FALL 2020 TRANSPLANTdigest A BI-ANNUAL PUBLICATION OF MEDSTAR GEORGETOWN TRANSPLANT INSTITUTE

Hepatitis C Positive Organs Increase Access to Transplant

The wait time for an organ transplant can be significant, ranging from months to years. For patients in need of kidney or liver transplant, one extremely effective approach to shortening wait times is the use of living donor organs. Another newer strategy to further expand organ supply is the use of hepatitis C positive organs from living or deceased donors in patients who do not have the disease.

A revolution in the treatment of hepatitis C has allowed physicians to cure the disease with medications Jason Hawksworth, MD, performs surgery using the da Vinci® robot. continued on page 9 Clinical Spotlight: Robotic Liver and Pancreas Surgery

MedStar Georgetown Transplant hepatopancreaticobiliary surgeries in Institute is home to one of the only the country.” programs in the country that offers robotic liver and pancreas resection for Prior to the robotic surgical option benign and malignant tumors of the being available, a laparoscopic liver, pancreas, and bile ducts. approach was the only minimally invasive surgical option. While Notes Jason Hawksworth, MD, that approach offered many chief of Robotic Surgery at MedStar patient benefits, there was still a Georgetown Transplant Institute, large volume of cases, about 40 to “Currently, 90 percent of our practice 50 percent, that could not be is focused on robotic surgeries, performed laparoscopically. Robotic and we performed 100 robotic surgery allows us to extend the benefits resections during the last calendar of a minimally invasive approach to a year—the highest volume of robotic broader population of patients. continued on page 9

IN THIS ISSUE

2 Letter From the Executive Director 4 Simultaneous Pancreas and Kidney 6 Living Liver Donor Program Transplantation Yields Better Outcomes 2 New Safety Protocol Allowed MedStar Increases Access to Transplantation for Diabetics Georgetown Transplant Institute to Perform 7 MedStar Georgetown Transplant Institute More Kidney Transplants Than Any Other U.S. 5 Can Pediatric Liver Transplant Patients Expect is Largest Center of Minor Blood Group Hospital During Pandemic’s Height a Normal Life Expectancy? Incompatible Transplants 3 Paired Kidney Exchange Markedly Increases 5 Inflammasome Activation Linked to Poor 8 Meet Our New Physicians Number of Transplants Outcomes in Comorbid COVID-19 Patients 10 By the Numbers: MedStar Georgetown’s Transplant Programs LETTER FROM THE EXECUTIVE DIRECTOR New Safety Protocol Allowed MedStar Georgetown Transplant Dear Colleague, Institute to Perform More Kidney Transplants Than Any Other U.S. What an extraordinary time we are Hospital During Pandemic’s Height living in. The COVID-19 pandemic hit the MedStar Georgetown Transplant During the height of the COVID-19 Institute as it did everyone, bringing dramatic changes and raising questions pandemic (March through May), MedStar never before faced. We began to see Georgetown Transplant Institute performed patients with transplants and cancer more kidney transplants than any other presenting to the hospital with severe hospital in the U.S., and successfully COVID-19 in March. Immediately, safeguarded all transplant recipients and we recognized we needed to pivot living donors from contracting COVID-19. from our current clinical strategy and See our March through August volumes research and undertake a redesign of chart on page 12. our approach to care.

