Summer 2006 Department of Surgery healthpoints NewYork-Presbyterian ALL THE POSSIBILITIES OF M O D E R N M E D I C I N E Jean C. Emond, MD Vice Chairman and Transplantation: Chief of Transplantation at NewYork-Presbyterian/ Columbia University Where we've been, where we're going Medical Center When Dr. Emond When he transplanted a chimpanzee kidney into a human patient in the late joined the faculty in 1960’s, the late Keith Reemtsma, MD, then Department of Surgery Chairman at 1997, he applied a Tulane University, revolutionized treatment of end-stage organ failure and initiated an multidisciplinary era of unprecedented exploration into organ transplantation that would affect the lives model to the liver transplant program, and established a joint collaboration of patients around the world. between hepatology and surgery. In the Transferring to Columbia-Presbyterian Medical Center in 1971, Dr. Reemtsma decade since then, the program has recruited Mark A. Hardy, MD, who laid another cornerstone of organ transplant transformed into one of the largest and medicine by founding the program for dialysis and kidney transplantation. Dr. Hardy most innovative in the country. His based the new program on the principle of collaborative clinical care between dedication to finding new and better surgeons and nephrologists. During a time when renal transplant programs were solutions for transplant patients continues to raise the bar of excellence managed by one or the other discipline but never by both simultaneously, the medical and inspire creative advances throughout the transplantation programs at Columbia University Medical Center. INNOVATIONS IN TIME 1969 Joseph Buda, MD, performs the first kidney transplant at Columbia- Presbyterian Medical Center.* Kidney Transplantation, page 3 1977 First heart transplant at at Columbia-Presbyterian Medical Center. Heart Transplantation, page 10 1986 Lung transplantation begins at Columbia-Presbyterian Medical Center. Eric A. Rose, MD, left center (current Chairman, Department of Surgery), performing the first Lung Transplantation, page 5 successful pediatric heart transplant in 1984. This special issue of healthpoints is dedicated to transplant pioneer Keith Reemtsma, MD, who is overseeing the operating field (top of photo). INNOVATIONS IN TIME 1997 community regarded the concept as folly. organs, performs transplants among National search assembles team to Yet the program grew steadily, as did the incompatible donors, and is a leader in establish Center for Liver Disease program’s immune tolerance research initia- coordinating “donor swaps” to maximize and Transplantation, for adults tives to induce the transplant recipient’s availability of compatible donor organs. and children. body to accept a donor organ. This multi- Since Dr. Ratner’s arrival, this program has Liver transplantation, page 8 disciplinary cooperation also led to major doubled its volume, performing over 300 contributions in immunogenetics, kidney transplants per year. immunosuppression, and treatment of Under the leadership of Dr. Hardy and autoimmune diseases and lymphoma — Kevan Herold, MD, Columbia has been and it ultimately became the overarching designated one of ten regional islet resource principle for all the NewYork-Presbyterian centers in the U.S. that isolate and trans- Hospital transplant services. plant pancreatic cells to treat type 1 Colleagues universally give credit to Eric diabetes as part of a limited protocol 2004 A. Rose, MD, who co-founded the heart controlled by the FDA. Recent progress in Intestinal Rehabilitation and Transplantation program opens at transplantation program with Dr. visualization of pancreatic islets using PET NewYork-Presbyterian/Columbia. Reemtsma, for his successful transformation technology, under the guidance of Paul Pediatric intestinal and of the program into the outstanding center Harris, PhD, has been recognized by the liver transplantation, page 5 it is today. A parade of achievements marks scientific community as a milestone in this the history of the heart transplant program, developing field. including the first mechanical bridge-to- While the transplantation program as a transplantation using intra-aortic balloon whole forecasts over 600 solid organ trans- pumps in the 1970’s, and the first successful plants this year, transplantation of cells, pediatric heart transplant, performed by Dr. rather than organs, is emerging as a therapy Rose in 1984. Under the guidance of Dr. with enormous potential. Transplantation 2004 Rose and his successors, the program has of either a patient’s own or a foreign First pancreatic islet cell pioneered research in immunosuppressant donor’s bone marrow cells, for example, transplantation at Columbia. medications, mechanical assist