History and

HO Experience

H3CO CH3 O H3C O OH CH2 N O CH3 O O HO CH3 O For more than years, UPMC Transplant Services H3C OCH3 H OCH3 30 has forged new treatments and innovative research that has allowed the field of transplantation to thrive around the world.

With this historical excellence in the field of solid- that has defined UPMC, our program has been consistently challenged with some of the most difficult and complex cases. Despite this, we maintain outcomes that are on par with national benchmarks.

This book is a comprehensive resource with information about our robust transplant programs. It is meant to assist you in determining if your patients would benefit from such treatments. Our Transplant Services PROGRAM HIGHLIGHTS PROGRAM HIGHLIGHTS

Heart >>Began performing >>Performed the world’s >>Second program in the Artificial >>Began performing >>Became the first medical heart transplantation first heart- transplant world to surpass 3,000 VAD implantation center in the world Transplant in 1980. in 1984, and the world’s heart, lung, and heart-lung Heart in 1987. to discharge a patient Program first heart-liver-kidney transplants procedures Program with a VAD in 1990. transplant in 1989. in 2012.

Summary Who is eligible? Summary Our surgeons and cardiologists are If patients waiting for a transplant become The UPMC Artificial Heart Program is integrated international leaders in heart transplant too sick before a suitable donor becomes with the UPMC Heart and Vascular Institute The HeartWare® HVAD left ventricular assist research. Such work has continued to available, they are evaluated for a ventricular and world-renowned UPMC Heart Transplant device has been approved improve the care and outcomes for heart assist device (VAD) to support their heart Program for truly comprehensive care. Program for bridge to transplant. transplant patients. We have pioneered function, relieve their heart failure, and allow leaders have authored widely published research techniques in high-risk cases, and the use them to wait at home with better exercise and are internationally regarded as pioneers of multiple-organ transplants. We are able tolerance and quality of life until they receive in VAD development and application. This to successfully handle complex cases because a transplant. This tailored, patient-centered program features a full complement of physicians, the breadth of experience at UPMC ensures approach continues after transplantation: nurses, and bioengineers working together 24/7 that patients receive care that is best suited our experience and resources ensure that along with referring physicians to co-manage all to their unique clinical needs. treatment strategies are individualized for aspects of patient care. The Thoratec HeartMate II® each patient. Unfortunately there are more patients waiting A VAD, or a ventricular assist device, is a left ventricular assist device has been approved for transplant than suitable donors, so most device that pumps blood for patients with a for bridge to transplant and patients have to wait a long time for transplant. weakened heart muscle. Blood flows from for destination therapy. Patients listed at our center have significantly the heart to the VAD, which then pumps it to shorter average waiting times until the body’s circulatory system. The VAD is transplantation, compared with national Who is eligible? typically used one of two ways: and regional averages. As a bridge to transplant — Patients get • Who is eligible? General indications for heart transplantation include patients with: a VAD so that they can then wait for heart transplantation while in a more • End-stage heart failure that fails to respond to maximal medical Candidates for VAD implantation include: therapy including intravenous drugs stable condition. • Patients with advanced heart failure, who may be eligible • Severe coronary artery disease with untreatable angina • As destination therapy — These patients live on the pump as an alternative to for transplant, but are too sick to wait for a heart to • Cardiogenic shock transplantation as outpatients. VAD become available • Recurrent ventricular arrhythmias technology for severe heart failure improves • Patients who have advanced heart failure but are not transplant • Congenital heart disease with heart failure that cannot be quality of life for patients and allows them candidates either because of other medical problems or age surgically repaired to live a life free of heart failure symptoms. • Severe hypertrophic heart disease

TO MAKE A REFERRAL, CALL 1-800-544-2500. PROGRAM HIGHLIGHTS PROGRAM HIGHLIGHTS >>Began performing lung >>One of the most active Lung transplantation in 1982. ECMO (extra-corporeal Lung >>Began performing lung >>membraneOne of the mostoxygenation) active >>In 2016, our program Kidney >>Began performing >>National leader in >>Expertise in Transplant transplantation in 1982. ECMO (extra-corporeal performed its 2,000th kidney transplantation solid-organ and minimally invasive Transplant centers in the country. Transplant Program membrane oxygenation) lung transplant, more in 1966. living-donor kidney living-donor Program centers in the country. than any other center Program transplantation. surgery. Program highlights in the country.