Transplant programs across the nation From March to May, the Institute performed were shutting down, temporarily expression of caspase-1 and other 115 organ transplants—90 of which inactivating their patient listings, and markers of pyroptosis appeared to were kidney transplants with 23 of these many suggested we could not provide be present among liver and kidney transplants involving living donors. This transplants until the pandemic passed. disease patients. These were further record number is nearly equal to the total But our patients with organ failure and upregulated when COVID-19 hit, number of transplants performed by all cancer faced a higher risk of death leading to extreme inflammatory regional hospitals combined during the from their underlying disease than from changes that caused severe disease and same period. COVID-19 and needed treatment. death. These findings were published in Journal of Hepatology rapidly, and the We quickly surveyed programs across In collaboration with MedStar Georgetown’s Institute now is working towards infectious disease team and coordinated the nation, took best practices, and a clinical trial with a new substance efforts across the MedStar Health System, enacted an aggressive strategy to for treatment. create COVID-free transplant floors and the Institute took early and aggressive ICU units and implement the highest Since the beginning of this pandemic, measures to implement the highest safety safety protocols to safeguard the as our world has turned upside down, protocols to safeguard the health of health of recipients and living donors. I have been so profoundly impressed transplant recipients and living donors. Working with hospital administration, to witness the teamwork, collaboration, infection control, infectious diseases, ingenuity, selflessness, and dedication “Patients with organ failure are among the and other colleagues, we overhauled of the MedStar Georgetown most vulnerable populations, and life- all our workflows, instituting telehealth, Transplant Institute staff, both clinical saving transplants are critical. While caring breaking up clinical teams, and creating and administrative. Through their for patients with COVID-19 was an urgent the transplant only inpatient units. tireless and unselfish dedication to mission, we could not abandon equally the patients we have the privilege We also recognized the need for of caring for, we managed to safely critical transplant patients. We surveyed best data to guide how we approach our provide more kidney transplants than practices across the nation and developed a patients who contracted COVID-19 any program in the country and remain systematic approach that was individualized though community transmission. one of the most active transplant for us. Working quickly and involving Working through both MedStar programs. I am truly fortunate to work everyone from the top of the organization Health and Georgetown University, with an incredible team that treats down led to our success,” Executive Director we refocused all our research on the all our patients with such dignity in of MedStar Georgetown Transplant Institute, inflammatory pathways that were extraordinarily difficult times. Dr. Thomas Fishbein, said. being activated through COVID-19 among transplant, liver disease, and kidney disease patients. The enhanced safety and infection prevention protocol included: We identified critical changes in Thomas M. Fishbein, MD inflammatory pathways upregulated Executive Director • Priority COVID-19 testing for transplant among these patients, which led to the MedStar Georgetown recipients to rule out recipients who had high risk of severe disease. Increased Transplant Institute the virus before they were transplanted continued on page 12

2 TO REFER A PATIENT, CALL 202-444-3700. TRANSPLANTdigest FALL 2020

Paired Kidney Exchange Markedly Increases Number of Transplants

When a patient in need of a kidney them to the top of the waiting list when transplant is not compatible with his they need a transplant. In addition, or her living donor, a paired kidney through the Family Voucher Program, exchange (PKE) can not only help if a donor is interested in donating a that initial patient get the needed kidney without having an intended transplant, it can also facilitate recipient but has a realistic concern that transplants for other recipients who a family member may need a kidney also do not have a compatible donor. transplant in the future, they are able to MedStar Georgetown Transplant designate up to five first-degree family Institute is a national leader in PKE. members who will receive vouchers In 2019, of the 115 living kidney that allow them to go to the top of the donor transplants performed at the waiting list if they ever need a kidney Institute, 57 were the result of the transplant. Institute’s participation in the National Kidney Registry’s (NKR) paired kidney Breaking down barriers exchange program. to donation Through the Institute’s partnership “Thirty-three percent of individual associated with any complications with the NKR, patients in need of a donor and recipient pairs that that result from donation, legal kidney also get help broadening their present to a transplant program representation should a donor’s search for a donor online. Through have incompatible blood types or a employment or health insurance be the program, patients searching for a positive cross match. This means they negatively affected by living donation, living kidney donor can set up a free can’t donate directly to their intended and prioritization for living donor microsite (webpage). The site gives recipient,” explains Matthew Cooper, transplant in the unlikely case that a them the chance to share their story MD, director of Kidney and Pancreas donor’s remaining kidney fails. Donors through social media with a wider Transplantation. “Fifteen years ago, we may also qualify for lost wage and travel audience, which can help them find a unfortunately told patients they had to and lodging reimbursement. donor more quickly. continue to seek a compatible donor. With PKE, we’re able to make many more life-saving transplants possible. In “When talking with patients with chronic kidney disease, we encourage physicians fact, MedStar Georgetown Transplant to speak to the value of transplant before dialysis and connect them with our team Institute is the nation’s second largest so we can help them begin the search for a donor.” PKE program through the NKR. This ~Matthew Cooper, MD, Director of Kidney and Pancreas Transplantation partnership helps us not only find compatible pairs; it also enhances our ability to find living donors for highly sensitized patients. In the past, our only “Living donation is the first and best “Our goal is to break down barriers option was desensitization, but the choice,” says Dr. Cooper. “These to donation and encourage physicians outcomes for these transplants are not protections enable recipients to to start the conversation about as good as those with a compatible consider people who might not transplantation sooner,” adds living donor. So not only are we able to otherwise be able to afford to make Dr. Cooper.“ transplant more patients, we also see an the donation, expanding the pool of improvement in outcomes.” potential donors.” To learn more about living kidney donor options, call 202-444-3714 The first and best choice Other programs that help increase the or visit MedStarGeorgetown.org/ PKE is only one of the benefits of the number of potential kidney donors Transplant. n Institute’s partnership with the NKR. include the Advance Donation Program. NKR donor benefits also include a Through this program, people can range of financial protections including donate a kidney before their intended donation life and disability insurance, recipient needs a transplant. Recipients financial protections that cover costs then receive a voucher that elevates

