TRANSPLANTATION | 2008 · In 2007 we initiated an auto-islet transplantation program for a sub-group of chronic pancreatitis patients. • Kidney Transplantation Cleveland Clinic

TRANSPLANTATION | 2008

ClevelandClinic.org/TRANSPLANT ClevelandClinic.org/TRANSPLANT

ON The COveR: Maria Siemionow, MD, PhD, leads a team of surgeons through the first near-total face transplant in the United States. The historical transplant was performed at Cleveland Clinic in December 2008.

2 Cleveland Clinic Transplant Center

10 The Transplant Process

12 Allogen Laboratories

18 Infectious Disease

24 Bone Marrow Transplantation

32 Cardiac Transplantation

40 Corneal Transplantation

44 Intestinal Transplantation

48 Liver Transplantation

58 Lung and heart/Lung Transplantation

64 Pancreas and Kidney/Pancreas Transplantation

68 Renal Transplantation

74 Tissue Transplantation

81 Staff Directory

102 Donation and Procurement Agencies

TABLe Of CONTeNTS

In honor of organ, tissue,

bone marrow and eye

donors and their family

members, ThANK YOU

for making the gift of life

possible for our patients.


Foundation of Excellence Leads to Advancements in Transplantation

From 1963, when physicians here performed the first kidney transplant in Ohio, to 2008, when our staff completed the nation’s first near-total face transplant, Cleveland Clinic has been recognized as a pioneer in the field of transplantation.

In 2008, we completed more than 800* transplants and are proud to offer patients one of the most comprehensive transplant programs in the world. Our physicians continue to achieve outstanding outcomes while performing complex transplant procedures involving multiple organs and the most critically ill patients. Additionally, our physicians work to maximize the use of all available donor organs, including those considered to be from extended criteria donors.

A Year of Firsts

•Near-Total Face Transplantation

Toward the close of 2008, we performed the first near-total face transplant in U.S. history. During a 22-hour procedure, surgeons transplanted 80 percent of the face of a woman who had suffered severe facial trauma. Surgeons essen-tially replaced her entire face, except for her upper eyelids, forehead, lower lip and chin. This was the largest and most complex face transplant in the world, integrating different functional components such as nose and lower eyelids, as well as different tissue types including skin, muscles, bony structures, arteries, veins and nerves.

The transplant team was led by Maria Siemionow, MD, PhD, head of Plastic Surgery Research, who received worldwide attention in November 2004 when Cleveland Clinic’s Institutional Review Board announced that face transplantation is both ethical and possible by approving the first protocol for the surgery. Dr. Siemionow, a highly regarded scientist, has dedicated her professional life to researching and developing the methods doctors could use to substantially help patients with severe facial disfiguration.

The Cleveland Clinic Dermatology & Plastic Surgery Institute led the face trans-plant surgery, partnering with the Cleveland Clinic head & Neck Institute with

support from the Transplant Center. Staff members from psychology/psychiatry, bioethics, social work, anesthesia, transplant, nursing, infectious disease, den-tistry, ophthalmology, pharmacy, environmental services and security also were significantly involved.

• Intestinal Transplantation

In 2008, we also completed our first intestinal transplant (first adult in Ohio). Drawing on the expertise of our liver transplant specialists, colorectal and general surgeons, infectious disease and intestinal rehabilitation and nutrition specialists and gastroenterologists, we are actively growing the program and, along with our patients, celebrating the renewed health an intestinal transplant can bring. Cleveland Clinic is one of the only centers in the region performing adult small bowel transplantation.

In 2007 we initiated an auto-islet transplantation program for a sub-group of chronic pancreatitis patients.

•Kidney Transplantation

Cleveland Clinic surgeons pioneered a single-port procedure to remove donor kidneys through a single incision in the umbilicus.

We also expanded our kidney transplant program in 2008. Staff members in the Glickman Urological & Kidney Institute collaborated with physicians and leadership at St. vincent Medical Center in Indianapolis to open a new kidney transplant program there.

Improving Data Quality

Throughout 2008, the Transplant Center focused on enhancing the quality of data via our Electronic Data Interface for Transplantation (EDIT). We formed an abstraction team to streamline the data collection process and make regulatory form submission a more deliberate and thoughtful process. eDIT, which was implemented in 2006, is utilized by all solid organ programs and centrally coor-dinates and tracks patients throughout the transplantation process from referral to post-transplant follow-up and contains more than 21,700 patient records and nearly 7,500 donor records. eDIT provides ample research data and communi-cates with the United Network for Organ Sharing (UNOS) to meet form submis-sion requirements at each phase in the transplant process.

Key enhancements in 2008 included a daily data feed to import patient vital signs from our electronic medical record, as well as downloads of detailed donor information and HLA tissue-typing data to further increase the data available for research and post-transplant follow-up.

Leadership

John Fung, MD, PhDDirector, Transplant Center; Chairman, General Surgery; Chairman, Hepato-pancreato-biliary and Transplant Surgery

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* Does not include all tissue transplants.


Number of solid organ transplants in 2008

Organ Number of Transplants

heart 60

Intestine 4

Kidney 168 *

Liver 147 **

Lung 57

Pancreas 31 ***

Advancing Research

We provide the highest quality care for patients facing transplantation and their families. We use a surgical-medical team approach, which enhances our efforts to develop more effective treatments.

Cleveland Clinic is committed to determining disease causation in an effort to better serve patients and their families in preventing illness. The Cleveland Clinic Genomic Medicine Institute (GMI) studies patients’ DNA to determine the genetic causes of disease and treats them accordingly. The GMI, launched three years ago, is composed of 90 physicians and researchers who work in the Lerner Research building on Cleveland Clinic’s main campus.

Continued Excellence

All Cleveland Clinic staff transplant physicians are board-certified in a related medical specialty, and all transplant surgeons are board-certified in a related surgical specialty or have the international equivalent of board certification.

Cleveland Clinic is accredited by The Joint Commission and meets the United Network for Organ Sharing (UNOS) standards as a center for heart, heart/lung, kidney, kidney/pancreas, liver, lung, intestinal and pancreas transplants.

Cleveland Clinic also meets Ohio Department of health and Ohio Solid Organ Transplant Consortium requirements for extra-renal organs.

We also meet standards set by the National Marrow Donor Program and the foundation for the Accreditation of Cellular Therapy as a center for bone marrow transplantation, and the eye Bank Association of America standards for corneal transplants. Our tissue transplantation program meets standards set by the American Association of Tissue Banking, the fDA, the American Association of Orthopaedic Surgeons and The Joint Commission.

Allogen Laboratories remains in compliance with all mandatory American Society for Histocompatibility & Immunogenetics (ASHI) standards and is accredited by the Centers for Medicare and Medicaid Services.

Cleveland Clinic was one of the first hospitals in the United States to become certified by Medicare under the new Conditions of Participation by the Centers for Medicare and Medicaid Services for heart, heart/lung, kidney, kidney/pan-creas, liver, lung and pancreas transplantation.

* (includes 16 kidney/pancreas and 8 kidney/liver)

** (includes 8 liver/kidney and 1 liver/pancreas)

*** (includes 16 pancreas/kidney and 1 pancreas/liver)

Number of patients on waiting lists†

Organ Number of Patients Waiting

heart 68 *

Intestine 4

Kidney 819 **

Liver 199 ***

Lung 61 ****

Pancreas 66 *****

† As of December 31, 2008

* (includes 5 heart/kidney and 4 heart/liver)

** (includes 33 kidney/pancreas, 1 kidney/liver and 5 kidney/heart)

*** (includes 3 liver/intestine/pancreas, 1 liver/kidney, 4 liver/heart and 2 liver/lung)

**** (includes 2 lung/liver)

***** (includes 3 pancreas/intestine/liver and 33 pancreas/kidney)

Transplantation Outcomes

We are pleased to present Transplantation 2008, a summary of outcomes and key data about Cleveland Clinic Transplant Center programs. The following data summarize our activities for the year.

2008 Transplant Center Highlights

Cleveland Clinic per-formed the first near-total face transplant in U.S. history in December.

In June, Cleveland Clinic performed the first adult intestinal transplant in Ohio. By the end of the year, a total of four intestinal transplants were performed.

Cleveland Clinic surgeons pioneered a single-port procedure to remove donor kidneys through a single incision in the umbilicus.

Children’s Hospital

Our 100th pediatric heart transplant was performed in October.

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ClevelandClinic.org/TRANSPLANT ClevelandClinic.org/staff

State of residence of transplanted patients 2008

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Number of evaluations in 2008

Organ Number of Patients

Bone marrow 333

heart 204

Intestine 15

Kidney 426

Liver 461

Lung 301

Pancreas 70

* (includes 9 heart/lung, 3 heart/kidney and 1 heart/liver) ** (includes 3 kidney/heart and 30 kidney/liver) *** (includes 30 liver/kidney, 1 liver/heart, 1 liver/lung and 4 liver/pancreas) **** (includes 9 lung/heart and 1 lung/liver) ***** (includes 101 pancreas/kidney and 4 pancreas/liver)

Number of post-transplant patients followed during 2008

Organ Number of Patients

heart 772*

Intestine 4

Kidney 1493 **

Liver 902 ***

Lung 366 ****

Pancreas 184 *****

State of Residence of Transplant Patients 2008 Bone Kidney & Kidney & Liver &State Marrow Heart Intestine Kidney Liver Lung Pancreas Liver Pancreas Pancreas Total

AR 1 1

CA 3 3

CO 2 2

CT 1 1

DE 1 1

FL 1 1 2

GA 1 1 1 3

IN 1 3 2 1 2 9

KS 1 1

KY 1 1

LA 1 1

MA 1 1 2

MD 1 1

ME 1 1

MI 1 4 1 7 2 1 16

NC 1 1

NV 1 1

NY 6 1 4 7 11 2 2 33

OH 135 36 2 128 103 28 8 6 14 1 461

PA 9 4 3 5 1 1 23

RI 1 1

SC 1 1 2

TN 1 1 2

VA 1 1

WI 1 1

WV 2 1 2 5 2 12

INTL 1 1 2 2 1 7

Total 152 60 4 144 135 57 13 8 16 1 590


Transplantation Facilities

Pre-Transplant Heart Failure Intensive Care Unit, 10 beds

Surgical Intensive Care Unit, 30 beds

Heart/Lung Post-Transplant Intensive Care, 14 beds

Cardiothoracic Intensive Care Unit, 76 beds

Transplant Special Care, 34 beds

heart/Lung Transplant Unit, 24 beds

Pediatric Intensive Care Unit, 15 beds

Pediatric Stepdown Unit, 18 beds

Bone Marrow Transplant Unit, 17 beds

Transplant hospitality housing Unit, 37 rooms

Transplant Center Historical Highlights

• Formation of the Department of Biomedical Engineering (formerly known as Artificial Organs), one of five research facilities in the United States funded by the National heart, Lung and Blood Institute

• The first kidney, lung, heart/lung and heart/liver transplants performed in Ohio

• Medicare certification for the heart, kidney, liver, lung and pancreas transplant programs

• World’s first successful laryngeal transplant performed in January 1998

• Enrolled our first patient in a multicenter trial of the Organ Care System in 2007. This new technology increases the amount of time that an organ can be maintained outside the body in a condition suitable for transplantation

• Cleveland Clinic heart, liver, lung and pancreas transplant programs named as Best Practices in preparation for hRSA Transplant Center Growth and Management Collaborative in 2007

Alternatives to Transplantation

Making the decision that transplantation is the best or only option to treat an individual’s disease is a crucial phase of transplant evaluation. Transplantation is one option in an overall strategy for treating patients with advanced organ disease and some types of cancer. Before making the decision to go ahead with transplantation, physicians explore all of the choices available to the patient.

Transplantation is not always the most appropriate choice, even for people with end-stage disease. Successful transplantation depends in part on careful patient selection, and patients must meet certain medical criteria before they even can be considered for transplantation.

for more information on the Transplant Center, call 800.223.2273, ext. 42394, or 216.444.2394.

visit our website at clevelandclinic.org/transplant.

A note on outcomes in this book

Many factors influence a transplant center’s actual outcomes (survival rates). For example, some transplant centers perform transplants on much sicker patients than others do. A good measure is to look at a transplant center’s actual vs. expected rates, as “expected” survival takes into ac count such factors as the recipient’s condition and other characteristics, donor characteristics and survival rates of all transplant patients in the United States.

Cleveland Clinic’s transplant outcomes generally meet or exceed expected survival rates.

To obtain comparisons of actual vs. expected outcomes, please go to ustransplant.org and click on “Program and OPO Data,” then “Transplant Program and OPO Specific Reports.”

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The TRANSPLANT PROCeSS*

Phase 1 Referral and Evaluation

Patients can be referred for transplant evaluations at Cleveland Clinic by call-ing 800.223.2273, ext. 42394, or 216.444.2394. At the time of referral, a member of the team will collect a basic history of the patient’s past medical conditions, results of any diagnostic studies performed and a description of the current clinical condition of the patient.

A transplant evaluation is scheduled, including tests and consults with a trans-plant physician and transplant surgeon, social worker, financial coordinator, nutritionist, transplant coordinator and other specialists.

Decisions regarding approval of candidates for transplantation are made by consensus, following review of each patient’s case at a selection meeting. for heart, intestinal, liver, lung and pancreas transplants, the final step in the review process includes approval by the Ohio Solid Organ Transplant Consortium. for heart, intestinal, liver, lung, kidney and pancreas transplants, the final step after the evaluation process is complete is notification of the patient, referring physi-cian and insurance carrier regarding the decision about transplantation.

Phase 2 Ongoing Medical Therapy Review

for those individuals not approved for transplantation, continuing medical therapy by a specialist is available.

The medical transplant team manages those patients approved for trans-plantation. Solid organ transplant patients are placed on the national transplant waiting list. Kidney and liver transplant patients may be considered for living donor transplantation.

Phase 3 Transplantation

When an organ is available for transplantation, the patient is notified by one of the transplant coordinators. The patient then reports to the hospital and is admitted to the transplant floor. Following transplantation, patients may be transferred to an Intensive Care Unit, where their care is jointly managed by the transplant team and staff of the intensive care unit. The team assumes primary care at the time of transplant and during the hospital stay in the Transplant Special Care Unit and provides long-term follow-up.

Detailed information regarding studies, consults, specific protocols and tests performed during the transplant and post-transplant hospitalization are outlined.

Patient and family education begins several days after the transplant and is viewed as a key ingredient in a patient’s successful recovery.

Phase 4 Follow-up

following discharge, the patient’s progress is monitored during regular out-patient visits with the transplant team. All transplant patients return to the transplant clinic on a schedule as needed where the medications are reviewed and adjusted as necessary. Additional appointments and diagnostic studies are scheduled as needed. All patients are asked to return to Cleveland Clinic annually for follow-up. We communicate regularly with the patients’ referring physicians throughout all phases of care.

for some patients outside the greater Cleveland area, arrangements can be made with a local physician for routine follow-up after a period of time. In this case, members of the transplant team will establish contact with the physician to continue to monitor the patient’s progress.

* Note: This process applies to solid organ transplantation only and may vary as necessary according to the patient’s condition and transplant type.

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ALLOGeN LABORATORIeS

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2008 Highlights

In 2008, technologists at Cleveland Clinic’s Allogen Laboratories performed more than 91,000 tests on transplant patients and potential donors to deter-mine compatibility. These included tests to determine whether the patient and donor had compatible blood and tissue types, as well as whether antibodies were present in the patient’s blood.

Blood test results are entered into a computer at the United Network for Organ Sharing (UNOS), which assists physicians in determining whether the patient is an appropriate candidate when an organ becomes available. (For more informa-tion on UNOS and the evaluation/waiting process, visit unos.org.)

A testing protocol was developed and implemented for the new Cleveland Clinic Intestine Transplant Program.

Allogen Laboratories successfully passed the following inspections:

• AShI focus inspection for new lab director

• LifeBanc annual audit

• Ohio CMS safety inspection

• ASHI interim self-inspection of the Cleveland lab

• ASHI interim self-inspection of the Charleston, W.Va., lab

Research and Innovations

Our current IRB-approved studies include:

Principal Investigator – Dr. Diane J. Pidwellhistocompatibility Lab Reagent Program.

Principal Investigator – Dr. Medhat Z. AskarThe association of killer immunoglobulin-like receptors (KIR) gene polymorphism on the incidence of BK viremia and viruria in posttransplant kidney and kidney/pancreas recipients.

Leadership

Diane J. Pidwell, PhDDirector, Allogen Laboratories

Medhat Z. Askar, MD, PhD Associate Director, Allogen Laboratories

See page 82 for complete staff listing

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Principal Investigator – Dr. Medhat Z. AskarThe association of killer immunoglobulin-like receptors (KIR) gene polymorphism on the incidence of BK viremia and viruria in posttransplant kidney and kidney/pancreas recipients.

Principal Investigator – Dr. Medhat Z. AskarMICA typing and antibody screening in lung transplants.

Principal Investigator – Dr. Medhat Z. AskarMICA typing for myeloablative allo hSCT for AML/MDS and outcomes in addition to a correlation with KIR typing.

Principal Investigator – Dr. Medhat Z. AskarMICA typing for reduced intensity conditioning allogeneic bone marrow transplants.

In addition, Allogen Laboratories’ samples/data are a component of the following studies:

Principal Investigator – Dr. Robin AveryCo-investigator – Dr. Medhat Z. AskarThe impact of killer immunoglobulin-like receptors (KIR) genotype profile and KIR/hLA combinations on primary CMv infections in the CMv D transplant recipient.

Principal Investigator – Dr. Peter CohenA collection protocol of healthy donor volunteers to provide blood components via monocytapheresis for in vitro research use.

Principal Investigator – Dr. Jaroslaw MaciejewskiCollection of blood and bone marrow from patients with hematologic disorders and from normal volunteers and patients for research purposes.

Principal Investigator – Dr. Jaroslaw MaciejewskiBone Marrow failure Research Center.

Principal Investigator – Dr. John FungUTD-histocompatibility testing results.

Principal Investigator – Dr. Emilio PoggioRelevance of B cell crossmatch and transplant markers in renal transplantation.

Principal Investigator – Dr. Titte SrinivasIRB under evaluation: Evaluation of pre-sensitization by pregnancy and kidney transplants.

Principal Investigator – Dr. Stuart FlechnerAnalysis of 10 years of UNOS mandatory share kidney transplants.

Principal Investigator – Dr. David Goldfarb (Michael Knight)effect of transplant nephrectomy on PRA.

Ongoing internal research and development in 2008 included:

• Predicting negative crossmatch in solid organ transplants; October 2008 AShI Workshop participant.

• Correlation of the strength of bead antibody with clinical outcome in solid organ transplants.

• Further analysis and product testing for pre- and posttransplant donor-specific hLA antibody testing.

• Short tandem repeat (STR) testing to determine the percentage of donor chimerism to support the diagnosis of graft-vs.-host disease (GvHD) after liver or other solid organ transplants.

• The association of killer immunoglobulin-like receptors (KIR) gene polymor-phism on the incidence of BK viremia and viruria in posttransplant kidney and kidney/pancreas recipients. September 2008, Project under the 15th Interna-tional Workshop for histocompatibility and Immunogenetics.

• hLA eplet antibody analysis in nephrectomized renal transplant patients. September 2008, Project under the 15th International Workshop for histo-compatibility and Immunogenetics.

• MIC-A typing and antibody kits; beta testing and evaluating for clinical utility, as well as optimizing the assay and increasing its robustness for testing clinical samples.

• Outcome of hematopoietic stem cell transplant (HSCT) donor searches from the U.S. National Marrow Donor Program (NMDP) Registry: Cleveland Clinic 10-year experience and comparison to searches from other U.S. and european centers.

• validation of buccal swab sampling and DNA typing.

• HLA antibody pre- and post-nephrectomy in renal transplant patients.

• Backup repository for B cell line developed in the lab of emilio Poggio, MD.

• Kidney/liver transplant survival study with David Goldfarb, MD, and ho Yee Tiong, MD.

• Pancreas post-transplant monitoring using HLA antigen-coated beads and/or flow cytometry crossmatch testing.

• Comparison and evaluation of donor specific antibody identified by flow bead and Luminex bead assays in relation to pre-transplant flow crossmatch results in solid organ transplants.

• Evaluation of flow crossmatch cut-offs and interpretation.

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Fast facts

Initiated: 1968

Number of tests performed in 2008: 91,000

Special Accreditations

Center for Medicare & Medicaid Services (CMS)-certified laboratory

fully accredited by the United Network for Organ Sharing (UNOS) and the American Society for histocompatibility and Immunogenetics (ASHI)

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• evaluation of RosetteSep cell isolation technology.

• Several product/instrument evaluations were conducted, including the SystemLink’s HistoTrac, AbSorber AB XM-ONE assay, E-Gene CE system, RoboSep, Maxwell DNA extractor, Texas BioGene Morgan hLA SSP kit, Abbott Molecular AlleleSEQR/HARPS, GTI-EZE type SSP system, Tepnel Lifematch RSSOP and LabType high-resolution DR-RSSOP kit.

• A possible new HLA allele was submitted to GenBank (HLA-B*0702variant Gene Bank ACCESSION #737982) and was officially named HLA-B*0770.

• Two new MICA alleles were submitted to GenBank (Gene Bank ACCESSION #FJ790820 and FJ790821) and were officially named MICA*058 and MICA*00203.

Education

In 2008, staff and technologists routinely organized lectures, discussions and presentations to Allogen Laboratories’ visitors, including residents, transplant coordinators, students, patients and new LifeBanc employees.

Two medical students have assisted with clinical projects (Lauren Moore and Michael Knight). Several employees attended and/or presented at national and international workshops, conferences, specialty courses and neighboring trans-plant centers.

