Newyork-Presbyterian Hospital Organ Transplant Program

Managing the spectrum of organ failure and transplantation

NewYork-Presbyterian Hospital Organ Transplant Program

HEART

INTESTINAL AND MULTIVISCERAL

KIDNEY

LIVER

LUNG

PANCREAS Leadership in Organ Transplantation

The comprehensive transplant services at NewYork-Presbyterian Transplant Initiative Hospita l support longstanding programs in heart, liver, lung, kid - ney, and pancreatic transplantation, and most recently, intestinal At NewYork-Presbyterian Hospital/Columbia University Medical and multivisceral transplantation. Ranking first in the nation in Center, a major transplant initiative has been launched to drive the number of solid organ transplants performed each year, the growth of both clinical and research aspects of transplanta - NewYork-Presbyterian physicians treat adults and children with tion. This multi-year undertaking will involve medicine, pathology, the most complex and challenging problems. These include many and surgery in both adults and children. patients referred from centers across the U.S. and internationally, Although the Hospital is already a national leader in clinical including multi-organ transplant recipients. The center’s out - transplantation with respect to volume and patient outcomes, comes are excellent in each program. this initiative will further leverage the diverse expertise of its transplant scientists and clinicians. The goal: new discoveries in NewYork-Presbyterian Hospital has made important contribu - patient care and deeper understanding of the biology of tions to increasing the pool of available donor organs through transplantation. “Formalizing and further integrating the com - innovative approaches in organ selection, preservation, immune munity of transplant professionals will better position NewYork- protocols, and improved monitoring of graft status. Its faculty Presbyterian/Columbia to carry out larger research initiatives are also dedicated to the study of ethics and public policy related both in the laboratory and in patient care,” according to Jean C. to transplantation, and the study of long-term health in donors Emond, MD. “The objective is to have a full-spectrum center and recipients. dedicated to transplantation – one at the leading edge of discov - The Hospital’s faculty have a distinguished history of advancing ery and delivery of care – a center of excellence for translational standards of care and survival rates by employing innovative research, new creativity in medical and surgical care, and the surgical techniques and by applying basic scientific research in achievement of groundbreaking outcomes.” immunosuppression to the clinical setting. Additionally, cardiac With its commitment to excellence in every facet of organ trans - and liver patients benefit from the invention and perfection of plantation, patients and their primary care physicians can expect life-sustaining cardiac and liver devices that extend and improve the Hospital to provide the highest level of care at every stage of the lives of patients awaiting organ transplantation. transplantation and beyond. Moreover, the program recognizes the complexity of how out - comes are affected by the myriad factors impacting donors’ and recipients’ health. When performing transplantation as an imme - diate lifesaving event, some disparities between donor and recip - ient are to be expected. In all cases, however, the clinicians strive to maximize patients’ health prior to transplantation, minimize donors’ medical issues, and, based on clinical experience, to best match donor organs with the most appropriate recipients.

Looking to the future of organ transplantation at NewYork- Presbyterian, Manikkam Suthanthiran, MD, says, “An important Manikkam Suthanthiran, MD Jean C. Emond, MD goal is to provide individualized treatment for each transplant Chief, Department of Transplantation Vice Chair and Director of Transplantation, Medicine , NewYork-Presbyterian Hospital / NewYork-Presbyterian Hospital/ recipient. With the use of molecular diagnostic approaches, we Weill Cornell Medical Cente r Columbia Medical Center plan to minimize immunosuppressive drug therapy and offer Chief, Division of Nephrology and Thomas S. Zimmer Professor of Surgery, personalized medicine to our patients. Our ultimate goal is to Hypertension, and Stanton Grifﬁs Columbia University College of Physi cians Distinguished Professor of Medicine, and Surgeons altogether eliminate the need for immunosuppressive drugs.” Weill Cornell Medical College NewYork-Presbyterian Hospital Comprehensive Capabilities for Adult Organ Transplantation

Heart Failure and Transplantation 2

Intestinal and Multivisceral Transplantation 6

Kidney Transplantation 8

Liver Transplantation 12

Lung Transplantation 16

Pancreas Transplantation 20 Heart Failure and Transplantation

The heart failure and transplantation program at NewYork-Presbyterian Hospital is the largest and most active heart transplant program in the nation. In 2007, the program celebrated its 2000 th transplant — a milestone no other U.S. hospital has achieved.

Overview

The program consistently treats patients with significant co- morbidities and high risks, including those with cardiac amyloi - dosis, diabetes-related end-stage organ damage, and HIV. Despite taking on these high-risk patients, the program’s survival rates have consistently met or exceeded the national average since its inception in 1977. UNOS ranked NewYork-Presbyterian Hospital’s heart transplantation program number one in 2006 and 2007, and the program continues to lead the nation in both transplant volume and outcomes today.

Patients with end-stage cardiac disease receive state-of-the-art care at both campuses of the Hospital.

Th e Center for Advanced Cardiac Care at NewYo rk-Presbyter - ian/Columbia has evolved from what was the very first U.S. program devoted solely to the treatment of congestive heart failure. Today it offers the full range of medical and surgical treatments for heart failure, including established as well as late generation investigational LVADs.

The Mechanical Circulatory Support Program at NewYork- Presbyterian/Columbia stands as a clear leader in the implan - tation, development, and study of left ventricular assist devices, both as bridge-to-transplantation and as destination therapy. The program is committed to improving LVAD tech - nology and to extending the availability of LVADs to under - served patient populations (including small adults and children). The latest devices, which are much smaller and more comfortable than earlier predecessors, are now being z e

r placed for longer-term use with excellent results. e P ´ e n e R The Perkin Center for Heart Failure at the Ronald O. Perelman L Heart Institute of NewYork-Presbyterian Hospital/Weill Cornell Surgeons performing a heart transplant at NewYork-Presbyterian Hospital. Medical Center is dedicated to medical and surgical manage - ment of heart failure. It offers special expertise in treating pa - tients with pulmonary hypertension and right heart failure.

2 Heart Transplantation Ultrasound of the heart (axial H section) showing left ventricular e L hypertrophy. a r t e k a t o t o h P / M S I ©

Innovations

Innovation is the driving force behind the heart failure and trans - plantation program, with physician-researchers making daily advances in medical therapies, surgical techniques, immunologic therapies, imaging methods, and device development.

The program’s long history of innovation encompasses many milestones, including: the first mechanical bridge-to-transplantation using intra- aortic balloon pumps, in the 1970's; the first pediatric heart transplant, in 1984; the development of minimally invasive and hybrid (surgical- catheter based) cardiac procedures; the development of third-generation LVAD technologies; the improvement of immunosuppressant regimens; the creation of a gene-based blood test to replace heart biopsies to detect rejection after transplantation; the implementation of extended criteria organ transplantation to improve access to transplantation; and z e

the use of gene therapy in the treatment of heart failure. r e P ´ e n e R L Implantation of LVAD.

