The Michael E. DeBakey Department of Surgery

bdominalThe Year in ReviewBCM Immune Evaluation Laboratory Opens Following UNOS Approval

The BCM Immune Evaluation Laboratory is a reference lab for solid organ transplants (kidney, heart, pancreas, liver and lung) performed at St. Luke’s Episcopal Hospital, Texas Heart Institute, and Texas Children’s Hospital. In addition, we have previously been responsible for all donor histocompatibility testing under contract with LifeGift Organ Procurement Organization. The lab is responsible for all pre-transplant histocompatibility testing of new end-stage patients to identify their HLA antigens and determine the degree of their pre-transplant immune reactivity towards possible donor antigens. We perform a series of sensitive crossmatch assays

ISSUE 1 n 2012

to pair appropriate donors and recipients for transplantation. Post-transplant, patients are evaluated for cellular or antibody-mediated rejection and we take part in consulting with transplant clinicians regarding therapies for these rejections. We get referrals from outside the Texas Medical Center for transplant consults as well, in fact we often get referrals and consults from around the world. Ronald H. Kerman, Ph.D., is Professor of Surgery and Laboratory Director. Dr. Kerman ensures excellence and accuracy in test performance within the lab and provides clinical consultation to the transplant clinicians. To carry out this work, the lab has ten lab technologists, a Lab

Supervisor, Eva McKissick, and Director in Training, Jerome Saltarrelli, PhD. Research interests are focused on determining the strength of transplant patient cellular and antibody immune responsiveness as it relates to immunologic rejection and graft loss. Studies are underway to determine the identity of clinically relevant HLA and non-HLA antibodies and their role in graft rejection. In addition, studies are being conducted to determine the immune response of patients receiving allogeneic stem cell infusions as part of regenerative therapy for heart failure patients. The laboratory has a Clinical Laboratory Improvement Amendments (CLIA) license, is certified by the College of American Pathologists (CAP) and the United Network for Organ Sharing (UNOS).

Inside1 BCM Immune Evaluation

Laboratory

2-3 Annual Report

4 First Pancreas Transplant

5 Half Marathon

6 Presentations & Publications

7 Division Update

TRANSPLANT

BCM Immune Evaluation Laboratory faculty and staff.

2

Annual ReportBCM Liver Transplant and Hepatobiliary Activity 2011

John A. Goss, MDProfessor of Surgery and Chief of the Division of Abdominal Transplantation in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine in Houston

BCM Transplant VolumeJan. 1 - Dec. 31, 2011

St. Luke's EpiscopalHospitalLiver transplants 69

Texas Children'sHospitalLiver transplants 32

Michael E. DeBakeyVA Medical CenterLiver transplants 9

Total 110

This past year we have increased our transplant volume, while maintaining higher than expected outcomes. We continue to deliver results at or above national averages according to the Scientific Registry of Transplant Recipients (SRTR). For 2011, Texas Children's Transplant Services retained a 100% 1 year survival rate for both grafts and patients while remaining one of the largest programs for children in the country.

HEPATOLOGYTRENDSPatient visits atSt. Luke's Episcopal Hospital

OUTCOMES: PATIENT AND GRAFT SURVIVALSt. Luke’s Episcopal HospitalSurvival data from the Scientific Registry of Transplant Recipients (SRTR) January 2008 through July 2010.

Based on hepatology patient visits byBCM faculty.

