UPMC Physician Resources

Archives for Abdominal Transplant

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.

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.

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.

New Machine-Perfusion Organ Preservation System Keeps Livers Healthier for Transplant

PITTSBURGH, Jan. 22, 2015 – A new preservation system that pumps cooled, oxygen-rich fluid into donor livers not only keeps the organs in excellent condition for as long as nine hours before transplantation, but also leads to dramatically better liver function and increases survival of recipients, according to a series of animal studies by researchers at the University of Pittsburgh School of Medicine and the McGowan Institute for Regenerative Medicine. The system could be tested with transplant patients at UPMC later this year.

The findings, which were published online in the American Journal of Transplantation, suggest that it’s possible to use the technique of “machine perfusion” with a newly created cell-free oxygenated solution to expand the number of high-quality livers available for transplant, thereby shortening waiting times and reducing patient mortality.

Currently, 20 to 40 percent of donor livers cannot be transplanted into recipients because oxygen deprivation during storage and transport in conventional containers can make pre-existing tissue damage worse, explained senior investigator Paulo Fontes, M.D., UPMC transplant surgeon, associate professor, Starzl Transplantation Institute, Department of Surgery, Pitt School of Medicine, and a deputy director of the McGowan Institute. If the damage is too extensive, the organ cannot be safely transplanted into a patient.

“Standard practice is to use a method called cold static preservation, which uses tissue cooling to slow down metabolism with the aim of reducing the demand for oxygen and thus protecting cells from death,” Dr. Fontes explained. “In our new system, we pump a special fluid designed to deliver oxygen to the liver, creating an environment that supports normal function. The integrity of the cells and vital metabolic activity is sustained for eventual transplantation of the organ.”

The research team optimized a machine-perfusion (MP) device that was developed by Organ Assist, a company in the Netherlands, and added a fluid with a hemoglobin-oxygen carrier component to deliver high concentrations of oxygen to the tissue. The liver is immersed in chilled fluid, which is also pumped through tubes inserted into the organ’s large blood vessels to effectively oxygenate the tissue.

The team transplanted six pigs with livers that had been kept for nine hours, roughly the average time between recovery of the organ and transplantation into a recipient, in the MP system and another six with organs placed in the standard container.

They found that 100 percent of the pigs who got MP livers survived, compared to 33 percent of those who received conventionally preserved organs. The MP livers functioned better, produced more bile and had higher oxygen levels than their conventional counterparts, and analyses of multiple biomarkers including inflammatory mediators indicated that the MP livers had been better preserved.

Also, “it was immediately obvious to us that the pigs who received MP livers looked much healthier and easily moved around their pens just hours after they woke up from the surgery,” Dr. Fontes said. “They didn’t look as ill as the animals treated with standard cold preservation. It was amazing.”

The data from the studies have been shared with federal regulators, he added, with the aim of launching a clinical trial to test the system at UPMC this year.

“This system has great potential to enhance our current standards for organ preservation, which should translate into more patients getting a life-saving procedure with potentially better outcomes,” Dr. Fontes said. “Not only that, we have hopes of a faster recovery because the liver could be less likely to become injured due to a lack of oxygen.”

Co-investigators include Roberto Lopez, M.D., Yoram Vodovotz, Ph.D., Marta Minervini, Ph.D., Victor Scott, M.D., Kyle Soltys, M,D., Sruti Shiva, Ph.D., Shirish Paranjpe, Ph.D., David Sadowsky, Derek Barclay, Ruben Zamora, Ph.D., Donna Stolz, Ph.D., Anthony Demetris, M.D., George Michalopoulos, M.D., Ph.D., and James Wallis Marsh, M.D., all of the University of Pittsburgh; and Arjan van der Plaats, Ph.D., of Organ Assist, Groningen, Netherlands.

The study was funded by a charitable gift from Mr. and Mrs. Garcia de Souza, as well as grant DK072146 from the National Institutes of Health.

Surgical, Other Advances Made at UPMC Improve Graft Survival of Intestinal, Multi-Visceral Transplant Patients

SAN FRANCISCO, July 30, 2014 – Innovations in surgical techniques, drugs and immunosuppression have improved survival after intestinal and multi-visceral transplants, according to a retrospective analysis of more than 500 surgeries done at UPMC over nearly 25 years.

The study was led by Goutham Kumar, M.D., a transplant surgery fellow at UPMC’s Thomas E. Starzl Transplantation Institute. Dr. Kumar was recognized for his work with the Young Investigator Award by the 2014 World Transplant Congress and presented his findings at the group’s July 26 to 31 meeting in San Francisco.

“UPMC has led the way in the development of new surgical techniques and important research involving transplantation, and our analysis shows that our innovations have made a real difference to patients,” Dr. Kumar said.

The researchers examined 541 intestinal and multi-visceral transplants done at UPMC from 1990 to 2013. The total consisted of 228 pediatric transplants and 313 adult transplants; 252 were intestine-only transplants, 157 were liver-intestine, 89 were full multi-visceral, and 43 were modified multi-visceral. A majority of the pediatric patients suffered from gastroschisis, followed by volvulus and necrotizing entercolitis. The adult patients needed transplants because of thrombosis, Crohn’s disease or some kind of obstruction.