Eligibility for Inclusion Criteria for Transplantation LVAD Implantation

Inclusion Criteria NYHA Class III or IV CHF re - Inoperable coronary artery Transplant candidate; Patients with end-stage card iac fractory to maximal medical disease with intractable NYHA Class III or IV CHF disease and a life expectancy therapy. Objective data anginal symptoms; refractory to maximal m edical of less than one year will be would include a reduced left Malignant ventricular ar - therapy; considered for transplantation. ventricular ejection fraction rhythmias unresponsive to Patients dependent on These patients will have one of and a reduced funct ional ca - medical or surgical therapy. intravenous inotropic support; the following: pacity with maximal oxygen PCW or LAP >20, systolic consumption <10 ml/kg/min; BP<80, CI<2.0;

Systolic BP<60.

3 y e l n

Research a M s e l r a

On the cutting edge: h C L Researchers at NewYork-Presbyterian/Columbia are currently Comparison of larger LVAD to newer, conducting a study on the SERCA-2 gene, which is critical smaller device. for proper contraction of the heart muscle. Intracoronary injections of the gene may restore cardiac function and output in patients with severe heart failure. Currect Clinical Trials: One arm of the SCCOR grant (see sidebar) is investigating the HeartMate ® II: For advanced-stage heart combination of stem cell therapy in conjunction with LVADs to failure patients: This multicenter trial, led facilitate recovery of the native heart. by NewYork-Presbyterian/Columbia, Columbia and Weill Cornell researchers are studying the found that recipients of the device as etiologies of heart failure and pulmonary hypertension, and bridge-to-transplantation achieved over are working to develop targeted therapies based on their 90% survival; discoveries. SCCOR: $17 million NIH grant to investi - Cardiac transplantation researchers at NewYork-Presbyterian/ gate the most significant challenges asso - Columbia developed a non-invasive blood test to detect organ ciated with LVAD therapy – infection, rejection after heart transplantation. The team is now applying coagulation, and neurological events; similar genetic techniques to better define the phenotypes of COPS: Cardiac Output Prognosis Study: heart failure and develop an approach that will be applicable noninvasively measuring cardiac output to to pulmonary hypertension. achieve better risk-stratification and iden - tify patients best suited for transplantation or LVAD therapies;

Rapamycin vs Neoral: Evaluation of therapy in preserving kidney function after cardiac transplant surgery;

NIH RO1 Grant: Erythropoietin in dias - tolic heart failure;

NIH RO1 Grant: Oxidized LDL in heart failure;

Assessment of Endothelial Dysfunction in heart failure with venous biopsies;

CARGO: Genomic profiling to detect allo - graft rejection after heart transplantation; o i z i r b

a CUPID: First gene therapy trial in heart

F a d

a failure. J L Richard Stowe received a HeartMate II in 2006. He feels completely normal and mobile, and has been able to eliminate or reduce many of his heart medications. Echo- cardiography in April 2009 revealed dramatic improve - ment: his left ventricle is perfectly normal in size, his ejection fraction has increased from 5-10% to 40%, and the other chambers of his heart continue to improve. 4 Heart Transplantation The use of extended donor and extended recipient criteria per“ mits

transplantation for patients who might never receive a transplant otherwise, H e

providing more options to improve patients’ quality of life . a “ r t — Ulrich P. Jorde, MD, Assistant Professor of Clinical Medicine Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center. Patient Care Outcomes

The surgeons and cardiologists at NewYork-Presbyterian Hospital The Hospital currently performs over 100 heart transplant surger - have a long and distinguished history of advancing standards of ies each year, making it the largest U.S. heart transplant program care and the survival rates of patients by using innovative surgical by volume. UNOS ranked this program first in the nation in 2006 techniques, by applying basic scientific research in immunosup - and 2007. One of 12 high-performing transplant centers in the pression to the clinical setting, and by inventing and perfect- nation, the Hospital's heart transplant program is part of the ing life-sustaining cardiac assist devices that prolong life during Health Resources Services Administration (HRSA) Transplant Cen - the wait for organ availability. Underpinning all their efforts is a ter Growth and Management Best Practices Study. solid foundation of collaborative, multidisciplinary cooperation. Kaplan-Meier actuarial analysis comparing the survival of High-risk surgeries, such as coronary bypass surgery with mitral high-risk and standard list recipients at NewYork-Presbyterian/ Columbia, post-transplant (p>0.05). valve repair, are routinely performed to restore ventricular func - tion and improve cardiac function sufficiently to avoid transplan - 1.00 tation. Where possible, catheter-based techniques are now replacing open surgeries, or they are employed in conjunction with traditional surgical techniques in new “hybrid” procedures, 0.75 to provide patients with the least invasive, least traumatic, most effective solutions. 0.50

Use of the newest ventricular assist devices now produces fewer complications and less bleeding than older versions, making 0.25 them suitable for patients in earlier stages of disease. The physi - cians’ expertise in choosing the best therapeutic window for VAD 0.00 implantation benefits many patients, who may now receive opti - Year 01 2 34 mal support before transplantation with smaller, quiet, comfort - able devices. Year 0 1 2 3 4

For patients who require transplant surgery, protocols are in place Standard 221 150 93 33 High Risk 37 24 17 5 to ensure rapid and seamless coordination of care between the two transplant centers of the Hospital. Alternate waiting list Source: NewYork-Presbyterian Heart Transplantation Program data, 2007 strategies for heart transplantation are helping to maximize the use of extended donor organs. As a result, waiting times to For the most current data regarding heart transplant transplantation are lower at the Hospital than at other centers in outcomes, please visit www.ustransplant.org. the region, and the ability to transplant sooner translates into better post-transplant outcomes.

The heart transplant program has implemented extended criteria Heart Failure and Transplantation protocols for both organ donors and transplant recipients. Today, NewYork-Presbyterian Hospital/ extended donor organs are routinely utilized, and may be offered Columbia University Medical Center to patients over age 65 or those formerly considered too com - Presbyterian Hospital Building, Room 1262 622 West 168th Street promised to undergo transplantation. These extended criteria New York, NY 10032 protocols are significantly widening the availability of organs and Cardiac Transplant Center: 212.305.7600 providing the option of transplantation to patients who would otherwise be denied treatment, with superior results. Emergency referrals and transfers: 800.NYP.STAT

5 Intestinal and Multivisceral Transplantation

Intestinal and multivisceral transplantation have become a standard of care in adults and children with intestinal failure or certain abdominal tumors.

Overview

Approximately 200 patients worldwide currently undergo intes - tinal and multivisceral transplantation each year, the majority of which take place in the United States. NewYork-Presbyterian Hospital/Columbia University Medical Center is among the few U.S. transplantation centers with the expertise to offer this rare clinical service.

Intestinal grafts are classified as one of the following types: Isolated intestinal transplantation for patients with intestinal 2 failure but who have a functioning liver ; Combined liver and intestinal transplantation, for patients 1 with liver and intestinal failure but normal stomach and pancreas; and Multivisceral transplantation including the stomach, liver, pancreas, and intestine.