Expertise

Allogen Laboratories was one of the first tissue typing laboratories in the coun-try and remains one of the largest in the United States today. It continues to develop, investigate and apply state-of-the-art histocompatibility techniques to support transplant centers nationwide. four of our employees were requested to perform 7 AShI lab inspections of other histocompatibility labs. Commercial vendors also rely on Allogen Laboratories’ expertise.

Publications

Pavlov v, Raedler h, Yuan S, Leisman S, Kwan Wh, Lalli PN, Medof Me, heeger PS. Donor deficiency of decay-accelerating factor accelerates murine T cell-mediated cardiac allograft rejection. J Immunol. 2008 Oct 1;181(7):4580-4589.

Lalli PN, Strainic MG, Yang M, Lin f, Medof Me, heeger PS. Locally produced C5a binds to T cell-expressed C5aR to enhance effector T-cell expansion by limiting antigen-induced apoptosis. Blood. 2008 Sep 1;112(5):1759-1766.

Strainic MG, Liu J, huang D, An f, Lalli PN, Muqim N, Shapiro vS, Dubyak GR, heeger PS, Medof Me. Locally produced complement fragments C5a and C3a provide both costimula-tory and survival signals to naive CD4+ T cells. Immunity. 2008. Mar;28(3):425-435.

Askar M, Gupta S, Zhang A, Danziger-Isakov L, Qian X, Thomas D, Klingman L, Murthy S, Mason D, Yun J, Mehta A, Pidwell D, Budev M. Pretransplant MICA antibodies in lung transplantation: the presence of MICA antibodies is not associated with increased acute rejections or bronchiolitis obliterans syndrome. (Accepted for poster presentation in ATC 2009)

Srinivas T, Poggio e, flechner S, fatica R, Goldfarb D, Shoskes D, Askar M. Donor and recipient gender interactions significantly impact kidney transplant outcome. (Accepted for oral presentation in ATC 2009)

Askar M, Hemachandra S, Zhang A, Thomas D, Pidwell D, Shrestha N, van Duin D, Avery R. MICA gene polymorphisms and primary CMV infection in the CMV D+/R- thoracic organ transplants. J Heart Lung Transplant. 2009;28(2S):S253.

Gupta S, Askar M, Sabe A, Nowicki E, Blackstone E, Gonzalez-Stawinski G. Do MICA antibodies prior to heart transplantation influence development of acute rejection? J Heart Lung Transplant. 2009;28(2S):S89.

Hemachandra S, Askar M, Zhang A, Thomas D, Pidwell D, Shrestha N, van Duin D, Avery R. The association between killer immunoglobulin-like receptors (KIR) genotype profile and primary CMV infection in CMV D+/R- heart and lung transplant recipients. J Heart Lung Transplant. 2009;28(2S):S111.

Sobeck R, Askar M, Zhang A, Thomas D, Kawczak P, Pidwell D, Rybicki L,, Jasek M, Kalaycio M, Andresen S, Pohlman B, Dean R, Copelan e, Maciejewski J, Bolwell B. Platelet engraftment in AML patients receiving matched related-donor allogeneic bone marrow transplant (BMT) correlates with major histocompatibility complex class l related molecule A (MICA) gene polymorphisms. Biol Blood Marrow Transplant. 2009;15(2S):107.

Jurcago R, eghtesad B, Schatz h, Thomas D, Kawczak P, Miller C, fung J, Pidwell D, Askar M. Donor lymphoid chimerism kinetics in a successfully treated case of acute graft versus host disease after orthotopic liver transplantation. Hum Immunol. 2008;69(S1):S122.

Askar M, Mytilineos J, howard A, fung M, Constantino D, Taves C, Wagenknecht D, Jensen M, Embrey C, Vayntrub T, Siegel R, Ayala D, Lind C. High-resolution HLA typing strategies and reporting practices of AShI and efI accredited laboratories. Tissue Antigens. 2008;72(3):249-250.

Askar M, Corey R, Avery R, Thomas D, Pidwell D, Eghtesad B, Miller M, Fung J, Zein N. Lack of killer immunoglobulin-like receptor KIR2DS2 and possibly other genes within the B haplotype predict poor response to antiviral therapy in liver transplantation recipients with recurrent hCv infection. Am J Transplant. 2008;8(S2):576.

Askar M, Avery R, Corey R, Thomas D, Pidwell D, Eghtesad B, Zein N, Fung J, Miller M. The association between immunoglobulin-like receptor B haplotype and post-transplant infections among liver transplant recipients with HCV. Am J Transplant. 2008;8(S2):576.

Askar M, Sobecks R, Kalaycio M, Dean R, Copelan e, Rybicki L, Pohlman B, Bolwell B. how realistic is it to expect a fully allele level matched donor from a search through the NMDP? A 10-year, single institution experience. Biol Blood Marrow Transplant. 2008;14(2S):53.

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INfeCTIOUS DISeASe

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Leadership

Steven Gordon, MD Chairman, Department of Infectious Disease

Robin Avery, MD Section Head, Transplant Infectious Disease


Close collaboration with infectious disease (ID) physicians who have expertise in post-transplant infections is essential to the success of any transplant program. This is primarily because many types of infections are common after transplan-tation due to the effects of immunosuppressive medications administered to prevent rejection.

Expertise

Under the chairmanship of Steven Gordon, MD, Cleveland Clinic’s Department of Infectious Disease (Adult) consists of 19 staff physicians. The Section of Transplant Infectious Disease was established to provide expert support and excellent clinical care and consultation for the transplant teams. It is comprised of nine adult physicians, one pediatric physician, and one nurse practitioner who rotate and perform inpatient consultations on solid organ transplantation and bone marrow transplant services.

Section Head Robin Avery, MD, was a co-editor of the infectious disease guide-lines for the American Society of Transplantation (AST) and is a past chair of the AST ID Community of Practice, a group of more than 75 clinicians involved in transplant infectious disease. her research involves viral and fungal infec-tions after transplant and the effects of infections on transplant function. Lara Danziger-Isakov, MD, MPH, is a member of the Executive Committee of the AST’s ID Community. Dr. Avery and Dr. Danziger-Isakov are members of several international guidelines committees.

Sherif Mossad, MD, specializes in bone marrow transplantation and respiratory viruses, including influenza. Steven Mawhorter, MD, is an expert in immunology, parasitic infections and travel medicine. David van Duin, MD, has expertise in immunology, aging and donor/recipient screening for infection before transplan-tation. Nabin Shrestha, MD, is an authority on new molecular diagnostic tests for infections.

Under the leadership of Alan Taege, MD, the hIv section provides clinical con-sultation and advice on transplantation for HIV-positive recipients.

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The transplant ID group also provides rapid outpatient access for transplant recipients with symptoms of infection and for transplant candidates who require evaluation for previous infections that could have an impact after transplant. For pre-transplant patients, every effort is made to treat past infections, update vaccinations and devise individualized programs for infection prevention after transplantation.

The transplant ID group advises all transplant teams on regimens for preventing infection after transplantation. This preventive approach involves close monitor-ing for viral infections with the goal of early treatment, if needed. It also helps to decrease hospitalizations and illnesses after transplant. Members of the transplant ID group also participate in patient education with the philosophy that better understanding of infectious risks can help transplant recipients avoid infections.

Awards and Achievements

Dr. Robin K. Avery received the 2008 American Society of Transplantation Astellas established Investigator Award.

Dr. Lara Danziger-Isakov received an AST/Roche Clinical Science Faculty Development Grant.

Research

Principal Investigator - Dr. Robin AveryA phase III, randomized, double-blind comparison of oral valganciclovir and placebo for prevention of CMv disease after lung transplantation. Roche Laboratories: vAL 038.

Principal Investigator – Dr. Robin AveryOrgan transplant infection prevention and detection project 1.0. Cohort study of transplant recipients at “ultra-high” risk for invasive fungal infections. Centers for Disease Control and Prevention/GCRC.

Principal Investigator – Dr. Robin AveryThe impact of killer immunoglobulin-like receptors (KIR) genotype profile and KIR/HLA combinations on primary CMV infection in the CMV D+/R-transplant recipient.

Principal Investigator - Dr. Robin AveryA randomized, double-blind study to assess the efficacy and safety of prophylactic use of maribavir versus oral ganciclovir for the prevention of cytomegalovirus disease in recipients of orthotopic liver transplants (ViroPharma, Incorporated).

Principal Investigator – Dr. Robin Avery (preliminary study)viral triggers of bronchiolitis obliterans syndrome in lung transplantation: Molecular detection of human herpes virus 6 and 7 in archived lung biopsy specimens from lung transplant recipients.

Principal Investigator – Dr. Lara Danziger-Isakov viral triggers of alloimmunity and autoimmunity in pediatric lung transplantation: The major goals of this project are to evaluate the natural history of respiratory viral infections and to evaluate the impact of respiratory viral infections on the development of alloimmunity and autoimmunity after pediatric lung transplantation.

Principal Investigator – Dr. Sherif MossadCase 6Z05. Incidence of rhinovirus infection in autologous and allogeneic myeloablative bone marrow transplantation in adults.

Principal Investigator – Dr. Sherif MossadA double-blind, randomized, stratified, multicenter trial evaluating conventional and high-dose oseltamivir in the treatment of immunocompromised patients with influenza. Hoffman-La Roche Ltd: NV20234.

Principal Investigator – Dr. David van DuinInfectious disease risk assessment in liver transplant candidates.

Phone number216.444.8845

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Publications

Avery RK, Michaels M. Update on immunizations in solid organ transplant recipients: what clinicians need to know. Am J Transplant. 2008;Jan 8(1):9-14.

Avery RK. Update in management of ganciclovir-resistant cytomegalovirus infection. Curr Opin Infect Disease 2008; 21:437.

Avery RK. Classic concepts and modern developments in transplant infectious disease: the work of Robert h. Rubin. Curr Opin Organ Transplant. 2008 Dec;13(6):601-603.

Danziger-Isakov LA, Worley S, Arrigain S, Aurora P, Ballmann M, Boyer D, Conrad C, eichler I, elidemir O, Goldfarb S, Mallory GB, Michaels MG, Michelson P, Mogayzel PJ, Parakininkas D, Solomon M, visner G, Sweet S, faro A. Increased mortality after pulmo-nary fungal infection within the first year after pediatric lung transplantation. J Heart Lung Transplant 2008 Jun;27(6):655-661.

Danziger-Isakov L, Mark Baillie G. Hematologic complications of anti-CMV therapy.Clin Transplant 2008;Dec 16(Epub ahead of print)

Flagg A, Danziger-Isakov LA. Infectious diseases in pediatric transplantation: Literature review 2006-2007. Pediatr Transplant. 2008 Nov;12(7):729-736.

Mawhorter S, Yamani Mh. hypogammaglobulinemia and infection risk in solid organ transplant recipients. Curr Opin Organ Transplant. 2008 Dec;13(6):581-585.

Mossad SB. Agranulocytosis induced by nonchemotherapy drugs. (Letter) Ann Intern Med. 2008;Feb 19;148(4):320; author reply 320-321.

Mossad SB. 2008-2009 influenza update: a better vaccine match. Cleve Clin J Med 2008;75:865-870.

Mossad SB, McElhaney JE, Bates J, Bolwell BJ. Immunogenicity of influenza vaccination in reduced-intensity conditioning allogeneic hematopoietic stem cell transplant recipients compared to healthy controls: a pilot study. Proceedings of the International Conference on Options for the Control of Influenza VI 2008;374-376.

Mossad SB. Larger dose of intradermal influenza vaccination may be more immunogenic in transplant recipients (letter). Am J Transplant 2008 May; 8(5):1073.

Poonyagariyagorn hK, Gershman A, Avery R, Minai O, Blazey h, Asamoto K, Alster J, Murthy S, Mehta A, Pettersson G, Mason DP, Budev M. Challenges in the diagnosis and management of Nocardia infections in lung transplant recipients. Transpl Infect Dis 2008 Dec;10(6):403-408.

Yee-Guardino S, Gowans K, Yen-Lieberman B, Berk P, Kohn D, Wang FZ, Danziger-Isakov L, Sabella C, Worley S, Pellett PE, Goldfarb J. Beta-herpes viruses in febrile children with cancer. Emerg Infect Dis 2008 Apr;14(4):579085.

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Leadership

Brian Bolwell, MDChairman, Department of Hematologic Oncology and Blood Disorders; Vice Chairman, Office of the Chief of Staff; Professor of Medicine, Cleveland Clinic Lerner School of Medicine of Case Western Reserve University

See pages 82-83 for complete staff listing

DOuGLAS SPuRRIER | BONE MARROW TRANSPLANT RECIPIENT

“I enjoy the days a little more. It’s special to be alive.” — Douglas Spurrier, 55, hinckley, Ohio.

Douglas underwent a bone marrow transplant in May 2008. The marrow was donated by his sister

as a treatment for the acute myelogenous leukemia that had Douglas fighting for his life. Douglas,

retired from a supervisory position at a large corporation and the father of two grown sons, has been

cancer-free since the transplant. He said the doctors kept him alive and his wife, Susan, kept him

going. “The mental aspect of the illness was tougher than the treatment,” he says.

BONe MARROW TRANSPLANTATION

2008 Highlights

The Bone Marrow Transplant Program team performed 152 bone marrow/stem cell/umbilical cord blood transplants in 2008. We performed 32 autologous transplants for multiple myeloma, which is the most in our program’s history.

The most common disease indication for transplantation was non-Hodgkin lymphoma. This was followed by acute leukemias, multiple myeloma, and hodgkin lymphoma.

Our 100-day survival rate for autologous transplantation was 92%. Our 100-day survival rate for related allogeneic transplantation and all non-myeloablative allogeneic transplantation was 86%.


We continue to have a program that is driven by clinical and translational investigation. We recently completed a multi-institutional study of a novel way to stimulate peripheral stem cells for transplantation. We were the second-leading accruing institution in the study. In December 2008, this molecule was FDA approved. This should be a significant clinical advance and give many patients the opportunity to mobilize stem cells for transplantation who might otherwise have been unable to do so.

We are poised to embark on a novel protocol using lenalidomide and rituxan following autologous stem cell transplant in an attempt to improve patient outcomes. This protocol will be part of the Leukemia and Lymphoma Soci-ety’s partnership with Cleveland Clinic. The partnership provides infrastructure support for clinical research in hematologic malignancies at Cleveland Clinic’s Taussig Cancer Institute and our affiliated cancer treatment centers within the Cleveland Clinic health system.

Additionally, our bone marrow transplant cell processing laboratory has moved to the Glickman Tower along with the rest of the blood bank. We now have a state-of-the-art BMT cell processing laboratory that is unmatched.

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Expertise

In 2008, Stephen Smith, MD, joined our BMT physician staff. Dr. Smith joins Drs. Bolwell, Andresen, Copelan, Dean, Kalaycio, Pohlman, Sobecks and Sweetenham in a program with significant depth, expertise and experience.

While we are very pleased with our wonderful year in 2008, we realize that much more work needs to be done before we achieve our goal of successfully combating the diseases that we treat, including leukemia, lymphoma, multiple myeloma and others. We look forward to 2009 as an opportunity to continue our excellence in patient care and to further enhance our research endeavors.

Number of transplants 2008

Number Percent

Autologous 89 58.6

Allogeneic 47 30.9

Non-myeloablative Allogeneic 16 10.5

Total 152*

* excluding 9 Tandems


Fast facts

Initiated: 1975

NMDP Approval: November 22, 1988

As of December 31, 2008, 3,269 bone marrow transplants have been performed at Cleveland Clinic.

One of four Ohio centers belonging to the National Marrow Donor Registry

Special Accreditations

foundation for the Accreditation of Cellular Therapy (FACT)

Collaboration

We continue successful collaboration with the Ireland Cancer Center as part of the Case Comprehensive Cancer Center.


In 2008 we had a total of 5 pediatric bone marrow transplant patients:

3 autologous1 allogeneic – related1 allogeneic – unrelated

Survival analysis: 100-day patient survival for primary transplants 2006-2007

100–Day Survival (%) NumberAutologous

Non-Hodgkin lymphoma 99.1 108Myeloma 98.0 50hodgkin’s disease 97.5 40

Allogeneic

Good risk 87.5 8Bad risk 78.7 75

Non-myeloablative allogeneic

Good risk 100 1Bad risk 77.8 27

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Primary diagnoses for bone marrow patients transplanted in 2008

Diagnosis Number Percent

Non-Hodgkin lymphoma 40 26.3

Myeloma 32 21.1

AML 23 15.1

hodgkin’s disease 17 11.2

Myelodysplastic syndrome 12 7.9

ALL 8 5.3

Aplastic Anemia 4 2.6

CLL 3 2.0

CML 2 1.3

Neuroblastoma 1 0.7

Others 10 6.6

Total 152

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Length of stay from admission to discharge for patients transplanted in 2008*

Mean Median Number

All 25.0 21.0 135

Autologous 19.0 20.0 88

Allogeneic (related donor) 30.0 27.0 21

Allogeneic (unrelated donor) 37.0 35.0 26

* Excluding non-myeloablative allogeneic transplants. One patient not discharged yet.


Research

Principal Investigator – Dr. Brian BolwellIRB 8316: A randomized, double-blind, placebo-controlled trial to evaluate palifermin (rHuKGF) in the reduction of acute graft versus host disease in subjects with hematologic malignancies undergoing allogeneic marrow/PBPC transplantation.

Principal Investigator – Dr. Brian BolwellAMD 1406: Long-term observational follow-up study of a multicenter, randomized, double-blind, placebo-controlled comparative trial of AMD3100 (240 µg/kg) plus G-CSF (10 µg/kg) versus G-CSF (10 µg/kg) plus placebo to mobilize and collect > 5 x 106 CD34+ cells/kg in non-Hodgkin’s lymphoma patients for autologous transplantation.

Principal Investigator – Dr. Brian BolwellAMD 1A06: Long-term observational follow-up study of a multicenter, randomized, double-blind, placebo-controlled comparative trial of AMD3100 (240 µg/kg) plus G-CSF (10 µg/kg) versus G-CSF (10 µg/kg) plus Placebo to Mobilize and Collect > 6 x 106 CD34+ cells/kg in multiple myeloma patients for autologous transplantation.

Principal Investigator – Dr. Brian BolwellIRB 5386: Tandem autologous stem cell transplantation for patients with pri-mary progressive or poor-risk Hodgkin’s disease.

Principal Investigator – Dr. Ronald SobecksIRB 6067: Multiple unit unrelated donor umbilical cord blood transplantation for patients with hematologic diseases.

Publications

Bishop MR, Logan BR, Gandham S, Bolwell BJ, Cahn JY, Lazarus hM, Litzow MR, Marks DI, Wiernik Ph, McCarthy PL, Russell JA, Miller CB, Sierra J, Milone G, Keating A, Loberiza FR, Jr., Giralt S, Horowitz MM, Weisdorf DJ. Long-term outcomes of adults with acute lymphoblastic leukemia after autologous or unrelated donor bone marrow transplantation: a comparative analysis by the National Marrow Donor Program and Center for International Blood and Marrow Transplant Research. Bone Marrow Transplant. 2008 Apr;41(7):635-642.

Boyiadzis M, Memon S, Carson J, Allen K, Szczepanski MJ, vance BA, Dean R, Bishop MR, Gress RE, Hakim FT. Up-regulation of NK cell activating receptors following alloge-neic hematopoietic stem cell transplantation under a lymphodepleting reduced intensity regimen is associated with elevated IL-15 levels. Biol Blood Marrow Transplant. 2008 Mar;14(3):290-300.

hamadani M, Awan fT, Copelan eA. hematopoietic stem cell transplantation in adults with acute myeloid leukemia. Biol Blood Marrow Transplant. 2008 May;14(5):556-567.

hsi eD, Jung Sh, Lai R, Johnson JL, Cook JR, Jones D, Devos S, Cheson BD, Damon Le, Said J. Ki67 and PIM1 expression predict outcome in mantle cell lymphoma treated with high dose therapy, stem cell transplantation and rituximab: a Cancer and Leukemia Group B 59909 correlative science study. Leuk Lymphoma. 2008 Nov;49(11):2081-2090.

Lazarus hM, Carreras J, Boudreau C, Loberiza fR, Jr., Armitage JO, Bolwell BJ, freytes CO, Gale RP, Gibson J, hale GA, Inwards DJ, Lemaistre Cf, Maharaj D, Marks DI, Miller AM, Pavlovsky S, Schouten hC, van Besien K, vose JM, Bitran JD, Khouri If, McCarthy PL, Yu H, Rowlings P, Serna DS, Horowitz MM, Rizzo JD. Influence of age and histology on outcome in adult non-Hodgkin lymphoma patients undergoing autologous hematopoi-etic cell transplantation (HCT): a report from the Center For International Blood & Marrow Transplant Research (CIBMTR). Biol Blood Marrow Transplant. 2008 Dec;14(12):1323-1333.

Lee SJ, Kukreja M, Wang T, Giralt SA, Szer J, Arora M, Woolfrey Ae, Cervantes f, Champlin Re, Gale RP, halter J, Keating A, Marks DI, McCarthy PL, Olavarria e, Stadt-mauer eA, Abecasis M, Gupta v, Khoury hJ, George B, hale GA, Liesveld JL, Rizzieri DA, Antin Jh, Bolwell BJ, Carabasi Mh, Copelan e, Ilhan O, Litzow MR, Schouten hC, Zander AR, Horowitz MM, Maziarz RT. Impact of prior imatinib mesylate on the outcome of hematopoietic cell transplantation for chronic myeloid leukemia. Blood. 2008 Oct 15;112(8):3500-3507.