6048

1253

2009 2011Year

Pat

ient

Vis

its

St. Luke’s Episcopal Hospital

Texas Children’s Hospital

Michael E. DeBakey VA Medical Center

Time Post-transplant

100

80

60

40

20

01 month 1 year 3 years

% G

raft

Sur

viva

l

* Higher than expected (Statistically significant)

100%93.21%

88.5%* * *

* Higher than expected (Statistically significant)† Higher than expected compared to national data

100

80

60

40

20

01 month 1 year 3 years

% P

atie

nt S

urvi

val

100%94.02%

89.29%* †*

100

80

60

40

20

01 month 1 year 3 years

% G

raft

Sur

viva

l

* Not significantly different than expected† Higher than expected compared to national data

96.97%93.94%

75%†

*

100

80

60

40

20

01 month 1 year 3 years

% P

atie

nt S

urvi

val

98.41% 95.24%83.33%

† **

100

80

60

40

20

01 month 1 year 3 years

% G

raft

Sur

viva

l

† Higher than expected compared to national data

100% 96.43%N/A

††

100

80

60

40

20

01 month 1 year 3 years

% P

atie

nt S

urvi

val

100% 96.43%N/A†

†

Time Post-transplant

Time Post-transplant

* Not significantly different than expected† Higher than expected compared to national data

† Higher than expected compared to national data

†

100% 3-year survival for patients over 18 years of age

100% 3-year survival for patients over 18 years of age

ST. LUKE'S COOLEY TRANSPLANT CENTER6720 Bertner AvenueHouston, TX 77030Toll-Free: 877.685.0361International Patients: 832.35.3350

ST. LUKE'S CENTER FOR LIVER DISEASE6620 Main, Suite 1475Houston, Texas 77030Tel: 713.798-8355Appointments: 713.798.6243

TEXAS CHILDREN'S TRANSPLANT SERVICES11th floor, Clinical Care Center6621 Fannin StreetHouston, Texas 77030Tel: 866.683.8032For referral or other information: 832-822-1551

MICHAEL E. DEBAKEY VA MEDICAL CENTER2002 Holcombe BoulevardHouston, Texas 77030Tel: 713.794.8985Toll-Free: 800.639.5137, Option 1

Clinics and Centers

Renal Transplant Activity 2011

BCM Transplant VolumeJan. 1 – Dec. 31, 2011

St. Luke's Episcopal HospitalRenal transplants 106 CAD 71 LRD 27 LURD 8

Texas Children's HospitalRenal transplants 23 CAD 17 LRD 6

Total 129

CAD = Cadaveric donor, LRD = Living related donor, LURD = Living unrelated donor.

OUTCOMES: PATIENT AND GRAFT SURVIVALSurvival data from the Scientific Registry of Transplant Recipients (SRTR) January 2008 through July 2010.

3

St. Luke’s Episcopal Hospital

Texas Children’s Hospital

Time Post-transplant

100

80

60

40

20

01 month 1 year 3 years

% G

raft

Sur

viva

l

96.24% 92.71%83.65%

* **

100

80

60

40

20

01 month 1 year 3 years

% P

atie

nt S

urvi

val

98.48% 96.17%88.95%

**

100

80

60

40

20

01 month 1 year 3 years

% G

raft

Sur

viva

l

* Not significantly different than expected

100% 100% 100%

†100

80

60

40

20

01 month 1 year 3 years

% P

atie

nt S

urvi

val

100% 100% 100%

†

Time Post-transplant

† Higher than expected compared to national data

†

100% 3-year survival for patients over 18 years of age

100% 3-year survival for patients over 18 years of age

100% 3-year survival for patients over 18 years of age

100% 3-year survival for patients over 18 years of age

* Not significantly different than expected

† † †

† Higher than expected compared to national data

*

3 weeks post-transplant, Randy, looking happy and healthy, poses with wife Tammy, Transplant Surgeon Jacqueline Lappin and St. Luke's Transplant Coordinator Susan Feliciano.