Because allograft rejection remains a serious risk, intestinal trans - plantation has largely been reserved for life-threatening condi - tions associated with total parenteral nutrition and liver failure. m i

e As advances in surgical technique, immunosuppressant drugs, H y c

3 n and post-operative monitoring have significantly improved a N L survival, earlier transplantation (before liver failure) has become a Advances in multivisceral transplantation now allow unprecedented viable option. Approximately 70% of multivisceral transplant procedures like the one illustrated above. recipients now survive at one year. Figure 1: A lemon-sized tumor, attached to the main arteries and wedged behind several organs, was considered unresectable by other Physicians should refer patients with short bowel syndrome for institutions. Figure 2: At NewYork-Presbyterian Hospital, surgeons successfully evaluation at the Center for Liver Disease and Transplantation as removed the patient’s liver, pancreas, spleen, stomach, small intestine, early as possible, and before the development of liver failure due and two-thirds of the large intestine. Figure 3: After excising the tumor safely, the team reconstructed the to total parenteral nutrition (TPN). blood vessels and performed auto-transplantation to reattach the patient’s organs. In a very similar procedure, surgeons successfully excised a deeply embedded tumor from a pediatric patient at NewYork- Presbyterian Morgan Stanley Children’s Hospital. Research A high priority of intestinal and multivisceral transplant research is expansion of the indications for transplantation to patients with tumors. The Hospital’s research plans include trials investi - gating oncological indications for transplant, as well as studies on induction of tolerance after transplantation.

6 Intestinal and Multivisceral Transplantation “ I n

Autotransplantation can also be used in place of traditional transplantation t e

for some patients, precluding the need for a donor organ. This could s t i save lives and make lifelong post-transplant immunosuppression unnecessary. n

“ a

—Jean C. Emond, MD, Vice Chair and Director of Transplantation, l a NewYork-Presbyterian Hospital/Columbia University Medical Center n d M u l t i v i Innovations s c Indications for referral and evaluation e r

Autotransplantation for Ex Vivo Tumor Resection a Columbia transplant surgeons at NewYork-Presbyterian have Short bowel syndrome caused by mesenteric vascular l T

established a new method of performing ex vivo tumor resection thrombosis; r a

for tumors involving the blood vessels that supply the major ab - Crohn’s disease; n s

dominal organs. Because of their inaccessibility and their location Trauma; p l in or near the major vessels, such tumors are considered inopera - Volvulus; a n

ble by most centers. The option of autotransplantation allows Functional disorders such as chronic intestinal pseudo- t a

surgeons to remove the intestine, liver, or other abdominal organs obstruction; t i as required in order to access the tumor resection. After excising Multiple or extensive desmoid tumors, including o n the tumor, they reconstruct the blood vessel and then reimplant Gardener’s syndrome, which necessitate extensive the patient’s native organs. Patients undergoing autotransplanta - intestinal removal. tion need no immunosuppressant medications following surgery, and outcomes have been excellent. Outcomes Abdominal Wall Transplantation Abdominal wall transplantation is the reconstruction and closure Worldwide, the one-year survival rate for isolated intestinal trans - of the abdominal compartment, which may be necessary after plantation is over 77%. Increased survival rates are associated extensive abdominal resections, repeated laparotomies, tumor with surgeons’ experience in intestinal and multivisceral trans - resection, wound infections or enterocutaneous fistulae. Abdo- plantation, patient volumes greater than 10 cases per year, and minal wall transplantation may also be required to close the immunosuppression protocols that include induction therapy.* abdomen after small-bowel and multivisceral transplantation. *Source: 2003 Report of the International Intestine Transplant Registry NewYork-Presbyterian is one of the few centers in the country with experience performing this novel technique.

Intestinal and Multivisceral Transplantation

NewYork-Presbyterian Hospital/ Columbia University Medical Center Presbyterian Hospital Building, 14th floor 622 West 168th Street New York, NY 10032 Phone: 877.LIVER.MD

Emergency referrals and transfers: 800.NYP.STAT

L Closure of the abdomen through abdominal wall transplantation.

7 Kidney Transplantation

Kidney transplantation is the optimal therapy for patients with end-stage renal disease, affording them healthy and productive lives free from dialysis.

Overview

The kidney transplantation programs at both NewYork-Presbyter - ian/Columbia and NewYork-Presbyterian/Weill Cornell are the oldest in the region and the largest in the nation. NewYork- Presbyterian/Weill Cornell works in conjunction with the Rogosin Institute, one of the top comprehensive renal centers in the na - tion. The multidisciplinary transplant team is composed of sur - geons, nephrologists, social workers, financial coordinators, and other specialists, who rely routinely on the expertise of an unpar - alleled pathology unit at the Hospital, as well as its blood bank and apheresis unit.

Both programs are committed to increasing access to transplan - tation and returning patients to active lives. Living donor transplantation is done whenever possible in order to perform transplantation before patients require dialysis.

For those patients on the UNOS waiting list for a deceased donor organ, the renal transplantation programs use a highly ef - fective method of managing their waiting lists. This aggressive approach ensures that those patients at the top of the list are ready to be transplanted as soon as a kidney is available. This ap - proach is complemented by comprehensive protocols to evaluate all potential organs, including those in the ‘extended criteria’ category. These strategies have reduced the waiting time for deceased donor organs by an average of four years, reducing the number of patient deaths while on the waiting list and sig - o i z i r

b nificantly improving outcomes after transplantation. a F a d a J For patients with other co-morbidities, the programs offer com - L prehensive medical and surgical care in every field. Diabetic pa - Preparation of a donor kidney before transplantation. tients with end-stage renal failure may receive pancreatic transplantation, either simultaneously with the kidney or in a separate procedure following kidney transplantation. Patients with advanced cardiac or liver disease may be candidates for combined heart-kidney or liver-kidney transplantation.

8 Kidney Transplantation K i d

The renal transplantation programs offer n e

patients with end-stage kidney disease four y transplant alternatives. o i z i r

b I Compatible live donor transplants: The gold standard of a F a

d kidney tra nsplant procedures. A kidney from a perfectly a J L matched sibling donor can function for an average of 35 Donor kidney ready for transplantation years, while less perfectly matched kidneys function for 20 at NewYork-Presbyterian Hospital. years on average.

