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Organ Transplant Program

NewYork-Presbyterian Hospital

HEART

INTESTINAL AND MULTIVISCERAL

KIDNEY

LIVER

LUNG

PANCREAS

Managing the spectrum

of organ failure

and transplantation

Leadership in Organ Transplantation

The comprehensive transplant services at NewYork-Presbyterian

Hospital support longstanding programs in heart, liver, lung, kid-

ney, and pancreatic transplantation, and most recently, intestinal

and multivisceral transplantation. Ranking first in the nation in

the number of solid organ transplants performed each year,

NewYork-Presbyterian physicians treat adults and children with

the most complex and challenging problems. These include many

patients referred from centers across the U.S. and internationally,

including multi-organ transplant recipients. The center’s out-

comes are excellent in each program.

NewYork-Presbyterian Hospital has made important contribu-

tions to increasing the pool of available donor organs through

innovative approaches in organ selection, preservation, immune

protocols, and improved monitoring of graft status. Its faculty

are also dedicated to the study of ethics and public policy related

to transplantation, and the study of long-term health in donors

and recipients.

The Hospital’s faculty have a distinguished history of advancing

standards of care and survival rates by employing innovative

surgical techniques and by applying basic scientific research in

immunosuppression to the clinical setting. Additionally, cardiac

and liver patients benefit from the invention and perfection of

life-sustaining cardiac and liver devices that extend and improve

the lives of patients awaiting organ transplantation.

Moreover, the program recognizes the complexity of how out-

comes are affected by the myriad factors impacting donors’ and

recipients’ health. When performing transplantation as an imme-

diate lifesaving event, some disparities between donor and recip-

ient are to be expected. In all cases, however, the clinicians strive

to maximize patients’ health prior to transplantation, minimize

donors’ medical issues, and, based on clinical experience, to best

match donor organs with the most appropriate recipients.

Looking to the future of organ transplantation at NewYork-

Presbyterian, Manikkam Suthanthiran, MD, says, “An important

goal is to provide individualized treatment for each transplant

recipient. With the use of molecular diagnostic approaches, we

plan to minimize immunosuppressive drug therapy and offer

personalized medicine to our patients. Our ultimate goal is to

altogether eliminate the need for immunosuppressive drugs.”

Transplant Initiative

At NewYork-Presbyterian Hospital/Columbia University Medical

Center, a major transplant initiative has been launched to drive

the growth of both clinical and research aspects of transplanta-

tion. This multi-year undertaking will involve medicine, pathology,

and surgery in both adults and children.

Although the Hospital is already a national leader in clinical

transplantation with respect to volume and patient outcomes,

this initiative will further leverage the diverse expertise of its

transplant scientists and clinicians. The goal: new discoveries in

patient care and deeper understanding of the biology of

transplantation. “Formalizing and further integrating the com-

munity of transplant professionals will better position NewYork-

Presbyterian/Columbia to carry out larger research initiatives

both in the laboratory and in patient care,” according to Jean C.

Emond, MD. “The objective is to have a full-spectrum center

dedicated to transplantation – one at the leading edge of discov-

ery and delivery of care – a center of excellence for translational

research, new creativity in medical and surgical care, and the

achievement of groundbreaking outcomes.”

With its commitment to excellence in every facet of organ trans-

plantation, patients and their primary care physicians can expect

the Hospital to provide the highest level of care at every stage of

transplantation and beyond.

Jean C. Emond, MD

Vice Chair and Director of Transplantation,

NewYork-Presbyterian Hospital/

Columbia Medical Center

Thomas S. Zimmer Professor of Surgery,

Columbia University College of Physicians

and Surgeons

Manikkam Suthanthiran, MD

Chief, Department of Transplantation

Medicine, NewYork-Presbyterian Hospital/

Weill Cornell Medical Center

Chief, Division of Nephrology and

Hypertension, and Stanton Grifﬁs

Distinguished Professor of Medicine,

Weill Cornell Medical College

NewYork-Presbyterian Hospital

Comprehensive Capabilities for Adult Organ Transplantation

Heart Failure and Transplantation 2

Intestinal and Multivisceral Transplantation 6

Kidney Transplantation 8

Liver Transplantation 12

Lung Transplantation 16

Pancreas Transplantation 20

Heart Failure and Transplantation

The heart failure and transplantation program at NewYork-Presbyterian Hospital is the

largest and most active heart transplant program in the nation. In 2007, the program

celebrated its 2000th transplant — a milestone no other U.S. hospital has achieved.