MedStarGeorgetown.org/Transplant 3 Simultaneous Pancreas and Kidney Transplantation Yields Better Outcomes for Diabetics

A study published in the American “Referring physicians shouldn’t make assumptions about eligibility for transplant based Journal of Transplantation, Three-month on their patients’ surgical fitness, age, or weight. Type 2 diabetics with a moderate level pancreas graft function significantly of obesity may still be potentially excellent candidates.” influences survival following simultaneous pancreas-kidney ~Peter Abrams, MD, Director of Pancreas Transplant transplantation in type 2 diabetes patients, supports what Peter Abrams, MD, kidney and pancreas transplant difficult-to-control diabetes impossible patients waiting for a kidney transplant surgeon at MedStar Georgetown to control. This can lead to frequent may wait six to seven years for an organ Transplant Institute, has seen in his hospitalizations for ketoacidosis and while those planning to undergo SPK own patients. hypoglycemic unawareness. And wait only an average of six to seven when you dig deeper and talk with months. “Well selected patients with type 2 patients, their quality of life in this diabetes do spectacularly well after situation goes from bad to worse. For patients, the advantages of simultaneous pancreas and kidney SPK comprehensively addresses the undergoing this procedure at the (SPK) transplantation,” he says. “Not complications of type 1 and 2 diabetes. Institute are many: only does the transplant cure the Beyond restoring kidney function, it patient’s diabetes and markedly also addresses brittle glycemic control, • In 2019, our surgeons performed improve quality of life, it also offers retinopathy, neuropathy, and quality of 24 SPK transplants and 13 pancreas a significant allograft and patient life issues such as the need for frequent transplants, the second highest survival benefit compared to kidney blood sugar checks.” volume of pancreas transplants transplant alone.” in the U.S. Patient advantages of SPK • One year graft survival is over Comparing kidney transplant alone to SPK increases the length of time that 95 percent. SPK, Dr. Abrams notes, “The current first the transplanted kidney remains healthy • Complication rates are well below line anti-rejection medication regimen and functioning and can also decrease national averages. used in 90 percent of patients makes the wait time for a transplant. Diabetic • Length of hospital stay is less than seven days. • Physicians don’t just procure organs locally; they go across the country to secure high quality pancreases.

“When treating uremic diabetic patients, the best approach is to refer them for pancreas transplant evaluation sooner rather than later,” adds Dr. Abrams. “Referring physicians shouldn’t make assumptions about eligibility for transplant based on their patients’ surgical fitness, age, or weight. Type 2 diabetics with a moderate level of obesity may still be potentially excellent candidates. In addition, our assessment is based on physiology not chronology. With good fitness, a patient shouldn’t be deprived of an evaluation simply on the basis of age.”