Mahindra A, Bolwell B, Sobecks R, Rybicki L, Pohlman B, Dean R, Andresen S, Sweetenham J, Kalaycio M, Copelan e. elevated ferritin is associated with relapse after autologous hematopoietic stem cell transplantation for lymphoma. Biol Blood Marrow Transplant. 2008 Nov;14(11):1239-1244.

Marks DI, Perez WS, He W, Zhang MJ, Bishop MR, Bolwell BJ, Bredeson CN, Copelan eA, Gale RP, Gupta v, hale GA, Isola LM, Jakubowski AA, Keating A, Klumpp TR, Lazarus hM, Liesveld JL, Maziarz RT, McCarthy PL, Sabloff M, Schiller G, Sierra J, Tallman MS, Waller eK, Wiernik Ph, Weisdorf DJ. Unrelated donor transplants in adults with Philadelphia-negative acute lymphoblastic leukemia in first complete remission. Blood. 2008 Jul 15;112(2):426-434.

Schlenk RF, Pasquini MC, Perez WS, Zhang MJ, Krauter J, Antin JH, Bashey A, Bolwell BJ, Buchner T, Cahn JY, Cairo MS, Copelan eA, Cutler CS, Dohner h, Gale RP, Ilhan O, Lazarus hM, Liesveld JL, Litzow MR, Marks DI, Maziarz RT, McCarthy PL, Nimer SD, Sierra J, Tallman MS, Weisdorf DJ, Horowitz MM, Ganser A. HLA-identical sibling allogeneic transplants versus chemotherapy in acute myelogenous leukemia with t(8;21) in first complete remission: collaborative study between the German AML Intergroup and CIBMTR. Biol Blood Marrow Transplant. 2008 Feb;14(2):187-196.

Sobecks RM, Ball eJ, Askar M, Theil KS, Rybicki LA, Thomas D, Brown S, Kalaycio M, Andresen S, Pohlman B, Dean R, Sweetenham J, Macklis R, Bernhard L, Cherni K, Copelan E, Maciejewski JP, Bolwell BJ. Influence of killer immunoglobulin-like recep-tor/HLA ligand matching on achievement of T-cell complete donor chimerism in related donor nonmyeloablative allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2008 Apr;41(8):709-714.

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Sobecks RM, Dean R, Rybicki LA, Chan J, Theil KS, Macklis R, Andresen S, Kalaycio M, Pohlman B, ferraro C, Cherni K, Sweetenham J, Copelan e, Bolwell BJ. 400 cGy TBI with fludarabine for reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2008 Dec;42(11):715-722.

Ueno NT, Rizzo JD, Demirer T, Cheng YC, Hegenbart U, Zhang MJ, Bregni M, Carella A, Blaise D, Bashey A, Bitran JD, Bolwell BJ, elfenbein GJ, fields KK, freytes CO, Gale RP, Lazarus hM, Champlin Re, Stiff PJ, Niederwieser D. Allogeneic hematopoietic cell transplantation for metastatic breast cancer. Bone Marrow Transplant. 2008 Mar;41(6):537-545.

Hari P, Carreras J, Zhang M, Gale RP, Bolwell BJ, et al. Allogeneic transplants in fol-licular lymphoma: higher risk of disease progression after reduced intensity compared to myeloablative conditioning. Biol Blood Marrow Transplant. 2008;14:236-245.

McIver Z, Serio B, Dunbar A, O’Keefe CL, Powers J, Wlodarski M, Jin T, Sobecks R,Bolwell BJ, Maciejewski JP. Double-negative regulatory T-cells induce allotolerance when expanded after allogeneic haematopoietic stem cell transplantation. Br J Haematol. 2008;141(2):170-178.

Copelan e, Pohlman B, Rybicki L, Brown S, Kalaycio M, Sobecks R, Andresen S, Dean R, Koo A, Chan J, Sweetenham J, Bolwell BJ. A randomized trial of etoposide and G-CSF with or without rituximab for peripheral blood stem cell mobilization in B-cell non-hodgkin’s Lymphoma. Bone Marrow Transplant. 2009;43(2):101-105.

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Leadership

Randall Starling, MD, MPH Program and Medical Director, Heart Transplant Program; Vice Chairman, Department of Cardiovas-cular Diseases; Section Head, Heart Failure and Cardiac Transplant Medicine; Medical Director, Kaufman Center for Heart Failure

Nicholas Smedira, MDProgram and Surgical Director, Heart Transplant Program and Kaufman Center for Heart Failure; Polly and W. Neil Rossborough Chair in Cardiac Transplantation


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CARDIAC TRANSPLANTATION

GRADY SCHLABACH | HEART TRANSPLANT RECIPIENT

“Grady is such a little blessing. We can’t imagine our lives without him!” — emma and Kenneth

Schlabach, parents of Grady Schlabach, Sugarcreek, Ohio. Before he was born in September 2007,

doctors discovered that Grady, now almost 2, had a life-threatening heart defect. Early interventions

proved to only temporarily help Grady and he was placed on a ventilator and Ivs. he was moved to

Cleveland Clinic in October 2007 and evaluated for transplant. The following month, Grady received

a heart transplant and a new start on his young life.

2008 Highlights

Cleveland Clinic’s Cardiac Transplant Program is a key component of the George M. and Linda h. Kaufman Center for heart failure. The clinical activity of the Cardiac Transplant Program remained robust in 2008. A total of 233 patients were formally considered for transplantation; 65 candidates were listed and 60 transplants were performed.

The program also continued to achieve excellent outcomes. The July 2009 report of the Scientific Registry of Transplant Recipients (SRTR) demonstrates that for patients receiving their first transplant between January 1, 2005, and January 30, 2007, 91% of adult recipients were alive one year after transplant, compared with the expected 87% (based on the characteristics of recipients and donors, as well as on the experience of similar patients throughout the United States). For patients receiving their first transplant between January 1, 2003, and January 30, 2005, the three-year survival rate for our program was 84% compared with the 81% that was expected nationally. These excellent results are testimony to the outstanding multidisciplinary care of our transplant program.

In 2008, 48 patients were implanted with a mechanical circulatory support device at the Kaufman Center for heart failure. Access to and expertise with four different mechanical support devices allows us to utilize the optimal device in each individual patient.


The Organ Care System is an eagerly awaited innovation in the field of cardiac transplantation. This new technology maintains organs in a warm, functioning state outside of the body to optimize their health and allow continuous clinical evaluation. Through the use of proprietary technology, the Organ Care System:

• increases the amount of time that an organ can be maintained outside the body in a condition suitable for transplantation by reducing time-dependent ischemic injury,

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Fast facts

Initiated: 1984

first Adult heart Transplant:August 15, 1984

UNOS Approval: March 21, 1988

Medicare Approval: June 13, 1988

As of December 31, 2008, 1,409 heart transplants have been performed at Cleveland Clinic.

Cleveland Clinic developed and tested temporary and permanent artificial heart devices.

In 2005, Cleveland Clinic was the first in America to implant the CardioWest Total Artificial Heart after its approval by the U.S. food and Drug Adminis-tration. The Total Artificial heart can provide a bridge to transplantation for patients who are at risk of imminent death from non-reversible biven-tricular failure.


first Pediatric heart Transplant: March 30, 1985

8 pediatric heart transplants were performed in 2008.

Phone number 216.444.8351

Number of transplants 2004-2008

Heart Only Heart/Lung Heart/Kidney Heart/Liver

2004 58 1

2005 71 1 1

2006 73 2 1

2007 60 3 1

2008 60

Total 332 (includes retransplants)


Heart Only Heart/Lung Heart/Kidney Heart/Liver

1984-2008 1,388 17 3 1

Total 1,409

Days on waiting list and post-transplant length of stay (LOS) for patients transplanted in 2008*

Mean Median Number

Days waiting 80.7 40.0 60

Post-transplant LOS 19.9 15.5 58*

* Two patients not discharged as of february 17, 2009

uNOS status of patients transplanted in 2008

Status frequency Percent

1A 31 51.7

1B 21 35.0

2 8 13.3

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• provides surgeons the opportunity to assess the function of the organ outside the body, and

• enables resuscitation of the organ and potentially improves function after removal from the donor.

Since the fall of 2007, we have enrolled 5 patients with no complications in a multicenter trial of the Organ Care System. We hope this technology will allow us to travel the 48 contiguous states to procure hearts for transplantation and eliminate adverse outcomes associated with long ischemic times.

The cardiac transplant program continues to participate in many clinical research studies. The goals of these trials are to improve long-term survival, minimize post-transplant morbidity and develop short- and long-term mechani-cal circulatory support.

We currently are engaged in the IMAGE Trial (Invasive Monitoring Attenuation through Gene Expression). This prospective multicenter, nonblinded, random-ized clinical trial will evaluate the safety and efficacy of GEP in the monitoring of asymptomatic heart transplant patients for acute rejection.

Education

We continue to offer an advanced fellowship in heart failure and cardiac trans-plant medicine.

Expertise

Adult Cardiac Transplant: Cleveland Clinic’s cardiac transplant program is a recognized leader in the field. We remain the highest-volume center in both Ohio and the Midwest and are the third largest program in the United States.

In August 1997, George M. and Linda h. Kaufman created a center focused on the clinical care and research challenges associated with heart failure and cardiac transplantation. The center has developed a more systemic, integrative approach to research, diagnosis and the treatment of heart failure, creating an extraordinary opportunity to make a major impact on the growing epidemic of heart failure.

Pediatric Cardiac Transplant: Cleveland Clinic offers more types of pediatric transplantation than any other center in the region. When an infant is diagnosed with a complex congenital cardiac defect, the pediatric heart transplant team works closely with families to determine whether transplantation is the optimal

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treatment option. The multispecialty team provides sophisticated assessment and management of all associated cardiac and non-cardiac issues. Cleveland Clinic has a five-year survival rate greater than 90 percent for infants who receive heart transplants.


Survival analysis: patient survival for 310 primary heart-only transplants 2004-2008

Time Survival %

6 months 94.1

1 year 92.6

2 years 86.5

Heart transplant mortality 2008

Hospital deaths (within 30 days post-transplant) 0

Primary diagnoses for patients transplanted in 2008


Dilated cardiomyopathy 25 41.7

hypertrophic cardiomyopathy 11 18.3

Coronary artery disease 9 15.0

Congenital heart disease with surgery 5 8.3

Restrictive cardiomyopathy 4 6.7

valvular heart disease 3 5.0

Amyloidosis 1 1.7

Congenital heart disease without surgery 1 1.7

Retransplant/graft failure 1 1.7

Total 60

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Publications

Chuang hh, Triposkiadis f, Starling RC. Dilated cardiomyopathy and cardiac transplan-tation. In: Klein AL, Garcia MJ, eds. Diastology: Clinical Approach to Diastolic Heart Failure. Philadelphia: Saunders/Elsevier; 2008:247-257.

Gargiulo NJ, III, veith fJ, Scher LA, Lipsitz eC, Suggs WD, Benros RM. experience with covered stents for the management of hemodialysis polytetrafluoroethylene graft seromas. J Vasc Surg. 2008 Jul;48(1):216-217.

Goel vR, Greenberg RK, Greenberg DP. Mathematical analysis of DICOM CT data-sets: Can endograft sizing be automated for complex anatomy? J Vasc Surg. 2008 Jun;47(6):1306-1312.

Gonzalez-Stawinski G, Smedira N, Starling R. Donors of hearts with increased left ventricular wall thickness: the unresolved issue. Am J Transplant. 2008 Sep;8(9):1961.

Gonzalez-Stawinski GV, Tan CD, Smedira NG, Starling RC, Rodriguez ER. Decay-accelerating factor expression may provide immunoprotection against antibody-mediated cardiac allograft rejection. J Heart Lung Transplant. 2008 Apr;27(4):357-361.

Greenberg RK, Chuter TAM, Cambria RP, Sternbergh WC, III, Fearnot NE. Zenith abdominal aortic aneurysm endovascular graft. J Vasc Surg. 2008 Jul;48(1):1-9.

Gunn MLD, Godwin JD, Kanne JP, Flowers ME, Chien JW. High-resolution CT findings of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. J Thorac Imaging. 2008 Nov;23(4):244-250.

hickey eJ, McCrindle BW, Blackstone eh, Yeh T, Jr., Pigula f, Clarke D, Tchervenkov CI, Hawkins J. Jugular venous valved conduit (Contegra) matches allograft performance in infant truncus arteriosus repair. Eur J Cardiothorac Surg. 2008 May;33(5):890-898.

Hoercher KJ, Nowicki ER, Blackstone EH, Singh G, Alster JM, Gonzalez-Stawinski GV, Starling RC, Young JB, Smedira NG. Prognosis of patients removed from a transplant waiting list for medical improvement: implications for organ allocation and transplantation for status 2 patients. J Thorac Cardiovasc Surg. 2008 May;135(5):1159-1166.

Horai T, Fukui T, Tabata M, Takanashi S. Early and mid-term results of off-pump coro-nary artery bypass grafting in patients with end stage renal disease: surgical outcomes after achievement of complete revascularization. Interact Cardiovasc Thorac Surg. 2008 Apr;7(2):218-221.

Jindra PT, hsueh A, hong L, Gjertson D, Shen XD, Gao f, Dang J, Mischel PS, Baldwin WM, III, Fishbein MC, Kupiec-Weglinski JW, Reed EF. Anti-MHC class I antibody activa-tion of proliferation and survival signaling in murine cardiac allografts. J Immunol. 2008 Feb 15;180(4):2214-2224.

Keslar K, Rodriguez eR, Tan CD, Starling RC, heeger PS. Complement gene expression in human cardiac allograft biopsies as a correlate of histologic grade of injury. Transplan-tation. 2008 Nov 15;86(9):1319-1321.

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Kolvenbach R, Pinter L, Cagiannos C, veith fJ. Remodeling of the aortic neck with a balloon-expandable stent graft in patients with complicated neck morphology. Vascular. 2008 Jul;16(4):183-188.

Kutty S, Greenberg RK, fletcher S, Svensson LG, Latson LA. endovascular stent grafts for large thoracic aneurysms after coarctation repair. Ann Thorac Surg. 2008 Apr;85(4):1332-1338.

Lane BR, Aron M, Pritchard C, Fergany AF, Desai MM. Laparoscopic cystoprosta-tectomy in a heart transplant recipient. Surg Laparosc Endosc Percutan Tech. 2008 Jun;18(3):319-321.

Lyden SP. Commentary on “fenestrated and branched stent grafts”. Perspect Vasc Surg Endovasc Ther. 2008 Jun;20(2):188-189.

Mamoun Nf, Xu M, Sessler DI, Sabik Jf, Bashour CA. Propensity matched comparison of outcomes in older and younger patients after coronary artery bypass graft surgery. Ann Thorac Surg. 2008 Jun;85(6):1974-1979.

Matsumura JS, Cambria RP, Dake MD, Moore RD, Svensson LG, Snyder S. International controlled clinical trial of thoracic endovascular aneurysm repair with the Zenith TX2 endovascular graft: 1-year results. J Vasc Surg. 2008 Feb;47(2):247-257.

Mehra MR, Kobashigawa JA, Deng MC, fang KC, Klingler TM, Lal PG, Rosenberg S, Uber PA, Starling RC, Murali S, Pauly DF, Dedrick R, Walker MG, Zeevi A, Eisen hJ. Clinical implications and longitudinal alteration of peripheral blood transcriptional signals indicative of future cardiac allograft rejection. J Heart Lung Transplant. 2008 Mar;27(3):297-301.

Miyazaki K, Colles SM, Graham LM. Impaired graft healing due to hypercholesterolemia is prevented by dietary supplementation with alpha-tocopherol. J Vasc Surg. 2008 Oct;48(4):986-993.

Moon MC, Dowdall Jf, Roselli ee. The use of right ventricular pacing to facilitate stent graft deployment in the distal aortic arch: A case report. J Vasc Surg. 2008 Mar;47(3):629-631.

Nowicki eR, Pettersson GB, Smedira NG, Roselli ee, Blackstone eh, Lytle BW. Aortic allograft valve reoperation: surgical challenges and patient risks. Ann Thorac Surg. 2008 Sep;86(3):761-768.e2.

Nozaki T, Rosenblum JM, Ishii D, Tanabe K, Fairchild RL. CD4 T cell-mediated rejection of cardiac allografts in B cell-deficient mice. J Immunol. 2008 Oct 15;181(8):5257-5263.

O’Connor GT, Olmstead eM, Nugent WC, Leavitt BJ, Clough RA, Weldner PW, Charles-worth DC, Chaisson K, Sisto D, Nowicki eR, Cochran RP, Malenka DJ. Appropriateness of coronary artery bypass graft surgery performed in northern New england. J Am Coll Cardiol. 2008 Jun 17;51(24):2323-2328.

Pavlov v, Raedler h, Yuan S, Leisman S, Kwan Wh, Lalli PN, Medof Me, heeger PS. Donor deficiency of decay-accelerating factor accelerates murine T cell-mediated cardiac allograft rejection. J Immunol. 2008 Oct 1;181(7):4580-4589.

Robertson JO, Lober C, Smedira NG, Navia JL, Sopko N, Gonzalez-Stawinski GV. One hundred days or more bridged on a ventricular assist device and effects on outcomes following heart transplantation. Eur J Cardiothorac Surg. 2008 Aug;34(2):295-300.

Roselli ee, Greenberg RK. fenestrated and branched endografts for the management of juxta-renal aneurysms. In: Thompson MM, ed. Endovascular Intervention for Vascular Disease : Principles and Practice. New York, NY: Informa Healthcare; 2008:377-386.

Sabik Jf, III, Stockins A, Nowicki eR, Blackstone eh, houghtaling PL, Lytle BW, Loop FD. Does location of the second internal thoracic artery graft influence outcome of coronary artery bypass grafting? Circulation. 2008 Sep 30;118(14 Suppl):S210-S215.

Sabik JF, III, Blackstone EH. Coronary artery bypass graft patency and competitive flow. J Am Coll Cardiol. 2008 Jan 15;51(2):126-128.

Schenk AD, Nozaki T, Rabant M, Valujskikh A, Fairchild RL. Donor-reactive CD8 memory T cells infiltrate cardiac allografts within 24-h posttransplant in naive recipients. Am J Transplant. 2008 Aug;8(8):1652-1661.

Soliman MM, Dorotta I, Larosa SP, Lytle BW, Koch CG, Drazba JA, Rodriguez eR, Bashour CA. A case of undiagnosed syphilis in a patient undergoing coronary artery bypass graft and aortic valve surgery. Infectious Diseases in Clinical Practice. 2008 Jan;16(1):76-78.

Subramaniam K, Koch CG, Bashour A, O’Connor M, Xu M, Gillinov AM, Starr NJ. Preoperative statin intake and morbid events after isolated coronary artery bypass grafting. J Clin Anesth. 2008 Feb;20(1):4-11.

Svensson LG, Kouchoukos NT, Miller DC, Bavaria Je, Coselli JS, Curi MA, eggebrecht h, elefteriades JA, erbel R, Gleason TG, Lytle BW, Mitchell RS, Nienaber CA, Roselli EE, Safi HJ, Shemin RJ, Sicard GA, Sundt TM, III, Szeto WY, Wheatley GH, III. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg. 2008 Jan;85(1 Suppl):S1-S41.

Wong RCC, Abrahams Z, Hanna M, Pangrace J, Gonzalez-Stawinski G, Starling R, Taylor D. Tricuspid regurgitation after cardiac transplantation: an old problem revisited. J Heart Lung Transplant. 2008 Mar;27(3):247-252.

Xiang J, Gu X, Qian S, Chen Z. Graded function of CD80 and CD86 in initiation of T-cell immune response and cardiac allograft survival. Transpl Int. 2008 Feb;21(2):163-168.

Yamani MH, Taylor DO, Czerr J, Haire C, Kring R, Zhou L, Hobbs R, Smedira N, Starling RC. Thymoglobulin induction and steroid avoidance in cardiac transplantation: results of a prospective, randomized, controlled study. Clin Transplant. 2008 Jan;22(1):76-81.

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MIKE KELLY | CORNEAL TRANSPLANT RECIPIENT

“You can’t imagine what it’s like to come so close to losing your eyesight and then have it

saved.” — Mike Kelly, 67, North Olmsted, Ohio. When Mike Kelly couldn’t read a highway sign,

he was shocked into seeking treatment for his failing eyesight. The retired pipefitter and welder

was diagnosed with fuchs’ dystrophy, an eye disease for which the only cure is corneal transplant.

having transplants in both eyes has given Mike back his vision and allowed him to build the

hunting cabin he now enjoys in retirement.


CORNeAL TRANSPLANTATION

2008 Highlights

In 2008, Cole eye Institute surgeons continued to be at the forefront of corneal surgery and research. Team members performed 210 surgical graft procedures, including penetrating keratoplasy, lamellar keratoplasty, deep anterior lamellar keratoplasty, keratoprosthesis and amniotic membrane grafts. They also devel-oped new techniques to improve on existing practices.


Cole Eye Institute surgeons were among the first in the country to perform a new transplant procedure, Descemet stripping automated endothelial keratoplasty (DSAEK). This procedure involves transplanting only the posterior side of the cornea in eyes with endothelial dysfunction, which greatly shortens recovery time and entails a smaller, stronger wound. Primary investigator David M. Meisler, MD, and our team initially enrolled patients in the IRB-approved research study. Because the procedure proved successful, DSAeK is now offered to patients without requiring study participation.

fuchs’ endothelial disease is among the leading indications in the United States for corneal transplantation. The National Institutes of Health (NIH) has funded the fuchs’ endothelial Corneal Dystrophy study, a multicenter trial to investigate the genetics of this disease. As one of the study centers, Cole eye Institute is en-rolling qualifying families under the direction of William J. Dupps, Jr., MD, PhD.

