N EWY ORK–PRESBYTERIANMonth 2004 Transplant Affiliated with COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS and SURGEONS and WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY Fall 2005 New Techniques, Protocols Improve Physicians Seek To Expand Kidney Outcomes in Pediatric Heart Transplant Donor Pool y applying new sur- gical techniques and Bexpanding the donor olumbia and Weill Cornell pool, Morgan Stanley researchers at NewYork- Children’s Hospital of C Presbyterian Hospital are seek- NewYork-Presbyterian/ ing to overcome the limitations pre- Columbia University sented by the small donor pool available Medical Center continues to for by aggres- make strides in pediatric sively pursuing several strategies that heart transplantation. “Last aim to solve the problem of blood-type year we performed more incompatibility as well as other issues. pediatric heart transplants Ultimately, the goal is to save lives. than were performed by any Columbia researchers are studying other institution in the the potential for transplantation of kid- United States,” noted Linda neys across blood groups by conducting Addonizio, MD. “And we Surgeons at Morgan Stanley Children’s Hospital of NewYork-Presbyterian are using VADs to stabilize plasmapheresis to remove antibodies accept cases that many other children pretransplantation. directed at the foreign blood group. institutions won’t. The most They are also developing procedures to notable of these are children “swap” kidneys when donors can be with very high pulmonary vascular The mortality rate of pediatric better matched to a different recipient. resistance. We were also the first hospi- patients awaiting transplantation at Each approach has its advantages tal to perform heart transplants in an the Hospital was 5% to 6% in 2004, and challenges and is selected according effective, single-lung physiology in chil- compared to about 20% nationwide, to the specific circumstances of the dren and also in adults.” see Heart, page 7 patient, but each has the potential to increase the pool of candidates who undergo successful transplantation. “Since we started these programs, we have performed 22 kidney transplants Islet Transplantation Lung Transplantation in patients who otherwise would not have received a transplant,” noted Lloyd Researchers at NewYork-Presbyterian Thanks to unique selection criteria, 2 Hospital use steroid-sparing regimens and 4 Columbia researchers at NewYork-