To learn more or to refer a patient for evaluation for pancreas transplantation, call 202-444-3701. n

Source: UNOS.org/data accessed Jan 2019. MGTI (DCCH + DCGU)

4 TO REFER A PATIENT, CALL 202-444-3700. FALL 2020

Can Pediatric Liver Transplant Patients Expect a Normal Life Expectancy? By Udeme D. Ekong, MD, MPH, FAASLD

With the success of pediatric liver in the diagnosis, prognosis, prevention, acute versus chronic), but also in terms transplant over the past four decades, and treatment of graft dysfunction of mechanisms of immunologic injury. it has become important to establish in pediatric liver transplant remain This we believe will allow us to begin to whether children who have undergone to be answered. answer questions about the application successful liver transplant can expect of donor specific antibody test results a normal life expectancy or whether Researchers at MedStar Georgetown in the context of normal graft function there will be a gradual decline in Transplant Institute are performing and graft dysfunction in pediatric liver liver function and eventual graft loss. detailed characterization of donor transplantation. n Moreover, there is an ever-widening specific antibodies in pediatric liver swathe of data that attests to a high transplant recipients in an attempt to Read about the author on page 8 under prevalence of silent chronic graft injury classify rejection phenotypes not only in “Meet Our New Physicians.” in pediatric liver transplant recipients terms of dynamics (early versus late and that may be a manifestation of antibody- mediated rejection. Inflammasome activation linked to poor One of the major reasons for graft loss outcomes in comorbid COVID-19 patients is immunologic damage; and one of the causes of immunologic damage is A study led by MedStar Georgetown Transplant Institute and recently published in post-transplant de novo autoimmune the Journal of Hepatology suggests that inflammation, resulting from heightened hepatitis. Researchers at MedStar inflammasome activity, leads to immune dysregulation and ultimately severe disease Georgetown Transplant Institute are for comorbid patients with COVID-19. seeking to better understand why some children develop de novo autoimmune Early COVID-19 risk profiles warned hepatitis following liver transplant and patients with inflammatory comorbidities “Examining the clinical courses and immune others do not, despite the use of the were at increased risk of morbidity and responses of our COVID-19 patients led us to same protocol-driven, anti-rejection mortality. Included in these populations explore the link between immune dysfunction medicines in every patient. are patients with liver disease and liver and inflammatory comorbidities.” transplant recipients, who are likely to ~Alexander Kroemer, MD, transplant surgeon To find these answers, researchers have comorbid illnesses. at the Institute are studying the pro- inflammatory properties of human The study’s lead authors, Alexander Kroemer, MD, transplant surgeon and MedStar endogenous retrovirus (HERV) proteins Georgetown Transplant Institute scientific director, Khalid Khan, MD, medical director in autoimmune hepatitis, and post- of the Islet Cell Transplant Program, and Thomas Fishbein, MD, executive director of transplant de novo autoimmune the Institute, recognized that transplant candidates and recipients were especially hepatitis, in an attempt to understand the vulnerable populations and worked to better understand how to provide specialized contribution of HERV proteins to disease treatment to these patients. pathogenesis in autoimmune liver disease. This has the potential to lead to “Examining the clinical courses and immune responses of our COVID-19 patients led complementary treatment options for us to explore the link between immune dysfunction and inflammatory comorbidities,” patients with autoimmune liver disease. said Dr. Kroemer. “The inflammasome and resulting inflammatory cell death, which may contribute to low lymphocyte and T-cell counts, has also been seen in other viral Another cause of immunologic diseases such as HIV.” damage and silent chronic graft injury in pediatric liver transplant recipients The study found that upon activation, the inflammasome can induce a form of is antibody-mediated rejection. The highly inflammatory cell death called pyroptosis. This leads to release of pro- mechanisms for antibody-mediated inflammatory cytokines, potentially contributing to the cytokine storms reported in rejection injury involve binding of donor severe COVID-19 cases. In addition, it can drive immune dysfunction via T-cell and specific antibodies to antigenic targets lymphocyte depletion, which prevents the adaptive immune system from mounting on the graft endothelium. However, an effective antiviral immune response. Viruses such as SARS-CoV-2, which can further many questions about the application activate the inflammasome, could exacerbate and accelerate this detrimental immune of donor-specific antibody test results response in patients who already have chronic activation. n

MedStarGeorgetown.org/Transplant 5 Living Liver Donor Program Increases Access to Transplantation

