It Was Twenty Years Ago Today Facts & Figures

IT WAS TWENTY YEARS AGO TODAY FACTS & FIGURES The State-Regions Conference The first group of nurses approves the creation of and doctors travels to The ECF project is launched: ISMETT as an experimental UPMC for a period of 1st liver transplant 37 grants awarded to management project training and education performed in Sicily transplant professionals

1997 1998 1999 2000

Official opening of new clinical premises. 1st pediatric liver transplant ISMETT performs its 1st kidney transplant ISMETT performs its 1st performed in a southern 1st living donor performed in Italy on an heart transplant Italian hospital liver transplant HIV+ patient

2004 2003 2002 2001

Opening of the Renato Fiandaca Simulation Center ISMETT performs its first ISMETT, UPMC, and University for training, and of the GMP Facility for cell therapies. lung and kidney-pancreas of Palermo sign agreement World's first lung transplant performed on an transplant to increase training programs HIV+ patient at ISMETT

2005 2006 2007

PPAA Quality Award. Launch of Joint Cardiac ISMETT's 1,000th transplant. ISMETT is the first hospital Surgery Program with ISMETT awarded HIMSS in southern Italy to receive Performance project launched: ARNAS Civico Hospital stage 6 JCI accreditation 18 grants for researchers

2011 2010 2009 2008

First-ever hepatic lobe procurement for purpose ISMETT is acknowledged as an IRCCS (Istituto di of transplant using the ISMETT performs its Ricovero e Cura a Carattere Scientifico) for Da Vinci robot 100th lung transplant end-stage organ failure treatment and research

2012 2013 2014

1st lung transplant performed using EVLP reconditioning 20 years of patient care. Opening of the new techniques. Opening of the new premises hybrid OR at ISMETT JCI Network Quality Award

2017 2016 2015 ISMETT was created in 1997 from an international partnership between the Region of Sicily and UPMC (University of Pittsburgh Medical Center). A center of excellence for transplants and highly specialized therapies and a reference hospital for the entire Mediterranean area, ISMETT is involved in important research projects designed to provide patients with the most advanced therapies for end-stage vital organ failure. With a decree signed by the Italian Minister of Health on 12 September 2014, ISMETT was acknowledged as an IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) for "End-stage organ failure treatment and research."

IRCCS ISMETT is an innovative health care model: it is the first hospital in Italy devoted entirely to the transplantation of all solid organs (liver, kidney, heart, lung, and pancreas) and therapies for end- stage organ diseases aimed at avoiding or delaying the transplant, when possible. Doctors and health care providers at ISMETT come from different parts of the world and work closely with UPMC, bringing to Palermo the expertise and professionalism gained in various international universities and hospitals.

In the last twenty years, working in synergy with an organization of excellence such as UPMC has allowed ISMETT to obtain top levels of patient care and safety, continually improving its performances in terms of clinical outcomes, hospitality, research, training, and management, as confirmed by the important awards it has received. Facts and Figures th

Transplan t Data as of March 31, 2017 Since the very first liver transplant performed in Sicily, in 1999, over 1,900 Liver 1093 (of which 116 from living donor) transplants have been Kidne y 475 performed. Heart 157 More than 1,000 are liver VAD 46 transplants. Lung 150 207 pediatric transplants Pancreas 19 and over 300 living donor liver and kidney transplants. Total 1940

Progressive increase in number of accredited beds 120 114

100 78 80 70 56 60

40 20 20

0 1999 2004 2006 2011 2017 Facts and Figures th

In 2016, a total of 1,551 OR procedures and 4,612 highly-specialized minimally invasive 725 surgeries were performed.

474 OR procedures

214 138

CARDIAC SURGERY ABDOMINAL SURGERY THORACIC TRANSPLANTS + VAD

2500 Minimally invasive surgeries

2000 2147 1500

1000 1318 1147 500

Radiology Cardiology Endoscopy Facts and Figures th

Every year, over one third of patients are admitted in Regular admissions emergency, about 20% are referred from other hospitals, clearly indicating ISMETT is fully integrated in the Sicilian Regional Health System network, and that it is able to offer uncommon levels of care and high-specialty 17% services, even under urgent and emergency conditions.

18% 65%

Data on activity (referring to 2016)

Regular admissions 2,822 Occupancy rate 95% Scheduled Average length of stay 9.6 Average DRG weigh t 3.15 Urgent Patients arriving from other 4.2% regions or other countries Transferred/Urgent

Outpatient services 230,562 Facts and Figures th

Quality

ISMETT is the first hospital in southern therapeutic services of Radiology, Italy to have received, for the first Endoscopy, Dialysis, Cath Lab, time in 2009, accreditation from JCI Pathology, and the Microbiology (Joint Commission International), and Clinical Pathology Laboratory. the most important quality Also, ISMETT's educational activities accreditation system for hospital earned the ISO 9001 certification, facilities. The JCI accreditation was and the environmental reconfirmed in October 2015: this management system and safety in demonstrates the ongoing efforts the workplace were certified as of ISMETT to improve its compliant with the ISO 14001 performances in terms of clinical regulations and with the OHSAS outcomes, nursing care, 18001 regulation. Finally, since 2015, management, hospitality, ISMETT is on the International humanization, and training Registry of the Society of Thoracic programs. In 2015, ISMETT's ISO Surgeons (STS), and the first 9001:2008 certification was also European medical center to use renewed for quality management Crimson technology to review the systems of diagnostic and quality of services provided.