Ratner, MD, adding that these new of modify immunosuppressive drug regimens to Presbyterian Hospital have found success with approaches appear to be viable and reduce toxicity while preserving graft survival. organs from “extended donor pools.” promise long-term graft survival. Plasmapheresis to remove antibodies Liver Transplantation in patients with either blood group or ABLE NewYork-Presbyterian Hospital’s leadership T Please visit cross-match incompatible grafts also CONTENTS 6 role in “informed disclosure” has led to removes antibodies important to www.nyptransplant.org. improved outcomes in liver transplantation, immune defenses, so Dr. Ratner and his particularly with “expanded criteria” organs. team have developed a protocol for see Kidney, page 5 an optimized immunosuppressive drug maintenance. N EWY ORK–PRESBYTERIAN “If we can identify signs of rejection in Transplant the earliest stages, we can adjust thera- pies rapidly,” said Dr. Suthanthiran, “and keep patients on the lowest doses and best tolerated immunosuppressive drugs until they need more aggressive therapy.” Islet Cell Transplantation Offers Currently, criteria for islet cell trans- plantation candidates at NewYork- Alternative to Therapy Presbyterian/Weill Cornell include fre- quent episodes of hypoglycemia despite optimal management that includes olumbia and Weill Cornell The second successful transplant was exogenously administered insulin. The researchers at NewYork- completed recently, and the patient is program is evolving quickly, and the CPresbyterian Hospital have been rapidly being weaned off insulin with selection criteria may change as more is involved in many of the key innovations islets from a single pancreas. Dr. learned about optimal techniques and in islet cell transplantation, an interven- Suthanthiran credited “refinements in the long-term outcomes. Transplantations at tion that has the potential to cure type 1 islet isolation procedure,” implemented NewYork-Presbyterian Hospital/ mellitus. by Hua Yang, MD; “the high level of Columbia University Medical Center are Currently, the work performed in expertise of our interventional radiolo- being restricted to diabetics who have steroid-sparing regimens by Sandip gist,” David Trost, MD; and the “meticu- already had a renal transplant. Candi- Kapur, MD, and Manikkam lous posttransplant care” by Dolca dates must have a kidney that is free of Suthanthiran, MD, has been important Thomas, MD, and Meredith Aull, MD. progressive diabetes-induced damage. because the research has an impact on “This is a great achievement because it Appropriate immunosuppression is the the toxicity that steroids pose to islet potentially means she will be cured with key to survival of both the renal and the cells. Mark Hardy, MD, has also been islets from just 1 donor, compared to islet cell grafts. an innovator in modifying and titrating standard islet transplants that require at “We are understanding much more immunosuppressive drug regimens to least 2 donors,” noted Dr. Kapur. about both the short-term and long- reduce toxicity without jeopardizing One reason to anticipate further term toxicities of immunosuppressive graft survival. progress in transplant survival is the agents, [which] is helping us to better The progress in steroid-sparing work being done on early detection of choose drugs and regimens that provide immunosuppression was pioneered in rejection. According to Dr. the greatest likelihood of a favorable renal transplantation. Due to the Suthanthiran, gene-based diagnostic outcome,” Dr. Hardy observed. He advances in preventing rejection after assays have demonstrated significant noted that careful monitoring of signs transplant, some of the focus on improv- promise and have the added advantage of rejection has also been important in ing long-term survival has turned to pre- of being minimally invasive procedures. achieving an optimal balance between venting long-term complications, such as Such an approach permits more fre- preventing episodes of rejection while atherosclerosis, which are associated with quent surveillance, earlier modification reducing the risk of toxicities or immunosuppressive regimens. Lessons of the immunosuppressive regimen, and excessive immunosuppression. With the generated from extensive experience in other types of organ transplantation are being applied in islet cell transplantation. The islet transplantation program at NewYork-Presbyterian Hospital/Weill Cornell Medical Center was initiated 2 years ago, with the first transplantation performed in 2004. According to Dr. Kapur, the program is “a true multidisci- plinary effort that involves transplant spe- cialists and endocrinologists” who work together to select candidates and plan preoperative, intraoperative, and postop- erative care. The first patient to receive islet cell transplantation has been able to abandon insulin completely due to the ability of the transplanted cells to respond Physicians at NewYork-Presbyterian Hospital recently completed appropriately to physiologic demands. their second successful islet cell transplantation.