4

First pancreas transplant recipient goes home

St. Luke’s Episcopal Hospital Expands Transplant Service

Faculty members in the Abdominal Transplant Division of the Michael E. DeBakey Department of Surgery at Baylor College of Medicine discharged their first pancreas recipient from the St. Luke's Cooley Transplant Center. The team, consisting of nephrologists, transplant surgeons and coordinators, were recently recruited from the UTHealth/Memorial Hermann program. The recipient, Randy Hernandez of Nederland, Texas, received a living related kidney at the same time, known as a Simultaneous Pancreas and Live-donor Kidney (SPLK) transplant. Randy received the kidney from his wife Tammy. The lead surgeon, Dr. Jacqueline Lappin, has been at the forefront of this type of transplant, citing the overall improved outcomes and shorter wait-list time for this type of transplant. Dr. Lappin is one of only

“There were no surprises, my team prepared me and

I knew what to expect.”

a handful of surgeons in the area currently qualified to perform pancreas transplants. Lappin moved one of the largest and most successful pancreas transplant practices in the Southwest to Baylor College of Medicine in July

of this year.

RINGING OUT As he left, Randy rang a bell located in the transplant center. The bell toll is a symbol of hope for others patients, and of a fresh start for Randy and his family. Randy explained, “Looking back, I didn’t know how bad I felt before my

surgery, now I feel great.” “There were no surprises, my team prepared me and I knew what to expect.” “I am especially grateful for my wife and her donation.” “My team was great, I wake up feeling good, I have energy and I don’t have to worry about my blood sugar swinging.”

Phot

o an

d st

ory

by S

cott

Hol

mes

5

Kidney Donors Compete in Half Marathon

Donation Doesn't Slow Them Down One Bit

Tammy Hernadez and Alison Smith Brown have at least two things in common. They both donated their kidneys to a relative and both competed in the La Porte By the Bay Half Marathon, the highest off-the-ground half marathon in Texas. I am extremely lucky to know and very proud of the two courageous women, Tammy and Alison who finished the La Porte by the Bay Half Marathon on December fourth. Tammy (see story on page 3) donated a kidney to her husband nine weeks ago (I took care of her). Alison donated to her daughter, Madison, eight years ago. They both are so inspirational! Tammy lives in Nederland, Texas and belongs to Sea Rim Striders in Beaumont, Texas. Alison belongs to Clearlake Fitness Club. Recipients of their kidneys tend to start walking and running as well. Tammy’s husband walked a 5K a few weeks ago. An amazing Madison just finished her first half marathon on December eleventh. They are living proof of what organ donation can do to change the lives of people who are in need of kidneys—kidney donation is safe.

– Kanae Ishihara, MD

From left: Dr. Kanae Ishihara, transplant nephrologist, with organ donors Tammy Hernandez and Alison Smith Brown.

Tammy Hernandez and Alison Smith Brown, organ donors, during the La Porte by the Bay Half Marathon on December 4, 2011.

Photos and story by Kanae Ishihara

6

PresentationsJOHN M. VIERLING, MDDiagnosis and Management of Autoimmune Hepatitis, St. Luke’s Episcopal Hospital—Hot Topics in Liver Diseases Conference, Houston, TX, October 16, 2011.

Novel Therapies in HCV Infection, Houston Chapter Association of Clinical Research Professionals, Houston, TX, November 1, 2011.

HIV Infection and the Liver, Early Morning Workshop – 62nd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD), San Francisco, CA, November 4-8, 2011.

Autoimmunity and DILI and Wrap-up Comments, Workshop of Special Interest Group on Drug-Induced Liver Injury–62nd Annual Meeting of the AASLD, San Francisco, CA, November 4-8, 2011.

Rifaximin Treatment in Hepatic Encephalopathy, NEJM, Advances for Clinicians Session–62nd Annual Meeting of the AASLD, San Francisco, CA, November 4-8, 2011.

Novel Therapies for Chronic Hepatitis C, GI Section Lecture, Baylor College of Medicine, Houston, TX, December 1, 2011.

Other Novel Therapies for HCV Infections, 2nd Annual AASLD Highlights Conference, Texas Gulf Coast Gastroenterological Society, Houston, TX, December 3, 2011.

Autoimmunity in Drug-Induced Liver Injury, Hepatology/Liver Transplantation Conference, Baylor College of Medicine, Houston, TX, December 5, 2011.

New Antiviral Therapies for HCV Infection, VA Medicine Grand Rounds, Michael E. DeBakey VA Medical Center, Houston, TX, December 19, 2011.

