Presented by: C. A. Moore, M. R. Pipeling, C. R. Ensor

 

0865 – Pay Me Now or Pay Me Later: A Tale of Two Sensitized Pediatric Heart Transplant Candidates

Presented by: M. Mangiola, B. Feingold, D. Magnetta, S. West, S. Miller, M. Zinn, M. Marrari, A. Zeevi

 

Thursday, April 6

Sunrise Symposium: “Those Darn CARVs”: Community Acquired Respiratory Viruses in Lung Transplant

In the Pipeline: Novel Therapeutics

Presented by: Christopher Ensor

 

Symposium: Antibodies in Mechanical Circulatory Support: The Phantom Menace

Epidemiology and Risk of the Sensitized MCS Patient

Presented by: Michael Shullo

 

Symposium: Taming of the Shrew: Mycobacterium Abscessus in Lung Transplantation

Management of M. Abscessus in the Lung Transplant Candidate: Preparation for Transplantation

Presented by: Fernanda Silveira

 

Symposium: HLA, AMR and DSA – Approaching Antibodies in Kids

Before Transplant: Why the PRA Doesn’t Matter Anymore

Presented by: Brian Feingold

 

0225 – Neopterin Elevation and Survival Following Left Ventricular Assist Device Implantation

Presented by: M. M. Lander, M. Mercurio, K. Hanley-Yanez, M. S. Sharbaugh, A. D. Althouse, M. A. Simon, J. J. Teuteberg, L. Lagazzi, C. M. Sciortino, C. McTiernan, R. Kormos, D. M. McNamara

 

Oral Session: Contemporary LVAD Trials – Same Old Song or New Tune?

0150 – ENDURANCE Destination Therapy Trial Outcomes as Stratified by Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Classification

Presented by: S. V. Pamboukian, F. D. Pagani, J. J. Teuteberg, R. L. Kormos, C. C. Caldeira, C. H. Selzmann, J. K. Kirklin, B. B. Reid, E. C. McGee, C. A. Milano, J. G. Rogers

 

Oral Session: Contemporary Challenges in Pediatric Heart Transplant

0182 – Impact of Newly Detected Donor Specific Anti-HLA Antibody in the First Year After Pediatric Heart Transplantation

Presented by: A. I. Dipchand, S. Webber, K. Much, B. Feingold, C. Bentlejewski, E. D. Blume, R. Shaddy, C. Canter, J. Lamour, W. Mahle, W. Zuckerman, H. Diop, Y. Morrison, B. Armstrong, D. Ikle, J. Odim, A. Zeevi

 

Mini Oral Session: Novel Strategies and Mechanisms in Lung Preservation, Heart Failure and Assist Devices

0215 – Microvasculature Analysis Using Micro CTA Techniques for Lungs After Different Preservation Process

Presented by: S. Tane, K. Noda, A. J. Hayanga, J. D’Cunha, J. D. Luketich, N. Shigemura

 

Poster Session 2: Lung Transplantation

Poster Discussant: Christopher R. Ensor

 

0988 – A Prophylaxis-Free, Pre-Emptive Approach to the Management of CMV After Lung Transplantation: Single Center Results

Presented by: A. Bertani, P. Vitulo, A. Mularoni, P. Grossi, L. De Monte, E. Russo, M. Beretta, L. Martino, A. Callari

 

Poster Session 2: Nursing, Health Sciences, Allied Health

Poster Discussant: Annette J. Devito Dabbs

 

Friday, April 7

Sunrise Symposium: Contrasts and Similarities in Children and Adults: IPAH, Portopulmonary Hypertension, and Perioperative Management

Co-Chair: Brian Feingold

 

Symposium: Dealing with Antibodies Before and After Heart Transplant

Co-chair: Michael Shullo

 

Symposium: E-Health, Wearables, Social Media and Big Data in Transplantation: Fancy Toys or True Care Innovations?

The Importance of Involving End-Users When Designing Interactive Health Technology Applications for Self-Management Support

Presented by: Annette Devito Dabbs

 

New Ethical and Legal Challenges Surrounding E-health in Transplantation

Presented by: JiYeon Choi, PhD, RN

 

Oral Session: New and Improving? Evolving Outcomes with MCS

0266 – Which INTERMACS 4-7 Patients Are at Low Risk for Mortality at One Year? Insights from the INTERMACS Database

Presented by: J. J. Teuteberg, A. D. Althouse, M. Shullo, N. Kunz, K. Lockard, E. Dunn, L. Lagazzi, C. Sciortino, J. Cowger, S. Joseph, R. L. Kormos

 

Oral Session: Saved by the Bell: Overcoming Adherence and Frailty

0331 – A Trajectory Analysis of Adherence to Recommended Exercise Following Lung Transplantation

Presented by: M. Alrawashdeh, J. Choi, A. DeVito Dabbs

 

Oral Session: PATH to Better Outcomes: Diagnostics in Heart and Lung Transplantation

0346 – Late Graft Dysfunction After Pediatric Heart Transplantation Is Associated with Fibrosis and Decreased Capillary Density by Automated, Whole-Slide Imaging

Presented by: B. Feingold, J. Picarsic, A. Lesniak, M. Wood-Trageser, B. Popp, A. J. Demetris

 

Oral Session: Heart Failure in MCS

0355 – The Duration of Inotropic Support and Survival After Left Ventricular Assist Device

Presented by: E. Grandin, D. Mooney, K. Kennedy, M. S. Kiernan, R. D. Kociol, J. J. Teuteberg, F. D. Pagani, A. C. Gaffey, P. Atluri, E. Y. Birati, S. Myers, D. Naftel, G. Oliveira, K. E. Simpson, R. W. Yeh, J. K. Kirklin, R. L. Kormos, J. Rame

