NYP Oncology 7.02
Total Page：16
File Type：pdf, Size：1020Kb
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 kidney transplantation 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 Insulin 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/ diabetes 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]