More than 14,000 people are “Because a living donor is extensively screened for health problems before being waiting for a liver transplant in the approved for donation, the quality of the donated liver is often superior to a liver United States. Despite significant from a deceased donor.” improvements in the process of deceased donation in recent years, the ~Juan Francisco Guerra, MD, Director of Living Donor Liver Program number of donors is still lower than the number of patients in need of a liver transplant. In addition, up to 30 percent of patients on the waitlist will become Living liver donation: an option A leader in living liver donor too sick for transplantation or die for all recipients transplantation A living donor can be a friend, family while waiting. MedStar Georgetown Transplant member, or stranger who has an Institute is a national leader in liver identical or compatible blood type with For a significant number of patients on transplantation, with more than the recipient. Comparable size match the waitlist, receiving a liver graft from 40 years’ experience performing between the donor and recipient is often a living donor could be an option that transplants. As one of the largest also required. A donor can donate to a allows them to get the transplant they liver transplant centers in the region pediatric or an adult recipient. The piece need much sooner. and one of the top six programs in of liver to be donated will be determined the nation in terms of outcomes, the by the recipient’s age and size. “Currently, the national organ allocation Institute provides recipients and donors system uses MELD score for liver with leading edge approaches to After the transplant, based on the liver’s allocation. There are always several transplantation to expand access to unique capacity to regenerate, both n people with unquestionable indications organs and shorten wait times. the donor’s liver and the donated for liver transplant who have a low portion grow to almost normal size MELD score on the waitlist, which within eight weeks. means they will have to wait a long time for their transplant or will have to become sicker and/or develop Juan Francisco Guerra, MD other life-threatening complications Dr. Guerra is a board-certified secondary to end stage liver disease, surgeon who specializes in intestinal such as liver tumors, to qualify for and liver transplantation, with a transplant sooner,” explains Juan special focus on living donor liver Francisco Guerra, MD, head of MedStar transplant. He treats both adult and Georgetown Transplant Institute’s Living pediatric patients who have been Liver Donor Transplantation Program. diagnosed with a wide range of conditions, including liver cancer, One of the major advantages of living benign and cancerous pancreatic donor liver transplantation is the fact tumors, portal hypertension, and that recipients can avoid waiting for biliary disease and tumors. months or years for a deceased donor. “Because a living donor is extensively He earned his medical degree and screened for health problems before completed his general surgery being approved for donation, the residency at Universidad de Chile. Dr. Guerra completed his fellowship quality of the donated liver is often in hepatobiliary surgery and transplantation at MedStar Georgetown superior to a liver from a deceased University Hospital. donor. In addition, recipients can undergo the transplant while they Dr. Guerra treats patients with complex liver, intestinal, pancreas, and bile duct are comparably in better health and disease and takes a multi-disciplinary, team-based approach to his patients’ schedule the transplant at the best care to ensure they have access to all treatment options for their condition. possible time in terms of their health,” He sees patients at MedStar Georgetown University Hospital and speaks both adds Dr. Guerra. English and Spanish.

6 TO REFER A PATIENT, CALL 202-444-3700. TRANSPLANTdigest FALL 2020

MedStar Georgetown Transplant Institute is Largest Center of Minor Blood Group Incompatible Transplants By Alexander Gilbert, MD

In 2014, the United Network for Expanding options for living Organ Sharing revised the process of donors allocating deceased donor kidneys. Building on our initial success, we have As part of this update, for the first time, expanded the program to include our there was a national policy to allow living donor pairs as well. Working with kidneys from blood group A2 donors to the National Kidney Registry, we now be used by blood group B recipients to can offer A2 living donors to our blood help address the relative lack of organs group B recipients. that were going to these individuals. More recently we have also started While not widely known, the A2 blood transplanting blood group O recipients group—a subgroup of the A blood type with A2 living donors. The Institute now caused by a mutation in the glycosyl has the largest reported single center transferase which is responsible for the A cohort of these minor blood group About the Author antigen—has been known since the early incompatible patients, encompassing Alexander Gilbert, MD 1970s. These A2 patients express far less 52 successful transplants (including the Dr. Gilbert completed his specialty antigen on their cells, especially in their largest national cohort of A2 to training with fellowships in both renal parenchyma. In the early 1990s, O transplants as well). These programs nephrology and kidney it was shown that if we select blood have helped us provide transplants that transplantation at Harvard’s Beth Israel group B patients who have low levels would not have otherwise been possible. Deaconess Medical Center. He has of anti-A antibodies in their blood, we More importantly, the outcomes for had academic appointments at both can transplant these A2 kidneys without these transplants show equal or better Harvard and New York University additional therapy and without any graft survival rates and rejection rates before coming to Georgetown in increased risk of graft failure or rejection. than with conventional transplants. 2013 to join MedStar Georgetown Transplant Institute. Dr. Gilbert has “Most centers feel uncomfortable performing these transplants in individuals with higher expertise in both the pre- and post- titer anti-A antibodies, often refusing to perform the transplant once titers reach levels of surgical management of transplant 1:8. With our experience and resources, we have been able to push back this barrier and patients, as well as managing living transplant successfully with titers as high as 1:256, all without need for additional kidney donors. In addition to his therapies or additional risks. ” clinical work, Dr. Gilbert is an active researcher focused on topics in ~Alexander Gilbert, MD, transplant nephrologist immunology and expanding our ability to safely use donor organs.