 

0356 – The Incidence of Early and Late Clinical Right Heart Failure and the Impact on Survival After Continuous Flow Mechanical Support: Insights from the New INTERMACS Definition of Right Heart Failure

Presented by: J. J. Teuteberg, G. Studdard, F. Pagani, M. Kiernan, G. Oliveria, E. Rame, P. Alturi, A. Gaffey, E. W. Grandin, J. Kirlin, S. Myers, C. Collum, R. L. Kormos

 

Mini Oral Session: Pediatric Heart Failure, MCS, and Peri-Transplant Issues

0416 – Post-Transplant Outcomes of Patients Supported with the Berlin Heart EXCOR as a Bridge to Transplantation: A Multi-Institutional Study

Presented by: A. Jeewa, M. Imamura, C. Canter, R. Niebler, C. VanderPluym, D. Rosenthal, J. K. Kirklin, M. Tresler, M. McMullan, V. Morell, M. Turrentine, R. Amedur1, K. Nguyen, K. Kanter, J. Conway, R. Gajarski, C. D. Fraser Jr

 

Mini Oral Session: Assessing and Managing the Failing Right Ventricle

0434 – Painting Profiles of Ambulatory Advanced Heart Failure: A Report from the REVIVAL Registry

Presented by: M. M. Kittleson, P. Shah, A. Lala, R. McLean, S. Pamboukian, D. Horstmanshof, J. Thibodeau, K. Shah, D. Lanfear, J. Teuteberg, W. Taddei-Peters, S. Khalatbari, L. Stevenson, D. Mann, K. Aaronson, G. Stewart

 

Mini Oral Session: Patient Centered Outcomes in Advanced Heart and Lung Disease

0456 – Most Survivors Are Glad to Have a VAD

Presented by: L. W. Stevenson, J. Lindenfeld, K. Grady, J. Vader, M. Givertz, D. Naftel, T. Baldwin, S. Myers, R. Kormos, J. K. Kirklin

 

0457 – Slower Gait Speed as a Measure of Frailty Tracks with INTERMACS Profiles, Quality of Life and Predicted Mortality in Ambulatory Patients with Advanced Heart Failure: A Report from the REVIVAL Registry

Presented by: A. Lala, A. Ambardekar, J. Estep, J. Stehlik, M. Mountis, D. Haas, D. Horstmanshof, J. Thibodeau, K. Shah, D. Lanfear, J. Teuteberg, W. Taddei-Peters, S. Khalatbari, L. Stevenson, D. Mann, K. Aaronson, G. Stewart

 

Poster Session 3: Basic Science & Translational Research

1147 – Pyroptosis of Passenger Leukocytes Negatively Impacts the Quality of Lung Grafts During Ex Vivo Lung Perfusion

Presented by: K. Noda, S. Tane, A. J. Hayanga, J. D’Cunha, J. D. Luketich, N. Shigemura

 

1151 – Optimal Perfusate Oxygenation During Ex Vivo Lung Perfusion Can Promote Alveolar Proliferation in Lung Grafts

Presented by: K. Noda, S. Tane, A. J. Hayanga, J. D’Cunha, J. D. Luketich, N. Shigemura

 

1154 – DUAL Ex Vivo Lung Perfusion Techniques Can Contribute to Better Posttransplant Outcomes Through Reconditioning Hypoxic Cells in Lung Grafts

Presented by: K. Noda, S. Tane, A. J. Hayanga, J. D’Cunha, J. D. Luketich, N. Shigemura

 

1155 – ST266 Improves Oxygenation and Reduces Tissue Injury in an In-Situ Rat Left Lung Ischemia-Reperfusion Model

Presented by: C. F. Evans, X. Wang, X. Liu, R. Mishra, V. Mishra, S. Rahimpour, A. Zeevi, R. Banas, S. M. Pham

 

1160 – Bronchial Artery Sparing Lung Preservation: Is It Feasible?

Presented by: S. Tane, K. Noda, A. J. Hayanga, J. D’Cunha, J. D. Luketich, N. Shigemura

 

1161 – Nitrite Improves Mitochondrial Dysfunction Induced by Hypoxia/Reoxygenation in Lung Epithelial Cells: Implications for Ischemia-Reperfusion (I/R) Injury in Lung Transplantation

Presented by: A. Kumar, C. Corey, S. Shiva, M. T. Gladwin, J. D’Cunha

 

Poster Session 3: Heart Transplantation

1192 – Informative and Uninformative Variables in the Scientific Registry of Transplant Recipients

Presented by: E. M. Hsich, L. Thuita, D. McNamara, J. G. Rogers, J. Schold, E. H. Blackstone, H. Ishwaran

 

Poster Session 3: Lung Transplantation

1244 – Systematic Review and Meta-Analysis of Death After Posttransplant Lymphoproliferative Disease in Lung Transplantation

Presented by: C. A. Moore, J. Cheng, C. J. Iasella, A. R. Glanville, M. R. Morrell, R. B. Smith, J. Hayanga, J. F. McDyer, C. R. Ensor

 

1255 – Successful Maintenance Belatacept-Based Immunosuppression in Lung Transplantation Recipients Who Failed Calcineurin Inhibitors

Presented by: C. J. Iasella, R. J. Winstead, C. A. Moore, B. A. Johnson, M. R. Morrell, J. Hayanga, A. Zeevi, E. A. Lendermon, J. F. McDyer, C. R. Ensor