2 Fall 2005 work of Kevan Herold, MD, as well as collaboration with Paul Harris, MD, NewYork-Presbyterian Transplant Editorial Board Peter Witowski, MD, and Ronald Van Heertum, MD, a radiologist, significant Linda Addonizio, MD Donna Mancini, MD progress has been made in detecting Medical Director, Pediatric Cardiac Transplant Program Medical Director, Cardiac Transplantation Program and Heart viable islet tissue in experimental studies Morgan Stanley Children’s Hospital of NewYork- Failure Center using positron emission tomography. Presbyterian/Columbia NewYork-Presbyterian/Columbia Professor of Pediatrics Associate Professor of Medicine This could permit rapid detection of Columbia University College of Physicians and Surgeons Columbia University College of Physicians and Surgeons islet rejection and may offer the oppor- [email protected] [email protected] tunity for more effective modification of immunosuppressive therapy. Selim Arcasoy, MD, FCCP, FACP Yoshifumi Naka, MD One of the greatest challenges to islet Medical Director, Lung Transplantation Program Director, Mechanical Circulatory Support Program NewYork-Presbyterian/Columbia NewYork-Presbyterian/Columbia cell transplantation has been acquiring Associate Professor of Clinical Medicine Herbert Irving Assistant Professor of Surgery donor tissue. According to Dr. Hardy, Columbia University College of Physicians and Surgeons Columbia University College of Physicians and Surgeons the pancreas is not being recovered from [email protected] [email protected] donors in the same numbers as other commonly transplanted organs, particu- Robert S. Brown, Jr, MD, MPH Lloyd Ratner, MD larly the kidney and the liver. However, Medical Director, Center for Liver Disease and Transplantation Director, Renal and Pancreatic Transplantation NewYork-Presbyterian Hospital NewYork-Presbyterian Hospital/Columbia unlike whole pancreas transplantation, Associate Professor of Medicine and Surgery [email protected] there are fewer restrictions on candidate Chief, Division of Hepatobiliary and Liver Transplant Surgery donors when only islet cells are used. Columbia University College of Physicians and Surgeons Stuart D. Saal, MD “Donors over the age of 50 or who [email protected] Medical Director, Kidney Transplantation have a body mass index greater than 29 The Rogosin Institute at David Cohen, MD NewYork-Presbyterian/Weill Cornell are not generally considered an accept- Medical Director, Renal Transplant Program Professor of Clinical Medicine and Surgery able source of a whole pancreas, but NewYork-Presbyterian/Columbia Weill Medical College of Cornell University these individuals may be appropriate Associate Professor of Clinical Medicine [email protected] donors of islet cells,” said Dr. Hardy. Columbia University College of Physicians and Surgeons However, he noted that even with fewer [email protected] Michael Schilsky, MD Medical Director, Center for Liver Disease and Transplantation restrictions, islet cell transplantation will Jean C. Emond, MD NewYork-Presbyterian/Weill Cornell continue to be limited by donor supply. Vice Chairman and Chief, Transplantation Services Associate Professor of Clinical Medicine “The success of islet cell transplanta- NewYork-Presbyterian/Columbia Weill Medical College of Cornell University tions so far provides a proof of principle Thomas S. Zimmer Professor of Surgery [email protected] that this is a viable procedure.” Columbia University College of Physicians and Surgeons [email protected] David Serur, MD Mark Hardy, MD, is Director, Renal and Medical Director, Kidney/Pancreas Transplantation Islet Transplantation at NewYork- Mark Hardy, MD The Rogosin Institute at NewYork-Presbyterian/Weill Cornell Presbyterian Hospital/Columbia University Director, Renal and Islet Transplantation NewYork-Presbyterian/Columbia Assistant Professor of Medicine Medical Center, and is Auchincloss Auchincloss Professor of Surgery Weill Medical College of Cornell University Professor of Surgery at Columbia University Columbia University College of Physicians and Surgeons [email protected] College of Physicians and Surgeons. [email protected] E-mail: [email protected]. Joshua R. Sonett, MD Sandip Kapur, MD Surgical Director, Lung Transplantation Program Sandip Kapur, MD, is Acting Chief, Acting Chief, Division of Transplant Surgery NewYork-Presbyterian/Columbia Division of Transplant Surgery at New NewYork-Presbyterian/Weill Cornell Associate Professor of Clinical Surgery, Division of York-Presbyterian Hospital/Weill Cornell Associate Professor of Surgery Cardiothoracic Surgery Medical Center, and is Associate Professor Weill Medical College of Cornell University Columbia University College of Physicians and Surgeons of Surgery at Weill Medical College of Adjunct Assistant Professor of Surgery [email protected] Cornell University, and is Adjunct Assistant Columbia University College of Physicians and Surgeons Professor of Surgery at Columbia University [email protected] Manikkam Suthanthiran, MD College of Physicians and Surgeons. Chief, Nephrology and Transplant Medicine NewYork-Presbyterian/Weill Cornell E-mail: [email protected]. Milan Kinkhabwala, MD Surgical Director, Center for Liver Disease and Transplantation Stanton Griffis Distinguished Professor of Medicine NewYork-Presbyterian/Columbia Weill Medical College of Cornell University Manikkam Suthanthiran, MD, is Chief, Associate Professor of Surgery [email protected]. Nephrology and Transplant Medicine at Weill Medical College of Cornell University NewYork-Presbyterian Hospital/Weill Adjunct Assistant Professor of Surgery John Wang, MD Cornell Medical Center, and is Stanton Columbia University College of Physicians and Surgeons Associate Attending Physician Griffis Distinguished Professor of Medicine [email protected] NewYork-Presbyterian/Weill Cornell at Weill Medical College of Cornell Associate Professor of Clinical Medicine and Surgery University. Weill Medical College of Cornell University E-mail: [email protected]. [email protected]