Innovations I Paired donor exchanges: Offer the benefits inherent in finding a compatible live donor, compared to waiting for Established in 1961 and 1969, respectively, the kidney transplant a deceased donor. Paired donor exchanges have been programs at NewYork-Presbyterian/ Weill Cornell and NewYork- performed at NewYork-Presbyterian Hospital since 2004. Presbyterian/ Columbia have a long history of innovation. Both Several three-way exchanges (requiring six simultaneous are dedicated to providing every possible opportunity for trans - operations), one four-way exchange, and a six-way ex - plantation, and to overcoming the most significant challenges in change have also been successfully performed. kidney transplantation. They have developed innovative strate - gies to increase access to transplantation not only for average patients, but for people with difficult problems, and those with Altruistic Unbalanced Paired Kidney Exchange immunologic incompatibilities. The programs are national lead - Recipients Donors ers in developing creative approaches including: ABO incompatible transplantation; Recipient 1 O X AB Spouse Transplantation across positive cross-match; Desensitization of HLA antibodies in deceased donor opera - tions; and Recipient 2 AB A Friend Paired exchanges, including both simple and complex ex - changes, and transplants involving both compatible and incompatible live donors. Recipient 3 A O Spouse NewYork-Presbyterian/Columbia is a national leader in the per - formance of multiple paired living donor kidney transplantation, A donor-recipient pair that was compatible with one another a revolutionary approach that may dramatically improve the op - (patient 3) participated in a paired kidney exchange in order to portunity for patients in need of kidney transplants to find a facilitate the transplantation of two other recipients who had incompatible donors (patients 1 and 2). compatible donor.

NewYork-Presbyterian/Weill Cornell was a pioneer in developing I Incompatible live donors: An option if the donor and re - the Never Ending Altruistic Donation (NEAD), in which one altru - cipient are either blood-group incompatible or incompatible istic (or “non-directed”) living kidney donor, willing to donate to due to antibodies against the transplant antigens. To accept any patient awaiting transplantation, can begin a chain of kid - a kidney from an incompatible donor, the recipient’s blood ney transplants that otherwise would not be possible. must be repeatedly “cleansed” of mismatched antibodies At NewYork-Presbyterian/Weill Cornell, physician scientists were through plasmapheresis. the first to develop gene-expression-based assays to non-inva - I Deceased donor procedures: Reserved for those patients sively detect organ rejection after kidney transplantation (pub - who do not have any willing or medically suitable live lished in 2001). Using biomarkers available in simple urine tests, donors. Deceased donor kidneys have a good chance of this unique program allows for individualizing and minimizing maintaining their function for 10 years post-transplant. the amount of immunosuppressive therapy that patients require.

9 L Research Suturing the anastomosis during kidney transplant surgery. A major area of research focuses on overcoming immunologic incompatibilities in transplant recipients. In particular, the pro - Patient Care grams are researching ways to optimize paired kidney exchanges Together, the two campuses perform over 450 kidney and to improve immunosuppressant protocols. Continued re - transplants per year. Trials of most new therapeutic op - search is underway to perform both donor and transplant opera - tions are available to NewYork-Presbyterian Hospital's tions through minimally invasive techniques. At this time all patients due to their high volume and superb academic donor operations are done laparoscopically. In recipients, smaller and research facilities. surgical incisions and laparoscopic operations are undergoing preclinical testing. Other research efforts include: Aggressive extended criteria protocols enable surgeons investigations of live donor risk; on both campuses to safely use more organs than ever for transplantation. These protocols are highly success - research to further reduce the already low risk of hemorrhagic complications in donors; ful, especially among older recipients and those doing poorly on dialysis. ways to expand the profile of suitable donors; and improving immunosuppression regimens. The programs are leaders in coordinating “donor swaps” to maximize the availability of compatible donor kidneys. Both centers actively encourage altruistic live organ donation and are prepared to perform multiple Incompatible Transplants and Paired Exchanges simultaneous donor and recipient operations.

Since the programs established their comp rehensive incompatible Where compatible donors are not available, the pro - renal transplant programs, over 90 patients have received kidney grams are among the few worldwide to offer incompati - transplants when they did not have a compatible live donor, via ble kidney transplantation. They use the latest ABO blood group incompatible transplants, transplants across a immunologic strategies to cleanse mismatched antibod - positive crossmatch, or paired kidney exchang es. ies from recipients' blood, allowing the transplantation of kidneys into recipients who would normally reject the Transplant Rate While on Waitlist graft. Long-term survival among incompatible recipients is equivalent to that for compatible transplants. NewYork-Presbyterian OPO Region U.S. 7/06-6/07 7/07-6/08 7/07-6/08 7/07-6/08 7/07-6/08 After transplantation, 90% of patients at NewYork- Kidney Columbia University 0.41* 0.36* 0.19 0.20 0.20 Presbyterian Hospit al are able to avoid steroid use, as Deceased 0.23* 0.23* 0.12 0.13 0.14 part of a highly successful steroid avoidance protocol in Donors Only place since 2001. Molecular-based techniques, which are Kidney 0.37* 0.34* 0.19 0.19 0.20 Weill Cornell under continued research, now provide patients at both Deceased 0.25* 0.16* 0.12 0.12 0.14 Donors Only campuses with highly personalized immunosuppressant

*Statistically higher compared to U.S. therapy in order to reduce or eliminate the use of steroids Source: SRTR Center and OPO Specific Reports, January 2009 after transplantation. Over 700 transplanted patients re - Patients at NewYork-Presbyterian Hospital are signiﬁcantly more likely to main completely free of steroid medications post-trans - receive a kidney transplant while on the waitlist than patients at other plant, with an average rejection rate of just six percent. hospitals regionally and nationally.

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e c a l p t a c i d e s d e h T u j n o e h t e v i e c o a e c e h t m r g o h s n e n e k a r p t a t v d a e h e h n a i r e t y b s e r P n a l p s n a e v i e c t s s e l m e r e h T s n o a - k e r a c r T e r e s i t a r l a c s t n p m o c r o Y w i g t n e i t e p e i e o t a N r u s a p t p t A u O - t s o p e v i s Liver Disease and Transplantation

For patients with advanced organ failure, the Center for Liver Disease and Transplantation provides comprehensive treatment including medical, radiologic, and surgical care for the most complex and serious diseases.

Overview

Protocols for early intervention and prevention of decompensation are highly effective in treating many patients. Transplantation serv - ices are available for patients in whom all other efforts fail.

The Center for Liver Disease and Transplantation (CLDT) performed its 1000th transplant in 2008. The center’s outcomes consistently meet or exceed the expected national average.

The center's uptown and downtown academic medical center loca - tions are seamlessly integrated, with close collaboration among he - patologists, gastroenterologists, hepatobiliary surgeons, diagnostic and pathology experts, advanced practice nurses, social workers, and patient support staff.

Living Donor Liver Transplantation By improving access to transplantation, particularly in regions such as New York that have longer waiting lists, living donor liver transplantation may reduce patients' risk of dying by 20-40%.

In living donor liver transplantation, up to 60% of a donor's liver may be removed for an adult transplant, and up to 20-25% for a child recipient. The donor's liver regenerates to its original size in several weeks, and donors return to normal activity within about a month.

The National Living Donor Assistance Center (NLDAC), established by the U.S. Health Resources and Services Administration (HRSA), provides financial assistance for travel, lodging, and meals to those who want to donate an organ and would otherwise not be able to afford these expenses.