Voluntary certifications

2009 2012 2013 2014 2015

Joint Commission ISO 9001:2008 Legality rating ISO 14001:2008 Environmental Society Thoracic International Radiology, Laboratory, 2016 score: **++ Management System Surgeons Database Cardiac Cath Lab, Endoscopy, ISO 9001:2008 OHSAS 18001 Crimson Pathology, and Dialysis Educational Quality System Safety in the workplace Facts and Figures th

Research

With a decree signed in September 2014 by the Italian Minister of Health, ISMETT was acknowledged as an IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) in the area of "End-stage organ failure treatment and research".

This recognition celebrates the excellence of ISMETT in developing biomedical research, training, quality of care, and organizing and managing clinical services.

ISMETT's research lines

Innovative techniques in Transplants and surgery, radiology, Regenerative medicine end-stage organ failure cardiology, and endoscopy

Information & Clinical immunology and Infections and Communication immunotherapy molecular medicine Technology in health care

Facts and Figures th

At ISMETT there are 5 research laboratories

Experimental Biomedicine Laboratory 1 GMP production, cell and tissue transplants, and QC laboratory 2 Molecular Biology Laboratory 3 Microbiology Laboratory 4 Immunology and Clinical Pathology Laboratory 5 Facts and Figures th

1 Experimental Biomedicine Laboratory The laboratory is equipped with all necessary devices for cell biology and experimental immunology studies, including a mass spectrometer, instrumentation for apheresis, equipment for immunometric determination, and for 3D and rotating cell cultures. The laboratory supports research in regenerative medicine.

2 GMP production, cell and tissue transplantation, and quality control laboratory Includes GMP laboratories dedicated to ATMP (Advanced Therapy Medicinal Products) practices, and compliant with AIFA (Italian Drug Agency) regulations; a laboratory dedicated to cell and tissue transplantation whose activities are regulated by the CNT (Italian National Transplant Center); the quality control laboratory is essential and mandatory under regulatory constraints. These labs are dedicated to the development of cell products for therapeutic use, and support research in the field of transplantation and end-stage organ failure, clinical immunology and immunotherapy, infections, and molecular medicine.

3 Molecular Biology Laboratory The laboratory is equipped with devices for nucleic acid extraction from any type of biological sample, instrumentation for real time PCR analysis, and a traditional next generation sequencing (NGS) sequencer. The laboratory mainly supports research in the field of infections and molecular medicine. Facts and Figures th

4 Microbiology Laboratory

The laboratory is equipped with the necessary instruments for isolation and identification of all microbial agents. It also has a dedicated spectrophotometer to identify microorganisms, and primarily supports the area of infections and molecular medicine.

5 Immunology and Clinical Pathology Laboratory The laboratory is fully equipped for biochemistry, immunometric, pharmacology, hematology, and coagulation tests for diagnostic and experimental use, a flow cytometer with a cell sorter, and a HPLC (high performance liquid cromatography) device. The laboratory supports research in the fields of transplantation and end-stage organ failure, clinical immunology and immunotherapy, and infections and molecular medicine.

Facts and Figures th

Scientific production in accredited journals (Research areas and impact factor) Infections and Molecular Medicine

Clinical Immunology and Immunotherapy

84.1 ICT in Health Care 26% Regenerative Medicine 288.5 59% 0 Transplants and End-Stage Organ Failure 17.4 0% 8% Innovative Techniques in Surgery, Diagnostic and Interventional Radiology, Endoscopy, and Interventional Cardiology 6.4 4% 4.4 2% 84

Number of publications per year 67 58 Scientific publications of IRCCS ISMETT 51 researchers. 43 43 42 35

24 26 21

9 8 5 5 2 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Facts and Figures th

Over the years ISMETT has entered into important scientific collaborations with regional, national, and international partners.

Ÿ Rete Regionale Sicilia Malattie Rare Ÿ ISPEMI (RI.MED Fondation, IZSS, ISZ) Ÿ

GIONAL Distretto Tecnologico Sicilia Micro e Nano Sistemi

RE Ÿ Distretto AMAR (Distretto tecnologico Sicilia per l’Ambiente MARino)

Ÿ Rete Cardiovascolare IRCCS Ÿ Network VAD (Ventricular Assist Devices) Ÿ Network ECMO (ExtraCorporeal Membrane Oxigenator) Ÿ TIONAL Italian Regenerative Medicine Infrastructure (IRMI) Ÿ NA Cluster ALISEI (Advanced Life SciEnces in Italy) Ÿ IATRIS - (Italian Advanced Translational Research Infrastructure)

Ÿ EATRIS - (European Advanced Translational Research Infrastructure) Ÿ MTN - (Mediterranean Transplant Network) TIONAL Ÿ Bioreactor Group Alliance Ÿ Diabetes Research Institute Federation Ÿ McGowan Institute INTERNA Facts and Figures th

Funds obtained by ISMETT-UPMC with competitive calls in 1999-2017

Funds divided by areas € 3,188,098 € 169,025 (Fig.1) 6% 0% Clinical Care Research Training € 17,771,366 € 34,783,062 Other 32% Fig.1 62%

€ 738,769 € 1,680,648 1% 3% € 5,581,936 10%

Type of funds (Fig.2)

National Regional Fig.2 European € 47,910,198 International 86% Facts and Figures th

Agreements for training activities

9% Regional and national training agreements

19%

72%

Public universities Private universities Other training institution

Type of curriculum

Postgraduate schools

University

Master

0 10 20 30 40 Via E. Tricomi, 5 - 90127 Palermo, Italy www.ismett.edu