3 of recipients of extended donor lungs N EWY ORK–PRESBYTERIAN with those of recipients of optimal donor Transplant lungs. Twenty-seven (53%) of 51 patients received extended donor lungs. Overall, the results showed no differences in the 30-day and longer-term survival rates of recipients of extended and optimal donor lungs. Recipients of extended donor Research Demonstrates Positive lungs, however, did have a longer stay in the intensive care unit and a longer time Outcomes with Extended Donor Lungs to hospital discharge than did recipients of optimal donor lungs. In addition, ex- tended donor recipients had a lower olumbia researchers at considered unusable lungs with good forced expiratory volume at 1 year than NewYork-Presbyterian Hospital results. “This can further increase the did optimal donor recipients. However, C have found that recipients of pool of special donors and help decrease this was a measured difference and did transplanted lungs from “extended donor the organ donor shortage,” said study not appear to have a clinical effect on pools” have the same survival rate as pa- co-author Joshua R. Sonett, MD. patients, explained Dr. Sonett. tients who receive lungs that meet the Drs. Arcasoy and Sonett and their col- Pulmonary function may have been formal criteria for transplant acceptability. leagues performed a retrospective cohort poorer in the recipients of extended Because lung transplantation is currently study of all patients who had undergone donor lungs because of older donor age, limited by the number of suitable donor lung transplantation at NewYork- cigarette use, or lung abnormalities that organs, according to Selim Arcasoy, MD, Presbyterian/Columbia from July 2001 to appeared on X-ray films, explained Dr. senior author of a recently published July 2003. They compared the outcomes Arcasoy. However, the real significance study, many lung transplant programs have begun using extended donor lungs or lungs that do not meet the formal cri- teria for acceptability. The ideal criteria for lung transplantation are based on very “We could use donors that we haven’t considered or used little evidence, noted Dr. Arcasoy. in the past with very few problems in the short and long “Instead, they’re based on experience and opinion,” he said. term. Certainly, a larger data analysis from different Indeed, results from the new study at centers, in a prospective fashion, would be quite NewYork-Presbyterian Hospital/ Columbia University Medical Center— important in trying to glean what the most significant published in the noted journal factors are when we choose donors.” Transplantation (2005;79:310-316)— indicate that transplant surgeons can —Selim Arcasoy, MD safely continue to use what have been

Chest radiograph before and after lung transplantation.

4 Fall 2005 of a lower level of pulmonary function Kidney patients who need a kidney can provide is unclear, he added. Furthermore, re- continued from page 1 a donor but face incompatibility issues. searchers are uncertain about what According to Choli Hartono, MD, mechanism reduces pulmonary func- reinfusing those antibodies that restore resolving blood group incompatibility is tion. It may be related to poorer donor protection from infection. During one of the most promising approaches quality compared with ideal donors, posttransplant recovery, conventional for reducing transplant waiting lists. he said. anti-rejection medications are titrated to “The desensitization program we are The researchers concluded that the prevent rejection episodes. using involves rituximab, plasmapheresis, criteria for the optimal lung donor Blood group incompatibility between and intravenous immunoglobulin, which should be reevaluated considering the patients and their donors has also been a is effective for bringing down antibody current shortage of acceptable organs. major focus of Weill Cornell researchers’ levels to permit cross-matching,” report- However, larger, multicenter studies efforts to increase the pool of patients ed Dr. Hartono, who is serving as a need to be conducted. receiving successful transplants. It is cur- principal investigator on several clinical “We could use donors that we haven’t rently estimated that about one third of trials testing these protocols. He empha- considered or used in the past with very sized that the work at NewYork- few problems in the short and long Presbyterian Hospital/Weill Cornell term,” said Dr. Arcasoy. “Certainly, a Medical Center is highly collaborative. larger data analysis from different cen- “The incompatibility issue is The desensitization protocol has proven ters, in a prospective fashion, would be certainly one that deserves effective both for transplanting organs quite important in trying to glean what across blood groups and for transplant- the most significant factors are when we to be a major focus of ing organs in patients who are sensitized choose donors.” Further studies could attention, because the ability due to a previous transplantation, blood also be developed to identify the genetic transfusion, or pregnancy. makeup of donors and recipients, help- to increase the proportion “The incompatibility issue is certainly ing to determine short- and long-term of patients who can be one that deserves to be a major focus of outcomes, he added. attention, because the ability to increase Columbia researchers at NewYork- successfully transplanted the proportion of patients who can be Presbyterian Hospital are currently work- across blood groups is one successfully transplanted across blood ing toward enhancing and preserving groups is one of our best opportunities donor lungs. All such endeavors are of our best opportunities to to allow patients to avoid the long wait directed toward alleviating the problem allow patients to avoid the for a compatible organ,” Dr. Hartono of a shortage of donated organs, accord- observed. He suggested that the ing to Dr. Sonett. Additionally, research- long wait for a compatible NewYork-Presbyterian Hospital pro- ers still need to evaluate how to match organ.” grams, where many of the innovations donor lungs with recipients. A recipient have taken place, have been among the who is more robust might more easily —Choli Hartono, MD most aggressive in seeking ways to receive an extended donor lung than a increase the donor pool. recipient who is frail and likely to require For the transplant kidney exchange intensive care or a longer hospital stay. program (or donor swapping program) “Sometimes, the outcomes we see are at NewYork-Presbyterian/Columbia, due to donor quality,” said Dr. Arcasoy. which has been used in 12 patients (6 “Sometimes, they’re due to recipient donors and 6 recipients) so far, patients quality.” with donors who are incompatible swap live donors so that each recipient Selim Arcasoy, MD, is Medical Director, receives a kidney from a donor who is Lung Transplantation Program at NewYork- Presbyterian Hospital/Columbia University compatible. Due to the very real possi- Medical Center, and is Associate Professor bility of the second donor withdrawing of Clinical Medicine at Columbia University from the agreement once the first pro- College of Physicians and Surgeons. cedure is performed, leaving one of the E-mail: [email protected]. potential recipients without an available organ, a large transplant program with Joshua R. Sonett, MD, is Surgical Director, sufficiently skilled surgeons is needed. Lung Transplantation Program at NewYork- “To make sure that no one backs out Presbyterian Hospital/Columbia University Medical Center, and is Associate Professor once their loved one gets a kidney, of Clinical Surgery at Columbia University both donors undergo anesthesia and College of Physicians and Surgeons. have the surgery at the same time,” E-mail: [email protected]. see Kidney, page 8