 

1263 – Increasing Tacrolimus Time-in-Therapeutic Range Is Associated with Reduced Chronic Lung Allograft Dysfunction

Presented by: C. A. Moore, K. M. Harrigan, C. J. Iasella, R. Venkataramanan, M. R. Morrell, J. Hayanga, J. D’Cunha, A. Zeevi, J. McDyer, C. R. Ensor

 

Poster Session 3: Mechanical Circulatory Support

1303 – Pre-Implant Under-Expression of CCR3 and Its Ligands Predicts One-Year Mortality in Left Ventricular Assist Device Patients

Presented by: A. Nayak, C. Neill, R. L. Kormos, L. Lagazzi, I. Halder, C. McTiernan, J. Larsen, A. Inashvili, J. Teuteberg, T. N. Bachman, K. Hanley-Yanez, D. M. McNamara, M. A. Simon

 

Saturday, April 8

Sunrise Symposium: Mechanical Circulatory Support – The Interface of Design and Outcome

Co-chair: R. Kormos

 

Sunrise Symposium: Extracorporeal Photopheresis: Shedding Light on Rejection?

Co-Chair: Matthew R. Morrell

 

Plenary Session 3

0496 – Advanced Therapy Utilization and Survival in Ambulatory Patients with Advanced Heart Failure: Results from the Medical Arm of Mechanically Assisted Circulatory Support (MedaMACS) Registry

Presented by: A. V. Ambardekar, M. Kittleson, M. Palardy, M. Mountis, R. Forde-McLean, A. DeVore, S. Pamboukian, J. Thibodeau, J. Teuteberg, L. Cadaret, R. Xie, L. Stevenson, G. Stewart

 

Oral Session: Not the Usual Suspects: Driving Outcomes in MCS

0500 – Temporal Patterns of Adverse Events (AE) Occurring within 60 Days of LVAD Implantation: The Concept of the AE Cascade

Presented by: J. O. Larsen, A. D. Althouse, J. J. Teuteberg, C. M. Sciortino, C. V. Nikas, L. F. Lagazzi, M. S. Sharbaugh, S. U. Iturra, N. M. Kunz, E. M. Dunn, K. L. Lockard, R. L. Kormos

 

Oral Session: Seeing the Patient Beyond the Device

0504 – Glad to Have a VAD Across Intermacs Profiles

Presented by: F. Pagani, M. Kittleson, G. Stewart, A. DeVore, M. Brinkley, S. Myers, M. Miller, D. Naftel, J. J. Teuteberg, L. W. Stevenson

 

Oral Session: Getting to the Heart of the Matter: Psychosocial Predict Outcomes in Transplant and MCS

0243 – Social and Clinical Characteristics Associated with Increased Short Term Mortality in Non-Inotrope Dependent Patients Undergoing Left Ventricular Assist Device Therapy: Results from InterMACS

S. M. Joseph, R. L. Kormos, J. Teuteberg, A. Althouse, J. Cowger.

 

Oral Session: The Weighting Game: Impact of Obesity, Age, and Other Comorbidities in MCS

0471 – Adverse Events After Device Implantation Are More Common in Obese Patients: An IMACS Registry Analysis

Presented by: S. J. Forest, R. Xie, J. K. Kirklin, J. A. Cowger, Y. Xia, A. I. Dipchand, C. Sivathasan, C. Merry, L. H. Lund, R. Kormos, T. Nakatani, U. Jorde, D. J. Goldstein

 

Oral Session: Optimizing Early Outcomes after Lung Transplantation

0482 – Treatment of Antibody Mediated Rejection of the Lung Allograft with Carfilzomib-Based Therapy

Presented by: C. R. Ensor, A. Zeevi, S. A. Yousem, M. Mangiola, M. Marrari, M. R. Morrell, J. M. Pilewski, J. D’Cunha, J. F. McDyer

 

Oral Session: Influencing Long-term Outcomes in Lung Transplantation

0516 – Regulation of KLRG1 Gene Expression by T-bet Correlates with Human Cytomegalovirus-Specific CD8+ T Cells Effector Function

Presented by: A. Hoji, I. Popescu, M. Pipeling, H. Mannem, J. McDyer

Thomas E. Starzl, MD, PhD, ‘Father of Transplantation,’ Dies at 90

Dr. Thomas E. Starzl, known as the “father of transplantation” for his role in pioneering and advancing organ transplantation from a risky, rare procedure to an accessible surgery for the neediest patients, died peacefully Saturday, March 4, 2017, at his home in Pittsburgh.
Dr. Starzl is survived by his wife of 36 years, Joy Starzl, of Pittsburgh, son Timothy (Bimla) of Boulder, Colorado, and a grandchild Ravi Starzl (Natalie) of Pittsburgh. He was preceded in death by a daughter, Rebecca Starzl, and a son, Thomas F. Starzl.

His family issued the following statement:

“Thomas Starzl was many things to many people. He was a pioneer, a legend, a great human, and a great humanitarian. He was a force of nature that swept all those around him into his orbit, challenging those that surrounded him to strive to match his superhuman feats of focus, will and compassion. His work in neuroscience, metabolism, transplantation and immunology has brought life and hope to countless patients, and his teaching in these areas has spread that capacity for good to countless practitioners and researchers everywhere. With determination and irresistible resolve, Thomas Starzl advanced medicine through his intuition and uncanny insight into both the technical and human aspects of even the most challenging problems. Even more extraordinary was his ability to gift that capacity to those around him, allowing his students and colleagues to discover the right stuff within themselves. Nobody who spent time with Thomas Starzl could remain unaffected.