Summary Summary UPMC’s Lung Transplantation Program is management, to surgery. Our physicians are lung and result in transplantation of lungs More than 26 million Americans have kidney While the typical wait for a deceased-donor waiting time. UPMC clinicians will educate one of the most experienced centers in pioneers in the use of ECMO, or extra-corporeal that were previously determined to be disease, and millions more are at risk. For many kidney transplant ranges from two to six years, a potential living donors about the procedure the world for lung and combined heart-lung membrane oxygenation, which replaces the unsuitable. Through ex vivo lung perfusion, we patients with end-stage renal disease (ESRD), living-donor transplant can usually be performed and determine whether donation is his or her transplantation. Since our program’s inception heart and lung function by circulating the hope to expand the utilization of donor lungs kidney transplantation is a viable, lifesaving within a few months. UPMC offers patients best option. Early referral for a living-donor in 1982, we have performed more than 2,000 patient’s blood through an artificial lung. and offer this life-saving therapy to more option. The UPMC Kidney Transplant Program one of the nation’s most experienced teams kidney transplant is key. It allows our lung and heart-lung transplants. The UPMC UPMC is also actively involved in research patients with end-stage lung disease. brings decades of experience in both dedicated to living-donor kidney transplantation. dedicated team to provide comprehensive Lung Transplantation Program works within the pertaining to organ perfusion. Perfusing the deceased-donor and living-donor transplants. Living-donor kidney transplantation consistently assessments and determine if living-donor UPMC Comprehensive Lung Center to provide organ outside of the body (ex vivo organ The significant expansion of UPMC’s exclusively improves both graft survival and patient survival kidney transplant is an option. With this exceptional care for patients along the entire perfusion) can improve the quality of the donor laparoscopic (minimally invasive) live donor compared with deceased-donor transplantation. option, the recipient can avoid spectrum of life-threatening lung diseases. program provides another option for patients dialysis altogether. Other advantages include a lower incidence Approximately 30 percent of our recipients have awaiting transplant. Although a kidney transplant of complications, less delayed graft function, been declined for lung transplantation at other is a complex, serious procedure, we maintain a shorter stay, and elimination of centers. Our clinical experience and dedicated a personal, patient-focused approach that takes support resources have allowed our specialists into consideration the stress and concerns that to medically manage the most complex cases, many individuals experience throughout the including pulmonary parenchymal disease Who is eligible? evaluation, operation, and recovery period. Who is eligible? that significantly limits life activities despite Living Donation previous surgical and medical therapy. UPMC lung and heart-lung transplant specialists care for people with life- Candidates for kidney transplants include: threatening lung diseases. Diseases treatable by transplantation therapy include: Living-donor kidney transplantation provides We share insight and knowledge with our • Patients suffering from end-stage renal disease. colleagues so that each patient receives the a way for patients to overcome the limitations • Chronic obstructive pulmonary • Bronchiectasis Patients do not have to be on dialysis to be evaluated for or receive a transplant. individualized treatment he or she needs, of the waiting list, with improved outcomes disease (COPD)/emphysema • Retransplantation for For some individuals, a kidney transplant may not be an option due to other medical from pulmonary rehabilitation to medical compared with deceased-donor kidneys. • Idiopathic pulmonary chronic rejection problems. These conditions can be identified based on your input or during our fibrosis (IPF) • Pulmonary fibrosis related to initial evaluation. • Cystic fibrosis collagen vascular disease • Alpha-1 antitrypsin deficiency • Sarcoidosis • Primary pulmonary hypertension • Scleroderma

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Liver >>The >>Expertise in solid- >>National leader in Pancreas >>Offering three types of >>Exploring research into >>Experienced in program is one of the organ, living-donor, treatment and transplant pancreas transplant: genetic biometrics leading total pancreatectomy Transplant oldest and largest in the and multivisceral for primary liver cancers. Transplant pancreas transplant alone; to pancreatitis. with auto-islet Program United States. transplantation. Program simultaneous pancreas- pancreas transplant. kidney transplant; pancreas- after-kidney transplant.