5 by the other centers in New York—the N EWY ORK–PRESBYTERIAN use of expanded criteria organs has Transplant done a lot to shorten the waiting time and reduce the likelihood of patients dying while waiting. If we didn’t use these organs, we would lose almost half of our potential cadaver livers, and there would be a big penalty for access Use of ‘Expanded Criteria’ Livers to liver transplants.” The working group, continued Dr. Increases Access to Transplantation Kinkhabwala, studied issues that includ- ed the definition of expanded-criteria donors, the actual risk for patients, and pproximately 30% to 50% of transplant centers in New York are the outcomes of transplantation proce- donated cadaver livers available using expanded donor organs more dures performed with expanded criteria A for transplantation are consid- aggressively than centers in other donors. The members also discussed ered less than ideal and placed in the regions. appropriate procedures for informing category known as “expanded criteria” “It is probably true,” he said, because patients about the risks involved. The organs. Nonetheless, most are used, with of “the specific supply-demand imbal- result of these meetings is a consensus successful outcomes, at centers such as ances in New York, which are greater report that will be presented to the state NewYork-Presbyterian Hospital, which than those in other parts of the United health commissioner, according to Dr. has taken the lead in “informed disclo- States. In our view—and this is shared Kinkhabwala. sure”—a process designed for patients One important recommendation receiving these organs. outlines a more vigorous process of The use of these organs, regarded as informed patient consent. For the past 2 less than ideal because of the donor’s age years, the Center has used a 3-stage or medical condition, has doubled pa- process to educate patients about the tients’ access to liver transplants in recent risks and benefits of liver transplanta- years, said John F. Renz, MD, PhD. Still, “The use of expanded-crite- tion. As a first step, transplant candi- the transplantation of livers that may dates receive a letter during their evalua- carry a somewhat higher risk for patients ria organs has done a lot to tion that fully describes their options. raises medical, legal, and ethical shorten the waiting time and “If patients consent to receive an questions about how much information expanded donor liver after having read should be conveyed to patients in critical reduce the likelihood of the information, they sign the letter and need of liver replacement. patients dying.... If we didn’t we put that in their file,” Dr. Kinkhab- To address these issues, the New York wala said. “They are then allowed in- State Health Commissioner last year use these organs, we would creased access to transplantation by being convened a working group of experts to lose almost half of our eligible to receive either an expanded develop informed consent guidelines donor organ or a standard deceased related to extended criteria livers. The potential cadaver livers, and donor organ. If an expanded donor organ working group included representatives there would be a big penalty becomes available in the middle of the from the 5 centers in New York author- night, we know who we can call.” ized to perform liver transplantation for access to liver transplants.” Patients going on the waiting list are surgery in addition to other experts in —Milan Kinkhabwala, MD also told about the different pathways medicine and medical ethics. available to shorten their waiting time. Milan Kinkhabwala, MD, represented In addition to receiving an expanded NewYork-Presbyterian Hospital, where criteria organ, patients can apply for liv- approximately 120 surgical procedures ing donation and simultaneous listings are performed each year as part of an at centers outside New York. Multiple active and successful liver transplant pro- listings offer the chance that an organ gram. Approximately 20% of the surger- will become available sooner in another ies at NewYork-Presbyterian Hospital region where not as many patients are involve living donors, and up to half of waiting. the rest use expanded criteria organs. In New York, the average wait is According to Dr. Kinkhabwala, the now somewhere between 6 months and working group was formed to find 1 year. However, the use of expanded answers to questions about whether liver criteria donors can cut that waiting