Thomas Starzl is a globally recognized pioneer in science and medicine, but beyond that mantle, he was simply known and loved for the person that he was. He was husband and soulmate to Joy Starzl, father to Tim Starzl (Bimla), Thomas F. Starzl and Rebecca Starzl, grandfather to Ravi Starzl (Natalie), and godparent to Lamont Chatman and Angela Ford. He was deeply loved for his tremendous wit, humor and sensitivity. His traits of humility, keen observation and seemingly limitless memory fused to create a unique personality that was at the same time inspiring and comforting. His drive to always remain in motion led him on grand adventures around the world, from his beloved Colorado Rockies to the Sea of Japan, from the tundra of northern Finland to the beaches of Monaco. He had an expansive knowledge and appreciation for all music, from classical to modern jazz. He enjoyed watching and analyzing movies, often researching their production and topic matter for hours, both before and after repeated viewings. He raised and cared for many canine companions, including Bevo, Thor, Maggie, Tiki, Shelby, Basta, Chooloo and Ophelia. Their unconditional love was matched only by his own love for them. He will be greatly missed.”

Dr. Starzl joined the University of Pittsburgh School of Medicine in 1981 as professor of surgery, and led the team of surgeons who performed Pittsburgh’s first liver transplant. Thirty liver transplants were performed that year, launching the liver transplant program—the only one in the nation at the time.

Until he retired from clinical and surgical service in 1991, Dr. Starzl served as chief of transplantation services at Presbyterian University Hospital (now UPMC Presbyterian), Children’s Hospital of Pittsburgh (now Children’s Hospital of Pittsburgh of UPMC) and the Veterans Administration Hospital in Pittsburgh, overseeing the largest and busiest transplant program in the world. He then assumed the title of director of the University of Pittsburgh Transplantation Institute, which was renamed the Thomas E. Starzl Transplantation Institute in 1996. Since 1996, Dr. Starzl held the titles of Distinguished Service Professor of Surgery at the University of Pittsburgh and director emeritus of UPMC’s Thomas E. Starzl Transplantation Institute.

Dr. Starzl performed the world’s first liver transplant in 1963 and the first successful liver transplant in 1967, both while at the University of Colorado. Despite prevailing worldwide pessimism regarding the ability to transplant allogenic (non-identical) human kidneys, he successfully combined azathioprine and corticosteroids in allogenic kidney transplants performed in 1962 and 1963, leading to the largest series of kidney transplants and invigorating clinical attempts throughout the world.

In addition to developing azathioprine and corticosteroid immunosuppression, Dr. Starzl later introduced anti-lymphocyte globulin and cyclosporine to prevent organ rejection. It was this development in 1980 that advanced transplantation from an experimental procedure to an accepted form of treatment for patients with end-stage liver, kidney and heart disease. It also allowed surgeons to explore the feasibility of transplanting other organs, such as the pancreas and lung.

In 1989, Dr. Starzl announced the first-time use of FK506 (tacrolimus) as a more effective anti-rejection agent. FK506 greatly improved patient and graft survival rates for liver and other organ transplants and made intestinal transplantation possible for the first time. Five years later, FK506 was approved for clinical use by the U.S. Food and Drug Administration.

Under Dr. Starzl’s leadership, the Thomas E. Starzl Transplantation Institute also researched the feasibility of cross-species, or xenotransplantation, for addressing the chronic shortage of human organs. In 1992 and 1993, his team made history when surgeons performed two baboon-to-human liver transplants. Dr. Starzl himself performed six baboon-to-human kidney transplants in 1963 and 1964 and the world’s first chimpanzee liver xenotransplants in three children between 1969 and 1974.

A major focus of Dr. Starzl’s later research was transplant tolerance and chimerism—the existence of cells from both the donor and recipient. His work in this area offered significant contributions to the understanding of transplant immunology, particularly with respect to how and why organs are accepted.

Dr. Starzl was the recipient of more than 200 awards and honors, including the Lasker-DeBakey Clinical Medical Research Award from the Albert and Mary Lasker Foundation in 2012; the 2004 Presidential National Medal of Science, the nation’s highest scientific honor; the David M. Hume Memorial Award from the National Kidney Foundation; the Brookdale Award in Medicine presented by the American Medical Association Board of Trustees and the Brookdale Foundation; the Sheen Prize from the American College of Surgeons; the Bigelow Medal from the Boston Surgical Society; the Medallion for Scientific Achievement presented by the American Surgical Association; the William Beaumont Prize from the American Gastroenterological Association; the Peter Medawar Prize of The Transplant Society; the Jacobson Innovation Award of the American College of Surgeons; the International Chiron Award from the Italian Academy of Science; the Lannelongue International Medal from the Academie Nationale De Chirurgie (National Academy of Surgery, France); the King Faisal International Prize for Medicine from Riyadh, Kingdom of Saudi Arabia; the Rhoads Medal of the American Philosophical Society; the Prince Mahidol Award from Mahidol University at Salaya, Bangkok, Thailand; the Gustav O. Lienhard Award from the Institute of Medicine; and 26 honorary doctorates from universities around the world.

Dr. Starzl’s national and international endeavors included membership in more than 60 professional and scientific organizations. He served as president of the Transplantation Society, founding president of the American Society of Transplant Surgeons and founding president of the Transplant Recipients International Organization. In 1992, he was inducted as one of only five American members into the prestigious National French Academy of Medicine. A sought-after speaker, Dr. Starzl gave more than 1,300 presentations at major meetings throughout the world. He belonged to the editorial boards of 40 professional publications and authored or co-authored more than 2,200 scientific articles, four books and 300 book chapters.