Researchers analyzed several outcomes and found that pre-conditioning with certain immunosuppressants, the time the graft is outside of the body, certain blood types and a disparity in the gender of donor and recipient were among the factors predicting graft survival.

Co-authors on the study are George Mazariegos, M.D., Guillerme Costa, M.D., Gaurav Gupta, M.D., Dolly Martin, Geoff Bond, M.D., Kyle Soltys, M.D., Rakesh Sindhi, M.D., Abhinav Humar, M.D., and Hiroshi Sogawa, M.D., all of either the Thomas E. Starzl Transplantation Institute, Children’s Hospital of Pittsburgh of UPMC or UPMC.

In addition to Dr. Kumar, six other UPMC and University of Pittsburgh Schools of the Health Sciences researchers were recognized this year with Young Investigator Awards by the World Transplant Congress. They and their presentations are:

Aravind Cherukuri, M.D., Ph.D.
“Transitional B Cell (TrB) T1/T2 Ratio is a Marker for Graft Dysfunction in Human Kidney Transplant Recipients (KTRs)”

Vinayak Rohan, M.D.
“Outcomes of Liver Transplantation for Unresectable Liver Malignancy in Children”

Qing Ding, Ph.D.
“TIM-1 Signaling is Required for Maintenance and Induction of Regulatory B Cells Through Apoptotic Cell Binding or TIM-1 Ligation”

Kanishka Mohib, Ph.D.
“TIM-4 Expression by C Cells Identifies an Inflammatory B Effector 1 Subset that Promotes Allograft Rejection and Inhibits Tumor Metastases”

Dalia Raich-Regue, Ph.D.
“Myeloid Dendritic Cell-Specific mTORC2 Deficiency Enhances Alloreactive Th1 and Th17 Cell Responses and Skin Graft Rejection”

Tripti Singh, M.D.
“B Cell Depletion of Naïve Recipients Enhances Graft Reactive T Cell Responses”

Naturally Occurring Antibodies May be Treatment for BK Nephropathy in Kidney Transplant Patients

SAN FRANCISCO, July 30, 2014 – A viral infection known as BK that commonly causes kidney transplant dysfunction in patients taking high doses of immunosuppressants may be treated with naturally occurring antibodies that already are widely available, according to UPMC-led research that was presented this week at the World Transplant Congress in San Francisco.

The BK virus infects most healthy children in the U.S., but the infection is usually asymptomatic and readily cleared by the immune system. However, following natural infection, latent virus persists in the kidneys for an indefinite time because antibodies in the plasma and circulating T-cells remain at levels that are high enough to prevent virus reactivation.

“However, if the immune system is suppressed — for example by kidney transplant medications designed to prevent rejection of the organ — viral infection flares up and damages the kidney. This causes a condition called BK virus nephropathy,” said Parmjeet Randhawa, M.D., a UPMC pathologist and professor of transplant pathology at the University of Pittsburgh, who led the research. “Currently, there are no anti-viral drugs or vaccines specifically designed for BK nephropathy, and none is likely to be licensed for at least the next 10 years.”

Dr. Randhawa and his team found that anti-BK antibodies are present at very high levels in immunoglobulin preparations currently being used to treat other viral infections, as well as immunologic disorders such as antibody mediated rejection of transplanted organs. These antibodies interact with a BK virus surface protein called VP-1 and effectively neutralize the virus. Such neutralized viruses can no longer infect human cells.

“By artificially constructing viruses varying in the composition of the proteins on their surface, we have shown that this neutralizing action is effective against all six common BK virus strains circulating in human populations,” Dr. Randhawa said. “These findings open the way to conduct clinical trials for preventing and treating BK nephropathy in kidney transplant patients.”

As the proposed immunoglobulin preparations are natural products derived from healthy human subjects, associated side effects are expected to be minimal, Dr. Randhawa said.

Collaborators on the study were Diana Pastrana, Ph.D., and Christopher Buck, Ph.D., both of the National Cancer Institute; Gang Zeng, M.D., of the University of Pittsburgh Department of Pathology; Mel Berger, Ph.D., of CSL Behring, in King of Prussia, Pa.; and Sundaram Hariharan, M.D., and Ron Shapiro, M.D., both of UPMC.

UPMC Presbyterian Receives Highest National Honor for Organ Donor Enrollment Efforts

PITTSBURGH, July 15, 2014 UPMC Presbyterian was recognized by the U.S. Department of Health and Human Services (HHS) for reaching the gold level of achievement, the highest possible, for conducting activities that promoted enrollment in state organ donor registries. The hospital’s efforts over the past year were part of a national campaign known as the Workplace Partnership for Life Hospital Campaign led by HHS to increase donor enrollments in state registries nationwide.

UPMC conducted awareness and registry campaigns to educate staff, patients, visitors and community members about the critical need for organ, eye and tissue donors. The activities included passing out information in Pittsburgh’s Market Square, a parade of transplant recipients throughout the hospital, the annual UPMC Donate Life flag-raising ceremony and outreach efforts on social media. UPMC earned points for each activity implemented between June 2013 and May 2014.