6 Fall 2005 Hospital/Columbia University Medical time in half, depending on the patient’s risk that a patient faces by accepting one Center, and is Adjunct Assistant Professor of condition. Liver transplant waiting lists is more than offset by the lowered risk Surgery at Columbia University College of are driven largely by patient condition. of dying while on the waiting list. Physicians and Surgeons and Associate A patient in immediate danger of liver Overall, the survival rates of patients in Professor of Surgery at Weill Medical failure may have to wait only 2 days; a the liver transplant program are 89% at College of Cornell University. E-mail: [email protected]. patient in no immediate peril may be 1 year and 82% over 3 years. These on the list for years. results, Dr. Renz said, “equal or exceed John F. Renz, MD, PhD, is Assistant NewYork-Presbyterian has been very the national average.” Attending Surgeon at NewYork-Presbyterian successful with extended criteria donors, Hospital/Columbia University Medical Cen- according to Dr. Renz. The livers may Milan Kinkhabwala, MD, is Surgical ter, and is Assistant Professor of Surgery at not be ideal, he said, “but they work al- Director, Center for Liver Disease and Columbia University College of Physicians most as well,” and the slightly added Transplantation at NewYork-Presbyterian and Surgeons. E-mail: [email protected].

Heart be present. The patient also receives Pediatric Cardiac Transplant Program continued from page 1 immunosuppressant drugs. “We almost has been at the forefront in the man- trick the body into not making antibod- agement of children after heart trans- according to Jonathan M. Chen, MD. ies against the incompatible blood type,” plantation. The Hospital also has a One explanation for this improved sur- said Dr. Addonizio. “This doesn’t mean leadership role in the Pediatric Heart vival rate may be that Hospital physi- that they won’t experience rejection, but Transplant Study Group, which con- cians are aggressive in getting young they won’t make antibodies against that sists of 23 institutions across North children into surgery as soon as possi- blood group.” America and is responsible for a signif- ble. A shorter waiting time often icant proportion of multi-institutional means a lower mortality. research related to pediatric heart Once children have undergone heart transplantation today. The Hospital transplant, evaluating long-term sur- plans to expand its organ transplant vival is crucial. Today, according to Dr. “There’s no reason why initiative in pediatric patients with the Chen, many patients have survived 20 creation of the Morgan Stanley years with palliative surgery, and some we can’t be the biggest Children’s Hospital Pediatric have undergone an additional 4 or 5 transplant center for Transplant Institute. This facility heart operations. Many researchers would house transplant teams for all question how well these patients fare children in the United types of solid organs, as well as special- when they are reconstructed or need States. We’re almost there.” ists in immunosuppression, rehabilita- new transplants. Dr. Chen and his col- tion, and neurocognitive development. leagues evaluated data (Ann Thorac Surg —Jonathan M. Chen, MD “There’s no reason why we can’t be 2004;78:1352-1361) that showed con- the biggest transplant center for chil- genital heart disease patients who dren in the United States,” said Dr. underwent transplant surgery years later Chen. “We’re almost there.” had outcomes similar to those with According to Dr. Chen, an evolving cardiomyopathy. This may be due to area of surgery is the use of ventricular Linda Addonizio, MD, is Medical Director technical improvements such as the assistance devices (VADs) in pediatric and Co-founder, Pediatric Cardiac Transplant Program at Morgan Stanley ability to reconstruct pulmonary arteries pretransplant patients. Currently, sur- Children’s Hospital of NewYork- and route blood back to where it should geons at the Hospital use VADs in 1 or Presbyterian/Columbia University Medical be flowing. 2 patients a year. Dr. Chen envisions Center, and is Professor of Pediatrics at NewYork-Presbyterian Hospital is that 5 years from now, surgeons will be Columbia University College of Physicians the first institution in the United States using the procedure in 25 to 50 chil- and Surgeons. to perform ABO-incompatible heart dren annually. VADs support the heart E-mail: [email protected]. transplants (meaning that donors and and stabilize the pretransplant patient, a recipients have different blood types) in process called “bridging.” This becomes Jonathan M. Chen, MD, is Attending pediatric patients. Dr. Chen noted that important as younger patients “will wait Surgeon, Pediatric Cardiac Surgery at when surgeons follow protocol, survival quite a while before surgeons can locate Morgan Stanley Children’s Hospital of NewYork-Presbyterian/Columbia University is the same as in children who receive a heart that is the right size,” he Medical Center, and is Adjunct Professor of ABO-compatible hearts (N Engl J Med. explained. Surgery at Columbia University College of 2001;344:793-800). Overall, the outlook for pediatric Physicians and Surgeons, and is Assistant Prior to transplant surgery, physicians transplant patients has improved in the Professor of Cardiothoracic Surgery at Weill exchange the patient’s blood, washing last 20 years. With Dr. Addonizio as Medical College of Cornell University. away any preformed antibodies that may co-founder, the NewYork-Presbyterian E-mail: [email protected].