Overview

The program consistently treats patients with significant co-

morbidities and high risks, including those with cardiac amyloi-

dosis, diabetes-related end-stage organ damage, and HIV.

Despite taking on these high-risk patients, the program’s survival

rates have consistently met or exceeded the national average

since its inception in 1977. UNOS ranked NewYork-Presbyterian

Hospital’s heart transplantation program number one in 2006

and 2007, and the program continues to lead the nation in both

transplant volume and outcomes today.

Patients with end-stage cardiac disease receive state-of-the-art

care at both campuses of the Hospital.



The Center for Advanced Cardiac Care at NewYork-Presbyter-

ian/Columbia has evolved from what was the very first U.S.

program devoted solely to the treatment of congestive heart

failure. Today it offers the full range of medical and surgical

treatments for heart failure, including established as well as

late generation investigational LVADs.



The Mechanical Circulatory Support Program at NewYork-

Presbyterian/Columbia stands as a clear leader in the implan-

tation, development, and study of left ventricular assist

devices, both as bridge-to-transplantation and as destination

therapy. The program is committed to improving LVAD tech-

nology and to extending the availability of LVADs to under-

served patient populations (including small adults and

children). The latest devices, which are much smaller and

more comfortable than earlier predecessors, are now being

placed for longer-term use with excellent results.



The Perkin Center for Heart Failure at the Ronald O. Perelman

Heart Institute of NewYork-Presbyterian Hospital/Weill Cornell

Medical Center is dedicated to medical and surgical manage-

ment of heart failure. It offers special expertise in treating pa-

tients with pulmonary hypertension and right heart failure.

Ren´e Perez

Surgeons performing a heart transplant

at NewYork-Presbyterian Hospital.

▲

2 Heart Transplantation

Innovations

Innovation is the driving force behind the heart failure and trans-

plantation program, with physician-researchers making daily

advances in medical therapies, surgical techniques, immunologic

therapies, imaging methods, and device development.

The program’s long history of innovation encompasses many

milestones, including:



the first mechanical bridge-to-transplantation using intra-

aortic balloon pumps, in the 1970's;



the first pediatric heart transplant, in 1984;



the development of minimally invasive and hybrid (surgical-

catheter based) cardiac procedures;



the development of third-generation LVAD technologies;



the improvement of immunosuppressant regimens;



the creation of a gene-based blood test to replace heart

biopsies to detect rejection after transplantation;



the implementation of extended criteria organ transplantation

to improve access to transplantation; and



the use of gene therapy in the treatment of heart failure.

Implantation of LVAD.

▲

Ultrasound of the heart (axial

section) showing left ventricular

hypertrophy.

Inclusion Criteria

Patients with end-stage cardiac

disease and a life expectancy

of less than one year will be

considered for transplantation.

These patients will have one of

the following:



NYHA Class III or IV CHF re-

fractory to maximal medical

therapy. Objective data

would include a reduced left

ventricular ejection fraction

and a reduced functional ca-

pacity with maximal oxygen

consumption <10 ml/kg/min;



Inoperable coronary artery

disease with intractable

anginal symptoms;



Malignant ventricular ar-

rhythmias unresponsive to

medical or surgical therapy.

Eligibility for

Transplantation

Inclusion Criteria for

LVAD Implantation



Transplant candidate;



NYHA Class III or IV CHF

refractory to maximal medical

therapy;



Patients dependent on

intravenous inotropic support;



PCW or LAP >20, systolic

BP<80, CI<2.0;



Systolic BP<60.

Ren´e Perez

▲

Heart

Research

On the cutting edge:



Researchers at NewYork-Presbyterian/Columbia are currently

conducting a study on the SERCA-2 gene, which is critical

for proper contraction of the heart muscle. Intracoronary

injections of the gene may restore cardiac function and output

in patients with severe heart failure.



One arm of the SCCOR grant (see sidebar) is investigating the

combination of stem cell therapy in conjunction with LVADs to

facilitate recovery of the native heart.



Columbia and Weill Cornell researchers are studying the

etiologies of heart failure and pulmonary hypertension, and

are working to develop targeted therapies based on their

discoveries.