According to the Institute for Scientific Information (ISI), Dr. Starzl for a time averaged one paper every 7.3 days, making him one of the most prolific scientists in the world. In 1999, ISI identified him as the most cited scientist in the field of clinical medicine, a measure of his work’s lasting influence and utility. The book, “1,000 Years, 1,000 People: Ranking the Men and Women Who Shaped the Millennium,” ranked Dr. Starzl 213th on its list of the 1,000 people having the greatest influence on the world in the preceding 1,000 years.

Dr. Starzl’s autobiography, “The Puzzle People: Memoirs of a Transplant Surgeon,” was published by the University of Pittsburgh Press in 1992. Translations have been published in Italian, Japanese, Korean and Spanish. All author’s royalties are donated to the Transplant Recipients International Organization.

Dr. Starzl was born March 11, 1926 in LeMars, Iowa, the son of newspaper editor and science fiction writer Rome Starzl and loving mother Anna Laura Fitzgerald.

He attended Westminster College in Fulton, Mo., where he earned his bachelor’s degree in biology. He went on to the Northwestern University Medical School in Chicago, where in 1950 he received a master’s degree in anatomy and in 1952 earned both a doctoral degree in neurophysiology and a medical degree with distinction.

Following postgraduate work at Johns Hopkins Hospital in Baltimore, Dr. Starzl pursued his interest in surgery and research with a fellowship and residencies at Johns Hopkins, the University of Miami and the Veterans Administration Research Hospital in Chicago. He was a Markle Scholar in Medical Science, a distinguished honor bestowed annually to a small group of exceptionally promising young physicians in academic medicine. Dr. Starzl served on the faculty of Northwestern University from 1958 to 1961 and joined the University of Colorado School of Medicine as an associate professor in surgery in 1962. He was promoted to professor in 1964 and served as chairman of the department of surgery from 1972 to 1980.

Regarding Dr. Starzl:
“Tom Starzl was a man of unsurpassed intellect, passion and courage whose work opened up a new frontier in science and forever changed modern medicine. He will be remembered for many things, but perhaps most importantly for the countless lives he saved through his pioneering work. We at Pitt have lost a friend and colleague who took the University to new heights of recognition and achievement — Patrick Gallagher, Chancellor, University of Pittsburgh

“Dr. Starzl’s pioneering work in organ transplantation set the standard for innovation and excellence at UPMC. An extraordinarily skilled and compassionate surgeon and brilliant researcher, he brought hope to the sickest of the sick, a legacy that we continue to build on today.” — Jeffrey A. Romoff, President and CEO, UPMC

“Tom Starzl’s tremendous respect and affection for his patients became the life force of his career. Countless lives were saved through his advances in technique and his pioneering work to prevent organ rejection. There is not a transplant surgeon worldwide who has not, in some way, been influenced by his work.” — Arthur S. Levine, MD, University of Pittsburgh Senior Vice Chancellor for the Health Sciences and John and Gertrude Petersen Dean of the University of Pittsburgh School of Medicine

“Tom Starzl devoted his life to the cause of human health and advanced the field of medicine in ways that were unimaginable to most. He applied a combination of extraordinary talent and steely determination to build an unparalleled record of impact as a uniquely gifted surgeon, a visionary researcher, a prolific scholar and the single most influential teacher in the ground-breaking field of organ transplantation. In the process, he became a hero to countless transplant patients, their families and their physicians, while also playing a key role in the elevation of Pitt and in the transformation of Pittsburgh.” — Mark A. Nordenberg, Chancellor Emeritus, University of Pittsburgh

“Words cannot convey how deeply saddened we all are with the passing of Dr. Starzl. It’s impossible to quantify the magnitude of his contributions to the field of transplant. I feel so deeply honored and privileged to have had the opportunity to know him personally over the last few years. The world has lost today the greatest figure in the history of transplant, and I have lost my greatest mentor. The Starzl Transplant Institute will continue to work tirelessly to carry on his rich legacy.” — Dr. Abhinav Humar clinical director of the Thomas E. Starzl Transplantation Institute and chief of the Division of Transplantation in the Division of Surgery at UPMC

UPMC Researchers Shine Light on Common Heart Complication After Lung Transplantation

Cardiac arrhythmia is a common complication following lung transplantation, and one that has a significant negative impact on long-term patient survival, reports a team of UPMC researchers in the largest study of its kind to date. The results, published online this week in the Journal of Thoracic and Cardiovascular Surgery, provide critical information that will hopefully lead to better care of transplant recipients.

Arrhythmia, a rapid and irregular heartbeat, can lead to chest pain, stroke and heart failure. In addition, the blood-thinning drugs often used to treat atrial fibrillation, the most common type of arrhythmia, carry risks of heavy bleeding.

“Arrhythmias present a lot of challenges for both physicians and patients. After noticing this complication in many of our lung transplant recipients, we decided to investigate how often and when it was happening, as well as any risk factors,” said lead researcher Jonathan D’Cunha, MD, PhD, associate professor, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, and chief of Lung Transplantation, Department of Cardiothoracic Surgery, UPMC. “Now that we have a better understanding of these events, we can develop a standardized treatment plan, and better educate patients in advance.”

Performing 70 to 100 lung transplants per year, UPMC is one of the leaders for this procedure in the nation. In the new study, researchers examined the medical records of 652 UPMC patients who underwent a single or double lung transplant between 2008 and 2013.

They found that about 30 percent of patients developed arrhythmia, most often during the first week following surgery. Risk factors for a postoperative arrhythmia included being older and having had a previous heart surgery.