devices, and offers hope of regenerating the heart so that minimally invasive surgical procedures. It patients with heart failure may be able to currently performs over 100 heart trans- avoid heart transplantation. The SCCOR plants yearly, with among the highest trial, a pivotal NIH-funded study including success rates in the nation. cell transplantation in patients with heart In 2004, Dominique M. Jan, MD, created failure, is enrolling patients now. a new rehabilitation and transplant service In introducing the transplantation 2005 for children with liver and small bowel programs, it would be remiss to neglect NewYork-Presbyterian Hospital sets U.S. diseases, also in a fully interdisciplinary mention of the yet another dimension in record for number of heart transplants fashion. Its team approach is unique in the which they excel – education. “Because this is performed in one year, at 119. U.S., combining the efforts of pediatricians, an academic medical center, physician train- hepatologists, and liver transplant surgeons. ing is a top priority along with patient care 2006 “Every problem is discussed by both and research,” says Dr. Rose. “We have First 3-way kidney swap at NewYork- pediatric specialists and surgeons, and this trained many of the greatest transplant Presbyterian/Columbia. gives patients the best results,” says Dr. Jan. surgeons over the last 20 years, including Also in 2004, Lloyd E. Ratner, MD, many of the leaders of transplant programs succeeded Dr. Hardy as director of the renal throughout the U.S.” and pancreas transplant program. One of the first to perform laparoscopic donor This special issue highlights just a few recent operations, Dr. Ratner has found creative exciting developments in transplantation solutions to overcome immune barriers to research and patient care. Readers can learn kidney transplantation. The program now more by visiting www.columbiatransplant.org * In 1998, Columbia-Presbyterian Medical Center and New York Hospital merged routinely uses extended-criteria donor or by calling the department. to form NewYork-Presbyterian Hospital. 2 healthpoints • summer 2006 Kidney Transplantation: Thinking Outside the Box Kidney transplantation has come a area, the program has developed new ns io long way since the first successful ways to safely use more organs than unicat mm transplant between identical twins in ever for transplantation. First, it has o 1954. Since then, improvements in implemented new protocols for using dical C me io B surgical technique, medical manage- extended criteria organs that may not f esy o ment, and immunosuppressive therapy meet the usual criteria for transplan- t our have facilitated transplants from family tation, but are healthy enough for a C members, genetically unrelated living successful transplant. Donor kidneys In many cases of living donor trans- plantation, family members donate donors, and deceased donors. In 2005, that might go unused in regions with organs to their loved ones. In the case over 16,400 kidney transplants were fewer people on the organ waiting list of the rare three-way kidney swap per- performed in the U.S., approximately can be matched with appropriate formed May 30, 2006, altruistic donor 60% from deceased donors and the candidates in areas with greater John McGuinness did not know any of remainder from living donors. Success demand, according to Dr. Ratner. the recipients, but just wanted to help. rates have increased steadily, and now Organs in this category include Public service is a way of life for exceed 90% at one year and 50% at ten those from donors who are older, have John, who came from a family with a years. Despite this extraordinary hypertension or diabetes, or who at the strong background in volunteer work. success, however, many challenges time of their death suffered mild Today he volunteers as a firefighter and remain. kidney injury. As is the case with heart, as a wrestling coach, serves in his Topping the list is the chronic short- liver, and lung transplantation, the use church, and regularly donates blood. age of organs, which creates dilemmas of extended criteria kidneys is proving Yet he wanted to do even more, and about fairly allocating kidneys to highly successful, especially among after a fellow firefighter and friend of ten years died in Iraq, John decided to patients with varying degrees of need, older recipients and those doing poorly give someone else the gift of a new life. risk, and potential benefit. Another on hemodialysis. He contacted the living donor major challenge is medical in nature – Second, the program has developed kidney transplant program at Columbia finding safe and effective ways of over- strategies to address immunologic in February 2006. By April, there was a coming