Because of the relatively high As a result of these successes, average prevalence of blood group B in waiting times for patients who receive the transplant once titers reach levels of Blacks, the Institute has been in a A2 kidneys have dropped by more than 1:8. With our experience and resources, unique position to make use of this two years, allowing patients to receive we have been able to push back this change in allocation, as our patient kidneys when younger and healthier, barrier and transplant successfully with population is about 75 percent Black increasing the advantages gained by titers as high as 1:256, all without need as compared to the national average of kidney transplantation. for additional therapies or additional about 34 percent. Since implementing risks. For blood group B patients, this this program in 2014, blood group Not only have we sought to increase has been of minor importance, since 72 B patients make up a far higher the number of transplants, but we are percent demonstrate titers of 1:8 or less. percentage of our transplants than the also pushing the boundaries of which However, blood group O patients are national average, and that increase is patients are possible to be transplanted. known to naturally have much higher almost entirely due to the addition of Most centers feel uncomfortable anti-A titers and this successful increase these A2 kidneys. performing these transplants in in titer limits has been of enormous individuals with higher titer anti-A benefit in making this option available antibodies, often refusing to perform to them. n

MedStarGeorgetown.org/Transplant 7 Meet Our New Physicians

Kathleen Nilles, MD She also cares for patients awaiting Dr. Nilles’ research interests include Transplant hepatologist Kathleen liver transplantation and those who management and outcomes of acute Nilles, MD, is board certified in internal have undergone liver transplantation, liver failure and post-transplant medicine, gastroenterology, and as well as performing living donor liver rejection, graft, and patient survival hepatology. Dr. Nilles treats adults with transplantation evaluations. outcomes. She has published articles a range of conditions, including: in Hepatology Communications, Transplantation, Journal of Hepatology, • Viral hepatitis and other refereed journals, and has • Autoimmune liver disease co-authored book chapters. She also enjoys teaching trainees. • Metabolic liver disease • Alcohol-related liver disease Dr. Nilles earned her medical degree • Cardiac-related liver disease from the University of Pittsburgh School of Medicine. She completed • Inherited liver disease her residency in internal medicine at • Hepatocellular carcinoma and other Emory University School of Medicine malignant and benign hepatic lesions Emory University Hospital and her fellowship training in gastroenterology • Cirrhosis and hepatology at the University • End stage liver disease of Colorado. She also completed • Complications of portal hypertension fellowship training in advanced transplant hepatology at Northwestern University. n

Udeme D. Ekong, MD, MPH, FAASLD She has published numerous articles in Dr. Ekong is board certified in the American Journal of Transplantation, pediatrics, transplant hepatology, and Journal of Immunology, Hepatology, as pediatric gastroenterology. She treats a well as book chapters. wide range of liver diseases including: • Autoimmune diseases Dr. Ekong earned her medical degree at Ahmadu Bello University, Zaria, • Biliary atresia Nigeria, and her Master of Public • Progressive familial intrahepatic Health at Northwestern University. She cholestasis syndromes completed her pediatrics residency at • Genetic/metabolic liver diseases Lincoln Hospital, Bronx, New York, and a fellowship in pediatric gastroenterology • Non-cirrhotic portal hypertension, at Morgan Stanley Children’s Hospital, chronic hepatitis B and C Columbia University. She also • Children who need a liver transplant completed an advanced transplant or have undergone liver transplant hepatology fellowship at Lurie Children’s Hospital, Northwestern University. n In addition to her clinical work, Dr. Ekong’s laboratory research focuses on developing ways to improve the long-term function of the transplanted liver in children. Her laboratory also investigates the pathogenesis of See page 5 of this issue for Dr. Ekong’s article, “Can Pediatric Liver Transplant autoimmune liver diseases both before Patients Expect a Normal Life Expectancy?” and following liver transplantation.