Researchers also found transplant recipients who developed an arrhythmia were 1.6 times more likely to die within 5 years than those who didn’t, a finding Dr. D’Cunha attributed more to the potential complications of treating arrhythmia than the abnormal heart beats themselves.

“Our study suggests that we may need to treat patients with blood thinners only for a short amount of time—until they are out of the window of highest risk—which will hopefully improve long-term outcomes,” Dr. D’Cunha explained.

In addition, because arrhythmia after lung transplant can be an anxiety-provoking experience for patients, the findings will allow surgeons to better prepare patients and families for what to expect.

“Most importantly, based on the results of this study, we can now predict, with a reasonable degree of certainty, when arrhythmia will happen,” Dr. D’Cunha said. “This allows us to begin to standardize our treatment approach and improve patient care in the postoperative setting.”

Other members of the research team include Alex D’Angelo, BA, Ernest Chan, MD, J. W. Awori Hayanga, MD, MPH, David Odell, M.D., MMSc, Joseph Pilewski, MD, Maria Crespo, MD, Matthew Morrell, MD, Norihisa Shigemura, MD, James Luketich, MD, Christian Bermudez, MD, and Andrew Althouse, PhD, all of UPMC.

Young Norfolk Girl Receives Liver Transplant in Unique Care Partnership between UVA Children’s Hospital and Children’s Hospital of Pittsburgh of UPMC

PrintA 13-year-old Norfolk girl is the first patient to receive a transplant in a unique pediatric liver transplant partnership between Children’s Hospital of Pittsburgh of UPMC and the University of Virginia Children’s Hospital.

India Johnson suffered from two rare genetic diseases that caused her liver and kidneys to fail. India needed a liver and kidney transplant, so on Feb. 11, her mother contacted the Charles O. Strickler Transplant Center at UVA, the only comprehensive transplant center in Virginia. Coincidentally, it was the same day that UVA’s partnership with Children’s Hospital of Pittsburgh of UPMC was announced.

The partnership was established to expand UVA’s pediatric liver transplant program and increase access to care for transplant patients throughout Virginia. Children’s Hospital of Pittsburgh of UPMC transplant surgeons consult with UVA counterparts and with Virginia-based patients via teleconsult. Once organs become available, a team of nurses, surgeons and specialists from Pittsburgh travel to UVA to perform the transplant alongside UVA transplant surgeons.

India and her mother, Melody Johnson, traveled to Charlottesville for evaluation with the UVA team in person and the Children’s Hospital of Pittsburgh of UPMC team via telemedicine.

“The team was so confident in what they could do, it made me confident,” Melody Johnson said. “I was really comfortable with the facility and the people.”

India received her new liver and kidney on May 17, two weeks after she was originally added to the national organ transplant waiting list. Physicians report that she is doing very well.

“We’re so pleased that India received her transplant closer to home with exceptional care from UVA and Children’s Hospital of Pittsburgh of UPMC,” said Kenneth Brayman, MD, PhD, FACS, division chief of transplant surgery and director of the Charles O. Strickler Transplant Center at UVA.

“We’re honored that India and her family entrusted her care to us and we’re very pleased with her progress so far,” said George V. Mazariegos, MD, director of pediatric transplantation at the Hillman Center for Pediatric Transplantation at Children’s. “She represents the beginning of an important collaboration between our transplant program and our colleagues at UVA. Working together, we plan to greatly enhance this region’s organ transplant capabilities so that families from Virginia can remain close to home and still get the highest level of pediatric transplant care available in the country.”

“India’s transplant experience is a remarkable example of UVA working with partners to provide the highest level of specialty care to the citizens of the commonwealth,” Richard P. Shannon, MD, executive vice president for health affairs at UVA.

Donate Life America and UPMC Partner to Increase Living Donor Transplant Awareness

Donate Life America and UPMC are collaborating on a first-of-its-kind online community aimed at increasing living donor transplant awareness. The initiative recently launched with the activation of the Donate Life America/UPMC Living Donor Transplant Facebook page, the first step in creating a social space for patients, donors and prospective donors to connect, get educated and share their stories.

“Donate Life America is proud to be a part of this effort to increase living donor transplant awareness,” said David Fleming, president and chief executive officer of Donate Life America, a nonprofit alliance of national organizations and state teams committed to increasing organ donation. “We applaud UPMC’s commitment to innovation and desire to educate the public about living donation and its lifesaving benefits.”

More than 120,000 men, women and children are in need of a lifesaving organ transplant. More than 28,000 people receive a transplant in the U.S. each year, including more than 6,000 from living organ donors. Although 90 percent of Americans say they support organ donation, only 52 percent are registered donors, and even fewer understand the benefits of kidney and liver transplants from living donors.

“The transplant field has come a long way over the last 20 years, but the organ shortage has gotten worse,” said Abhinav Humar, MD, UPMC’s chief of transplantation. “One of the main reasons living donor transplants haven’t taken off is because of a lack of information about the process, what it involves and who can be candidates. This initiative is a way to disseminate living donor transplant information to more people, which could help alleviate the organ shortage and save countless lives.”

More than 1 billion people are active on Facebook worldwide, and recent studies have shown that 28 percent of health-related conversations on Facebook support health-related causes, followed by 27 percent of people commenting about health experiences or updates.

“With more than 115,000 Americans waiting for a kidney or liver transplant, it is vital people know about living donation as an option,” Mr. Fleming added. “Living donation offers a key opportunity to save more lives, and Donate Life America is excited to be a part of this initiative to build a national living donation community through the power of social media.”