L Examination of a donor liver that was stored with machine preser - Microscopic comparison vation. of normal liver biopsy

L (left) with hepatocellular carcinoma (right) .

12 Liver Transplantation L i

Innovations v e

The Center for Liver Disease and Transplantation (CLDT) is com - r mitted to understanding and extending the limits of organ transplantation in order to provide the greatest number of trans - plants possible with a limited organ supply.

Numerous clinical trials have yielded methods to reduce the size of tumors, and in so doing, render patients eligible for trans - plantation. Among patients with unresectable localized cancer who have undergone transplantation, the five-year survival rate is 75-80%.

Living Donor Transplantation Dr. Emond was a member of the team that pioneered living donor liver transplantation, which is now considered one of the most important advances in the treatment of severe liver dis - ease. Approximately 15-20% of the center's transplant patients currently receive a liver from a living donor.

Partial Liver Transplantation L NewYork-Presbyterian Hospital was one of the first institutions Top: Cirrhotic liver stained with trichrome stain. Diffuse scarring (excess collagen) appears blue; rounded to perform split liver transplantation. This procedure now ac - regenerative nodules (hepatocytes) appear red. counts for a substantial proportion of liver transplants in the Bottom: In auxiliary partial orthotopic liver transplanta - U.S., primarily in children. tion (APOLT), a partial donor liver provides support while the native liver recovers. Organ Preservation The CLDT has completed a pilot stu dy in machine perfusion to Partial Liver Transplantation for Acute Liver Failure improve organ preservation between procurement and transplan - Patients with fulminant hepatic failure traditionally have had tation. By better protecting the donor organ and preventing dam - limited options: timely recovery of the native liver with medical age that can occur between harvesting and transplantation, management, or liver transplantation. Having revamped a proce - surgeons can safely use a wider range of organs with excellent dure that was largely abandoned in the 1980’s, transplant sur - outcomes. The next step of this study involves repairing and trans - geons at NewYork-Presbyterian/Columbia are now able to offer planting organs that would otherwise have been considered un - patients an important alternative. In auxiliary partial orthotopic usable, but that are safe and effective af ter treatment. liver transplantation (APOLT), the surgeons resect part of the fail - ing native liver and attach a partial donor liver to it. The donor Multi-Organ Transplantation liver supports the patient during recovery, clearing toxins and Th e Hospital has extensive experience in perfo rming combined preventing brain injury. In the majority of patients, the native liver liver-kidney transplantations. Approximately 5% of the trans - recovers with this support. Immuno suppressant medication can plant volume consists of combination procedures. In the sum - then be withdrawn, and the donor liver withers in most patients. mer of 2007, one pediatric patient received five organs in a rare multi- organ transplant operation, reflecting the Hospital’s expert Although partial liver transplantation is particularly suited to chil - capabilities. dren because the regenerative capacity of their livers is optimal, this technique may also be applied in young adults. In studies it Tran splantation for Patients with Liver and Bile Duct Cancer has proven highly successful, with 100% of patients surviving at The CLDT has established a new protocol to perform transplanta - the time of this publication. Over half of patients have com - tion in patients wi th hilar cholangiocarcinoma. In this experi - pletely withdrawn from immunosuppression and the remainder mental protocol, patients receive chemoradiation to eliminate are in the process of withdrawal. One patient required surgical systemic malignant cells, followed by transplant. Early results removal of the donor liver. NewYork-Presbyterian Hospital is one are promising, with no patients having tumor recurrence after of only a few hospitals worldwide with the expertise to perform ortho topic liver transplantatio n. This compares favorably with partial liver transplantation. the recurrence rate of cholangiocarcinoma after medical or sur - gical therapy. 13 Current Clinical Trials:

Solid Organ Transplantation in HIV: The primary aim of this observational trial is to evaluate the safety and efficacy of solid organ transplantation in patients with HIV disease;

Boceprevir (SPRINT 2): A phase 3 safety and efficacy study of boceprevir in previously untreated patients with Research chronic hepatitis C genotype 1; Clinical innovation and scientific progress constitute the core of Telaprevir (Vertex 111): A randomized study of stopping the Center for Liver Disease and Transplantation’s mission. The treatment at 24 weeks vs. continuing treatment to 48 CLDT participates in multiple government- and industry-funded weeks in treatment naive patients with genotype 1 hepati - clinical research studies at any given time. Patients at the CLDT tis C who achieve an extended viral response (eRVR) while have the opportunity to receive treatments that are available in receiving telaprevir, pegylated interferon and ribavirin; few or no other centers. The Hospital is also a major center for the study of outcomes for liver disease treatment and liver trans - Rimonabant (NASH): A placebo controlled trial to study plantation. rimonabant treatment in non-diabetic and type 2 diabetic patients with nonalcoholic steatohepatitis; Many of the CLDT’s 40-plus studies address hepatitis C, which is the leading indication for transplantation and a major cause of Adefovir Plus Vaccination: Determining the efficacy of organ failure after transplantation. adefovir dipivoxil (ADV) and vaccination in recipients of liv - ers testing positive for hepatitis B core antibody; The CLDT is a leader in the multi-center Adult to Adult Living- donor Liver Transplant (A2ALL) study, a NIH sponsored trial to in - HBV Inflammatory Markers: Assessment and clinical vestigate the outcomes of living donor transplantation. utility of non-invasive parameters of inflammatory activity in chronic hepatitis B;

Gilead-0108: Double-blind, multi-center, randomized study comparing tenofovir disoproxil fumarate, emtric - itabine plus tenofovir disoproxil fumarate, and entecavir in the treatment of chronic hepatitis B subjects with decom - pensated liver disease;

Live Donor Education: Increasing liver donation through peer-developed education: baseline survey (HRSA);

ALF Adult: A multi-center study of acute liver failure in L adults; Regina Williams with her son, Paul Mladineo, who Liver Perfusion: Hypothermic machine preservation of donated part of his liver when his mother experi - enced liver failure due to autoimmune disease. liver grafts for transplantation; “Paul and I are doing great. Our livers are functioning perfectly,” says Williams. A2ALL Cohort Study: Adult-to-adult living donor liver transplantation cohort study;

A2ALL LADR: Low accelerating dose regimen of pegy - lated interferon and ribavirin pretransplant, to eliminate post transplant hepatitis C virus recurrence;

ELAD: A bioartificial liver assist device for patients with acute or chronic liver failure.