Summary Living Donation Summary Successful pancreas transplantation of a comprehensive system that brings improves quality of life, achieves a euglycemic together highly experienced surgical and The UPMC Liver Transplant Program As the disparity between organs available for with every patient on the waiting list. UPMC Diabetes is the leading cause of end-stage state, and may help to prevent or improve medical specialists to care for patients distinguishes itself as a worldwide leader transplantation and the number of potential offers patients one of the nation’s most renal disease and a national health problem; secondary complications of diabetes. The throughout their course of treatment. with respect to volume and experience in recipients increases, the waiting list grows experienced teams dedicated to living-donor liver 23.6 million Americans have been diagnosed UPMC Pancreas Transplant Program is part treating a wide range of patients, including rapidly. Living-donor liver transplantation provides transplantation. There are many advantages for with type 1 or type 2 diabetes. Many patients those with complex liver disease. The UPMC a way for patients to overcome the limitations a recipient with a living-donor transplant. Most with diabetes seek pancreas transplantation Liver Transplant Program has historically of the waiting list, with improved outcomes importantly, the recipient can receive a life-saving as a medical alternative to lifelong dialysis. been home to many of the world’s most compared with deceased-donor liver transplants. transplant before he or she becomes critically Frequently, these select patients also may be recognized transplant experts. From pioneering While the typical wait for a deceased-donor liver ill or dies from their liver disease. Additionally, candidates for pancreas transplantation to Who is eligible? surgeons to highly skilled hepatologists and transplant ranges from one-and-a-half to two with the growing liver transplant waiting list, replace insulin therapy. The UPMC Pancreas specially trained nurses who provide care years, a living-donor transplant can usually be living donation increases the amount of Transplant Program has historically been Patients with the following conditions may benefit from a pancreas transplant: before, during, and after surgery, to the performed within a few months. Living donation deceased-donor organs available and helps to home to many of the world’s most recognized • Insulin-dependent type 1 diabetes • Hypoglycemic unawareness researchers who move the field forward, is a life-saving option that should be discussed reduce deaths on the transplant waiting list. transplant experts for both pancreas and that is difficult to control event with excellent medical our level of expertise enables us to medically kidney-pancreas transplants in patients with management manage patients along the entire spectrum diabetes. With improved surgical techniques, The ideal candidate has diabetes with no renal failure. However, the majority of liver disease. To ensure that each patient Who is eligible? UPMC surgeons have found that pancreas of pancreas transplant candidates have progressive secondary complications of is carefully evaluated to determine his or transplantation offers new hope to patients type 1 diabetes, despite satisfactory glucose control. These include: her best course of treatment, many patient Candidates for liver transplantation are those patients whose no with insulin-dependent diabetes, with referrals start at the UPMC Center for Liver longer function adequately (liver failure). This can be treated in: or without end-stage renal disease. Our • Diabetic nephropathy • Autonomic neuropathy Diseases (CLD), which provides patients with team considers the advantages of medical or gastroparesis 1. Patients with hepatocellular disease (chronic viral hepatitis, hepatitis B • Diabetic neuropathy a variety of comprehensive medical options treatments before evaluating patients [HBV], hepatitis C [HBC], alcoholic liver disease, autoimmune cirrhosis, • Diabetic retinopathy • Accelerated atherosclerosis that may delay, or even prevent the need for a pancreas transplant. cryptogenic cirrhosis) for transplantation altogether. The CLD Due to the prevalence of renal complications in patients with diabetes, complements the UPMC Liver Transplant 2. Patients with cholestatic disease (primary biliary cirrhosis [PBC], primary some whom become candidates for pancreas transplantation may Program by offering convenient access to the sclerosing cholangitis [PSC], secondary cholangitis) have underlying renal problems. These patients may be candidates for a simulta- most advanced methods of evaluation and 3. Patients with metabolic disease (hemochromatosis, Wilson’s disease, alpha-1 neous kidney-pancreas transplant or a kidney transplant followed by a pancreas medical management of patients diagnosed antitrypsin deficiency, oxalosis, hemophilia, cystic fibrosis, amyloidosis, transplant at a later date. Pancreas-after-kidney transplantation is best when a with acute or chronic liver disease. non-alcoholic steatohepatitis [NASH]) living donor is available to provide the kidney. 4. Unique patient populations (co-infected patients [HIV], bloodless liver transplant, multiple organ transplants – liver/kidney, liver/heart, liver/lung)