Persistent corneal epithelial defects can plague corneal transplants and cause them to scar and fail. Research is being pursued to evaluate the role of autolo-gous serum in the healing of persistent corneal epithelial defects.

Other ongoing studies in the department include the NIH-sponsored Corneal Donor Study.

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Expertise

Cole eye Institute surgeons are experts in performing all types of transplantation procedures to treat anterior segment diseases. These procedures include:

Corneal transplantation

• Full-thickness

• Partial-thickness

Anterior lamellar

Posterior lamellar

Limbal stem cell transplantation

Amniotic membrane grafting

Artificial corneas

Approximately 35,000 corneal transplants are performed in the United States every year. They are considered to be safe, as medical histories of all corneal tissue donors are reviewed carefully, and blood tests are performed to check for infections. Corneal tissue is scrutinized by specular microscopy to ascertain viability. Corneal transplant success rates are high and rejection rates are low (with the use of only topical immunosuppressive medications).

Publications

Amescua G, Collings F, Sidani A, Bonfield TL, Rodriguez JP, Galor A, Medina C, Yang X, Perez VL. Effect of CXCL-1/KC production in high risk vascularized corneal allografts on T cell recruitment and graft rejection. Transplantation. 2008 Feb 27;85(4):615-625.

Bonilha VL, Rayborn ME, Shadrach KG, Li Y, Lundwall A, Malm J, Hollyfield JG. Semenogelins in the human retina: Differences in distribution and content between AMD and normal donor tissues. Exp Eye Res. 2008 Jan;86(1):150-156.

Dupps WJ, Qian Y, Meisler DM. Multivariate model of refractive shift in Descemet stripping with automated endothelial keratoplasty (DSAEK). J Cataract Refract Surg 2008;34:578-584.

Gorovoy M, Meisler DM, Dupps WJ. Late repeat descemet stripping automated endothelial keratoplasty (DSAEK). Cornea 2008;27:238-240.

Gorovoy M, Meisler D, Dupps W Jr. Late repeat descemet stripping automated endothelial keratoplasty. Cornea 2008;27:1216. Reply to letter.

Jeng Bh, Marcotty A, Traboulsi eI. Descemet stripping automated endothelial keratoplasty in a 2-year-old child, J. AAPOS, 2008, 12, 3, 317-318.

Fast facts

Initiated: 1970

In 2008, 210 corneal transplants were performed atCleveland Clinic.


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Jeng Bh, Dupps WJ, Meisler DM. epithelial debridement for the treatment of epithelial basement membrane abnormalities coincident with endothelial disorders. Cornea 2008;27:1207-11.

Kitzmann AS, Goins KM, Reed C, Padnick-Silver L, Macsai MS, Sutphin JE. Eye bank survey of surgeons using precut donor tissue for descemet stripping automated endothelial keratoplasty. Cornea. 2008 Jul;27(6):634-639.

Koenig SB, Meisler DM, Dupps WJ, Rubenstein JB, Kumar R. External refinement of the donor lenticule position during descemet’s stripping and automated endothelial keratoplasty. Ophthalmic Surg Lasers Imaging. 2008 Nov;39(6):522-523.

Sinha Roy A, Dupps WJ. Effects of altered corneal stiffness on native and post-LASIK corneal biomechanical behavior: a whole-eye finite element analysis. J Refract Surg 2009; January 30 [epub ahead of print].

Weiss JS, Kruth hS, Kuivaniemi hK, Tromp G, Karkera J, Mahurkar S, Lisch W, Dupps Jr WJ, White PS, Winters RS, Kim C, Rapuano CJ, Sutphin Je, Reidy J, hu fR, Lu DW, ebenezer N, Nickerson ML. Genetic analysis of 14 families with Schnyder crystalline corneal dystrophy reveals clues to UBIAD1 protein function. Am J Med Genet A 2008;146:271-83.

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MICHAEL BATTAGLIA | INTESTINAL TRANSPLANT RECIPIENT

“It will be nice to be able to go away and not have to bring TPN (intravenous feeding) supplies.” —

Michael Battaglia, 47, Painesville, Ohio. Michael has been battling ileitis (Chrons disease) since the early

1980s and has had surgeries to remove much of his small intestine, create a stoma, repair fistulas and

have his rectum and anus removed. The former tool and dye maker was the first patient to undergo an

intestinal transplant at Cleveland Clinic. Since then, Michael has had his stoma reversed and has been

freed from TPN. He enjoys time with his dog and is looking forward to starting part-time work.

New in 2008

The Cleveland Clinic Digestive Disease Institute and Transplant Center have collaborated to form the Intestinal Rehabilitation and Transplantation Program (IRTP).

In June, Cleveland Clinic performed the first adult intestinal transplant in Ohio. By the end of the year, a total of four intestinal transplants were performed.

The IRTP is able to offer the broadest spectrum of medical and surgical treat-ment options to patients diagnosed with intestinal failure.

In conjunction with the Cleveland Clinic Nutrition Support Team, the IRTP represents one of the largest intestinal failure programs in the country.

Patients with intestinal failure are evaluated by a team of experts in nutrition that includes gastroenterologists, intestinal rehabilitation and transplant surgeons, colorectal surgeons, anesthesiologists, intensivists, dietitians, psychiatrists, pharmacists, nurses, social workers and ethicists.

The first intervention is diet modification. The next step utilizes medications to increase or decrease bowel motility and function. In patients who are not responding to medical treatment, our team of transplant and colorectal surgeons is able to offer a variety of surgical procedures designed to increase the ability of absorption. Among the most commonly performed procedures are operations to restore intestinal continuity, relieve obstruction, lengthen the intestine, taper a dilated bowel and reconstruct or reverse a previous surgical procedure.

failure of medical and conservative surgical treatments translates into the need for either enteral or parenteral nutrition. In a selected group of patients, total par-enteral nutrition (TPN) can cause recurrent episodes of line sepsis, loss of vascu-lar access, and/or TPN-induced liver failure. Our nutrition support team interacts with the IRTP to identify and treat patients who have failed the “artificial gut.”

Patients with irreversible intestinal failure who have failed TPN may be candi-dates for isolated small bowel, combined small bowel and liver or multivisceral transplantation depending on how many organs have been affected by the

INTeSTINAL TRANSPLANTATION Leadership

Cristiano Quintini, MD Program Director, Intestinal Transplant;Surgical Director, Intestinal Rehabilitation and Transplantation Program

Donald Kirby, MD Medical Director, Intestinal Transplantation Program


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Fast facts

Initiated: 2008

Performed first Adult Intestinal Transplant in Ohio: June 2008

As of December 31, 2008, four intestinal transplants have been performed at Cleveland Clinic.

original disease and TPN. Other common indications for intestinal transplant in the adult includes dismotility disorders and benign intrabdominal tumors (such as desmoid tumors) that require an extensive intrabdominal evisceration.

In the last five years, the outcomes of intestinal transplant have been dramati-cally influenced by the use of newer and more effective anti-rejection drugs. Currently, Cleveland Clinic is the only hospital in Ohio to perform adult intestinal transplants and is among only a few in the United States to do so.

There are commonly three types of intestinal transplantation performed:

Isolated small bowel transplantation

Isolated small bowel transplantation (SBTx) typically includes the jejunum and the ileum. Occasionally, part of the colon may also be transplanted. Isolated SBTx is recommended when the cause of intestinal failure is primarily the small bowel. Successful SBTx may reverse TPN–induced liver dysfunction.

Combined liver and small intestine

This type of transplant includes the liver, jejunum, and ileum (may also include the colon), and part or all of the pancreas. In this case, transplant is reserved for candidates with intestinal failure and irreversible liver failure induced by prolonged TPN therapy. Medical presentation in these situations is more likely to include portal hypertension, severe fibrosis, or cirrhosis.

Multivisceral transplantation

Multivisceral transplantation usually includes stomach, duodenum, jejunum, ileum (colon may also be included), and pancreas. This procedure can be performed with or without liver transplant. When the liver is spared, the native liver (the patient’s own liver) is preserved. Multivisceral transplant is used to treat candidates with locally aggressive, non-metastasizing abdominal tumors; pseudo-obstruction and very poor gastric emptying; and surgically unrecon-structable gastrointestinal tracts (such as encountered in patients with multiple fistulas, congenital GI tract anomalies or trauma).

Clinical Activities

A total of 228 new patient referrals were seen in 2008 by the Intestinal Rehabilitation and Transplant Program. Of those, 66 were referred with the possibility of intestinal transplant (79 percent internally referred and 21 percent externally referred). Of the 66 new intestinal transplant referrals, 27 patients were seen in the hospital setting for initial evaluation, 28 were seen initially in clinic, and 11 received initial phone evaluation. fifteen of these patients

completed a full intestinal transplant evaluation and eight were listed for an intestinal (isolated or combined with a liver) transplant. Four of these patients went on to be transplanted in 2008.

Developed the educational material for our intestinal transplant patients includ-ing a video featuring our first intestinal transplant recipient.

Developed the protocol manual for procedures and management of intestinal transplant patients.

Research Activities

Current clinical trials:

• TPN-induced liver disease: incidence, prognosis, monitoring and prevention.

• Outcomes of intra-abdominal desmoid tumors.

• Use of GLP-2 growth factor to enhance absorption in TPN- or IVF-dependent patients with short bowel syndrome.

future clinical trial:

• Animal research to study the intestinal transplant rejection mechanism and the use of new immunosuppressant agents and protocols.

Expertise

Cleveland Clinic is consistently ranked by U.S.News & World Report as one of the top two hospitals in treating digestive diseases. It is currently the top ranked hospital for treating digestive diseases that offers intestinal transplant. Additionally, the American Society for Parenteral and Enteral Nutrition (ASPEN) recognizes Cleveland Clinic as a program of excellence in nutrition support.

Publications

Beath S, Pironi L, Gabe S, horslen S, Sudan D, Mazeriegos G, Steiger e, Goulet O, fryer J. Collaborative strategies to reduce mortality and morbidity in patients with chronic intestinal failure including those who are referred for small bowel transplantation. Trans-plantation. 2008 May 27;85(10):1378-1384.

Speerhas R, Austin T, Seidner D, hamilton C, emery M, Stafford J, Steiger e, Lopez R, examination of complications in new patients receiving home parenteral nutrition who discontinue therapy within 30 days of hospital discharge. JPEN 2008; 32(2); 344.

Steiger e. vascular access for parenteral nutrition. In: DeLegge Mh, ed. Nutrition and Gastrointestinal Disease. Totowa, NJ: Humana Press; 2008:289-298.

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2008 Highlights

Cleveland Clinic’s liver transplant program had many successes in 2008. We performed 147 transplants, with improved outcomes and survival rates. Accordingly, our program is one of the largest in the country and the largest in the region, finishing in the top 4 for volume in the United States.

Wait-list death in the period from July 1, 2007 through June 30, 2008 decreased to 5.7%, compared with nearly 15% wait-list death from July 1, 2002 through June 30, 2003, when liver transplant volume at Cleveland Clinic was much lower. This decrease occurred despite a significant increase in the number of patients with a MeLD score greater than 21. Additionally, our program maintained graft and patient survival above the national averages: observed graft 83.98 (expected 82.59) and national 83.38 (all SRTR July 1, 2005 – December 31, 2007) and observed patient survival 90.97 (expected 88.42) and national 87.85.

A national survey of OLT programs throughout the United States identified the 10 exemplary programs in which organs were most efficiently utilized, maintain-ing excellent outcomes. Cleveland Clinic’s liver transplant program was among these 10 programs.

The year 2008 was a time of continued growth and adjustment for the hepatol-ogy team as we experienced an increased demand for our services and changes in staff. A total of 461 patients underwent liver transplant evaluation, and 213 patients were listed for transplantation. About 200 patients are on our liver transplant waiting list.

Pediatric Liver Transplant: Cleveland Clinic offers more types of pediatric trans-plantation than any other center in the region. Our multidisciplinary team has performed 20 liver transplants in 20 pediatric patients over the last four years, with 95 percent patient survival.

Leadership

Charles Miller, MDProgram and SurgicalDirector, Liver Transplant

Nizar N. Zein, MDMedical Director, Liver Transplant; Chief, Section of Hepato-biliary Diseases


FIONA O’NEILL | LIVER TRANSPLANT RECIPIENT

“She’s the most amazing kid. Her spirit, her spunk and her happiness never wavered through this

whole thing.” — Julie O’Neill on her 1-year-old daughter Fiona, Concord, Ohio. When she was just four

days old, fiona had surgery to repair a malrotated bowel. That was the beginning of a series of proce-

dures Fiona went through in her first year of life. Biliary atresia — a disease of the liver and bile ducts

— was preventing fiona from gaining weight and growing. In July 2008, fiona’s mother Julie donated

part of her liver to fiona. her daughter now is doing most of the same things other kids her age do.

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Days on waiting list and post-transplant length of stay (LOS) for liver patients transplanted in 2008

Mean Median Number


Post-transplant LOS 14.3 10.0 144

* Includes 3 retransplants

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Fast facts

Initiated: 1984

first Adult Liver Transplant: November 8, 1984


Medicare Approval: October 14, 1992

Performed first lung-liver transplant in Ohio in 2007.

Active living donor programs established for kidney (laparoscopic live donor nephrectomy) and liver transplants.

As of December 31, 2008, 1,296 liver transplants have been performed at Cleveland Clinic.


first Pediatric Liver Transplant: August 26, 1986

Two pediatric liver transplants were performed in 2008.

Number of liver transplants by donor type in 2008

Organ Number Deceased Living/Related Living/Unrelated

Liver 138* 133 3 2

Liver/kidney 8 8

Liver/pancreas 1 1

Total 147

Type of liver transplant Number Percent

Whole 139 94.6

Split 4 2.7

Reduced/partial 4 2.7

Survival analysis: patient survival for 587 primary liver, liver/heart, liver/kidney, liver/lung and liver/pancreas transplants 2004-2008

Time Survival %

6 months 92.3

1 year 90.3

2 years 86.5

Primary diagnoses for liver patients transplanted in 2008


hepatoma and Cirrhosis 43 29.9

hepatitis C 25 17.4

NASh 18 12.5

Primary sclerosing cholangitis 11 7.6

Cryptogenic cirrhosis 9 6.3

Alcohol cirrhosis 8 5.6

Other cirrhosis 7 4.9

Benign tumor 5 3.5

Biliary cirrhosis 3 2.1

Metabolic disease 3 2.1

Retransplant/graft failure 3 2.1

Others 3 2.1

Biliary atresia 2 1.4

Cholestatic liver disease 1 0.7

Congenital hepatic fibrosis 1 0.7

Cystic fibrosis 1 0.7

fulminant hepatic failure 1 0.7

Total 144

Liver transplant mortality 2008

hospital deaths 6


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The liver transplant program achieved several milestones and made numerous improvements during 2008.

fasTrac program to improve referral to listing time was initiated. Many changes to our patient evaluation approach were made. Significant improvement had already been seen by the time the program was officially implemented.

federico Aucejo, MD, began work on a multidisciplinary hepatocellular Carcinoma Clinic, specializing in treating patients with hCC.

Work began to update the liver surgery website on clevelandclinic.org to provide more information to referring providers and easily accessible education to patients.

Personnel update

The following individuals joined the liver transplant program in 2008:

Koji hashimoto, MD, was appointed Clinical Scholar for Liver Transplant.

Ganesh Gunasekaran, MD, and Naveed Ahmed, MD, began their transplant fellowships.

Other Personnel Highlights

The Liver Transplant Coordinators began to use E-Script to make refilling prescriptions for transplant patients more efficient.

Dympna Kelly, MD, was a judge for the Bumpus Clinical Research Awards in September.

Charles Miller, MD, traveled to St. Louis, Mo., to represent Cleveland Clinic and the Ohio Solid Organ Transplant Consortium to maintain the Statewide Liver Sharing Agreement.

Dr. Miller gave the Keynote ethics Address at the DDW meeting in San Diego on Living Donor Liver Transplantation.

Education

The Liver Transplant Program coordinated several educational programs with the Division of Surgery Grand Rounds and Transplant Center Grand Rounds for 2008.

Cristiano Quintini, MD, was appointed as the liaison for the general surgery and visiting residents as they rotate through the liver transplant service.

Dr. Kelly is responsible for the surgical educational curriculum for surgical interns, including didactic lectures and a skills program.

The large animal transplant lab is now fully functional. This is an excellent source for teaching the fellows and residents. There are two surgical fellows, a surgical resident and a Project Scientist under Dr. Kelly’s supervision. This lab also allows Dr. Kelly to be involved in the training of veterinary and OR technicians.

We continue to attract and recruit excellent fellows who are passionate about liver transplantation and liver surgery.

A cross-training program with the HBP fellows was created.

Awards and Achievements

Dr. Miller was appointed Chairman of the Governance Board of DDI CRU.

Developed and implemented new techniques for en-bloc liver-pancreas transplantation in three cases.

Peggy George was elected President, Cleveland Chapter of the American Liver foundation.

Renee Bennett was elected to the International Transplant Nurses Society Board of Directors.

John fung, MD, was awarded the 2008 francis Moore excellence in Mentor-ship in the field of Transplantation Award by the American Society of Transplant Surgeons (ASTS) Vanguard Committee.

Dr. Kelly was awarded the ASTS-Wyeth Mid-Level Faculty Research Award.

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Research

Principal Investigator – Dr. Federico AucejoHepatocellular carcinoma (HCC) genetic profiling: Searching for predictors of tumor recurrence after liver transplantation - validation of the University of Pittsburgh study and assessment of hCC p53 loss, telomere lengthening and VEGFr2 activation. (IRB 08-463)

Principal Investigator – Dr. Charles Miller (Completed and closed) A prospective, open-label, multicenter, randomized trial of the efficacy and safety of a long-term calcineurin inhibitor free maintenance regimen with mycophenolate mofetil and sirolimus in recipients of an orthotopic liver transplant. (ML18423)

Principal Investigator – Dr. Bijan Eghtesad (Closed to enrollment) A multi-center, randomized, open-label study to compare the development of liver fibrosis at 12 months after transplantation for hepatitis C cirrhosis in patients receiving either Neoral or Prograf. (COLO400A2426)

Principal Investigator – Dr. John Fung (Closed to enrollment)Immunosuppression with Campath-1H and tacrolimus in liver transplantation (ILEX Oncology, Inc. & NIAID, Immune Tolerance Network). (IRB 7782)

Principal Investigator – Dr. John Fung evaluation of hepaGam BTM in combination with antiviral treatment in hepatitis B liver transplant patients. (IRB 08-050)

A randomized, double-blind study to assess the efficacy and safety of prophy-lactic use of Maribavir vs. oral ganciclovir for the prevention of cytomegalovirus disease in recipients of orthotopic liver transplantation. (1263-301)

Principal Investigator – Dr. John FungStudy of the antiviral activity of entecavir in patients receiving liver transplant due to chronic hepatitis B virus infection. (IRB 07-375)

A 24-month multicenter, randomized, open-label study to evaluate the efficacy and safety of concentration controlled everolimus with corticosteroids in combi-nation with minimization or elimination of tacrolimus in de novo liver transplant recipients compared to tacrolimus and corticosteroid. (CARD001H2304)

Principal Investigator – Dr. Dympna Kelly (August 2006-Present)Very small for size living donor liver transplantation (LDLT) in a pig model. CCF Animal Lab.

Principal Investigator – Dr. John FungSolid organ transplant in HIV. NIH sulti-site study. (IRB 8230)

Principal Investigator – Dr. John FungPhase II multicenter trial to assess the safety and efficacy of Campath-1H and tacrolimus followed by immunosuppression withdrawal in liver transplant.NIH/ITN (ITN024ST)

Principal Investigator – Dr. John Fung Phase II trial to assess the safety of immunosuppression withdrawal in liver transplant recipients with hepatitis C. NIH/ITN (ITN030ST)

Co-Principal Investigator – Dr. John FungInfliximab (Remicade®) as an adjunct to pegylated-interferon α2b and ribavirin in the treatment of hepatitis C virus infection. Centocor (CO168X98)

A randomized, open-label, multicenter, efficacy and safety study of pegasys as a prophylaxis against hepatitis-C virus infection recurrence after liver transplantation. Roche (GCO # 99-1022 SU)

The effect of Pegasys on hep C viral load and cytokines after liver treatment. Roche (GCO# 99-1022 (02)

A phase II, open-label, concentration controlled, randomized study of conventional-dose tacrolimus plus corticosteroids compared with reduced-dose tacrolimus plus sirolimus and sorticosteroids in recipients of orthotopic liver allografts. Wyeth-Ayerst (GCO# 00-0451 SU)

Pilot study to assess the pharmacokinetics of intravenous Nabi 5% hepatitis B immune globulin (Boca HBVIg) used in combination with camivudine for patients with hepatitis B virus (HBV) associated liver disease undergoing liver transplantation. Mayo (GCO # 99-852 SU)

A Randomized, Double-Blind, Double-Dummy, Active-Comparator Controlled Multi-Center Study of the Efficacy and Safety of Valganciclovir (Ro107-9070) Vs. Oral Ganciclovir for Prevention of Cytomegalovirus Disease in High-Risk Heart, Liver and Kidney Allograft Patients. Roche (GCO# 00-010 SU)

A randomized, open-label preference study of Gengraf compared to Neoral in stable solid-organ transplant subjects (Phase 4 post tx study). Abbott (GCO# 00-454 SU)

Principal Investigator – Dr. Bijan Eghtesad (Closed to enrollment)A multicenter, randomized open-label study to compare the development of liver fibrosis at 12 monts after transplantation for hepatitis C cirrhosis in patients receiving either cyclosporine or tacrolimus. (IRB 05-138)

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Principal Investigator – Dr. Dympna KellyThe impact of immunosuppression on post-liver transplant rejection in crossmatch positive and negative patients. (IRB 05-181)

Principal Investigator – Dr. John FungREGISTRY: Electronic data interface for transplant (EDIT). (IRB 06-167)

Principal Investigator – Dr. Dympna KellyeXeMPT: Risk factors for developing biliary complications following liver transplantation. (IRB 06-758)

Principal Investigator – Charles MillerReGISTRY: Parenchymal perfusion of native and graft livers during transplantation. (IRB 7497)

Publications

Hanouneh IA, Miller C, Aucejo F, Lopez R, Quinn MK, Zein NN. Recurrent hepatitis C after liver transplantation: on-treatment prediction of response to peginterferon/ribavirin therapy. Liver Transpl. 2008 Jan;14(1):53-58.