Donya McCoy knows all too well the power of social media when it comes to finding a donor.

At 3 years old, her daughter Kennedy was diagnosed with a rare metabolic disorder, and doctors believed a liver transplant could correct some of the factors contributing to the disease. Kennedy didn’t have a very good chance at securing a deceased donor liver, and living-donor liver transplant was her best option. Due to her rare condition, the donor had to be unrelated.

After researching how the living donor transplant process worked on several websites, Ms. McCoy posted what she called the “request of a lifetime” on her Facebook page in July 2014 looking for anyone with O positive blood willing to donate 25 percent of his or her liver to save her daughter’s life.

Firefighter Mike Thompson, a former classmate, messaged her back and wanted to help. A successful living donor transplant later took place at Children’s Hospital of Pittsburgh of UPMC.

Today, Mr. Thompson and Kennedy are doing well.

“I wasn’t just going to stand in the fruit section of the grocery store and ask for someone to save my daughter’s life, so I went online to find everything I could about the process,” Ms. McCoy said. “Facebook is my largest network of people unrelated to me and seemed like the natural place to find a donor. As humans we need to share our experiences in the hope of helping others, and this online community will help do that.”

In addition to featuring educational content about living donation, including videos from experts, articles and patient stories, the intent of the Facebook page is to allow patients and families a place to share their stories and connect with others whose lives have been affected by transplantation.

The goal of the partnership is to reduce the pediatric and adult liver and kidney waiting lists, eradicate pediatric waiting-list deaths, and improve access to transplants nationally.

UPMC Passavant and UPMC Shadyside Receive Nation’s Top Ratings for Heart Surgery

The Society of Thoracic Surgeons (STS) has awarded top quality ratings to UPMC Passavant and UPMC Shadyside. UPMC Passavant received the maximum “three star” rating for coronary artery bypass grafting procedures, placing it in the top 8.8 percent of hospitals nationally. UPMC Shadyside received the same rating for aortic valve replacement procedures, placing it in the top 9.9 percent of hospitals nationally.

 

Based on a review of data that was compiled and publicly reported for the 2014 fiscal year, the three star score designates that UPMC Passavant and UPMC Shadyside are statistically better than the national average in their respective procedures.

 

“The UPMC Heart and Vascular Institute works to provide innovative cardiac care of the highest quality to patients throughout the UPMC system,” said Victor Morell, M.D., vice chairman and director of cardiovascular services, UPMC Department of Cardiothoracic Surgery. “We are proud of the dedication displayed by our physicians and staff that led to these tremendous results.”

 

The STS National Database was established to drive quality and safety improvements among cardiothoracic surgeons. It covers adult cardiac, general thoracic and congenital heart surgery.

UPMC-Managed Transplant Hospital Drives Major Economic Benefits for Sicily, Study Finds

PITTSBURGH, May 28, 2015 ISMETT, a leading transplant hospital managed by UPMC in Palermo, Italy, boosted the Sicilian economy by €132.5 million in expenditure in 2013, generated nearly 2,000 jobs and provided a net benefit of more than €73 million by retaining patients who otherwise would have traveled outside of Sicily for care, according to a new study by the Battelle Memorial Institute. At the same time, the partnership with UPMC provided access to research, training and advanced health care management that is transforming Sicily into a biomedical hub for the entire Mediterranean basin.

Formally known as the Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, ISMETT has performed more than 1,600 transplants since it began operations in 1999. An unusual public-private partnership among UPMC, the Region of Sicily and Cervello and Civico hospitals, ISMETT is the only hospital in Italy designed and intended exclusively for solid organ transplantation and highly specialized therapies. It boasts patient survival rates that are among the best in Europe and treats more than 30,000 patients a year with severe organ disease.

“The results of this study reach beyond ISMETT and Sicily, and are evidence of the positive economic benefits generated when high-quality health care combines with cutting-edge research,” said Bruno Gridelli, M.D., chief executive officer of ISMETT and executive vice president of UPMC International Services. “When health care and its various elements—therapy, training and research—are properly managed, they can be powerful forces in the financial and social growth of an entire region.”

To identify and quantify the economic and social benefits of ISMETT for Sicily, UPMC commissioned this detailed analysis from Battelle’s Technology Partnership Practice. The study examined the direct impact of expenditures made by ISMETT, its employees and visitors, as well as the indirect, or multiplier, effects. The researchers also assessed the many and varied “functional impacts” of ISMETT, or those generated by its clinical services, research and development activity, and education of medical staff.

In 2013, the overall impact of ISMETT’s expenditures on the Sicilian economy included €67.9 million directly and €64.5 million through the indirect, multiplier effect. ISMETT and its related economic activities generated 1,793 jobs in Sicily—862 direct and 931 indirect. Battelle estimated that Sicily receives €3.1 million in annual taxes because of ISMETT’s operations, while the Italian national government receives approximately € 19.6 million annually.

As expected when ISMETT was created, the hospital’s presence has reversed the trend of Sicilian patients traveling abroad to receive transplants and high-specialty care, which means more convenience for patients and their families and significant savings for the regional government. According to Battelle, the presence and operation of ISMETT retained a net €73.2 million in the Sicilian economy that otherwise would have been spent outside the region to pay for care, patient transportation and associated costs. Ninety-two percent of ISMETT’s patients are from Sicily, while the rest come from other Italian regions or from abroad.