Cardiac transplantation researchers at NewYork-Presbyterian/

Columbia developed a non-invasive blood test to detect organ

rejection after heart transplantation. The team is now applying

similar genetic techniques to better define the phenotypes of

heart failure and develop an approach that will be applicable

to pulmonary hypertension.

Currect Clinical Trials:



HeartMate®II: For advanced-stage heart

failure patients: This multicenter trial, led

by NewYork-Presbyterian/Columbia,

found that recipients of the device as

bridge-to-transplantation achieved over

90% survival;



SCCOR: $17 million NIH grant to investi-

gate the most significant challenges asso-

ciated with LVAD therapy – infection,

coagulation, and neurological events;



COPS: Cardiac Output Prognosis Study:

noninvasively measuring cardiac output to

achieve better risk-stratification and iden-

tify patients best suited for transplantation

or LVAD therapies;



Rapamycin vs Neoral: Evaluation of

therapy in preserving kidney function after

cardiac transplant surgery;



NIH RO1 Grant: Erythropoietin in dias-

tolic heart failure;



NIH RO1 Grant: Oxidized LDL in heart

failure;



Assessment of Endothelial Dysfunction in

heart failure with venous biopsies;



CARGO: Genomic profiling to detect allo-

graft rejection after heart transplantation;



CUPID: First gene therapy trial in heart

failure.

Richard Stowe received a HeartMate II in 2006. He feels

completely normal and mobile, and has been able to

eliminate or reduce many of his heart medications. Echo-

cardiography in April 2009 revealed dramatic improve-

ment: his left ventricle is perfectly normal in size, his

ejection fraction has increased from 5-10% to 40%, and

the other chambers of his heart continue to improve.

▲

Comparison of larger LVAD to newer,

smaller device.

▲

Charles Manley

4 Heart Transplantation

Jada Fabrizio

Patient Care

The surgeons and cardiologists at NewYork-Presbyterian Hospital

have a long and distinguished history of advancing standards of

care and the survival rates of patients by using innovative surgical

techniques, by applying basic scientific research in immunosup-

pression to the clinical setting, and by inventing and perfect-

ing life-sustaining cardiac assist devices that prolong life during

the wait for organ availability. Underpinning all their efforts is a

solid foundation of collaborative, multidisciplinary cooperation.

High-risk surgeries, such as coronary bypass surgery with mitral

valve repair, are routinely performed to restore ventricular func-

tion and improve cardiac function sufficiently to avoid transplan-

tation. Where possible, catheter-based techniques are now

replacing open surgeries, or they are employed in conjunction

with traditional surgical techniques in new “hybrid” procedures,

to provide patients with the least invasive, least traumatic, most

effective solutions.

Use of the newest ventricular assist devices now produces fewer

complications and less bleeding than older versions, making

them suitable for patients in earlier stages of disease. The physi-

cians’ expertise in choosing the best therapeutic window for VAD

implantation benefits many patients, who may now receive opti-

mal support before transplantation with smaller, quiet, comfort-

able devices.

For patients who require transplant surgery, protocols are in place

to ensure rapid and seamless coordination of care between the

two transplant centers of the Hospital. Alternate waiting list

strategies for heart transplantation are helping to maximize the

use of extended donor organs. As a result, waiting times to

transplantation are lower at the Hospital than at other centers in

the region, and the ability to transplant sooner translates into

better post-transplant outcomes.

The heart transplant program has implemented extended criteria

protocols for both organ donors and transplant recipients. Today,

extended donor organs are routinely utilized, and may be offered

to patients over age 65 or those formerly considered too com-

promised to undergo transplantation. These extended criteria

protocols are significantly widening the availability of organs and

providing the option of transplantation to patients who would

otherwise be denied treatment, with superior results.

Outcomes

The Hospital currently performs over 100 heart transplant surger-

ies each year, making it the largest U.S. heart transplant program

by volume. UNOS ranked this program first in the nation in 2006

and 2007. One of 12 high-performing transplant centers in the

nation, the Hospital's heart transplant program is part of the

Health Resources Services Administration (HRSA) Transplant Cen-

ter Growth and Management Best Practices Study.