Aucejo fN, hashimoto K, Quintini C, Kelly D, vogt D, Winans C, eghtesad B, Baker M, Fung J, Miller C. Triple-phase computed tomography and intraoperative flow measurements improve the management of portosystemic shunts during liver transplantation. Liver Transpl. 2008 Jan;14(1):96-99.

Aucejo F, Ibrahim Z, Hashimoto K, Quintini C, Kelly D, Vogt D, Eghtesad B, Fung J, Miller C, Tuthill R. Cruveilhier-Baumgarten disease in a patient with Turner syndrome: case report of a rare indication for liver transplantation. Liver Transpl. 2008 Mar;14(3):299-302.

Quintini C, hirose K, hashimoto K, Diago T, Aucejo f, eghtesad B, vogt D, Pierce G, Baker M, Kelly D, Miller CM. “Splenic artery steal syndrome” is a misnomer: the cause is portal hyperperfusion, not arterial siphon. Liver Transpl. 2008 Mar;14(3):374-379.

Hanouneh IA, Feldstein AE, McCullough AJ, Miller C, Aucejo F, Yerian L, Lopez R, Zein NN. The significance of metabolic syndrome in the setting of recurrent hepatitis C after liver transplantation. Liver Transpl. 2008 Sep;14(9):1287-1293.

Aucejo F, Kim R, Zein N, Quintini C, Uso TD, Lopez R, Eghtesad B, Fung J, Miller C, Yerian L. Vascular endothelial growth factor receptor 2 expression in non-tumorous cirrhotic liver is higher when hepatoma is beyond Milan criteria. Liver Transpl. (In press)

Cywinski JB, Mascha e, Miller C, eghtesad B, Nakagawa S, vincent JP, Pesa N, Na J, Fung JJ, Parker BM. Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function. Liver Transpl. 2008 Jan;14(1):59-65.

Kleeman M, Duclos AJ, Krishnamurthi v, Lard M, Winans C, Goldfarb DA. Arterial reconstruction during pancreas transplant. (Submitted)

Tanchanco R, Krishnamurthi v, Winans C, Wee A, Duclos A, Nurko S, fatica R, Lard M, Poggio ED. Beneficial outcomes of a steroid-free regimen with thymoglobulin induction in pancreas-kidney transplantation. Transplant Proc. 2008 Jun;40(5):1551-1554.

Canes D, Aron M, Nguyen MM, Winans C, Chand B, Gill IS. Common bile duct injury during urologic laparoscopy. J Endourol. 2008 Jul;22(7):1483-1484.

Quintini C, Aucejo f, Miller CM. Split liver transplantation: Will it ever yield grafts for two adults? Liver Transpl. 2008 Jul;14(7):919-922.

Miller CM. ethical dimensions of living donation: experience with living liver donation. Transplant Rev (Orlando). 2008 Jul;22(3):206-209.

hashimoto K, Miller C. The use of marginal grafts in liver transplantation. J Hepatobiliary Pancreat Surg. 2008;15(2):92-101.

Quintini C, Miller CM, hashimoto K, Philip D, Uso TD, Aucejo f, Kelly D, Winans C, Eghtesad B, Vogt D, Fung J. Side-to-side cavocavostomy with an endovascular stapler: Rescue technique for severe hepatic vein and/or inferior vena cava outflow obstruction after liver transplantation using the piggyback technique. Liver Transpl. 2009 Jan;15(1):49-53.

Mahajan D, Miller C, hirose K, McCullough A, Yerian L. Incidental reduction in the size of liver hemangioma following use of veGf inhibitor bevacizumab. J Hepatol. 2008 Nov;49(5):867-870.

Konstadoulakis MM, Roayaie S, Gomatos IP, Labow D, fiel MI, Miller CM, Schwartz Me. Aggressive surgical resection for hilar cholangiocarcinoma: is it justified? Audit of a single center’s experience. Am J Surg. 2008 Aug;196(2):160-169.

Konstadoulakis MM, Roayaie S, Gomatos IP, Labow D, fiel MI, Miller CM, Schwartz ME. Fifteen-year, single-center experience with the surgical management of intrahepatic cholangiocarcinoma: operative results and long-term outcome. Surgery. 2008 Mar;143(3):366-374.

Avery RK, Michaels M. Update on immunizations in solid organ transplant recipients: what clinicians need to know. Am J Transplant. 2008 Jan;8(1):9-14.

Avery RK. Update in management of ganciclovir-resistant cytomegalovirus infection. Curr Opin Infect Dis. 2008 Aug;21(4):433-437.

Avery RK. Classic concepts and modern developments in transplant infectious disease: the work of Robert h. Rubin. Curr Opin Organ Transplant. 2008 Dec;13(6):601-603.

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LUNG AND heART/LUNG TRANSPLANTATION

ROLANDO QuIROGA | DOuBLE LuNG TRANSPLANT RECIPIENT

“To look back, I don’t even feel like I went through what I did. I feel that good.” — Rolando Quiroga,

44, Lansing, Mich. After inhaling toxic gases in a car fire in 1995, Rolando spent 31 days in a coma

and several months in a hospital. his lungs aged 30 years from the accident, and Rolando later devel-

oped a condition that made breathing difficult. After a double-lung transplant in April 2008, Rolando is

back to exercising and is chaplain to the local minor league Spanish-speaking baseball players.

2008 Highlights

The year 2008 was a successful year for Cleveland Clinic’s Lung and heart/Lung Transplant Program. We completed our 683rd transplant since the program’s inception in 1990. This year we performed 57 lung transplants.

The transplant program has established a reputation for accepting challenging, complex cases, which has led to a high referral rate. In 2008, the transplant team evaluated more than 415 end-stage lung disease patients from across the United States and other countries. The program’s average waiting time for a graft remains stable, despite the new lung allocation score (LAS). Our median waiting time is 82 days.

Our hospital and 30-day mortality remain low despite heightened case severity resulting from LAS giving priority to the sickest patients. The lung transplant program has achieved very strong survival rates that are at or above national averages. Median and long-term outcomes continue to improve, with a 1-year survival rate of 86.5 % and 2-year survival rate of 76.9 %. A continued emphasis on quality assurance and quality improvement remains central to the program, reflected by the decrease in post-transplant length of stay to a median of 15 days.


The Cleveland Clinic lung transplant team is involved in a series of multicenter trials focusing on primary graft dysfunction and acute rejection therapy, as well as on induction therapy.

Our surgeons also have pioneered transplant surgical techniques that may further improve outcomes by reducing ischemic injury. This includes a bronchial artery revascularization technique and transplantation off eCMO and other bridging therapies to transplantation.

Leadership

Marie M. Budev, DO, MPH, FCCP Program and Medical Director, Lung Transplant

Gösta Pettersson, MD, PhD Program and Surgical Director, Lung and Heart-Lung Transplant; Vice Chairman, Thoracic and Cardiovascular Surgery


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Expertise

Our highly experienced physicians are frequently sought for their opinions and advice. They have served on the advisory boards of various organizations that have helped advance lung transplantation, including the American Thoracic Society (ATS), International Society for Heart and Lung Transplantation (ISHLT), United Network for Organ Sharing (UNOS), the American College of Chest Phy-sicians (ACCP) and the World Transplant Congress (WTC).

Our physicians frequently speak at national and international conferences and serve as peer reviewers for medical journals. As part of a statewide quality assurance program, we continue to actively participate in the Ohio Solid Organ Consortium, providing educational programs and hosting site visits for other programs in the state.

Fast facts Initiation date: 1990

first Adult Lung Transplant: february 14, 1990

First liver-lung transplant:January 13, 2007

first double lung transplant with bronchial artery revascularization performed December 15, 2007 at Cleveland Clinic.

Performed first lung-liver transplant in Ohio in 2007.

UNOS approval: March 3, 1993

Medicare Approval: October 22, 1997

As of December 31, 2008, 683 lung transplants have been performed at Cleveland Clinic.


first Pediatric Lung Transplant: September 8, 1991

Phone Number 216.444.8282

Lung transplant mortality 2008

Hospital deaths (within 30 days post-transplant) 4


Organ Double Single Total

Lung 326 339 665

heart/lung 17 17

Lung/liver 1 1

Total 344 339 683

Days on waiting list and post-transplant length of stay (LOS) for lung patients transplanted in 2008

Mean Median Number



Survival analysis: patient survival for 316 primary lung transplants 2004-2008 (includes 6 heart/lung and 1 lung/liver)

Time Survival %

6 months 88.7

1 year 86.5

2 years 76.9

Number of lung transplants 2004-2008 (includes 7 heart/lung and

1 lung/liver)

Single Double Total

2004 28 36* 64

2005 22 43* 65

2006 21 43** 64

2007 15 57*** 72

2008 28 29 57

Total 114 208**** 322

* (includes 1heart/lung)

** (includes 2 heart/lung)

*** (includes 3 heart/lung)

**** (includes 3 heart/lung and 1 lung/liver)

***** (includes 7 heart/lung and 1 lung/liver)

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Publications

Boffa DJ, Mason DP, Su JW, Murthy SC, feng J, McNeill AM, Budev MM, Mehta AC, Pettersson GB. Decortication after lung transplantation. Ann Thorac Surg. 2008 Mar;85(3):1039-1043.

Cywinski JB, Mascha e, Miller C, eghtesad B, Nakagawa S, vincent JP, Pesa N, Na J, Fung JJ, Parker BM. Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function. Liver Transpl. 2008 Jan;14(1):59-65.

Danziger-Isakov LA, Worley S, Arrigain S, Aurora P, Ballmann M, Boyer D, Conrad C, eichler I, elidemir O, Goldfarb S, Mallory GB, Jr., Michaels MG, Michelson P, Mogayzel PJ, Jr., Parakininkas D, Solomon M, visner G, Sweet S, faro A. Increased mortality after pulmonary fungal infection within the first year after pediatric lung transplantation. J Heart Lung Transplant. 2008 Jun;27(6):655-661.

Diaz-Guzman E, Mireles-Cabodevila E, Arrossi A, Kanne JP, Budev M. Amio-darone pulmonary toxicity after lung transplantation. J Heart Lung Transplant. 2008 Sep;27(9):1059-1063.

Girnita AL, Lee TM, McCurry KR, Baldwin WM, III, Yousem SA, Detrick B, Pilewski J, Toyoda Y, Jelinek L, Lomago J, Zaldonis D, Spichty KJ, Zeevi A. Anti-human leukocyte antigen antibodies, vascular C4d deposition and increased soluble c4d in broncho-alveolar lavage of lung allografts. Transplantation. 2008 Jul 27;86(2):342-347.

Mason DP, Murthy SC, Gonzalez-Stawinski GV, Budev MM, Mehta AC, McNeill AM, Pet-tersson GB. early experience with lung transplantation using donors after cardiac death. J Heart Lung Transplant. 2008 May;27(5):561-563.

Mason DP, Rajeswaran J, Murthy SC, McNeill AM, Budev MM, Mehta AC, Pettersson GB, Blackstone eh. Spirometry after transplantation: how much better are two lungs than one? Ann Thorac Surg. 2008 Apr;85(4):1193-1201.e2.

Mason DP, Thuita L, Alster JM, Murthy SC, Budev MM, Mehta AC, Pettersson GB, Black-stone EH. Should lung transplantation be performed using donation after cardiac death? The United States experience. J Thorac Cardiovasc Surg. 2008 Oct;136(4):1061-1066.

Minai OA, Shah S, Mazzone P, Budev MM, Sahoo D, Murthy S, Mason D, Pettersson G, Mehta AC. Bronchogenic carcinoma after lung transplantation: characteristics and outcomes. J Thorac Oncol. 2008 Dec;3(12):1404-1409.

Murata K, Iwata T, Nakashima S, Fox-Talbot K, Qian Z, Wilkes DS, Baldwin WM. C4d deposition and cellular infiltrates as markers of acute rejection in rat models of orthotopic lung transplantation. Transplantation. 2008 Jul 15;86(1):123-129.

Poonyagariyagorn hK, Gershman A, Avery R, Minai O, Blazey h, Asamoto K, Alster J, Murthy S, Mehta A, Pettersson G, Mason DP, Budev M. Challenges in the diagnosis and management of Nocardia infections in lung transplant recipients. Transpl Infect Dis. 2008 Dec;10(6):403-408.

Su JW, Mason DP, Murthy SC, Budev MM, Mehta AC, Goodwin R, Pettersson GB. Successful double lung transplantation in 2 patients with severe scoliosis. J Heart Lung Transplant. 2008 Nov;27(11):1262-1264.

Vadi S, Shah SS, Budev M, Mehta AC. Spontaneous pneumothoraces post-lung transplantation. Artif Organs. 2008 Jan;32(1):85-86.

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Primary diagnoses for patients transplanted in 2008


Idiopathic pulmonary fibrosis 28 49.1

COPD/emphysema 12 21.1


Sarcoidosis 3 5.3

Alpha-1 antitrypsin deficiency 2 3.5

Bronchiectasis 2 3.5

Primary pulmonary hTN 2 3.5

Other diagnosis 5 8.8

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PANCReAS AND KIDNeY/PANCReAS TRANSPLANTATION

KIM HOLMES | KIDNEY-PANCREAS TRANSPLANT RECIPIENT

“I am ready to live on my own again and start my life over.” — Kim holmes, 30, Cleveland, Ohio.

Kim underwent a kidney-pancreas transplant in January after the diabetes she had been dealing with

since she was 9 years old led to kidney failure and blindness. Kim had been on dialysis and in and

out of the hospital for the past three years. She had to live in a nursing home prior to her transplant.

She now looks forward to living on her own again with her two children, Xavier, 11, and Shiara, 10.

2008 Highlights

In 2008, a total of 31 pancreas transplants were performed, accounting for the second consecutive year we’ve done more than 30 transplants. The 2008 total included 16 simultaneous pancreas-kidney transplants, 3 pancreas after kidney transplants, 11 pancreas transplants alone and one multivisceral transplant. This brings the total number of transplants performed since the beginning of the program to 249.

By maintaining this level of clinical activity, the Cleveland Clinic Pancreas/Kid-ney Transplant Program continues to rank among the 10 busiest pancreas trans-plant programs in the country. equally important, clinical outcomes continue to remain excellent along with the increased clinical volumes. Patient survival for transplants performed in 2008 was 97 percent and overall pancreas graft survival was 90 percent.

Also in 2008, the size of the program’s staff grew with the addition of Alvin Wee, MD. In addition to kidney and pancreas transplantation, Dr. Wee brings a wealth of experience in laparoscopic surgery, including laparoscopic donor nephrectomy.

The majority of pancreas transplants performed at Cleveland Clinic result from diabetes.

Leadership

Venkatesh Krishnamurthi, MDProgram and Surgical Director, Pancreas Transplant

Emilio Poggio, MD Medical Director, Pancreas Transplant; Director, Renal Function Laboratory


Number of pancreas transplants in 2008

Organ Number Percent

Pancreas 14 45.2

Pancreas/kidney 16 51.6

Pancreas/liver 1 3.2

Total 31 (1 patient retransplanted same year)

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Survival analysis: patient survival for 126 primary pancreas, pancreas/kidney and pancreas/liver transplants 2004-2008

Time Survival %

6 months 97.5

1 year 94.2

2 years 91.0

Days on waiting list and post-transplant length of stay (LOS) for pancreas patients transplanted in 2008

Mean Median Number



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Fast facts

Initiated: 1985

first Pancreas Transplant: March 22, 1988

first Kidney/Pancreas Transplant: October 23, 1985

As of December 31, 2008, 160 kidney/pancreas, 114 pancreas, and 5 liver/pancreas transplants have been performed at Cleveland Clinic.

Survival analysis: pancreas graft survival for 126 primary pancreas, pancreas/kidney and pancreas/liver transplants 2004-2008

Time Survival %

6 months 88.1

1 year 83.7

2 years 70.9

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KRISTA DIDDLE | KIDNEY TRANSPLANT RECIPIENT

“My energy level is back to normal. I work out and participate in a lot more activities now rather than

just coming home from work and calling it a day.” — Krista Diddle, 31, Columbus, Ohio. Krista was

diagnosed with membranoproliferative glomerulonephritis (MPGN), a kidney disease, when she was 18

years old. About 3 years ago, the kindergarten teacher experienced renal failure and was put on medica-

tion. In June 2008, Krista underwent a kidney transplant with a kidney donated by her brother, Marcus,

29. She says she had a good recovery experience and was able to go back to teaching school in August.

2008 Highlights

Clinical activity in renal transplantation remained strong at Cleveland Clinic’s Glickman Urological & Kidney Institute in 2008. We performed 168 transplants in 2008.

Transplantation, more than other clinical endeavors, is carried out with signifi-cant regulatory oversight. All Cleveland Clinic programs were among the first to be re-certified by CMS.

The renal transplant program continues to be active in the Paired Donation Network, an innovative service for incompatible donor-recipient pairs. To date, Cleveland Clinic is the highest-enrolling center in the program.


The laboratory of Robert L. Fairchild, PhD, continues to focus on: 1) mecha-nisms that produce high levels of inflammation early in transplanted tissues and organs, 2) understanding how this inflammation directs alloantigen-primed T cells and other leukocytes into allografts, and 3) effector mechanisms leading to solid organ graft rejection.

Current studies are focused on the factors directing the memory CD8 T cells into the allografts within hours after the transplant. Preliminary results indicate that initial neutrophil activity is a prerequisite, but the recruiting factors produced directly or induced by neutrophils remain unidentified. Additional studies are under way to identify the functions expressed by these memory CD8 T cells that amplify inflammation in the allograft at early times post-transplant, if these CD8 T cells are capable of rejecting cardiac allografts on their own, and if the activity of these memory CD8 T cells is resistant to immunosuppressive drugs that are used in human transplant patients.

We recently have identified a serine protease, cathepsin G, produced by the neutrophils, that is important for the development of renal dysfunction following

ReNAL TRANSPLANTATION Leadership

David A. Goldfarb, MDProgram and Surgical Director, Renal Transplant

Richard Fatica, MDMedical Director, Renal Transplant


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Fast facts

Initiated: 1963

first Adult Kidney Transplant: January 9, 1963

Medicare Approval: July 1, 1966


As of December 31, 2008, 3,378 kidney, 143 kidney/pancreas, 35 kidney/liver and 3 kidney/heart transplants have been performed at Cleveland Clinic.

Cleveland Clinic developed and refined dialysis tech-niques in the 1950s to enable survival of patients with kidney failure.

We developed one of the first deceased-donor kidney transplant programs in the world, established in 1963.

We established active living donor programs for kidney (laparoscopic live donor nephrectomy) and liver transplant.


first Pediatric Kidney Transplant: April 4, 1963

four pediatric kidney transplants were performed in 2008.

the ischemia/reperfusion injury, and ongoing studies are testing potential mechanisms by which this protease causes renal injury.

We are also focusing on identifying molecular mechanisms leading to the development of renal interstitial fibrosis. Imposition of renal ischemia/reperfusion in the absence of cathepsin G abrogates the development of interstitial fibrosis in the kidney.

William (Wink) Baldwin, MD, is now an active member of the research team.

Education

The Glickman Urological & Kidney Institute’s Section of Renal Transplantation continues to contribute significantly to graduate and postgraduate education. This program is considered the premier urological transplant fellowship training program in the United States, and it continues to attract outstanding candidates.

Number of transplants 2008

Organ Number Deceased Living/Related Living/Unrelated

Kidney 144 80 38 26

Kidney/pancreas 16 16

Kidney/liver 8 8

Total 168

Waiting list and post-transplant length of stay (LOS) for kidney patients transplanted in 2008

Mean Median Number

Years waiting (deceased donor) 2.7 2.7 104

Days post-transplant LOS 8.1 6.0 168

Survival analysis: patient survival for 714 primary kidney, kidney/heart, kidney/liver and kidney/pancreas transplants 2004-2008

Time Survival %

6 months 96.8

1 year 94.7

2 years 92.8

Survival analysis: kidney graft survival for 714 primary kidney, kidney/heart, kidney/liver, and kidney/pancreas transplants 2004-2008

Time Survival %

6 months 93.1

1 year 90.8

2 years 86.8

Survival analysis: kidney graft survival for 65 primary kidney/pancreas transplants 2004-2008

Time Survival %

6 months 84.5

1 year 81.3

2 years 72.8

Primary diagnoses for kidney patients transplanted in 2008


Diabetes 44 26.2

Cystic disease 25 14.9

Glomerular disease 20 11.9

Nephritis/interstitial disease 19 11.3

hypertension 17 10.2

Re-transplant/graft failure 10 6.0

Multi-system disease 9 5.4

Obstructive disease 3 1.8

Congenital hereditary disease 2 1.2

Cirrhosis 1 0.6


vascular disease 1 0.6

Others 10 6.0

Unknown 6 3.6

Total 168

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Publications

Augustine JJ, Poggio ED, Heeger PS, Hricik DE. Preferential benefit of antibody induc-tion therapy in kidney recipients with high pretransplant frequencies of donor-reactive interferon-gamma enzyme-linked immunosorbent spots. Transplantation. 2008 Aug 27;86(4):529-534.

