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LOS ANGELES (April 8, 2002) -- After recruiting several additional world-renowned specialists to its transplant surgery programs, Cedars-Sinai Medical Center has refined and restructured its abdominal organ transplant services. The resulting Multi-Organ Transplant Program (MOTP) brings a multi-disciplinary perspective that will improve efficiency and timeliness of transplants.
"Traditionally, transplant specialists and coordinators have worked in organ-specific areas," said Achilles A. Demetriou, M.D., Ph.D., Chairman of the Department of Surgery at Cedars-Sinai. "Now we're taking a more broad view, consolidating the efforts of those who do kidney transplants and those who do liver transplants. Instead of thinking about organs as separate entities, we're thinking of the whole patient, the various organs that can come from one donor, and we're working together as a unified group."
The MOTP includes the "visceral" abdominal organs -- those enclosed within the abdominal cavity -- according to Dr. Demetriou.
With the addition of new faculty, including transplant surgeons as well as physicians who specialize in the medical management of transplant patients, Cedars-Sinai's teams are performing a greater number of kidney and liver transplants for both children and adults. They also are providing increasingly intricate and sophisticated procedures.
For example, in the first phase of implementation of the MOTP, Cedars-Sinai began offering a laparoscopic kidney donor technique that is available at only a few medical centers. Also, family members and friends now have the opportunity to share a liver with a loved one in need, thanks to a new resection technique employed in the adult living-donor liver transplantation program. And a new Pancreas Transplantation Program has been inaugurated, with two transplants done to date.
"The transplant faculty at Cedars-Sinai have a well-established reputation for outstanding skills and success rates," said Christopher R. Shackleton, M.D., Director of the MOTP and the Center for Liver and Kidney Diseases and Transplantation. "We're striving to offer our patients and providers a level of service that remains on the forefront and is recognized among the top tier of transplant centers nationally and internationally."
Dr. Shackleton, who had been with Cedars-Sinai in the mid-1990s, returned in the summer of 1999. He is known internationally for his high rates of success in organ transplantation, his involvement in establishing transplantation programs and policies in Canada, and for leadership roles in the whole-organ pancreas and pediatric liver transplant programs at the University of California, Los Angeles. He currently serves as professor of surgery at the UCLA School of Medicine.
Because of the rapidly growing need for organ transplants and the severe shortage of donor organs, Dr. Shackleton and his colleagues at Cedars-Sinai are focusing attention on procedures that "expand the donor pool."
"The liver transplant waiting list is compounding at an annual growth rate of 30 percent per year, far outstripping the 2 to 3 percent growth in the annual number of cadaver liver donors," said Dr. Shackleton. "Rapidly approaching 20,000 patients, the waiting list exceeds the annual number of cadaver liver donors by close to four-to-one, and about 10 percent of those waiting die each year for lack of an available organ." In fact, according to the United Network for Organ Sharing (UNOS), the organization that oversees the government's transplant program in the United States, fewer than 50 percent of the patients added to the waiting list will ever receive a transplant.
"Faced with this dilemma, transplant surgeons have looked to increase the supply of available organs through the application of innovative techniques based upon the segmental anatomy of the liver," Dr. Shackleton said.
In the early 1990s, surgeons pioneered living-donor liver transplantation, transplanting the left-lateral segment of adult livers into infants and children. This was followed by split-liver transplantation of a cadaver liver, which allowed two recipients to benefit from a single cadaver organ. "These techniques transformed the practice of pediatric liver transplantation, yielding dramatic reductions in waiting time and waiting list mortality, and improving patient outcomes," according to Dr. Shackleton.
In the recent past, technical advances and years of experience led liver surgeons to an improved technique for resecting the organ, making possible the transplantation of the liver's larger right lobe from an adult living donor into an adult recipient. The advent of this approach, which Dr. Shackleton performs and directs at Cedars-Sinai, dramatically increased the use of living donors for liver transplantation. Until recently, fewer than 100 adult living-donor liver transplants were performed in the United States each year. In 1999, that number jumped to nearly 200. In the year 2001, that number jumped to nearly 450. To date, Cedars-Sinai has performed 17 living donor transplants, placing the hospital in the top dozen transplant centers by volume in the United States.
An expert in microsurgical techniques in pediatric liver transplantation, Dr. Shackleton brings an extra set of hands and years of additional experience to the well-established pediatric transplant program, as well as to the adult program. "Adult living-donor liver transplantation holds the potential to at least partially alleviate the cadaver organ donor shortage and allows for more timely elective intervention in many instances," Dr. Shackleton said.
The living-donor kidney transplantation program also received a major boost in 2000 when Gerhard J. Fuchs, M.D., joined Cedars-Sinai on a full-time basis after holding a number of administrative and academic positions at UCLA over the past 15 years. He is one of a very few surgeons in the world to specialize in laparoscopic live donor nephrectomies -- removing a living donor's kidney through small abdominal ports instead of a long open incision.
The laparoscopic technique reduces or eliminates the need for pain medications and blood transfusions, and donors are able to avoid months of painful recovery time and return to their normal routines much more quickly than previously possible. Most importantly, because of the reduced risk, pain and time away from work, laparoscopy makes a living donation a more enticing option than before, thus providing another way to increase the donor pool.