“As transplant pioneers at UPMC, we recognize the importance of the gift of life and have always encouraged our clinicians, staff and members of the community to make the pledge to be an organ donor. We are grateful for the support of the Pittsburgh region in making our efforts a success,” said John Innocenti, president of UPMC Presbyterian Shadyside.

In all, 1,228 hospitals and transplant centers participated in the HHS campaign. Their combined efforts have added 327,659 donor enrollments to state registries nationwide since 2011, exceeding the HHS goal of 300,000. In Pennsylvania, more than 4.5 million people, or 46 percent of registered drivers, are registered organ donors.

UPMC works closely with the Center for Organ Recovery & Education, one of 58 federally designated not-for-profit organ procurement organizations in the United States, to promote organ donor awareness all year long.

For more than 30 years, UPMC has been providing care to adult and pediatric transplant patients through services at the Thomas E. Starzl Transplantation Institute, the UPMC Department of Cardiothoracic Surgery and the Children’s Hillman Center for Pediatric Transplantation. Today, UPMC has performed more than 17,000 transplants, including heart, lung, intestinal, kidney, liver, pancreas and multiple-organ transplants, along with heart assist device implantation.

Dendritic Cell Therapy Improves Kidney Transplant Survival in Preclinical Model, Pitt Experts Say

PITTSBURGH, June 28, 2013 – A single systemic dose of special immune cells prevented rejection for almost four months in a preclinical animal model of kidney transplantation, according to experts at the University of Pittsburgh School of Medicine. Their findings, now available in the online version of the American Journal of Transplantation, could lay the foundation for eventual human trials of the technique.
Organ transplantation has saved many lives, but at the cost of sometimes lifelong requirements for powerful immunosuppressive medication that can have serious side effects, said senior investigator Angus Thomson, Ph.D., D.Sc., distinguished professor of surgery and of immunology, Pitt School of Medicine. Scientists have long sought ways to encourage the organ recipient’s immune system to accept or tolerate the donor organ to reduce the need for drugs to stave off rejection.
“This study shows it is possible to prepare the patient’s immune system for a donor kidney by administering specially treated immune cells from the donor in advance of the transplant surgery,” Dr. Thomson said. “This could be very helpful in the context of planned kidney donations from living relatives, and could one day be adapted to transplantation from deceased donors.”
For the project, the research team generated immune cells called dendritic cells (DCs) from the blood of rhesus macaques that would later provide a kidney to recipient monkeys. Dendritic cells are known to be key regulators of the immune system by showing antigens to T-cells to either activate them against the foreign protein or to suppress the T-cell response. The researchers treated the donor DCs in the lab to prevent them from fully maturing and having the capacity to trigger an immune reaction against foreign proteins.
One week before having a kidney transplant, recipient monkeys received a single infusion of treated DCs obtained from their respective donor animals. Another group of monkeys was transplanted without receiving the cells, but both groups were given the same regimen of immunosuppression drugs, a modified protocol for experimental purposes that eventually results in donor organ rejection. The researchers found that the donor kidney was rejected in about 40 days among animals that got only the drugs, but survived for about 113 days in the group that had a prior infusion of treated DCs.
The modified donor DCs sent signals to the recipient immune system to stay quiet and not launch an attack against the donor organ, explained lead author Mohamed Ezzelerab, M.D., research assistant professor, Department of Surgery, Pitt School of Medicine.
“The results indicate that we achieved immune system regulation without side effects of the DCs, but better yet, the monkeys were healthier from a clinical perspective,” he said. “They maintained a better weight, had less protein in the urine and fewer signs of kidney damage than the other group. Ultimately, all these factors played a role in prolonging organ survival in the group that received DC therapy.”
Co-authors of the paper include other researchers from the Thomas E. Starzl Transplantation Institute, and the departments of Surgery, Immunology, Medicine and Pathology, Pitt School of Medicine. The project was funded by National Institutes of Health grant AI051698.

PSC Partners Seeking a Cure Announces Ninth Annual Conference

UPMC is proud to be a sponsorof the PSC Partners Seeking a Cure’s ninth annual conference for physicians and those affected by primary sclerosing cholangitis (PSC). The conference will be held April 26 to 28, 2013, at the DoubleTree Hotel & Suites, located in downtown Pittsburgh.

The purpose of the conference is to discuss the latest medical advances in the search for better treatments and a cure for PSC, and to offer PSC patients and caregivers the chance to network in an informal setting.

Highlights from UPMC experts include:

  • Natural History of PSC – Kapil Chopra, MD
  • New Advances in the Evaluation of Biliary Strictures – Adam Slivka, MD
  • PSC in Children: The Same Disease? – Benjamin Shneider, MD
  • Improving Quality of Life in PSC: Targeting Pain, Sleep, and Fatigue – Eva Szigethy, MD, PhD
  • Living-Donor Liver Transplant – Abhinav Humar, MD

To register and for more conference information, visit www.pscpartners.org/nextannual or email us at contact@pscpartners.org.

Page 1 of 3:1 2 3 »