Heart Failure and Transplantation

NewYork-Presbyterian Hospital/

Columbia University Medical Center

Presbyterian Hospital Building, Room 1262

622 West 168th Street

New York, NY 10032

Cardiac Transplant Center: 212.305.7600

Emergency referrals and transfers: 800.NYP.STAT

The use of extended donor and extended recipient criteria permits

transplantation for patients who might never receive a transplant otherwise,

providing more options to improve patients’ quality of life.

“

— Ulrich P. Jorde, MD, Assistant Professor of Clinical Medicine

Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center.

For the most current data regarding heart transplant

outcomes, please visit www.ustransplant.org.

01 234

Standard 221 150 93 33

High Risk 37 24 17 5

Year 0 1 2 3 4

Year

1.00

0.75

0.50

0.00

0.25

Kaplan-Meier actuarial analysis comparing the survival of

high-risk and standard list recipients at NewYork-Presbyterian/

Columbia, post-transplant (p>0.05).

Source: NewYork-Presbyterian Heart Transplantation Program data, 2007

Heart

Intestinal and Multivisceral Transplantation

Intestinal and multivisceral transplantation have become a standard of care in adults

and children with intestinal failure or certain abdominal tumors.

6 Intestinal and Multivisceral Transplantation

▲

Overview

Approximately 200 patients worldwide currently undergo intes-

tinal and multivisceral transplantation each year, the majority of

which take place in the United States. NewYork-Presbyterian

Hospital/Columbia University Medical Center is among the few

U.S. transplantation centers with the expertise to offer this rare

clinical service.

Intestinal grafts are classified as one of the following types:



Isolated intestinal transplantation for patients with intestinal

failure but who have a functioning liver;



Combined liver and intestinal transplantation, for patients

with liver and intestinal failure but normal stomach and

pancreas; and



Multivisceral transplantation including the stomach, liver,

pancreas, and intestine.

Because allograft rejection remains a serious risk, intestinal trans-

plantation has largely been reserved for life-threatening condi-

tions associated with total parenteral nutrition and liver failure.

As advances in surgical technique, immunosuppressant drugs,

and post-operative monitoring have significantly improved

survival, earlier transplantation (before liver failure) has become a

viable option. Approximately 70% of multivisceral transplant

recipients now survive at one year.

Physicians should refer patients with short bowel syndrome for

evaluation at the Center for Liver Disease and Transplantation as

early as possible, and before the development of liver failure due

to total parenteral nutrition (TPN).

Research

A high priority of intestinal and multivisceral transplant research

is expansion of the indications for transplantation to patients

with tumors. The Hospital’s research plans include trials investi-

gating oncological indications for transplant, as well as studies

on induction of tolerance after transplantation.

Advances in multivisceral transplantation now allow unprecedented

procedures like the one illustrated above.

Figure 1: A lemon-sized tumor, attached to the main arteries and wedged

behind several organs, was considered unresectable by other

institutions.

Figure 2: At NewYork-Presbyterian Hospital, surgeons successfully

removed the patient’s liver, pancreas, spleen, stomach, small intestine,

and two-thirds of the large intestine.

Figure 3: After excising the tumor safely, the team reconstructed the

blood vessels and performed auto-transplantation to reattach the

patient’s organs. In a very similar procedure, surgeons successfully

excised a deeply embedded tumor from a pediatric patient at NewYork-

Presbyterian Morgan Stanley Children’s Hospital.

Nancy Heim

▲

Innovations

Autotransplantation for Ex Vivo Tumor Resection

Columbia transplant surgeons at NewYork-Presbyterian have

established a new method of performing ex vivo tumor resection

for tumors involving the blood vessels that supply the major ab-

dominal organs. Because of their inaccessibility and their location

in or near the major vessels, such tumors are considered inopera-

ble by most centers. The option of autotransplantation allows

surgeons to remove the intestine, liver, or other abdominal organs

as required in order to access the tumor resection. After excising

the tumor, they reconstruct the blood vessel and then reimplant

the patient’s native organs. Patients undergoing autotransplanta-

tion need no immunosuppressant medications following surgery,

and outcomes have been excellent.

Abdominal Wall Transplantation

Abdominal wall transplantation is the reconstruction and closure

of the abdominal compartment, which may be necessary after

extensive abdominal resections, repeated laparotomies, tumor

resection, wound infections or enterocutaneous fistulae. Abdo-

minal wall transplantation may also be required to close the

abdomen after small-bowel and multivisceral transplantation.

NewYork-Presbyterian is one of the few centers in the country

with experience performing this novel technique.