The "convenience" and risk-reduction resulting from the laparoscopic approach has no down side, based on data gathered from Dr. Fuchs' own experience and from the few other transplant centers that have offered the laparoscopic technique. "It does not compromise the donor's health and it does not compromise the health or viability of the kidney," according to Dr. Fuchs. "When the kidney is implanted into the recipient, it works the same way as if it had been harvested by the open surgical technique."
Dr. Fuchs, a pioneer in performing delicate surgical procedures on organs and structures accessible through the urinary tract without making an incision in a patient's skin, serves as Director of the Endourology Institute at Cedars-Sinai, retaining his academic post as professor of clinical surgery/urology at UCLA.
The anticipated volume of the kidney-pancreas transplant program at Cedars-Sinai, as well as the unprecedented growth of the kidney transplant program, will both benefit from the recruitment of Mike Bunnapradist, M.D., and Alice Ping, M.D. Dr. Bunnapradist, a board-certified specialist in internal medicine with a subspecialty in nephrology, is Medical Director of Kidney-Pancreas Transplantation. He came to Cedars-Sinai last year after completing a fellowship in nephrology at New England Medical Center in Boston and a fellowship in kidney and pancreas transplantation at the UCLA Medical Center. Dr. Ping serves as Assistant Medical Director of Kidney-Pancreas Transplantation at Cedars-Sinai.
John M. Vierling, M.D., has been named Medical Director of the MOTP, and Stanley C. Jordan, M.D., has been appointed Pediatric Medical Director of the MOTP.
Dr. Jordan, who has been at Cedars-Sinai for more than 14 years, is Medical Director of the Kidney Transplant Program and Director of Pediatric Nephrology and Transplant Immunology, in addition to serving as professor of pediatrics at UCLA. For more than two decades, he has performed research into various aspects of immunology and transplantation, and his discoveries have led to major advances in diagnostic and treatment approaches in the care of patients receiving transplanted organs.
Dr. Vierling, who also has an excellent reputation for both patient care and research, is the immediate past Chair of the Board of Directors of the American Liver Foundation, and is a professor of medicine at UCLA. He is also President-elect of the American Association for the Study of Liver Diseases. Since 1990, he has been Director of Hepatology and Medical Director of the Liver Transplantation Program at Cedars-Sinai. He has devoted years of research into the molecular and cellular mechanisms of the immune system that impact diseases of the liver. His studies led to the development of novel molecular diagnostic tests for hepatitis B and C infections, and he also is recognized for his work in designing and directing clinical trials of antiviral medications.
With Dr. Vierling's appointment to the MOTP, Paul Martin, M.D., former Director of Hepatology at UCLA, has accepted Cedars-Sinai's invitation to step into the position of Medical Director of Liver Transplantation. A professor of medicine at the UCLA School of Medicine, Dr. Martin is a highly respected researcher in the areas of chronic viral hepatitis and liver transplantation.
Nicholas N. Nissen, M.D., who recently completed his fellowship in liver, pancreas and kidney transplantation at the University of California, Los Angeles, has been named Assistant Surgical Director of the Multi-Organ Transplant Program at Cedars-Sinai.
Board-certified in both general surgery and surgical critical care, Dr. Nissen was recognized as fellow of the year during a previous fellowship in the University of Pittsburgh Medical Center's multidisciplinary critical care training program. He also served a research fellowship and a residency in general surgery at Loyola University Medical Center.
"For the liver in particular, our Center has become truly comprehensive, encompassing prevention, diagnosis and treatment of all forms of liver disease, employing both medical and surgical means," said Dr. Shackleton. "We provide specialization in hepatology, hepatobiliary surgery, and transplantation for both adults and children, and we offer cadaver donor, split liver, reduced-size and living donation capabilities. In addition, Cedars-Sinai has special expertise in the treatment of fulminant hepatic failure (sudden, catastrophic liver failure) through medical therapy, the Bioartificial Liver and transplantation."
The Bioartificial Liver (BAL), the first device of its kind to be tested in a large multi-center clinical trial, is made partly of biologic material -- billions of liver cells from pigs -- and partly of man-made materials. When a patient suffers acute liver failure, the BAL can take over such critical liver functions as detoxification, nourishment, and filtration of the blood. By extending the patient's life, the BAL provides time for the organ to recover or for a donor liver to become available for transplantation.
Dr. Demetriou, who also serves as professor of surgery and Vice Chairman of the Department of Surgery at UCLA, has been instrumental in the design of the BAL. He began to study the biologic mechanisms and functions of liver cells while at the National Institutes of Health in the 1970s and continued his research at Vanderbilt University before coming to Cedars-Sinai. He now is the lead investigator of a large Phase II/Phase III multi-center research project that is nearing completion.
Cedars-Sinai's kidney transplant teams performed their first adult kidney transplant in 1969 and their first pediatric kidney transplant in 1987. The medical center's first liver transplant was performed in 1989. In addition to other milestones, Cedars-Sinai surgeons in 1998 performed the first combined heart/liver transplant in the western United States. In 2000, surgeons performed the first transplant of two lungs and a liver in the western United States.
Cedars-Sinai Medical Center is one of the largest non-profit academic medical centers in the Western United States. For the fifth straight two-year period, Cedars-Sinai has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthrough in biomedical research and superlative medical education. Named one of the 100 "Most Wired" hospitals in health care in 2001, the Medical Center ranks among the top 10 non-university hospitals in the nation for its research activities.
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