F. BLAINE HOLLINGER, MD“Occult HBV and Reactivation,” 2nd Annual AASLD Highlights Conference, Texas Gulf Coast Gastroenterological Society, Houston, TX, December 3, 2011.

KHOZEMA HUSSAIN, MDAcute Liver Failure and Artificial Liver Support,”2nd Annual AASLD Highlights Conference, Texas Gulf Coast Gastroenterological Society, Houston, TX, December 3, 2011.

GAGAN SOOD, MDAdvances in the Management of Varices, 2nd Annual AASLD Highlights Conference, Texas Gulf Coast Gastroenterological Society, Houston, TX, December 3, 2011.

RONALD H. KERMAN, PHDHLA, Baylor College of Medicine, December 20, 2011, Houston, Texas.

PublicationsMcGuire AL, Oliver JM, Slashinski MJ, Graves JL, Wang T, Kelly PA, Fisher W, Lau CC, GOSS JA, Okcu M, Treadwell-Deering D, Goldman AM, Noebels JL, Hilsenbeck SG. To Share or Not to Share: A Randomized Trial of Consent for Data Sharing in Genome Research. Genet Med. 2011 Nov;13(11):948-955. ABSTRACT

Ilyas JA, O'MAHONY CA, VIERLING JM. Liver Transplantation in Autoimmune Liver Diseases. Best Pract Res Clin Gastroenterol. 2011 Dec;25(6):765-82. ABSTRACT

Balachandran K, Alford PW, Wylie-Sears J, GOSS JA, Grosberg A, Bischoff J, Aikawa E, Levine RA, Parker KK. Cyclic Strain Induces Dual-mode Endothelial-Mesenchymal Transformation of the Cardiac Valve. Proc Natl Acad Sci USA. 2011 Dec 13;108(50):19943-8. ABSTRACT

Harring TR, O'MAHONY CA, GOSS JA. Extended Donors in Liver Transplantation. Clin Liver Dis. 2011 Nov;15(4):879-900. ABSTRACT

Tarcin O, Basaranoglu M, Tahan V, Tahan G, Sücüllü I, Yilmaz N, SOOD G, Snyder N, Hilman G, Celikel C, Tözün N. Time course of collagen peak in bile duct-ligated rats. BMC Gastroenterol. 2011 Apr 28;11:45. ABSTRACT

7

The Abdominal Transplant newsletter is a publication of The Michael E. DeBakey Department of Surgery at Baylor College of Medicine

To be added to the Newsletter e-mail database please write to:

Scott HolmesOne Baylor Plaza, MS: BCM 504

Houston, Texas 77030or e-mail: scotth@bcm.edu

Editor-in-ChiefJohn Goss, MD

Editor Scott C. Holmes

© 2012 Baylor College of Medicine

Division Update

CHARLES G. PHAN, MDAssistant Professor

GREGORY CODY, MSHistocompatibility Technologist I

New Faculty and Staff

Honors and AwardsRISË STRIBLING, MD, Dr. Stribling was recognized for her outstanding contributions for work performed for the Membership Committee of the American Association for the Study of Liver Diseases for 2009-2011.

JACQUELINE A. LAPPIN, MD, Dr. Lappin was appointed to serve as a member of the Southern Texas District 1 Committee on Applicants of the American College of Surgeons for 2012 fellowship applicants.

NICHOLE BABERSAdministrative Assistant

ST. LUKE'S COOLEY TRANSPLANT CENTER, SLEH received a HealthGrades Liver Transplant Excellence Award. Hospitals with adult acute care transplant programs received HealthGrades Transplant Excellence Awards if they had a statistically significantly higher three-year survival rate. Award recipients were also required to have a waitlist mortality rate that was either not significantly different than expected or was significantly lower than expected based on Scientific Registry of Transplant Recipients (SRTR) calculations. Of the 230 hospitals evaluated, only 19 other hospitals received this award.