Bickerstaff A, Nozaki T, Wang JJ, Pelletier R, hadley G, Nadasdy G, Nadasdy T, fairchild RL. Acute humoral rejection of renal allografts in CCR5(-/-) recipients. Am J Transplant. 2008 Mar;8(3):557-566.

Braun We. Cardiovascular and other noninfectious complications after renal transplantation in adults. In: Wilcox CS, ed. Therapy in Nephrology & Hypertension: a Companion to Brenner & Rector’s The Kidney. 3rd ed. Philadelphia, PA: Saunders/Elsevier; 2008:1009-1033.

Chuang fP, Novick AC, Sun Gh, Kleeman M, flechner S, Krishnamurthi v, Modlin C, Shoskes D, Goldfarb DA. Graft outcomes of living donor renal transplantations in elderly recipients. Transplant Proc. 2008 Sep;40(7):2299-2302.

Derweesh IH, Ismail HR, Goldfarb DA, Araki M, Zhou L, Modlin C, Krishnamurthi V, flechner SM, Novick AC. Intraoperative placing of drains decreases the incidence of lymphocele and deep vein thrombosis after renal transplantation. BJU Int. 2008 Jun;101(11):1415-1419.

Flechner SM. Risk factors for and management of sirolimus-associated pneumonitis in kidney transplant recipients. Nat Clin Pract Nephrol. 2008 May;4(5):250-251.

flechner SM, Duclos A. Renal transplantation. In: Montague DK, ed. Textbook of Reconstructive Urologic Surgery. London, [England]: Informa Healthcare; 2008:133-142.

Flechner SM, Kobashigawa J, Klintmalm G. Calcineurin inhibitor-sparing regimens in solid organ transplantation: focus on improving renal function and nephrotoxicity. Clin Transplant. 2008 Jan-Feb;22(1):1-15.

flechner SM. Renal transplantation. In: Tanagho eA, McAninch JW, eds. Smith’s General Urology. 17th ed. New York, NY: McGraw-Hill Medical; 2008:539-558.

Gill IS, Canes D, Aron M, haber GP, Goldfarb DA, flechner S, Desai MR, Kaouk Jh, Desai MM. Single port transumbilical (E-NOTES) donor nephrectomy. J Urol. 2008 Aug;180(2):637-641.

Goldfarb DA, Campbell SC. Kidneys from patients with small renal tumours: A novel source of kidneys for transplantation - Commentary. BJU Int. 2008 Jul;102(2):192-193.

Issa N, Meyer Kh, Arrigain S, Choure G, fatica RA, Nurko S, Stephany BR, Poggio eD. Evaluation of creatinine-based estimates of glomerular filtration rate in a large cohort of living kidney donors. Transplantation. 2008 Jul 27;86(2):223-230.

Kasiske BL, de Mattos A, Flechner SM, Gallon L, Meier-Kriesche HU, Weir MR, Wilkinson A. Mammalian target of rapamycin inhibitor dyslipidemia in kidney transplant recipients. Am J Transplant. 2008 Jul;8(7):1384-1392.

Lachat M, Mayer D, Criado FJ, Pfammatter T, Rancic Z, Genoni M, Veith FJ. New technique to facilitate renal revascularization with use of telescoping self-expanding stent grafts: vORTeC. Vascular. 2008 Mar-Apr;16(2):69-72.

Schold JD, Srinivas TR, Kayler LK, Meier-Kriesche HU. The overlapping risk profile between dialysis patients listed and not listed for renal transplantation. Am J Transplant. 2008 Jan;8(1):58-68.

Schold JD, Srinivas TR, Howard RJ, Jamieson IR, Meier-Kriesche HU. The association of candidate mortality rates with kidney transplant outcomes and center performance evaluations. Transplantation. 2008 Jan 15;85(1):1-6.

Tanchanco R, Krishnamurthi v, Winans C, Wee A, Duclos A, Nurko S, fatica R, Lard M, Poggio ED. Beneficial outcomes of a steroid-free regimen with thymoglobulin induction in pancreas-kidney transplantation. Transplant Proc. 2008 Jun;40(5):1551-1554.

Thomas AA, Nguyen MM, Gill IS. Laparoscopic transperitoneal radical prostatectomy in renal transplant recipients: a review of three cases. Urology. 2008 Feb;71(2):205-208.

Yarlagadda SG, Coca SG, Garg AX, Doshi M, Poggio e, Marcus RJ, Parikh CR. Marked variation in the definition and diagnosis of delayed graft function: a systematic review. Nephrol Dial Transplant. 2008 Sep;23(9):2995-3003.

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KAREN L.KACHMAR | BONE AND SOFT TISSuE TRANSPLANT RECIPIENT

“I will be eternally grateful to Dr. Michael Joyce and his assistants at Cleveland Clinic for all they

have done for me.” — Karen Kachmar, 59, Crescent, Pa. About 8 years ago, Karen fell down six steps,

breaking the same femur bone she had broken when she was 2 years old. After two rods were placed

in her leg, Karen was able to walk but in terrible pain. In 2004, Karen underwent a bone transplant at

Cleveland Clinic. She is now pain-free with a straight healthy leg. The mother and grandmother swims

regularly and enjoys time with her husband Paul.

TISSUe TRANSPLANTATION

2008 Highlights

Some 20 disciplines across 11 of Cleveland Clinic’s institutes and ambulatory surgery centers utilize bone and soft tissue during surgical reconstruction. In 2008, Cleveland Clinic used approximately 4,317 tissue segments and obtained hundreds of oocytes and sperm donations for in vitro fertilization.


Cleveland Clinic has established activities in musculoskeletal stem cell research, tissue engineering and musculoskeletal tissue healing at the Orthopaedic Re-search Center. Cleveland Clinic physicians also have been active in the American Association of Tissue Banks, American Academy of Orthopaedic Surgeons Com-mittee on Biological Implants, American Society of Testing and Materials, as well as with the fDA and Centers for Disease Control in promoting safety of tissues.

The tissue transplant program includes cardiology/cardiothoracic surgery, bone transplant (which includes adult and pediatric orthopaedics, spine and neurol-ogy), urology, colorectal surgery, vascular surgery, dentistry, plastic surgery, obstetrics and gynecology, andrology and in vitro fertilization, general surgery and dermatology.

Cardiology/Cardiothoracic Surgery

Cleveland Clinic’s heart and heart surgery program has been ranked No. 1 in the nation for the past 14 years. Cleveland Clinic has the largest heart valve surgery practice in the United States, performing 2,355 procedures in 2008.

Bone Transplant

Adult and Pediatric Orthopaedics: Adult and pediatric procedures are performed to address trauma, bone healing problems and congenital deformities. Large bone replacement for reconstruction after cancer resection also is performed. To provide support, donor bone is used to fill in defects secondary to fractures

Leadership

Michael Joyce, MDMedical Director, Musculoskeletal Tissue Bank


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Fast facts

Initiated: 1983

fresh Osteochondral Graft Transplant Program established in 1998 by the Department of Orthopaedic Surgery, Adult Reconstruction Section.

first sacral bone trans-plant performed by neuro-spine surgeons in 2001.

first mosaicplasty per-formed by Orthopaedic Adult Reconstruction and Sports Medicine surgeons in 2001.

Performed first near-total facial transplant in the United States in 2008.

and joint replacement. The pediatric service uses allograft tissue that is size-matched with the recipient, with the intent that the allograft eventually will be replaced by normal living host tissue.

Sports Medicine: Knee and ankle soft tissue injuries can be surgically repaired using tendons and ligaments from tissue donors. These donated soft tissues also can be used in partial or total joint replacement. Tissue also is used in repairing rotator cuff injuries.

Cleveland Clinic offers a fresh-tissue osteochondral-allograft program via Life-Banc for cartilage defects in the knee. Team members also perform autologous cell-cultured chondrocyte transplantation for cartilage surface defects of the knee, as well as allograft meniscal transplants.

Spine/Neurology: Cleveland Clinic spine surgeons are experienced in the surgical management of spinal stenosis, disc herniation, spinal tumors, spinal trauma, scoliosis and other complex deformities and disorders of the cervical, thoracic and lumbar spine. These disorders may require bone transplants to help allevi-ate pain and to enhance the patient’s quality of life.

urology

U.S.News & World Report has ranked Cleveland Clinic’s urology program one of the top in the United States every year since 1990. The urology program utilizes tissue as a treatment option for incontinence and for the reinforcement of soft tissue after surgery. Tissue allografts also are used in urethroplasties and pubovaginal sling procedures.

Colorectal Surgery

Our gastrointestinal disorders program was ranked second in the nation in 2008 by U.S.News & World Report. The Department of Colorectal Surgery utilizes tissue in specialized procedures, including anal fistula repair using a tissue plug and ventral hernia repair.

Vascular Surgery

The Department of vascular Surgery performs more that 6,000 procedures each year and frequently uses tissue allografts for repair and reconstruction of weak or severely diseased blood vessels. One-third of all procedures performed by the department are for atherosclerosis, peripheral arterial disease and peripheral vascular disease. Other conditions treated surgically include aneurysms, carotid artery disease and venous disease.

Dentistry

The Department of Dentistry utilizes tissue in the surgical repair of extraction sockets and periodontal defects, as well as during dental implantation. Bone allografts in these procedures promote additional bone growth to strengthen the various implants used.

Plastic Surgery

The Department of Plastic Surgery uses tissue (primarily skin grafts) for a variety of procedures and surgeries. These include facial cosmetic surgery, reconstruction of pediatric craniofacial defects, wound coverage and cosmetic and reconstructive breast surgery.

Andrology and In Vitro Fertilization

Cleveland Clinic’s Andrology Laboratory and Reproductive Tissue Bank, which has provided therapeutic sperm banking services since 1980, conducts sperm counts and a variety of tests on semen. The fertility Center, part of the Ob/Gyn & Women’s health Institute, offers a wide range of procedures. They include in vitro fertilization (IVF), intracytoplasmic sperm injection, sperm aspiration, assisted hatching, blastocyte transfer and embryo cryopreservation. The center also obtains egg and sperm donations and offers an Ivf surrogate program.

Focus on Quality

To ensure safety and the best possible results, allograft donors are thoroughly screened with an in-depth medical history and tested for viruses and bacteria. Safety procedures follow published rules, standards and guidelines of the U.S. Food and Drug Administration (FDA) and the American Association of Tissue Banks. Our Tissue Transplantation Program also adheres to the new Joint Com-mission standards that were established in 2007. These standards are meant to provide higher quality assurance and patient safety through the ability to trace all tissues from the donor or source facility to all recipients or other final disposition.

Throughout 2008, the Transplant Center utilized software developed specifi-cally to track tissue implants, ensure compliance, and enhance patient safety. The web-based system, Tissue TrackCore, provides an electronic record for all actions associated with tissues received until final disposition and is currently implemented in over 125 operating and procedure rooms. In 2008 the system was responsible for handling the tracking of the 4,317 tissues segments and has electronic interfaces with the Cleveland Clinic Operating Room Information System and receives product and donor information from vendor systems.

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Publications

Nasir S, Krokowicz L, Bozkurt M, Siemionow M. Inlay technique for large skin graft replacement in the small animal. Plast Reconstr Surg. 2008 Nov;122(5):167e-168e.

Siemionow M, Nasir S. Impact of donor bone marrow on survival of composite tissue allografts. Ann Plast Surg. 2008 Apr;60(4):455-462.

Siemionow M. Transplanting a Face: Notes on a Life in Medicine. Cleveland, Oh: Cleve-land Clinic Press; 2008.

Siemionow M, hivelin M. Przeszczep twarzy: Kliniczne zastosowanie [face transplantation: clinical application of the concept] [Polish]. Pol Przegl Chir. 2008 Oct;80(10):1041-1053.

Siemionow M, Klimczak A, Unal S, Agaoglu G, Carnevale K. hematopoietic stem cell engraftment and seeding permits multi-lymphoid chimerism in vascularized bone marrow transplants. Am J Transplant. 2008 Jun;8(6):1163-1176.

Siemionow M, Klimczak A. Basics of immune responses in transplantation in preparation for application of composite tissue allografts in plastic and reconstructive surgery: part I. Plast Reconstr Surg. 2008 Jan;121(1):4e-12e.

Siemionow M, Nasir S. Immunologic responses in vascularized and nonvascularized skin allografts. J Reconstr Microsurg. 2008 Oct;24(7):497-505.

Siemionow M, Kulahci Y. In preparation for facial transplantation. In: Eisenmann-Klein M, Neuhann-Lorenz C, eds. Innovations in Plastic and Aesthetic Surgery. Berlin; New York, NY: Springer; 2008:150-159.

Siemionow M, Agaoglu G. face transplantation. In: hewitt CW, Lee WPA, Gordon CR, eds. Transplantation of Composite Tissue Allografts. New York, NY: Springer; 2008:344-354.

Yazici I, Cavusoglu T, Comert A, vargel I, Cavusoglu M, Tekdemir I, Siemionow M.Maxilla allograft for transplantation: an anatomical study. Ann Plast Surg. 2008 Jul;61(1):105-113.

Bedaiwy MA, El-Nashar SA, El Saman AM, Evers JLH, Sandadi S, Desai N, Falcone T. Reproductive outcome after transplantation of ovarian tissue: a systematic review. Hum Reprod. 2008 Dec;23(12):2709-2717.

Bohrer JC, Chen CC, Walters MD. Pudendal neuropathy involving the perforating cutane-ous nerve after cystocele repair with graft. Obstet Gynecol. 2008 Aug;112(2):496-498.

fujishiro T, Nishikawa T, Niikura T, Takikawa S, Saegusa Y, Kurosaka M, Bauer TW. Histologic analysis of allograft mixed with hydroxyapatite-tricalcium phosphate used in revision femoral impaction bone grafting. Orthopedics. 2008 Mar;31(3):277.

fujishiro T, Kobayashi h, Bauer TW. Autograft bone. In: Pietrzak WS, ed. Musculoskel-etal Tissue Regeneration: Biological Materials and Methods. Totowa, NJ: humana Press; 2008:65-79.

Grazul-Bilska AT, Banerjee J, Yazici I, Borowczyk E, Bilski JJ, Sharma RK, Siemionov M, falcone T. Morphology and function of cryopreserved whole ovine ovaries after hetero-topic autotransplantation. Reprod Biol Endocrinol. 2008 Apr 11;6:16.

Iannotti JP, Defranco MJ, Codsi MJ, Maschke SD, Derwin KA. Natural extracellular ma-trix grafts for rotator cuff repair. In: Abrams JS, Bell Rh, eds. Arthroscopic Rotator Cuff Surgery: a Practical Approach to Management. New York, NY: Springer; 2008:246-268.

Lorenz RR, Strome M. Laryngeal transplantation. In: hewitt CW, Lee WPA, Gordon CR, eds. Transplantation of Composite Tissue Allografts. New York, NY: Springer; 2008:330-343.

Lubiatowski P, Unsal fM, Nair D, Ozer K, Siemionow M. The epineural sleeve technique for nerve graft reconstruction enhances nerve recovery. Microsurgery. 2008;28(3):160-167.

Mahdy A, elmissiry M, Ghoniem G. The outcome of transobturator cystocele repair using biocompatible porcine dermis graft: our experience with 32 cases. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Dec;19(12):1647-1652.

Mekhail AO, Bell GR. Alternatives to autogenous bone graft in revision lumbar spine surgery. Semin Spine Surg. 2008 Dec;20(4):257-269.

Mroz Te, Joyce MJ, Steinmetz MP, Lieberman Ih, Wang JC. Musculoskeletal allograft risks and recalls in the United States. J Am Acad Orthop Surg. 2008 Oct;16(10):559-565.

Parker RD, Maschke SD. Mechanical agitation and serial dilution: an option for anterior cruciate ligament graft sterilization. J Knee Surg. 2008 Jul;21(3):186-191.

Scalise JJ, Iannotti JP. Bone grafting severe glenoid defects in revision shoulder arthroplasty. Clin Orthop Relat Res. 2008 Jan;466(1):139-145.

varghese AC, du Plessis SS, falcone T, Agarwal A. Cryopreservation/transplantation of ovarian tissue and in vitro maturation of follicles and oocytes: Challenges for fertility preservation. Reprod Biol Endocrinol. 2008;6:47.

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82 Allogen Laboratories

82 Bone Marrow

83 Cardiac

86 Corneal

87 Infectious Disease

88 Intestinal

89 Liver

93 Lung and heart/Lung

95 Pancreas and Kidney/Pancreas

96 Renal

98 Tissue

99 Support

STAff DIReCTORY

clevelandclinic.org/staff

ClevelandClinic.org/staff ClevelandClinic.org/staff

Diane J. Pidwell, PhDDirector, Allogen LaboratoriesOffice Phone: 216.444.2805Appointments: 216.444.2804Email: [email protected] Appointment: 2007Specialty Interests: histocompatibility of solid

organ and bone marrow transplantation, effects of anti-HLA antibody on graft function and survival

Medhat Z. Askar, MD, PhDAssociate Director, Allogen LaboratoriesOffice Phone: 216.444.5918Appointments: 216.444.2804Email: [email protected] Appointment: 2006Specialty Interests: Immunogenetics and

transplant immunology

A L L O G e N L A B O R AT O R I e S B O N e M A R R O W

Brian Bolwell, MDChairman, Hematologic Oncology and Blood Disorders; Vice Chairman, Office of the Chief of Staff; Professor of Medicine, Cleveland Clinic Lerner School of MedicineOffice Phone: 216.444.6922Appointments: 216.444.6833

Email: [email protected] Appointment: 1987Specialty Interests: Bone marrow transplantation, leukemia, lymphoma

Steven Andresen, DOHematologic Oncology and Blood DisordersOffice Phone: 216.444.3737Appointments: 216.444.6833Email: [email protected] Appointment: 1987Specialty Interests: hematology, hematologic

malignancies, bone marrow transplantation, breast cancer

Edward Copelan, MDProgram Director, Acute Leukemia; Hematologic Oncology and Blood DisordersOffice Phone: 216.445.5647Appointments: 216.444.6833Email: [email protected] Appointment: 2006

Specialty Interests: Preparative regimens for transplantation, CML, acute leukemias

Robert Dean, MDHematologic Oncology and Blood DisordersOffice Phone: 216.445.5365Appointments: 216.444.6833Email: [email protected] Appointment: 2005Specialty Interests: Bone marrow and stem

cell transplantation, lymphoma, leukemia, multiple myeloma

Matt Kalaycio, MDProgram Director, Chronic Leukemia and Multiple Myeloma; Hematologic Oncology and Blood DisordersOffice Phone: 216.444.3705Appointments: 216.444.6833Email: [email protected]

Staff Appointment: 1994Specialty Interests: Leukemia, lymphoma, bone marrow transplantation

Brad Pohlman, MDProgram Director, Lymphoma; Hematologic Oncology and Blood DisordersOffice Phone: 216.445.6070Appointments: 216.444.6833Email: [email protected] Appointment: 1993

Specialty Interests: Hodgkin and non-Hodgkin lymphoma, bone marrow transplantation

Stephen Smith, MDHematologic Oncology and Blood DisordersOffice Phone: 216.444.8258Appointments: 216.444.6833Staff Appointment: 2008Specialty Interests: Non-Hodgkin lymphoma, targeted therapy, hematologic diseases, benign

and malignant

Ronald Sobecks, MDHematologic Oncology and Blood DisordersOffice Phone: 216.445.4626Appointments: 216.444.6833Email: [email protected] Appointment: 1999Specialty Interests: Leukemia, hematopoietic

stem cell transplantation, other hematologic malignancies, drug development/clinical trials for these diseases

John Sweetenham, MDClinical Research Director, Taussig Cancer Institute; Hematologic Oncology and Blood DisordersOffice Phone: 216.445.6707Appointments: 216.444.6833Email: [email protected]

Staff Appointment: 2005Specialty Interests: Hodgkin and non-Hodgkin lymphoma, autologous stem cell transplantation, hematologic malignancies

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Randall C. Starling, MD, MPH, FACCProgram and Medical Director, Heart Transplant Program and Kaufman Center for Heart Failure; Head, Section of Heart Failure and Cardiac Transplant Medicine; Vice Chairman, Department of Cardiovascular Diseases; Cardiovascular Medicine

Office Phone: 216.444.2268Appointments: 216.444.6697Email: [email protected] Appointment: 1995Specialty Interests: heart failure, cardiomyopathy, cardiac transplantation; mechanical circulatory support devices

Nicholas Smedira, MDProgram and Surgical Director, Heart Transplant Program and Kaufman Center for Heart Failure; Thoracic and Cardiovascular Surgery; Polly and W. Neil Rossborough Chair in Cardiac TransplantationOffice Phone: 216.445.7052

Appointments: 216.444.4466Email: [email protected] Appointment: 1995Specialty Interests: heart and heart/lung transplantation, ventricular assist devices, eCMO, heart failure surgery, aortic and mitral valve repair and replacement, off-pump coronary bypass grafting, myectomy, reoperations, ascending and descending thoracic aortic replacement

Eugene Blackstone, MDThoracic and Cardiovascular Surgery; Quantitative Health SciencesOffice Phone: 216.444.6712Staff Appointment: 1997Email: [email protected] Interests: Clinical research in adult

and congenital cardiac surgery, adult thoracic surgery clinical research, cardiac and pulmonary transplantation, novel mathematical methods for analysis of time-related events and longitudinal clinical outcomes, predictive modeling, semantic database research and development