Intestinal and Multivisceral Transplantation

Outcomes

Worldwide, the one-year survival rate for isolated intestinal trans-

plantation is over 77%. Increased survival rates are associated

with surgeons’ experience in intestinal and multivisceral trans-

plantation, patient volumes greater than 10 cases per year, and

immunosuppression protocols that include induction therapy.*

*Source: 2003 Report of the International Intestine Transplant Registry

Indications for referral and evaluation

Short bowel syndrome caused by mesenteric vascular

thrombosis;

Crohn’s disease;

Trauma;

Volvulus;

Functional disorders such as chronic intestinal pseudo-

obstruction;

Multiple or extensive desmoid tumors, including

Gardener’s syndrome, which necessitate extensive

intestinal removal.

Closure of the abdomen through

abdominal wall transplantation.

Autotransplantation can also be used in place of traditional transplantation

for some patients, precluding the need for a donor organ. This could

save lives and make lifelong post-transplant immunosuppression unnecessary.

—Jean C. Emond, MD, Vice Chair and Director of Transplantation,

NewYork-Presbyterian Hospital/Columbia University Medical Center

“

Intestinal and Multivisceral Transplantation

NewYork-Presbyterian Hospital/

Columbia University Medical Center

Presbyterian Hospital Building, 14th floor

622 West 168th Street

New York, NY 10032

Phone: 877.LIVER.MD

Emergency referrals and transfers: 800.NYP.STAT

Kidney Transplantation

Kidney transplantation is the optimal therapy for patients with end-stage renal disease,

affording them healthy and productive lives free from dialysis.

8 Kidney Transplantation

Preparation of a donor kidney

before transplantation.

▲

Overview

The kidney transplantation programs at both NewYork-Presbyter-

ian/Columbia and NewYork-Presbyterian/Weill Cornell are the

oldest in the region and the largest in the nation. NewYork-

Presbyterian/Weill Cornell works in conjunction with the Rogosin

Institute, one of the top comprehensive renal centers in the na-

tion. The multidisciplinary transplant team is composed of sur-

geons, nephrologists, social workers, financial coordinators, and

other specialists, who rely routinely on the expertise of an unpar-

alleled pathology unit at the Hospital, as well as its blood bank

and apheresis unit.

Both programs are committed to increasing access to transplan-

tation and returning patients to active lives. Living donor

transplantation is done whenever possible in order to perform

transplantation before patients require dialysis.

For those patients on the UNOS waiting list for a deceased

donor organ, the renal transplantation programs use a highly ef-

fective method of managing their waiting lists. This aggressive

approach ensures that those patients at the top of the list are

ready to be transplanted as soon as a kidney is available. This ap-

proach is complemented by comprehensive protocols to evaluate

all potential organs, including those in the ‘extended criteria’

category. These strategies have reduced the waiting time for

deceased donor organs by an average of four years, reducing

the number of patient deaths while on the waiting list and sig-

nificantly improving outcomes after transplantation.

For patients with other co-morbidities, the programs offer com-

prehensive medical and surgical care in every field. Diabetic pa-

tients with end-stage renal failure may receive pancreatic

transplantation, either simultaneously with the kidney or in a

separate procedure following kidney transplantation. Patients

with advanced cardiac or liver disease may be candidates for

combined heart-kidney or liver-kidney transplantation.

Jada Fabrizio

Innovations

Established in 1961 and 1969, respectively, the kidney transplant

programs at NewYork-Presbyterian/Weill Cornell and NewYork-

Presbyterian/Columbia have a long history of innovation. Both

are dedicated to providing every possible opportunity for trans-

plantation, and to overcoming the most significant challenges in

kidney transplantation. They have developed innovative strate-

gies to increase access to transplantation not only for average

patients, but for people with difficult problems, and those with

immunologic incompatibilities. The programs are national lead-

ers in developing creative approaches including:



ABO incompatible transplantation;



Transplantation across positive cross-match;



Desensitization of HLA antibodies in deceased donor opera-

tions; and



Paired exchanges, including both simple and complex ex-

changes, and transplants involving both compatible and

incompatible live donors.

NewYork-Presbyterian/Columbia is a national leader in the per-

formance of multiple paired living donor kidney transplantation,

a revolutionary approach that may dramatically improve the op-

portunity for patients in need of kidney transplants to find a

compatible donor.