8 TO REFER A PATIENT, CALL 202-444-3700. TRANSPLANTdigest FALL 2020

Hepatitis C Positive Organs Increase Access to Transplant continued from page 1 that result in fewer side effects in 98 “As transplant specialists, we weigh the risk and benefit of sooner transplant with a hepatitis C to 99 percent of patients. This use of positive organ against waiting for an organ that is negative for the disease. The benefit of hepatitis C positive organs in patients sooner transplantation astronomically outweighs the risk.” without the disease markedly increases the speed with which transplantation ~Rohit S. Satoskar, MD, Medical Director of Liver Transplantation is possible. That’s important because the longer a patient waits for transplantation, the higher the risk of MedStar Georgetown Transplant transplanted 32 hepatitis C positive mortality. For example, every year on Institute is taking the lead in this new kidneys and 5 hepatitis C positive dialysis increases the risk of death for approach to organ procurement. Since livers in patients who are hepatitis C end-stage kidney disease patients. 2019, surgeons at the Institute have negative. n

Clinical Spotlight: Robotic Liver and Pancreas Surgery continued from page 1

“Our goal is to offer patients the full spectrum of treatment options for liver, pancreas, and Case Study: bile duct tumors and carefully coordinated, compassionate care delivered by experienced Robotic Hepatectomy specialists in one convenient location.”

~Jason Hawksworth, MD, Chief of Robotic Surgery The patient, a healthy 40-year- old female, was discovered to have a massive right liver lesion In contrast, the average hospital stay as hepatopancreaticobiliary surgeons during evaluation for abdominal for patients who undergo robotically and medical specialists and transplant pain. MRI with Eovist confirmed a assisted resection is 2.5 days. surgeons. 10 centimeter hepatic adenoma spanning her entire right liver. In addition, less than 3 percent of To refer a patient please call patients on average require a blood 202-444-7287. transfusion and less than 1 percent She underwent minimally invasive are admitted to the ICU after surgery. robotic right hepatectomy through Patient benefits also include a small several 8 millimeter incisions. bikini incision, less post-surgical The surgery was uncomplicated, pain, shorter recovery period and with minimal blood loss and no quicker return to work, and fewer transfusion requirements. The complications. specimen was removed through a bikini incision maximizing cosmesis The robotic surgery program is part in this young woman. of the Center for Liver and Pancreas Surgery under the umbrella of MedStar Her post-operative stay was Georgetown Transplant Institute. Like uncomplicated and she was all patients who receive care at the discharged home on post-operative Institute, those who undergo robotically Jason Hawksworth, MD, recorded a assisted liver and pancreas resection Day 2. She was on no narcotics in robotic right hepatectomy for a large are treated by an experienced, follow up one week post-surgery. liver adenoma. You can watch the multidisciplinary team that includes Final pathology confirmed hepatic video on YouTube at YouTube.com/ oncologists and radiation oncologists adenoma, and she continues to do watch?v=QeiZXCwRwn8. from the Georgetown Lombardi well one year post surgery. n Comprehensive Cancer Center, as well

MedStarGeorgetown.org/Transplant 9 By the Numbers: MedStar Georgetown’s Transplant Programs

• The region’s only 5-tier program for 1-year organ survival after liver transplant

Liver • Top 25 percent in volume of liver transplants in U.S. Transplant Program • Superior 1-year adult graft survival outcomes compared to local programs

• Transplanted a higher proportion of the sickest (Status 1) patients and performed a higher proportion of the most complex transplants (split liver transplants) than any other program in the country

• One of 6 programs in the U.S. with liver transplant outcomes statistically better than expected