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Gustavo Rincon, MDCardiovascular MedicineOffice Phone: 216.444.6721Appointments: 216.444.6697Email: [email protected] Appointment: 1972Specialty Interests: Cardiac catheterization

and angiography, clinical cardiology, clinical pharma-cology in cardiac failure, cardiac transplantation

Rene Rodriguez, MDHead, Section of Autopsy Pathology, Anatomic Pathology; Thoracic and Cardiovascular Surgery; Molecular CardiologyOffice Phone: 216.444.2091Email: [email protected] Appointment: 2004

Specialty Interests: Cardiovascular pathology, cardiomyopa-thies, cardiac transplant pathology, aortic diseases, valvular diseases, congenital heart disease, molecular diagnostics of cardiovascular diseases

Carmela Tan, MDAnatomic PathologyOffice Phone: 216.444.9489Email: [email protected] Appointment: 2005 Specialty Interests: Anatomic pathology, cardiovascular pathology, antibody-mediated

rejection in cardiac allografts, regulation of complement activation in antibody-mediated rejection, gene expression in cardiac allograft vasculopathy

W.H. Wilson Tang, MD, FACC, FAHACardiovascular MedicineOffice Phone: 216.444.2121Appointments: 216.444.6697Email: [email protected] Appointment: 2004Specialty Interests: Cardiomyopathy, heart

failure, cardiac transplantation and mechanical circulatory support, diabetic heart disease, chemotherapy-induced cardiomyopathy, cardio-renal syndrome

Tomislav Mihaljevic, MDThoracic and Cardiovascular SurgeryOffice Phone: 216.444.0648Appointments: 216.444.4466Email: [email protected] Appointment: 2004Specialty Interests: Minimally invasive valve

surgery, mitral and aortic valve repair and replacement, coronary artery disease, beating heart revascularization, maze procedure, robotic cardiac surgery, cardiac transplantation, lung transplantation, ventricular assist devices, adult congenital heart disease

Muhammad Ali Mumtaz, MDPediatric and Congenital Heart SurgeryOffice Phone: 216.444.9125Appointments: 216.445.5015Email: [email protected] Appointment: 2000Specialty Interests: Neonatal cardiac surgery,

pediatric cardiac transplantation, adult congenital heart disease, anomalies of pulmonary veins, minimally invasive surgery for congenital heart disease, valve repair for congenital valvular lesions, anomalies of coronary arteries, pediatric heart surgery

Constantine Mavroudis, MDChairman, Pediatric and Congenital Heart SurgeryOffice Phone: 216.636.5288Appointments: 216.444.3627Email: [email protected] Appointment: 2008

Specialty Interests: Pediatric heart surgery, congenital coronary artery surgery, arrhythmia surgery, repair of transposition of great arteries, valve sparing repair of tetralogy of fallot, adult congenital heart surgery

Maria Mountis, DOCardiovascular MedicineOffice Phone: 216.636.6101Email: [email protected] Appointment: 2008Specialty Interests: heart failure, cardiac transplantation, mechanical circulatory

support devices, women’s cardiac care, pulmonary hypertension

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Corinne Bott-Silverman, MDCardiovascular MedicineOffice Phone: 216.444.8414Appointments: 216.444.6697Email: [email protected] Appointment: 1986Specialty Interests: heart failure, heart

transplantation, clinical cardiology, cardiac catheterization, myocardial biopsy

Gerard J. Boyle, MDChairman, Pediatric Cardiology; Head, Section of Pediatric Heart Transplantation and Congestive Heart Failure; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityOffice Phone: 216.444.3083

Appointments: 216.445.5015Email: [email protected] Appointment: 2004Specialty Interests: Pediatric heart transplantation, conges-tive heart failure

Brian Duncan, MDPediatric and Congenital Heart SurgeryOffice Phone: 216.297.8276Email: [email protected] Appointment: 2001Specialty Interests: Pediatric cardiothoracic transplantation, neonatal cardiac surgery,

pediatric mechanical circulatory support, research: angiogen-esis in cyanotic congenital heart disease, pediatric heart surgery

Gonzalo V. Gonzalez-Stawinski, MDCardiovascular SurgeryOffice Phone: 216.444.6708Appointments: 216.444.4466Email: [email protected] Appointment: 2006Specialty Interests: Adult cardiac surgery,

heart transplantation, reoperations, pump coronary andvalve procedures, pulmonary embolectomy and thrombo-endarterectomy, mechanical circulatory device

Mazen A. Hanna, MDCardiovascular MedicineOffice Phone: 216.444.3490Appointments: 216.444.6697Email: [email protected] Appointment: 2006Specialty Interests: Congestive heart failure,

hypertrophic cardiomyopathy, cardiac transplantation and mechanical circulatory support devices

Robert Hobbs, MDCardiovascular MedicineOffice Phone: 216.444.6936Appointments: 216.444.6697Email: [email protected] Appointment: 1979Specialty Interests: Congestive heart failure,

cardiac transplantation

Eileen Hsich, MDCardiovascular MedicineOffice Phone: 216.444.7527Appointments: 216.444.6697Email: [email protected] Appointment: 2004Specialty Interests: heart failure in women,

cardiac transplantation, nuclear cardiology

Karen James, MDCardiovascular MedicineOffice Phone: 216.444.9288Appointments: 216.444.6697Email: [email protected] Appointment: 1991Specialty Interests: Cardiac transplantation,

congestive heart failure

Kenneth McCurry, MD Thoracic and Cardiovascular SurgeryOffice Phone: 216.445.9303Appointments: 216.445.6860Email: [email protected] Appointment: 2009Specialty Interests: Thoracic and

cardiovascular surgery, pathobiology

C A R D I A C continued

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Alan Taege, MDDirector of HIV CareOffice Phone: 216.444.5834Appointments: 216.444.8845Email: [email protected] Appointment: 1998Specialty Interests: hIv, surgical infections,

transplant infections

David van Duin, MD, PhDInfectious DiseaseOffice Phone: 216.444.8472Appointments: 216.444.8845Email: [email protected] Appointment: 2007Specialty Interests: general infectious disease

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David Taylor, MDCardiovascular Medicine; Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityOffice Phone: 216.444.2492Appointments: 216.444.4462Email: [email protected]

Staff Appointment: 2001Specialty Interests: Congestive heart failure, cardiac transplantation, mechanical circulatory support

James Young, MDExecutive Dean, Education Institute; Chairman, Endocrinology and Metabolism Institute; Staff, Cardiovascular MedicineOffice Phone: 216.444.2270Appointments: 216.444.6697Email: [email protected]

Staff Appointment: 1995Specialty Interests: heart failure, heart transplantation, mechanical circulatory assist devices

C O R N e A L

William J. Dupps, MD, PhDCole Eye InstituteOffice Phone: 216.444.8396Appointments: 216.444.2020Email: [email protected] Appointment: 2006Specialty Interests: Refractive surgery,

cataract surgery, corneal transplantation

David M. Meisler, MDCole Eye InstituteOffice Phone: 216.444.8102Appointments: 216.444.2030Email: [email protected] Appointment: 1982Specialty Interests: Corneal and external

disease, corneal transplantation, adult cataract surgery

Roger H.F. Langston, MDCole Eye InstituteOffice Phone: 216.444.5898Appointments: 216.444.2030Email: [email protected] Appointment: 1974Specialty Interests: Corneal and external

disease, corneal transplantation, cataract and implant surgery

Allen Roth, MDBeachwood OphthalmologyOffice Phone: 216.831.0120Appointments: 216.444.2020Email: [email protected] Appointment: 1999Specialty Interests: Corneal and refractive

surgery, LASIK, cataract surgery

Elias Traboulsi, MDHead, Department of Pediatric Ophthalmol-ogy; Director, Graduate Medical Education; Education Institute; Children’s Hospital staff; Genomic Medicine InstituteOffice Phone: 216.444.4363Appointments: 216.444.3627

Email: [email protected] Appointment: 1997Specialty Interests: Ocular diseases of children, genetic eye diseases, strabismus, retinoblastoma, congenital cataracts, childhood glaucoma, residency education

I N f e C T I O U S D I S e A S e

Steven Gordon, MDChairman, Infectious DiseaseOffice Phone: 216.444.8975Appointments: 216.444.8845Email: [email protected] Appointment: 1994Specialty Interests: epidemiology,

infections, endocarditis, cardiac device infections

Robin Avery, MDSection Head, Transplant Infectious Disease; Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityOffice Phone: 216.444.8977Appointments: 216.444.8845

Email: [email protected] Appointment: 1993Specialty Interests: Transplantation infectious disease, infection in the immunocompromised host

Steven Mawhorter, MDInfectious DiseaseOffice Phone: 216.445.2412Appointments: 216.444.8845Email: [email protected] Appointment: 1995Specialty Interests: Immunology, parasitic

medicine, infections, travel/tropical medicine, diagnostic testing in infectious diseases

Sherif Mossad, MDInfectious DiseaseOffice Phone: 216.445.2572Appointments: 216.444.8845Email: [email protected] Appointment: 1996Specialty Interests: Infectious complica-

tions and vaccinations in bone marrow and solid organ transplant recipients; upper respiratory tract infections, including influenza and rhinovirus

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Koji Hashimoto, MDHepato-pancreato-biliary and Transplant SurgeryOffice Phone: 888.410.1775, option 4Email: [email protected] Appointment: 2009Specialty Interests: Abdominal multi-organ

transplant

Ezra Steiger, MDHead, Intestinal Rehabilitation Program; Co-Director, Nutrition Support Team;Hepato-pancreatic-biliary and Transplant SurgeryOffice Phone: 216.444.6667Appointments: 216.445.2090

Email: [email protected] Appointment: 1975Specialty Interests: Parenteral nutrition, home parenteral nutrition, intestinal rehabilitation

Le-Chu Su, MD, PhD, CPNSGastroenterology and HepatologyOffice Phone: 216.445.4875Appointments: 216.444.6536 Email: [email protected] Appointment: 2003Specialty Interests: Malabsorption, short

bowel syndrome, celiac disease, inflammatory bowel disease, small bowel transplant

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Cristiano Quintini, MDProgram Director, Intestinal Transplant; Surgical Director, Intestinal Rehabilitation and Transplantation Program; Hepato-pancreato-biliary and Transplant Surgery; General SurgeryOffice Phone: 216.445.3388

Appointments: 216.444.6664Email: [email protected] Appointment: 2006 Specialty Interests: Living donor liver transplantation, liver transplant, liver surgery, intestinal transplant and surgery

Donald Kirby, MD Medical Director, Intestinal Transplant Program; Director, Center for Human Nutrition; Gastroenterology and HepatologyOffice Phone: 216.445.6609Appointments: 216.444.6536Email: [email protected]

Staff Appointment: 2008Specialty Interests: Gastroenterology and internal medicine, complex nutritional issues

Bijan Eghtesad, MDHepato-pancreato-biliary and Transplant Surgery; General SurgeryOffice Phone: 216.444.9898Appointments: 216.444.6664Email: [email protected] Appointment: 2005

Specialty Interests: Liver transplantation, hepatitis B and C, liver transplantation in HIV-positive patients, living donor liver transplantation, immunosuppression, organ donation, recovery and preservation

John J. Fung, MD, PhDDirector, Transplant Center; Chairman, Hepato-pancreato-biliary and Transplant Surgery; Chairman, General SurgeryOffice Phone: 216.444.3776Appointments: 216.444.6664Email: [email protected]

Staff Appointment: 2004Specialty Interests: Liver transplantation; hepatobiliary and liver, kidney, pancreas and intestinal transplant surgery; immunology; liver cancer

L I v e R

Charles Miller, MDProgram and Surgical Director, Liver Transplantation; Hepato-pancreato-biliary and Transplant Surgery; General SurgeryOffice Phone: 216.445.2381Appointments: 216.444.6664Email: [email protected]

Staff Appointment: 2004.Specialty Interests: Liver transplantation, hepato-biliary surgery, living donor liver transplantation

Nizar N. Zein, MDMedical Director, Liver Transplantation; Chief, Section of Hepatobiliary Diseases; Gastroenterology and Hepatology; Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

Office Phone: 216.444.6126Appointments: 216.444.6536Email: [email protected] Appointment: 2002Specialty Interests: Liver diseases, liver transplantation, viral hepatitis

Talal Adhami, MDGastroenterology and HepatologyOffice Phone: 216.444.8501Appointments: 216.444.6536Email: [email protected] Appointment: 2006Specialty Interests: hepatitis C, hepatitis, liver

conditions, liver transplantation

Federico Aucejo, MDHepato-pancreato-biliary and Transplant Surgery; General SurgeryOffice Phone: 216.445.7159Appointments: 216.444.6664Email: [email protected] Appointment: 2006

Specialty Interests: Liver transplantation, living donor liver transplantation, hCC, general surgery, pediatric liver transplant, laparoscopic liver surgery

David Barnes, MDVice Chairman, Gastroenterology and HepatologyOffice Phone: 216.444.1764Appointments: 216.444.6536Email: [email protected] Appointment: 1986

Specialty Interests: Liver and biliary tract disease, liver transplantation, diagnostic/therapeutic endoscopy

Ana Bennett, MDAnatomic PathologyOffice Phone: 216.444.3796Appointments: 216.444.3796Email: [email protected] Appointment: 2003Specialty Interests: Gastrointestinal pathology

with emphasis on polyposis syndromes and idiopathic inflammatory bowel disease; liver and pancreas pathology including neoplastic, inflammatory conditions and transplan-tation pathology

Mary Bronner, MDAnatomic Pathology; Cancer BiologyOffice Phone: 216.444.4833Email: [email protected] Appointment: 2003Specialty Interests: Gastrointestinal hepatic and pancreaticobiliary pathology, molecular

diagnostics

William Carey, MDGastroenterology and Hepatology; Director, Center for Continuing Education; Vice Chairman, Division of EducationOffice Phone: 216.444.6885Appointments: 216.444.6536Email: [email protected]

Staff Appointment: 1976Specialty Interests: liver transplantation, liver-biliary tract disease, endoscopy

Jacek Cywinski, MDAnesthesiologyOffice Phone: 216.444.2305Email: [email protected] Appointment: 2003 Specialty Interests: hepatic transplantation anesthesia, intraoperative Tee, vascular

anesthesia, organ preservation, clinical research

I N T e S T I N A L

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John J. Fung, MD, PhDDirector, Transplant Center; Chairman, Hepato-pancreato-biliary and Transplant Surgery; Chairman, General SurgeryOffice Phone: 216.444.3776Appointments: 216.444.6664Email: [email protected]

Staff Appointment: 2004Specialty Interests: Liver transplantation; hepatobiliary and liver; kidney; pancreas and intestinal transplant surgery; immunology; liver cancer

Michael Geisinger, MDDiagnostic RadiologyOffice Phone: 216.444.6654Appointments: 216.444.5405Email: [email protected] Appointment: 1982Specialty Interests: Interventional radiology,

angiography, angioplasty, uroradiology, hepatobiliary intervention

John Goldblum, MDChairman, Anatomic Pathology; Professor of Pathology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityOffice Phone: 216.444.8238Email: [email protected] Appointment: 1995

Specialty Interests: Gastrointestinal, hepatic and soft tissue pathology

Koji Hashimoto, MDHepato-pancreato-biliary and Transplant SurgeryOffice Phone: 888.410.1775, option 4Email: [email protected] Appointment: 2009Specialty Interests: Abdominal multi-organ

transplant

Robert Helfand, MDHead, Anesthesia for Orthopaedic and Rheumatologic InstituteOffice Phone: 216.444.0185Email: [email protected] Staff Appointment: 1999Specialty Interests: Regional anesthesiology,

blood conservation, anesthesia for liver transplantation

Srinivasan Dasarathy, MDGastroenterology and HepatologyOffice Phone: 216.444.2980Appointments: 216.444.6536Email: [email protected] Appointment: 2006Specialty Interests: Liver transplantation, non-

alcoholic fatty liver disease, skeletal muscular loss in liver disease

Milan Dodig, MDGastroenterology and HepatologyOffice Phone: 216.444.8501Appointments: 216.444.2276Email: [email protected] Appointment: 2006Specialty Interests: Noninvasive GI imaging

(wireless capsule endoscopy), liver fibrosis, cirrhosis

Bijan Eghtesad, MDHepato-pancreato-biliary and Transplant Surgery; General SurgeryOffice Phone: 216.444.9898Appointments: 216.444.6664Email: [email protected] Appointment: 2005

Specialty Interests: Liver transplantation, hepatitis B and C, liver transplantation in HIV-positive patients, living donor liver transplantation, immunosuppression, organ donation, recovery and preservation

Kyrsten Fairbanks, MDGastroenterology and HepatologyOffice Phone: 216.444.2708Appointments: 216.444.6536Email: [email protected] Appointment: 2004Specialty Interests: Liver disease, liver

transplantation

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Vera Hupertz, MDDirector, Pediatric Transplant Hepatology; Pediatric Gastro-enterologyOffice Phone: 216.444.0964Appointments: 216.444.9000Email: [email protected] Appointment: 2000

Specialty Interests: Pediatric liver disease and transplanta-tion, inflammatory bowel disease, chronic pancreatitis

SamuelIrefin,MDAnesthesiologyOffice Phone: 216.445.1152Email: [email protected] Appointment: 1997Specialty Interests: Anesthesia for liver transplantation, critical care medicine, clinical

research, orthopaedic anesthesia, resident education

Dympna Kelly, MDHepato-pancreato-biliary and Transplant Surgery; General SurgeryOffice Phone: 216.444.1888Appointments: 216.444.8770Email: [email protected] Appointment: 2005

Specialty Interests: Liver transplantation, liver transplant research, resident education

Jia Lin, MD, PhDAnesthesiologyOffice Phone: 216.444.4613Email: [email protected] Staff Appointment: 2001Specialty Interests: Anesthesia for compli-cated cardiovascular, neurologic and spine

surgical procedures; anesthesia for transplant procedures; anesthesia for patients with difficult airways

Theodore Marks, MD, PhDHead, Anesthesia for Heart and Vascular InstituteOffice Phone: 216.444.6154Email: [email protected] Staff Appointment: 2000Specialty Interests: vascular anesthesia,

anesthesia for liver transplantation

Arthur McCullough, MDChairman, Gastroenterology and Hepatology; PathobiologyOffice Phone: 216.444.2766Appointments: 216.444.6536Email: [email protected] Appointment: 2006

Specialty Interests: fatty liver, nutrition in liver disease, chronic liver disease and cirrhosis of the liver, viral hepatitis, hepatocellular carcinoma

Robert O’Shea, MD, MSCEGastroenterology and HepatologyOffice Phone: 216.444.6518Appointments: 216.444.6536Email: [email protected] Appointment: 2004Specialty Interests: End-stage liver disease,

liver transplantation, viral hepatitis, drug-induced liver disease

Brian M. Parker, MDHead, Section of Anesthesia for General Surgery and Liver TransplantationOffice Phone: 216.444.4136Email: [email protected] Appointment: 1997Specialty Interests: hepatic transplantation

anesthesia

Claudene Pritchard, MDAnesthesiologyOffice Phone: 216.445.7008Email: [email protected] Staff Appointment: 2007Specialty Interest: Liver transplantation

Cristiano Quintini, MDProgram Director, Intestinal Transplant; Surgical Director, Intestinal Rehabilitation and Transplantation Program; Hepato-pancreato-biliary and Transplant Surgery; General SurgeryOffice Phone: 216.445.3388

Appointments: 216.444.6664Email: [email protected] Appointment: 2006 Specialty Interests: Living donor liver transplantation, liver transplant, liver surgery, intestinal transplant and surgery

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Jamile Wakim-Fleming, MDGastroenterology and HepatologyOffice Phone: 216.444.1764Appointments: 216.444.6536Email: [email protected] Appointment: 2002Specialty Interests: Liver diseases, women’s

health

Charles Winans, MDHepato-pancreato-biliary and Transplant Surgery; General SurgeryOffice Phone: 216.445.0612Appointments: 216.444.6664Email: [email protected] Appointment: 2002

Specialty Interests: Liver and pancreas transplantation, hepatobiliary surgery, general surgery

Lisa Yerian, MDAnatomic PathologyOffice Phone: 216.445.7234Email: [email protected] Appointment: 2004Specialty Interests: Liver pathology, gastro-intestinal pathology

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Kadakkal Radhakrishnan, MDPediatric GastroenterologyOffice Phone: 216.444.9322Email: [email protected] Appointment: 2006Specialty Interests: Chronic pancreatitis, cyclic vomiting, diagnostic and therapeutic

endoscopy, Intestinal failure and small bowel rehabilitation in children, liver disorders in children and care of liver trans-plant patients, metabolic disorders - care of GI problems in metabolic disorders - care of liver related metabolic problems, pediatric liver disease, pediatric liver transplantation, pediat-ric liver diseases, small intestine short bowl rehab

Mangalakaraipudur Ramachandran, MDAnesthesiologyOffice Phone: 216.444.5581Email: [email protected] Staff Appointment: 2002Specialty Interests: Cardiothoracic anesthesia, vascular anesthesia, obstetric anesthesia,

regional anesthesia

Mark Sands, MDRadiologyOffice Phone: 216.444.5616Appointments: 216.444.6381Email: [email protected] Appointment: 1998Specialty Interests: vascular and interven-tional radiology

Ralph Tuthill, MDAnatomic PathologyOffice Phone: 216.444.2245Email: [email protected] Appointment: 1981Specialty Interests: Dermatopathology, hepatic pathology and cytopathology

David Vogt, MDGeneral SurgeryOffice Phone: 216.444.6968Appointments: 216.444.6664Email: [email protected] Appointment: 1981Specialty Interests: Liver, biliary and pancreatic surgery; liver transplantation

L I v e R continued

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L U N G A N D h e A R T / L U N G

Atul C. Mehta, MDVice Chairman, Pulmonary, Allergy andCritical Care Medicine; Head, Section of BronchologyOffice Phone: 216.444.2911Appointments: 216.444.6568Email: [email protected]

Staff Appointment: 1983Specialty Interests: Lung transplantation, advanced lung diseases; diagnostic and therapeutic bronchoscopy, endo-bronchial laser therapy, endobronchial radiation therapy, fiberoptic bronchoscopy, rigid bronchoscopy, bronchogenic carcinoma, transtracheal oxygen therapy, congenital lung disease, alpha-1 antitrypsin deficiency

Gösta Pettersson, MD, PhDVice Chairman, Thoracic and Cardiovascular Surgery; Program and Surgical Director, Lung and Heart-Lung Trans plantOffice Phone: 216.444.2035Appointments: 216.444.4466Email: [email protected]

Staff Appointment: 1999Specialty Interests: Adult and congenital acquired heart and aortic diseases including reoperations; surgical treatment of endocarditis; aortic valve repair, preservation (including remodeling and reimplantation) and replacement (including homograft and Ross procedure); adult congenital heart surgery; surgery of the thoracic aorta; lung and heart/lung transplantation.