14 Liver Transplantation Our surgical team has become expert at assessing the quality and properties of different “

types of organs — deceased standard criteria donor, deceased extended criteria organs, L i v

“or living donor — and can determine which patient will most benefit from each one. e r — Dianne LaPointe-Rudow, DNP, Senior Transplant Coordinator and Clinical Director of the Living Donor Liver Transplant Program, NewYork-Presbyterian Hospital/Columbia University Medical Center

Patient Care Outcomes

The Center for Liver Disease and Transplantation offers the The Center for Liver Disease and Transplantation has the highest full spectrum of services to patients with liver disease, from con - survival rate while on the waiting list, and the shortest waiting sultations on all forms of benign and malignant liver disease, time, in the New York State region. According to SRTR data from to antiviral therapies for hepatitis B and hepatitis C, to transplan - 2007, the Center’s waiting list mortality rate is 7%, compared tation. with 13% at the other four regional transplant centers. This is even better than expected when adjusted for the severity of pa - Patients co-infected with hepatitis C or HIV may also receive tients’ illness while on the waiting list. transplant services at the CLDT, as can patients with cancer of the bile ducts. NewYork-Presbyterian Hospital is one of very few From January 2004 to June 2006, the CLDT had a 98% survival institutions to provide these options. rate for the 267 adults, and 97% survival rate for the 43 children on whom it performed liver transplants; the national rate was The CLDT is committed to providing care to patients and will 96%. In that period, the one-year post-transplant survival rate work to assist them with their financial needs. was 88% for adults (87% nationally) and 94% for children.

2007 One-Year Patient Survival at New York Transplant Centers Living Donor Recipient Criteria: (percentage of patients survivng one year) A potential live donor liver transplant recipient must: 89 Meet the current listing criteria for liver transplant; 87 Be listed with OPTN/UNOS; 85 Be informed of the risks/benefits, alternative treatments and 83 outcomes for living donor and deceased donor transplantation; 81 Sign consent to have potential donors evaluated for living donation. 79 77

75 NYPH-CUMC Other Centers

Source: OPTN/SRTR 2007 Annual Report

For the most current data regarding liver transplant outcomes, please visit www.ustransplant.org.

Liver Disease and Transplantation L Living donor liver transplantation NewYork-Presbyterian Hospital/ Columbia University Medical Center Presbyterian Hospital Building, 14th floor 622 West 168th Street New York, NY 10032 Phone: 877.LIVER.MD

NewYork-Presbyterian Hospital/ Weill Cornell Medical Center 1305 York Avenue, 4th floor New York, NY 10065 Phone: 646.962.LIVER

Emergency referrals and transfers: 800.NYP.STAT

15 Lung Transplantation

Lung transplantation can prolong and dramatically improve quality of life for patients with severe end-stage, non-malignant pulmonary disease and no alternative treatment options. The majority of patients return to work, school, and other activities within three to six months of surgery.

Overview

Widely regarded as the preeminent center for lung transplanta - tion in the New York tri-state area, the Center for Lung Disease and Transplantation at NewYork-Presbyterian/Columbia Univer - sity Medical Center has the highest three-year survival rate among the U.S. News & World Report Honor Roll Hospitals. Its patient volume has dramatically risen during the last seven years, earning the program a position in the top five programs in the nation in 2007.

Comprehensive, coordinated, multidisciplinary care is provided to patients with every type of lung disease. To avoid transplantation whenever feasible, patients are evaluated with second opinion consultations for eligibility in the interstitial lung disease pro - gram, the pulmonary hypertension program, adult cystic fibrosis program, lung volume reduction program, or for eligibility in

e new clinical trials. These options can effectively treat certain k a t o

t conditions with less invasive alternatives, or offer therapies that o h P / serve as a bridge to lung transplantation, delaying the need to M S I L perform this difficult treatment option. Chest X-ray showing chronic Specialized programs within or affiliated with the Center for obstructive pulmonary disease (COPD). Lung Disease and Transplantation include: The Jo-Ann F. LeBuhn Center for Chest Disease; High Risk Lung Assessment Program; Thoracic Oncology Program; Interventional Bronchoscopy and Endobronchial Therapy Program, for the treatment of endobronchial tumors or tracheobronchial obstructions. For patients who progress to end-stage lung failure, transplanta - tion is offered when the expected survival with their native lungs is one to two years.

16 Lung Transplantation L u

Chest X-ray, front view, n

of a 25-year-old woman g L with pulmonary sarcoidosis. e k a t o t o h P / M S I

Innovations Understanding Rejection after Transplantation

Since 1986, lung transplant research has been dedi cated to im - The Lung Transplant Program is in the vanguard of addressing proving outcomes in life-threatening lung diseases. Studies at the most significant risks to lung transplantation patients: the Center for Lung Disease and Transplantation continue to rejection of the donor organ and infections. Although medical improve treatment options, prevent or delay the progression of regimens can successfully protect patients against acute organ serious lung diseases, and improve the quality of life and sur - rejection that occurs usually in the first year following transplant vival for patients. These achievements have been most notable surgery, chronic rejection slowly and steadily undermines the in the areas of emphysema, idio pathic pulm onary fibrosis, pul - health of over half of lung transplant patients during the first five monary arterial hypertens ion, and cystic fibrosis . years after transplantation.

The Center has pioneered the use of minimally invasive lung Research at NewYork-Presbyterian/Columbia has shed light on volume reduction (LVR) surgery as well as bronchoschopic LVR the important role of gastro-esophageal reflux (GER) as one of for patients with emphysema. It also uses video-assisted thoracic the causes of chronic lung graft dysfunction, also known as surgery (VATS) for both diagnostic and therapeutic interventions chronic rejection. for a number of chest problems that previously required large, Researchers at the Center have recently discovered the role open surgical incisions. played by a pair of protein receptors in the immune system’s Through laboratory research and participation in multi-center ability to develop tolerance to a new organ. Their work is part clinical trials, the Center’s physicians continue to drive progress in of an ongoing investigation into why and how transplanted lung transplantation. New immunosuppressive drugs and drug organs are rejected by the body so that new and improved combinations are increasing the longevity of the transplanted methods for protecting a transplanted lung can evolve. organ, and decreasing side effects associated with therapy. Ther - The Center is testing new immunological surveillance tech - apeutic regimens to prevent and treat infections are also being niques to enable the diagnosis of more subtle forms of rejec - investigated. The researchers are investigating methods for pre - tion earlier than ever before, which ultimately could improve serving donor lungs for a longer period of time before they must lung transplant patients’ quality and length of life. be transplanted into the recipient. Additionally, lung transplant program clinical investigators are focusing on identifying specific factors in patients that may help determine the optimal timing of transplantation.