TO MAKE A REFERRAL, CALL 1-800-544-2500. Team Members

PROGRAM HIGHLIGHTS

Intestinal >>Began performing >> More than 600 intestinal >>Our team developed Throughout each patient’s transplant journey at UPMC, they will interact Rehabilitation intestinal transplantation and multivisceral transplants and standardized many in 1990. on both adult and pediatric of the procedures with a dedicated transplant team whose main goal is to provide a seamless and Transplant patients have been performed currently used by top and comforting experience for them and their loved ones. Program at UPMC, representing centers around more than 25 percent of the world. This team includes: the worldwide total.

Summary • Transplant specialists

The UPMC Intestinal Rehabilitation and Gastrointestinal rehabilitation means The surgical approach is tailored >> Hepatologists Transplantation Center (IRTC) was formally restoration of nutritional autonomy with an according to patients’ needs, including >> Gastroenterologists developed in 1999, at which time UPMC unrestricted oral diet and elimination of restoring continuity of the gut, repairing already had a decade of experience in the need for intravenous nutritional support. enteric fistulae, and lengthening >> Pulmonologists performing intestinal transplants. The This has recently been achieved with more procedures, such as serial transverse >> Cardiologists specialists at the IRTC use state-of-the-art successful outcomes by surgical autologous enteroplasty (STEP). When rehabilitation medical and surgical treatments to successfully reconstruction combined with a special alone is not successful, the highly >> Nephrologists treat patients, restoring his or her lifestyle diet regimen and pharmacologic experienced transplant team at >> Endocrinologists without the need for intravenous nutrition. manipulation of the gut with enterocyte the IRTC will provide intestinal >> Pathologists Many of our patients have experienced trophic factors such as growth hormone, transplant based on the length of success with rehabilitation services, while and most recently GLP-2. the remaining bowel. • Transplant surgeons others with more advanced diseases • Dedicated pre- and post-transplant benefit from transplant. Patients from Who is eligible? nurse coordinators both of these groups have gone on • Dedicated transplant pharmacists to experience greatly improved quality Candidates for intestinal rehabilitation or transplant include: of life, enjoying a normal oral diet. • Psychologists and psychiatrists • Patients with irreversible intestinal failure due to: Our dietitians assist with the management • Transplant social workers >> Short bowel syndrome >> Vascular occlusion of TPN therapy and provide individualized • Dedicated transplant dietitians diet counseling to patients at home, as >> Complex enterocutaneous >> Abdominal trauma • Financial credit analysts well as in the hospital or at clinic appointments. fistula >> Dysmotility Whether the patient has surgical or medical >> Complications of gastric • Independent living-donor advocates intervention, nutritional counseling is an bypass surgery >> Unresectable desmoid and integral part of the treatment process. complex tumors >> Crohn’s disease Patients go through a nutritional assessment to determine the appropriate needs and • Other gut disorders combined with organ failure course of action.