• More minority liver transplant candidates than any other program in the nation

TheThe Region’sRegion’s OnlyOnly LiverLiver TransplantTransplant ProgramProgram Adult One Year Survival With Functioning Graft toto AchieveAchieve anan SRTRSRTR 5-Tier5-Tier RatingRating Far Exceeds Local and National Programs

WORST BEST 98% GETTING A DECEASED 1-YEAR LIVER DONOR TRANSPLANT SURVIVAL FASTER 96%

MedStar Georgetown Transplant Institute 96.09% (Georgetown University 94% Medical Center) Washington, D.C. 90.96% 92%

Johns Hopkins Hospital National Average Baltimore, Maryland 90% 91.43% 91.61% 90.78% 88% University of Maryland Medical System Baltimore, Maryland 86%

84% Virginia Commonwealth University Medical Center 84.88% Richmond, Virginia 82%

80% University of Virginia MedStar Virginia Johns University University of HealthSciences Georgetown Commonwealth Hopkins of Virginia Maryland Medical Center Transplant University Hospital HealthSciences System Charlottesville, Virginia Institute Medical Center Center (Georgetown University Medical Center)

Data on pages 10-11: SRTR.org, Published on 1/07/2020, Data from 10/31/2019 Single organ transplants performed between 07/01/2016 and 12/31/2018From https://www.srtr.org/transplant-centers/?&organ=liver&recipientType=adult&location=20037&distance=750&sort=volume&page=2

10 TO REFER A PATIENT, CALL 202-444-3700. TRANSPLANTdigest FALL 2020

By the Numbers: MedStar Georgetown’s Transplant Programs Pediatric • Among top 3 programs by volume in the country Liver Transplant • 95 percent 3-year survival rate Program

• Top 10 program in volume of kidney transplants in the U.S.

• More than double the number of kidney transplants performed compared to other Washington, D.C. centers Kidney Transplant • 307 total kidney transplants performed in 2019 Program

• 115 living donor transplants in 2019, more than any other program in the region

• Largest national paired kidney exchange sharing program

• Among top 2 intestinal transplant programs by volume in the U.S., with patients from 15 countries Other • Second largest program by volume for pancreas transplants in the U.S. Highlights

• Among top 10 programs by volume for all abdominal transplants in the U.S.

• 48 clinical trials actively enrolling

MedStarGeorgetown.org/Transplant 11 3800 Reservoir Rd., NW Washington, DC 20007 NON-PROFIT ORG. U.S. POSTAGE PAID WASHINGTON, D.C. PERMIT NO. 2457

TRANSPLANTdigest A PUBLICATION OF THE MEDSTAR GEORGETOWN TRANSPLANT INSTITUTE FALL 2020

Transplant Digest is a bi-annual publication New Safety Protocol Allowed MedStar Georgetown featuring news of interest to physicians about Transplant Institute to Perform More Kidney Transplants the MedStar Georgetown Transplant Institute. continued from page 2 Please submit comments or questions • COVID-19-free floors in the hospital to significantly reduced the number of to Daphne Torney at 202-444-6815, or by emailing minimize infection risk for transplant transplants they performed during [email protected]. patients this time. “It’s easy to say no,” said Dr. Matthew Cooper, director of Kidney MICHAEL C. SACHTLEBEN • Use of telehealth to reduce hospital and Pancreas Transplantation. “We are President, visits for pre-screenings and post- fortunate that with the hard work of the MedStar Georgetown University Hospital transplant management Institute, the administration at MedStar Senior Vice President, Georgetown, and the overall MedStar MedStar Health • Deployment of travel nurses to patient Health system, we were able to JUDSON STARR homes for laboratory testing continue to say yes during the Chairman of the Board MedStar Georgetown University Hospital pandemic.” n Many transplant programs around the KENNETH A. SAMET, FACHE country temporarily halted or President and CEO, MedStar Health

THOMAS M. FISHBEIN, MD Transplants Performed During COVID-19 Pandemic Executive Director Living donor transplants Total kidney transplants Editors Karen Alcorn Lisa Arrington MedStar Georgetown 51 167 Transplant Institute Writer Susan Walker

Designer Inova Fairfax 18 52 Laura Sobelman

George Washington 6 18

University of Maryland 18 70

Johns Hopkins 13 75

0 20 40 60 80 100 120 140 160 180 200

Data: OPTN, March through August 2020