Main Disease Indications For Transplantation Interstitial Lung Disease Cystic Fibrosis Chronic Obstructive Pulmonary Disease Pulmonary Hypertension and Sarcoidosis

17 Indications for Referral

Chronic Obstructive Pulmonary Disease Guideline for Referral BODE index >5 Guidelines for Transplantation Research Patients with a BODE index of 7-10; Chronic progressive hypercapnia or hospitalization for Current clinical studies in lung transplantation include: exacerbation associated with acute hypercapnia; Pulmonary hypertension and/or cor pulmonale despite oxygen The use of inhaled cyclosporine versus placebo to prevent the development of chonic lung rejection after lung transplantation ; therapy; FEV1 <20% with DLCO <20% or homogeneous disease. Comparison of a Tacrolimus/Sirolimus/Prednisone Regimen versus Tacrolimus/Azathioprine/Prednisone Immnosuppressive Idiopathic Pulmonary Fibrosis Regimen in Lung Transplantation after Lung Transplantation; Guidelines for Referral Genetic Analysis to Predict Rejection of Lung Transplants Histologic or radiographic evidence of UIP irrespective of vital (LARGO Study): Utilizing microarray analysis techniques to capacity in patients with idiopathic disease; determine peripheral blood gene expression, this study fo - Histologic evidence of fibrotic NSIP. cuses on the prediction of acute rejection after lung transplan - Guidelines for Transplantation tation; Histologic or radiographic evidence of UIP in idiopathic disease or fibrotic NSIP and any of the following: Lung Transplant and Hypogammaglobulinemia: Evaluating the safety and efficacy of intravenous immunoglobulin in patients A DLCO of <39% (UIP) or <35% (NSIP) predicted; with hypogammaglobulinemia after lung transplanta tion; A 10% or greater decrement in FVC or 15% decline in DLCO during six months of follow-up; Role of Activated Protein C in Early Acute Respiratory Distress A decrease in pulse oximetry below 88% during a 6MWT; Syndrome: Determining whether levels of activated protein C Honeycombing on HRCT. after lung transplantation are associated with lung allograft function; Cystic Fibrosis Molecular Monitoring after Solid Organ Transplantation: Ex - Guidelines for Referral amining which genes are active in patients undergoing lung FEV1 <30 percent of predicted or rapid decline in FEV1, transplantation; particularly in young female patients; Increasing frequency of exacerbations or exacerbation requir - Pathogen Discovery in Chronic Lung Disease: Analyzing the microbes present in patients after lung transplantation; ing ICU hospitalization; Recalcitrant and/or recurrent pneumothorax; Genetic Predictors of Primary Graft Dysfunction after Lung Recurrent hemoptysis not controlled by embolization. Transplantation. Guidelines for Transplantation Oxygen-dependent respiratory failure; Progressive hypercapnia; Pulmonary hypertension.

Pulmonary Arterial Hypertension Guidelines for Referral NYHA functional class III-IV, irrespective of therapy; Rapidly progressive disease; Pulmonary veno-occlusive disease and PCH; Endarterectomy candidates. e

k Guidelines for Transplantation a t o t

o Persisting NYHA class III or IV on medical therapy; h P /

M Failing therapy with IV epoprostenol or equivalent;

S I L Cardiac Index <2 L/min/m2; CT scan of the thorax, axial section, showing pulmonary cystic fibrosis. Right atrial pressure >15 mm Hg. Opacities that are annular (ring-like) and dispersed in parallel lines Reference: Orens, JB; Estenne, M; Arcasoy, S, et al. International Guidelines for the (tram-lines) correspond to dilations of the bronchi. Selection of Lung Transplant Candidates: 2006 Update – A Consensus Report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006;25:745-55. 18 Lung Transplantation Lung “ 0 0 9 0 0 1 1 1 - k r , t - n a m a r e t a r r e g p 0 0 o Y w e l p . s 6 o 8 8 s r 4 N . . n o P s d e r d n u h l a t 4 0 9 8 l a v i v r t a m a r . i p f o 7 s n tra e t a r n o t 7 u s o n o i t a g o r . g r H 3 4 p e t a r l a v t n g n 8 1 6 l l . . 0 a 91 e 8 6 7 . e m i t 60 6 . u l i v r r 6 6 4 4 s n o i o R o . t n h t 6 6 t T u s l p s n r , e t n o i t a t n a l p l a v i v r A g n i t a t n a l p s n p 7 i a l p o n a r T 0 r e C r a e y - e e r h t e m a s r o u s T S d l e t a a r t s n a r o o 0 2 o H l / s n a g T r a e y - r F , g n u 0 0 r e h t c i d l a L n . 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e p b i e r e v e s h t f x e r e d c f i s a h n n u o i i t s y c t a t Pancreas Transplantation Whole organ pancreas transplantation is a viable and preferred option for patients with type 1 diabetes and end-stage renal disease.

Overview

Transplantation restores normal sugar control, allowing the majority of type 1 diabetic patients to stop using insulin. When performed in conjunction with renal transplantation, pancreas transplantation protects the new kidney from the damage caused by diabetes. In some patients, it slows the progression or even reverses some of the secondary compli - cations of diabetes. Overall, when successful, pancreas transplantation is much better than insulin therapy in im - proving quality of life, and in prevention of morbidity and mortality.

Patients with hypoglycemic unawareness, or ‘brittle dia - betes,’ may be appropriate candidates for pancreas trans - plantation regardless of the need for kidney transplantation, L despite the potential complications of immunosuppression. Islet cells In such cases, pancreas transplantation can “cure” their dia - betes and protect the native kidney.

A small subset of patients with type 2 diabetes may also be Indications for Pancreas Transplantation candidates for pancreas transplantation.

Type 1 diabetes with renal failure During the last six years, outcomes in pancreas transplanta - Pancreas after kidney transplantation (PAK); tion have improved markedly due to advancements in im - Simultaneous kidney/pancreas transplantation (SPK). munosuppressant regimens and the increased use of enteric Type 1 diabetes without renal failure (PTA) drainage of pancreatic secretions. Enteric drainage allows Extremely brittle ; Hypoglycemic unawareness ; the pancreas to be connected to the intestine instead of the Progressive secondary complications despite bladder, where pancreatic secretions can cause significant optimal insulin regimen. inflammation and toxicity. Type 2 diabetes Phenotypic Type 1 ; Surgeons at NewYork-Presbyterian/Weill Cornell have been • Thin ; performing pancreas transplantation since 1996. Outcomes • Early onset ; have generally met or exceeded the national average. UNOS • Persistent C-peptide ; Decreased insulin production. approved pancreas transplantation at NewYork-Presbyter - ian/Columbia in January 2008; it is expected that NewYork- Presbyterian/Columbia’s premier kidney transplant program will facilitate rapid growth of the new pancreas transplanta - tion program, which will overlap both in its patient popula - tion and its surgical and medical expertise.

20 Pancreas Transplantation “ P

Pancreas transplantation can save lives, in particular for type 1 a n

diabetics who have advanced secondary complications of diabetes c r e

such as renal impairment. a

“ s — Sandip Kapur, MD, FACS, Chief, Division of Transplant Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center L Axial view of pancreas, which is marked by the arrow.