TO MAKE A REFERRAL, CALL 1-800-544-2500. Approach to the patient with advanced The Transplant heart failure Process Chronic Heart Failure

Advanced Symptoms

Advanced Heart • Preliminary Clinical Review – • Financial Authorization – • Evaluation – Typically conducted • Pretransplant – The UPMC • Transplant Surgery and • Long-term Collaboration for Failure Clinic A pretransplant nurse coordinator Before scheduling a transplant on an outpatient basis, transplant transplant team partners with Hospitalization – Once an Follow-up Care – The transplant collects the patient’s medical evaluation, a UPMC transplant evaluation requires a week-long the referring physician in the organ becomes available, the team provides primary care history, radiology studies, recent credit analyst and insurance stay in , during which ongoing care of the patient once transplant coordinator notifies during hospitalization and Assessment for Surgical Options blood work, and current physical case manager will work together a multidisciplinary team of he or she is listed for an organ the patient, who then reports collaborates with referring findings, which are then reviewed to determine the extent of specialists provide diagnostic with the United Network for for admission to UPMC and specialists to provide by the transplant team. insurance coverage for the testing and consultation. Organ Sharing (UNOS). is prepped for surgery. long-term and follow-up care individual patient. after discharge. Heart Failure Surgery Transplant Evaluation

Transplant Candidate

No Yes ~40% ~60%

We will communicate with Destination Therapy Bridge to Transplant Transplant Referred for Transplant the patient’s own physician Approach to the No Yes transplant evaluation Preliminary Clinical Review process as a valued team member Transplant Candidate

Financial Authorization during key steps of the No transplant process and work Recovery? Evaluation

Further Studies together to co-manage the Completed/Medical Short-term support Shock team Condition Deteriorating NOT SUITABLE FOR APPROVED FOR TRANSPLANT TRANSPLANT patient after transplantation. ECMO program Ongoing Medical or Waitlist Once the patient is transferred Surgical Management Management Acute Heart Failure back to the physician’s care • Acute MI • Myocarditis Transplant full time, our transplant team • Other will continue to be available Post-Op Medical Management/Partner With Local MD for consultation.

TO MAKE A REFERRAL, CALL 1-800-544-2500. Partnering for Life

We take pride in keeping the lines of communication open with patients, families, and referring physicians regarding status, procedures, treatments, and follow-up care. Although transplantation is a complex, serious procedure, we maintain a personal, patient- focused approach that takes into consideration the stress and concerns many individuals experience.

To ensure optimal continuity of patient care, the UPMC transplant team pursues a collaborative approach with referring physicians. UPMC’s transplant surgeons and physicians are available for consults 24 hours a day, seven days a week. ERIE Thomas E. Starzl Transplantation Institute PITTSBURGH UPMC Montefiore, 7 South 3459 Fifth Ave. Pittsburgh, PA 15213 Telephone: 1-877-640-6746 or 412-647-5800 Email: [email protected]

Cardiothoracic Transplantation Program UPMC Presbyterian, Suite C-900 200 Lothrop St. Pittsburgh, PA 15213 Telephone: 1-800-544-2500 Email: [email protected]

Hillman Center for Pediatric Transplantation Children’s Hospital of Pittsburgh of UPMC One Children’s Hospital Drive 4401 Penn Ave. Pittsburgh, PA 15224 Telephone: 412-692-5325 PITTSBURGH

Kidney Transplant Specialist Clinics

Liver Transplant Specialist Clinics

Cardiothoracic Transplant Specialist Clinics

ISMETT, or the Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione in , , has performed more than 1,300 transplants in the last decade, making it one of the leading organ transplant centers in Europe and a major referral center for other Mediterranean countries. For more than a decade, UPMC Transplant Services has been partnering with ISMETT to provide cutting-edge training to transplant surgeons in Italy. Exporting our expertise abroad means that we can provide patients in other countries closer access to life-saving transplant treatments. And, as a world-class transplant center, this provides an unparalleled

standard of training with hopes of spurring medical innovation in other parts of the world.

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