ISMETT also is an institution that is helping Sicily to build a reputation for science, technological advancement, research and specialty medical training. This has helped to pave the way for the planned Biomedical Research and Biotechnology Center in Carini, which will employ more than 600 people when it opens in 2017. The government-funded center will operate under the leadership of the Ri.MED Foundation, a partnership of UPMC, the government of Italy, the Region of Sicily and the Italian National Research Council.

“Originally seen as an institution that would fill a gap in clinical services in Italy, ISMETT has succeeded beyond our expectations and has grown to become a major economic engine for the Sicilian economy,” said Dr. Gridelli. “Most importantly, ISMETT is improving the well-being of patients throughout Italy and beyond and promises to advance health and science for years to come.”

Rebooting Cell Programming Can Reverse Liver Failure, Says Children’s Hospital/Pitt Study

PITTSBURGH, March 16, 2015 – It might be possible to heal cirrhotic liver disease by rebooting the genes that control liver cell function, according to researchers at Children’s Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine. If validated in human studies, the game-changing strategy, described today in the online version of the Journal of Clinical Investigation, could potentially treat patients who are too sick for liver transplantation and, in the future, reduce the need for transplants.

The project grew out of the observation that not everyone who develops cirrhosis, or scarring of the liver, progresses to liver failure and its life threatening complications, explained Ira Fox, M.D., professor of surgery, Pitt School of Medicine, and director of the Center for Innovative Regenerative Therapies at Children’s Hospital and the McGowan Institute for Regenerative Medicine.

“Even with the large amount of scar tissue that comes with cirrhosis, there should be enough cells left to carry out the normal functions of the liver,” Dr. Fox said. “So when the liver fails, it is the liver cells themselves that aren’t working properly. In this study, we demonstrate what has caused the problem, and more importantly, a way to repair it.”

His team developed a rat model of liver disease that mimics the form of human cirrhosis that progresses to organ failure. In previous work, they found that liver cells taken from animals with cirrhosis, but no liver failure, immediately functioned properly when transplanted into another animal. But cells transplanted from animals with both cirrhosis and liver failure did not function normally at first, indicating that both the liver cells and the liver tissue environment were damaged.

The researchers then compared the genes in the liver cells of the two groups of cirrhotic rats and found unusually low activity levels of the genes that control proteins which play a central role in liver cell function, the most important being a factor called HNF4.

In the new paper, they showed that restoring production of HNF4 by gene therapy reboots the liver cells to normal function. The team first showed this in lab tests and then in rats with liver failure.

“We were pleased to see that the animals got better almost immediately. Remarkably, our tests indicated that it wasn’t stem cells, regeneration or growth of new liver cells that caused improvement. Instead, the diseased cells had healed,” Dr. Fox said. “It seems that in at least some forms of cirrhosis, chronic injury reprograms the liver cells to shut down HNF4 production, a dysfunction that eventually causes liver failure.”

HNF4 gene therapy provided unique insight into the cause of liver failure and has significant potential for human therapy, but the investigators are now looking for other gene targets to develop simpler therapies, such as drugs that block the pathways that mediate failure. The team also is confirming their results with human liver cells.

Co-investigators include Alejandro Soto-Gutierrez, M.D., Ph.D., Joseph Locker, M.D., Ph.D., and other researchers from Children’s Hospital, Pitt School of Medicine and the McGowan Institute; Kyoto Prefectural University of Medicine, Japan; and the University of Pennsylvania.

The project was funded by National Institutes of Health grants DK48794, DK099320 and DK099257, as well as grants from the U.S. Department of Defense.

UPMC Approved to Perform Kidney Transplants at UPMC Hamot

ERIE, Pa., Jan. 22, 2015 – The private organization that manages the nation’s organ sharing network has given approval for UPMC surgeons to start performing kidney transplants at UPMC Hamot. The decision by the United Network for Organ Sharing (UNOS) means kidney recipients in northwestern Pennsylvania will have access to the same world-class care offered at UPMC hospitals in Pittsburgh, where organ transplantation was pioneered and perfected.

UPMC officials expect to begin performing  kidney transplant surgeries, with organs from both living and deceased donors, at Hamot starting this summer. It will mark the first time that UPMC has performed transplant surgeries outside of Pittsburgh.

“This is a really exciting time for the UPMC transplant program. Over the last several years, we’ve expanded our clinics across western Pennsylvania and are seeing more patients for clinic visits where they live, instead of having them travel to Pittsburgh,” said Abhinav Humar, M.D., UPMC’s chief of transplantation. “Now we have our first opportunity to perform transplant surgeries outside of Pittsburgh, and hopefully offer this lifesaving procedure to many more people living with kidney disease.”

Officials estimate that about 250 patients who are currently being evaluated for transplants, are on the waiting list, or are post-transplant will have their care transferred from Pittsburgh to Hamot.  Over the next few months, officials at UPMC Hamot plan to spread the word about the new program through community outreach and town hall meetings. Dates for the meetings are still being determined.

“UPMC has led the way in organ transplantation, from performing first-of-its kind procedures to developing drug regimens that made it possible for transplant survivors to thrive. Now patients can stay here in our community to get the benefit of these amazing innovations,” said David P. Gibbons, M.H.A., R.N., UPMC Hamot’s chief operating officer.

The transplant team at Hamot is currently being assembled and will consist of individuals based at Hamot as well as individuals from the transplant program at Pittsburgh, allowing for a close partnership with the University of Pittsburgh’s Thomas E. Starzl Transplantation Institute. The institute’s namesake, Dr. Starzl, is considered by many to be the father of transplantation.

Since 1981, UPMC has performed more than 17,000 organ transplants, and has developed some of the most extensive clinical expertise in the field, giving hope to patients across the country and around the world.

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