Innovations Patient Care

The first successful islet cell transplantation in the tri-state area The northeast region of the U.S. has been consistently under - was carried out at NewYork-Presbyterian/Weill Cornell in 2004. served as far as access to pancreas transplantation, with rela - Tolerance tively few centers serving a disproportionately large metropolitan Both centers have been conducting research to promote immuno - population. The expanding programs at NewYork-Presbyterian logic tolerance in pancreas transplant recipients, working towards Hospital now provide much-needed access to patients with dia - the goal of complete freedom from immunosuppressant medica - betes in the New York metropolitan area, particularly those with tions after transplantation. the most complex medical and surgical challenges. NewYork- Presbyteri an/Columbia works in close collaboration with the Steroid Avoidance Naomi Berrie Diabetes Center, the leading diabetes center in the With gene-based therapies and steroid-avoidance protocols now metropolitan area. in place, patients at both centers receive highly personalized im - munosuppressant therapies that permit lower steroid doses or In addition to its transplantation options, NewYork-Presbyter - steroid-free protocols. ian/Weill Cornell offers a novel surgical alternative, an intestinal switch operation, and both centers maintain active metabolic sur - Research gery programs, which hold promise for reversing type 2 diabetes. Tolerance induction to islet transplantation using primed or non-primed UVB irradiated dendritic cells (human antigen presenting cells) with brief peritransplant immunosuppression;

The development of a new intramuscular site for islet transplants using an alginate scaffold impregnated with angiogenic, antiapoptotic, and immunosuppressant factors;

Development of the use of PET techniques to visualize and eval - uate the function and viability of pancreatic islets in humans and After simultaneous kidney- pancreas transplants at in experimental models for diagnostic and prognostic use. NewYork-Presbyterian/ Weill Cornell in 1999,

L Glenda Daggert has no symptoms of the diabetes Candidates for solid organ Candidates for islet that once threatened pancreas transplant transplant her life. (but not islet) (but not solid organ) Patients with large body habi - Small BMI patients who do not tus (>180 lbs) or large insulin want invasive procedure ; requirements ; Patients with life threatening Patients with life threatening diabetes with high cardiac diabetes ; risks. Patients receiving a simultane - ous kidney.

21 Islet Transplantation

Transplantation of pancreatic islet cells into patients with type 1 diabetes offers the possibility of reversing the disease without the need for major surgery. Even partial islet function in patients with hypoglycemic unawareness, or “brittle diabetes,” can sig - nificantly improve the management of this disease and abolish PATIENT hypoglycemic unawareness. CARE In this procedure, islet cells obtained from the pancreas of one or two deceased donors are infused via catheter into the recipient’s liver, where they act as a back-up pancreas, producing insulin and regulating blood sugar. When this is performed with the patient’s own cells (autotransplantation), the success is very high, and such patients avoid developing diabe tes after pancre - atic resection. This contributes significantly to their long-term prognosis.

Cutting-edge research at NewYork-Presbyterian/Weill Cornell has developed a systemic gene therapy that a) eliminates the need for immunosuppressant medications to protect islet grafts, b) restores tolerance, and c) facilitates regeneration, in animal models. To reduce the volume of islet cells needed for successful transplantation, the researchers developed a novel anti-oxidant therapy that optimizes islet isolation and improves their post- Three types of whole organ pancreas transplantation: transplant function. The program has successfully reversed dia - Pancreas transplantation alone as a cure for type 1 diabetes; betes in animal models without the use of immunosuppressants Pancreas transplantation combined with kidney transplantation; after transplantation. Continued work on these therapies holds Pancreas transplant following live-donor kidney transplantation. considerable promise for transcending challenges to pancreatic transplantation, and for extending the long-term durability of islet transplantation in people.

At NewYork-Presbyterian/Columbia, a team has been conducting islet transplantation research since 1976. It is one of ten regional Pancreas Transplantation islet resource centers in the U.S. that isolate and transplant islet NewYork-Presbyterian Hospital/ cells to treat type 1 diabetes as part of a limited FDA protocol. Columbia University Medical Center Presbyterian Hospital Building, 12th Floor At this time, the team is investigating a new method of islet cell 622 West 168th Street transplantation by impregnating islets into pretreated, non-reac - New York, NY 10032 tive scaffolds, along with agents to attract blood vessels and Phone: 212.305.6469 repel rejecting cells. When the treated scaffolds are placed into abdominal muscles and injected with pancreatic islets, experi - NewYork-Presbyterian Hospital/ Weill Cornell Medical Center mentally induced diabetes is reversed in animal models. Both 525 East 68th Street centers will perform autotransplantation for patients undergoing New York, NY 10065 pancreatic resection for pancreatitis as part of a broad program Phone: 212.517.3099 in islet transplantation. Emergency referrals and transfers: 800.NYP.STAT

22 Pancreas Transplantation NewYork-Presbyterian International Physicians and Patients Pediatric Transplantation Programs Please visit www.nyp.org/international

PEDIATRIC KIDNEY TRANSPLANTATION Each year, thousands of patients from all over the world travel to NewYork-Presbyterian Hospital. NewYork-Presbyterian Morgan Stanley Children’s Hospital Our International Services staff provides personalized attention and 3959 Broadway, Suite 701 makes international patients and their families feel comfortable during New York, NY 10032 their stay with us. Our managers, coordinators and financial counselors Please call: 866.697.7755 speak many languages and assist patients with a variety of details such as scheduling physician appointments, escorting patients to procedures, NewYork-Presbyterian requesting second medical opinions, providing information about lodg - Komansky Center for Children's Health ing and other medical and non-medical services. The first step to learn - 525 East 68th Street ing more about our services at NewYork-Presbyterian Hospital is to New York, NY 10065 contact our International Services Office at: Please call: 646.962.4324 INTERNATIONAL SERVICES PEDIATRIC LIVER AND INTESTINAL REHABILITATION NewYork-Presbyterian Hospital/Columbia University Medical Center AND TRANSPLANT PROGRAM 177 Fort Washington Avenue NewYork-Presbyterian Milstein Hospital Building 9 Central Morgan Stanley Children’s Hospital New York, NY 10032 3959 Broadway – 7th Floor Phone: +1 212.305.4900 New York, NY 10032 Fax: +1 212.342.5393 Please call: 866.697.7755 E-mail: [email protected]

NewYork-Presbyterian Hospital/Weill Cornell Medical Center PEDIATRIC CARDIAC TRANSPLANT PROGRAM 525 East 68th Street NewYork-Presbyterian Greenberg Pavilion 1-503 Morgan Stanley Children’s Hospital New York, NY 10065 3959 Broadway – 2 North Phone: +1 212.746.4455 New York, NY 10032 Fax: +1 212.746.4777 Please call: 866.697.7755 E-mail: [email protected]

PEDIATRIC LUNG TRANSPLANT PROGRAM NewYork-Presbyterian Morgan Stanley Children’s Hospital 3959 Broadway, Suite 701 New York, NY 10032 Please call: 866.697.7755

23 NewYork-Presbyterian Hospital/Weill Cornell Medical Center

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New York residents may enroll in the Donate Life Registry to give legal consent for the recovery of organs and tissues for transplantation and research. Contact the New York Organ Donor Network at www.donatelifeny.org.