Marie Budev, DO, MPH, FCCPProgram and Medical Director, Lung Transplant; Pulmonary, Allergy and Critical Care MedicineOffice Phone: 216.444.3194Appointments: 216.444.6503Email: [email protected]

Staff Appointment: 2004Specialty Interests: Lung and heart lung transplantation, secondary pulmonary hypertension, cystic fibrosis, gender specific pulmonary issues

Nicholas Smedira, MDProgram and Surgical Director, Heart Transplant Program and Kaufman Center for Heart Failure; Thoracic and Cardiovascular Surgery; Polly and W. Neil Rossborough Chair in Cardiac TransplantationOffice Phone: 216.445.7052

Appointments: 216.444.4466Email: [email protected] Appointment: 1995Specialty Interests: heart and heart/lung transplantation, ventricular assist devices, eCMO, heart failure surgery, aortic and mitral valve repair and replacement, off-pump coronary bypass grafting, myectomy, reoperations, ascending and descending thoracic aortic replacement

Jeffrey Chapman, MDPulmonary, Allergy and Critical Care MedicineOffice Phone: 216.444.4222Appointments: 216.444.6503Email: [email protected] Appointment: 2000

Specialty Interests: Interstitial lung disease, idiopathic pulmonary fibrosis, advanced lung disease

Lara Danziger-Isakov, MD, MPHPediatric Infectious DiseasesOffice Phone: 216.636.1077Appointments: 216.444.5437Email: [email protected] Appointment: 2003Specialty Interests: Infections in transplanta-

tion and the immunocompromised host, epidemiology, clinical trials, pediatric infectious diseases

Carol Farver, MDAnatomic Pathology; Pathobiology; Pulmonary, Allergy and Critical Care MedicineOffice Phone: 216.445.7695Appointments: 216.445.7695Email: [email protected]

Staff Appointment: 1995Specialty Interest: Pulmonary pathology


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Thomas R. Gildea, MDMedical Director, Center for Major Airway Diseases; Pulmonary, Allergy and Critical Care Medicine; Transplant CenterOffice Phone: 216.444.6490Appointments: 216.444.6503Email: [email protected]

Staff Appointment: 2003Specialty Interests: Advanced diagnostic/therapeutic bronchoscopy, interventional pulmonary medicine, lung volume reduction, lung transplantation, alpha-1 antitrypsin deficiency

Steven Gordon, MDChairman, Infectious DiseaseOffice Phone: 216.444.8975Appointments: 216.444.8845Email: [email protected] Appointment: 1994Specialty Interests: epidemiology, infections,

hIv/AIDS, interventional pulmonary medicine, lung volume reduction, lung transplantation, alpha-1 antitrypsin deficiency

Michael Machuzak, MDPulmonary, Allergy and Critical Care MedicineOffice Phone: 216.444.2718Appointments: 216.444.6503Email: [email protected] Appointment: 2006

Specialty Interests: Bronchoscopy with advanced diagnostics, including endobronchial ultrasound, TBNA and electromag-netic navigation; therapeutics, including rigid bronchoscopy, laser and endobronchial surgery, and bronchial thermoplasty; COPD and lung cancer, including clinical trials; pleural disease; stent placement

David P. Mason, MDCardiothoracic SurgeryOffice Phone: 216.444.4053Appointments: 216.445.6860Email: [email protected] Appointment: 2004Specialty Interests: General thoracic surgery,

minimally invasive thoracoscopic and laparoscopic surgery, lung cancer, esophageal cancer, malignant mesothelioma, lung transplantation, immunosuppression

L U N G A N D h e A R T / L U N G continued Kenneth McCurry, MD Thoracic and Cardiovascular SurgeryOffice Phone: 216.445.9303Appointments: 216.445.6860Email: [email protected] Appointment: 2009Specialty Interests: Thoracic and

cardiovascular surgery, pathobiology

Omar A. Minai, MDPulmonary, Allergy and Critical Care MedicineOffice Phone: 216.445.2610Appointments: 216.445.2610Email: [email protected] Appointment: 1999

Specialty Interests: Pulmonary hypertension, COPD, sleep apnea, lung volume reduction, lung transplantation

Sudish Murthy, MD, PhDThoracic and Cardiovascular SurgeryOffice Phone: 216.444.5640Appointments: 216.445.6860Email: [email protected] Appointment: 1999Specialty Interests: Lung transplantation,

esophageal, pulmonary, mediastinal, chest wall and diaphragm surgery; minimally invasive surgery; lung volume reduction surgery; general thoracic surgery

Thomas Olbrych, MDPulmonary, Allergy and Critical Care MedicineOffice Phone: 216.445.8733Appointments: 216.444.6503Email: [email protected] Appointment: 2006

Specialty Interests: Adult cystic fibrosis, lung transplantation, COPD, asthma, general pulmonary medicine

PA N C R e A S A N D K I D N e Y / PA N C R e A S

Venkatesh Krishnamurthi, MDProgram and Surgical Director, Pancreas Transplant; UrologyOffice Phone: 216.444.0393Appointments: 216.444.5600Email: [email protected] Appointment: 2000

Specialty Interests: Kidney and pancreas transplantation, urologic oncology

Emilio Poggio, MDMedical Director, Pancreas Transplant; Director, Renal Function Laboratory; Nephrology and HypertensionOffice Phone: 216.444.5383Appointments: 216.444.6771Email: [email protected]

Staff Appointment: 2003Specialty Interests: Kidney and pancreas transplantation, chronic kidney disease in solid organ transplantation, chronic kidney disease, evaluation of renal function

Charles Winans, MDSurgical Co-Director, Pancreas Transplant; Hepato-pancreato-biliary and Transplant Surgery; General SurgeryOffice Phone: 216.445.0612Appointments: 216.444.6664Email: [email protected]

Staff Appointment: 2002Specialty Interests: Liver and pancreas transplantation, hepatobiliary surgery, general surgery

Richard Fatica, MDVice Chairman, Nephrology and Hypertension Medical Director, Kidney Transplant; Nephrology and HypertensionOffice Phone: 216.445.9953Appointments: 216.444.6771Email: [email protected]

Staff Appointment: 2000Specialty Interests: Chronic kidney disease, dialysis, kidney transplant, fellowship education

Saul Nurko, MDNephrology and HypertensionOffice Phone: 216.445.8628Appointments: 216.444.6771Email: [email protected] Appointment: 1997Specialty Interests: Chronic kidney disease,

anemia of chronic renal disease, iron metabolism, hemodialy-sis, acute renal failure, glomerulonephritis, acute renal failure, renal transplantation

John Rabets, MDUrologyOffice Phone: 216.444.1120Appointments: 216.444.5600Email: [email protected] Appointment: 2007 Specialty Interests: Kidney transplantation,

pancreas transplantation, general urology

Titte Srinivas, MDNephrology and HypertensionOffice Phone: 216.445.0034Appointments: 216.444.6771Email: [email protected] Appointment: 2008 Specialty Interests: Kidney and pancreas

transplantation, medical evaluation and long-term follow-up of living kidney donor, renal issues after non-renal organ transplants

Alvin Wee, MDRegional Urology (Indianapolis)Office Phone: 317.338.6556Email: [email protected] Appointment: 2008Specialty Interests: Renal transplantation, renal vascular surgery

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David A. Goldfarb, MDProgram and Surgical Director, Renal Transplant; UrologyOffice Phone: 216.444.8726Appointments: 216.444.5600Email: [email protected] Appointment: 1992

Specialty Interests: Renal transplantation

Richard Fatica, MDMedical Director, Renal Transplant; Nephrology and HypertensionOffice Phone: 216.445.9953Appointments: 216.444.6771Email: [email protected] Appointment: 2000

Specialty Interests: Chronic kidney disease, dialysis, kidney transplant, glomerulonephritis

William Baldwin, MD, PhDImmunologyOffice Phone: 216.445.9953Email: [email protected] Appointment: 2008Specialty Interests: Cardiac and renal allograft rejection, vascular inflammation

William Braun, MDNephrology and HypertensionOffice Phone: 216.444.6995Appointments: 216.444.6771Email: [email protected] Appointment: 1968Specialty Interests: Renal transplantation,

polycystic kidney disease, glomerulonephritis

Shih-Chieh Chueh, MD, PhDRegional Urology (Charleston Area Medical Center)Office Phone: 304.388.6370Email: [email protected] Appointment: 2009Specialty Interests: Laparoscopic surgery

(especially laparoscopic donor nephrectomy), immunosuppressive monitoring

Robert Fairchild, PhDUrology; ImmunologyOffice Phone: 216.444.3146Email: [email protected] Appointment: 1990Specialty Interests: Transplantation immunology, T-lymphocyte tolerance

Stuart M. Flechner, MDUrologyOffice Phone: 216.445.5772Appointments: 216.444.5600Email: [email protected] Appointment: 1993Specialty Interests: Renal transplantation,

vascular disease, oncology

Surafel Gebreselassie, MDNephrology and HypertensionOffice Phone: 216.444.6768Appointments: 216.444.6771Email: [email protected] Appointment: 2008Specialty Interests: CKD, renal

transplantation, glomerulonephritis

Priya Kalahasti, MDNephrology and HypertensionOffice Phone: 216.444.5788Appointments: 216.444.6771Email: [email protected] Appointment: 2006Specialty Interests: nephrology and

hypertension

Jihad Kaouk, MDDirector, Center for Advanced Laparoscopic and Robotic Surgery; UrologyOffice Phone: 216.444.2976Appointments: 216.444.5600Email: [email protected] Appointment: 2002

Specialty Interests: Laparoscopic surgery of the adrenal, kidney, bladder and prostate; cryosurgery and needle ablation of kidney tumor; robotic surgery

Venkatesh Krishnamurthi, MDProgram and Surgical Director, Pancreas Transplant; UrologyOffice Phone: 216.444.0393Appointments: 216.444.5600Email: [email protected] Appointment: 2000

Specialty Interests: Kidney and pancreas transplantation, urologic oncology

Charles Kwon, MDCenter for Pediatric NephrologyOffice Phone: 216.444.6123Appointments: 216.444.3627Email: [email protected] Appointment: 2008Specialty Interests: Congenital renal

malformations, nephrotic syndrome, pediatric hypertension, dialysis and kidney transplantation

Charles Modlin, MD, FACSDirector, Minority Men’s Health Center; Director, Cleveland Clinic Minority Organ Donation Initiative; UrologyOffice Phone: 216.445.7550Appointments: 216.444.5600Email: [email protected]

Staff Appointment: 1996Specialty Interests: Renal transplantation, general urology, prostate, renal cancer, minority healthcare initiatives

Joseph Nally, MDNephrology and HypertensionOffice Phone: 216.444.8897Appointments: 216.444.6771Email: [email protected] Appointment: 1987Specialty Interests: Renal disease and

transplantation, hypertension, renovascular disease

Saul Nurko, MDNephrology and HypertensionOffice Phone: 216.445.8628Appointments: 216.444.6771Email: [email protected] Appointment: 1997Specialty Interests: Chronic renal disease,

anemia of chronic kidney disease, iron metabolism, hemodialysis, acute renal failure, glomerulonephritis, acute renal failure, renal transplantation

Emilio Poggio, MDMedical Director, Pancreas Transplant; Director, Renal Function Laboratory; Nephrology and HypertensionOffice Phone: 216.444.5383Appointments: 216.444.6771Email: [email protected]

Staff Appointment: 2003Specialty Interests: Kidney and pancreas transplantation, transplant immunobiology, immune biomarkers, living donation

John Rabets, MDUrologyOffice Phone: 216.444.1120Appointments: 216.444.5600Email: [email protected] Appointment: 2007 Specialty Interests: Kidney transplantation,

pancreas transplantation, general urology

Bashir Sankari, MDRegional Urology (Charleston Area Medical Center)Office Phone: 304.388.6370Email: [email protected] Appointed: 1991 Specialty Interests: Renal transplantation,

renal vascular surgery

Martin Schreiber Jr., MDChairman, Nephrology and HypertensionOffice Phone: 216.444.6365Appointments: 216.444.6771Email: [email protected] Appointment: 1982Specialty Interests: Diabetic renal disease,

home dialysis, cardiorenal syndrome, complications of dialysis, ICU nephrology, peritoneal dialysis, renovascular hypertension

Daniel Shoskes, MDUrologyOffice Phone: 216.445.4757Appointments: 216.444.5600Email: [email protected] Appointment: 2000Specialty Interests: Kidney transplantation,

chronic prostatitis, interstitial cystitis, chronic pelvic pain syndrome

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Titte Srinivas, MDNephrology and HypertensionOffice Phone: 216.445.0034Appointments: 216.444.6771Email: [email protected] Appointment: 2008 Specialty Interests: Kidney and pancreas

transplantation, medical evaluation and long-term follow-up of living kidney donor, renal issues after non-renal organ transplants

Brian Stephany, MDNephrology and HypertensionOffice Phone: 216.444.5382Appointments: 216.444.6771Email: [email protected] Appointment: 2004Specialty Interests: Renal transplantation,

chronic kidney disease after non-renal solid organ transplantation

Alvin Wee, MDRegional Urology (Indianapolis)Office Phone: 317.338.6556Email: [email protected] Appointment: 2008Specialty Interests: Renal transplantation, renal vascular surgery

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Michael Joyce, MDMedical Director, Musculoskeletal Tissue Bank, Orthopaedic SurgeryOffice Phone: 216.444.4282Appointments: 216.444.2606Email: [email protected] Appointment: 1993

Specialty Interests: Trauma, oncology, total joint replace-ment, musculoskeletal tissue banking

Steven Lietman, MDOrthopaedic Surgery; Director, Musculo-skeletal Tumor CenterOffice Phone: 216.445.2742Appointments: 216.444.2606Email: [email protected] Appointment: 2004

Specialty Interests: Bone and soft tissue tumors, total joint replacement (hip and knee)

George Muschler, MDVice Chairman, Orthopaedic and Rheumatologic Institute; Director, Clinical Tissue Engineering Center; Director, Orthopaedic and Rheumatologic Research Center; Vice Chairman, Department of Biomedical EngineeringOffice Phone: 216.444.5338

Appointments: 216.444.2606Email: [email protected] Staff Appointment: 1988Specialty Interests: Joint replacement of the hip and knee, treatment of fracture non-union, arthritis surgery

Kenneth Marks, MDOrthopaedic SurgeryOffice Phone: 216.692.7780Appointments: 216.444.2606Specialty Interests: hip and knee replacement

Maria Siemionow, MD, PhDPlastic Surgery; Orthopaedic Surgery; ImmunologyOffice Phone: 216.445.2405Appointments: 216.444.6900Email: [email protected] Appointment: 1995

Specialty Interests: Microsurgery, hand surgery, peripheral nerve surgery, microcirculation research

S U P P O R T

BioethicsEric Kodish, MD

Chairman, Bioethics DepartmentOffice Phone: 216.444.3850Email: [email protected] Appointment: 2004Specialty Interests: Pediatric ethics, research ethics, childhood cancer

Paul Ford, PhDBioethics DepartmentOffice Phone: 216.444.8723Email: [email protected] Appointment: 2001Specialty Interests: Bioethics, clinical ethics consultation, neurosurgical ethics

Carmen Paradis, MDBioethics DepartmentOffice Phone: 216.445.2767Email: [email protected] Appointment: 2006Specialty Interests: Research ethics, informed consent, ethics education

Martin Smith, STDDirector, Clinical Ethics, Bioethics DepartmentOffice Phone: 216.445.2769Email: [email protected] Appointment: 1987Specialty Interests: ethics consultation,

end-of-life issues, institutional ethics committees, medical mistakes, informed consent

Anthony Thomas, MDBioethics DepartmentOffice Phone: 216.445.7850Email: [email protected] Appointment: 1982Specialty Interests: Reproductive and pediatric ethics

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S U P P O R T continued

Bioethics continued

Kathryn Weise, MD, MABioethics DepartmentOffice Phone: 216.445.1404Email: [email protected] Appointment: 1997Specialty Interests: Pediatric critical care; pediatric palliative medicine; biomedical ethics

Biomedical engineeringPaul Murray, PhD

Biomedical Engineering; Center for Anesthesiology ResearchOffice Phone: 216.444.0543Email: [email protected] Appointment: 1994Specialty Interests: Pulmonary vasoregula-

tion, anesthesia, lung transplantation, signal transduction

endocrinologyAngelo A. Licata, MD, PhD

EndocrinologyOffice Phone: 216.444.6248Appointments: 216.444.6568Email: [email protected] Appointment: 1982–2002;Consultant: 2002 – present

Specialty Interests: Calcium disorders, metabolic bone and skeletal problems, osteoporosis

ImmunologyThomas Hamilton, PhD

Chairman, ImmunologyOffice Phone: 216.444.6246Email: [email protected] Appointment: 1987Specialty Interests: Macrophage activation, inflammation, inflammatory gene expression

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Psychiatry and PsychologyKathy Coffman, MD, FAPM

Psychiatry and PsychologyOffice Phone: 216.444.8832Appointments: 216.636.5860Email: [email protected] Appointment: 2007 Specialty Interests: Alcohol and drug abuse

in liver transplant patients, delirium, immunomodulatory effects of psychotropic drugs, CNS effects of scleroderma and celiac disease

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ThANKS TO OUR DONATION AND PROCUReMeNT AGeNCIeS

The Cleveland Eye Bank

Founded in 1958, the Cleveland Eye Bank is a nonprofit organization dedicated to restoring sight by providing tissue for transplantation, research and teaching. Donated eyes are retrieved, evaluated and distributed by the eye Bank. The Cleveland eye Bank serves almost 5 million people and 65 area hospitals. Last year more than 600 corneas were provided for sight-restoring corneal trans-plants.

for more information, please call 216.844.EYES.

LifeBanc

LifeBanc is Northeast Ohio’s federally designated, nonprofit organ procurement organization (OPO). Increasing organ and tissue donation for those awaiting transplant is one of LifeBanc’s main goals. Working with more than 80 hospi-tals, LifeBanc is responsible for all aspects of the organ and tissue recovery and donation processes, public and professional education programs, and bereave-ment services for donor families. LifeBanc is a member of the United Network of Organ Sharing (UNOS) and an accredited member of the Association of Organ Procurement Organizations (AOPO) and the American Association of Tissue Banks (AATB).

for more information, please call 216.752.LIFE (5433) or888.558.LIFE (5433), or visit lifebanc.org.

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Cleveland Minority Organ Tissue Transplant Education Program

The Cleveland Minority Organ Tissue Transplant Education Program (MOTTEP) is a nonprofit organization that seeks to increase awareness through education and advocacy about organ and tissue donation, disease prevention and wellness within minority communities of Greater Cleveland.

for more information, or to schedule educational programs, please call 216.295.7007.

The National Marrow Donor Program

The National Marrow Donor Program (NMDP) is a nonprofit organization that manages the world’s largest register of volunteer stem cell donors and cord blood units. It facilitates lifesaving blood stem cell transplants for patients fight-ing diseases such as leukemia, aplastic anemia and other blood and marrow diseases.

for more information, please call 800.MARROW2.

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Cleveland Clinic Transplant CenterDesk A110

9500 euclid Ave.

Cleveland, Ohio 44195

216.444.2394

800.223.2273, ext. 42394

fax: 216.444.9375

Cleveland Clinic encompasses 1,800 physicians and scientists in 120 specialties and subspecialties. All of these specialties — along with pediatrics at the Cleveland Clinic Pediatric Institute and Children’s hospital — are present in one facility, making multidisciplinary consultation, diagnosis and treatment readily available.

In 2008, Cleveland Clinic was ranked one of America’s top four hospitals, according to U.S.News & World Report’s annual “Best hospitals Survey.” Cleveland Clinic has been listed among the nation’s top five hospitals every year since 1999. Cleveland Clinic also celebrated 14 years of being ranked as the nation’s No. 1 cardiac care center. In addition, the survey ranks 16 Cleveland Clinic specialty care areas among the nation’s best, with 10 of those areas ranked among the Top 10 in the United States.

CLeveLAND CLINIC

Photography: Tom Merce, Don Gerda,

Steve Travarca, Al fuchs

08-TRC-002

Documents

TRANSPLANTATION | 2008 · In 2007 we initiated an auto-islet transplantation program for a sub-group of chronic pancreatitis patients. • Kidney Transplantation Cleveland Clinic