7 Kidney continued from page 5 “The demand for kidneys is expected to increase due to the said Dr. Ratner, noting that he devel- oped this program at NewYork- rising rates of renal failure, but the donor supply is likely to remain Presbyterian/Columbia because the limited. These approaches are increasing the opportunities to facility has the capacity to undertake such a program. “We need 4 operating complete a successful transplant in those who need them.” rooms, 4 surgical teams, and 4 sets of anesthesiologists. The logistics need to —Lloyd Ratner, MD be synchronized perfectly.” One of the most common obstacles to transplantation is the problem of pre- Program, The Rogosin Institute at existing antibodies to grafts due to “The demand for kidneys is expected NewYork-Presbyterian Hospital/Weill a previous transfusion or a previous to increase due to the rising rates of Cornell Medical Center, and is Assistant organ transplantation. Progress in renal failure, but the donor supply is Professor of Medicine in Surgery at Weill removing antibodies to these antigens likely to remain limited,” noted Dr. Medical College of Cornell University. E-mail: [email protected]. has permitted NewYork-Presbyterian/ Ratner, citing the 5-year waiting list Columbia surgeons to perform 10 trans- for donated organs. “These approaches Lloyd Ratner, MD, is Director, Renal and plantations in the past year in patients are increasing the opportunities to Pancreatic Transplantation at NewYork- with antibodies directed against the complete a successful transplant in Presbyterian Hospital/Columbia University donor antigens at baseline. In 2 addi- those who need them.” Medical Center, and is Assistant Professor of tional cases, patients were both blood Surgery at Columbia University College of group incompatible and incompatible Choli Hartono, MD, is Assistant Medical Physicians and Surgeons. due to donor-specific antibodies. Director, Kidney/Pancreas Transplant E-mail: [email protected].

SERVICE LINE ADMINISTRATOR: Jennifer Rabina, 627 West 165th Street, New York, NY 10032, 212.342.6052 E-mail: [email protected]

Fall 2005 NONPROFIT ORG. NewYork-Presbyterian Hospital U.S. Postage PAID 425 East 61st Street Permit No. 1517 New York, NY 10021 San Antonio, TX

Important news from

SBYTERIAN the NewYork-

Presbyterian Transplant RE Institute, at the fore-

front of heart, lung, –P liver, kidney, and

pancreas transplanta- ransplant ORK tion, and clinical Y T research to advance

transplant surgery and EW organ health. N