NewYork-Presbyterian/Weill Cornell was a pioneer in developing

the Never Ending Altruistic Donation (NEAD), in which one altru-

istic (or “non-directed”) living kidney donor, willing to donate to

any patient awaiting transplantation, can begin a chain of kid-

ney transplants that otherwise would not be possible.

At NewYork-Presbyterian/Weill Cornell, physician scientists were

the first to develop gene-expression-based assays to non-inva-

sively detect organ rejection after kidney transplantation (pub-

lished in 2001). Using biomarkers available in simple urine tests,

this unique program allows for individualizing and minimizing

the amount of immunosuppressive therapy that patients require.

Donor kidney ready for transplantation

at NewYork-Presbyterian Hospital.

▲

Kidney

The renal transplantation programs offer

patients with end-stage kidney disease four

transplant alternatives.

■

Compatible live donor transplants: The gold standard of

kidney transplant procedures. A kidney from a perfectly

matched sibling donor can function for an average of 35

years, while less perfectly matched kidneys function for 20

years on average.

■

Paired donor exchanges: Offer the benefits inherent in

finding a compatible live donor, compared to waiting for

a deceased donor. Paired donor exchanges have been

performed at NewYork-Presbyterian Hospital since 2004.

Several three-way exchanges (requiring six simultaneous

operations), one four-way exchange, and a six-way ex-

change have also been successfully performed.

■

Incompatible live donors: An option if the donor and re-

cipient are either blood-group incompatible or incompatible

due to antibodies against the transplant antigens. To accept

a kidney from an incompatible donor, the recipient’s blood

must be repeatedly “cleansed” of mismatched antibodies

through plasmapheresis.

■

Deceased donor procedures: Reserved for those patients

who do not have any willing or medically suitable live

donors. Deceased donor kidneys have a good chance of

maintaining their function for 10 years post-transplant.

A donor-recipient pair that was compatible with one another

(patient 3) participated in a paired kidney exchange in order to

facilitate the transplantation of two other recipients who had

incompatible donors (patients 1 and 2).

OAB

AB A

Spouse

Recipient 1

Recipient 2

Recipient 3

Friend

Spouse

Altruistic Unbalanced Paired Kidney Exchange

Recipients Donors

Jada Fabrizio

10 Kidney Transplantation

Research

A major area of research focuses on overcoming immunologic

incompatibilities in transplant recipients. In particular, the pro-

grams are researching ways to optimize paired kidney exchanges

and to improve immunosuppressant protocols. Continued re-

search is underway to perform both donor and transplant opera-

tions through minimally invasive techniques. At this time all

donor operations are done laparoscopically. In recipients, smaller

surgical incisions and laparoscopic operations are undergoing

preclinical testing. Other research efforts include:



investigations of live donor risk;



research to further reduce the already low risk of hemorrhagic

complications in donors;



ways to expand the profile of suitable donors; and



improving immunosuppression regimens.

Patient Care

Together, the two campuses perform over 450 kidney

transplants per year. Trials of most new therapeutic op-

tions are available to NewYork-Presbyterian Hospital's

patients due to their high volume and superb academic

and research facilities.

Aggressive extended criteria protocols enable surgeons

on both campuses to safely use more organs than ever

for transplantation. These protocols are highly success-

ful, especially among older recipients and those doing

poorly on dialysis.

The programs are leaders in coordinating “donor

swaps” to maximize the availability of compatible donor

kidneys. Both centers actively encourage altruistic live

organ donation and are prepared to perform multiple

simultaneous donor and recipient operations.

Where compatible donors are not available, the pro-

grams are among the few worldwide to offer incompati-

ble kidney transplantation. They use the latest

immunologic strategies to cleanse mismatched antibod-

ies from recipients' blood, allowing the transplantation

of kidneys into recipients who would normally reject the

graft. Long-term survival among incompatible recipients

is equivalent to that for compatible transplants.

After transplantation, 90% of patients at NewYork-

Presbyterian Hospital are able to avoid steroid use, as

part of a highly successful steroid avoidance protocol in

place since 2001. Molecular-based techniques, which are

under continued research, now provide patients at both

campuses with highly personalized immunosuppressant

therapy in order to reduce or eliminate the use of steroids

after transplantation. Over 700 transplanted patients re-

main completely free of steroid medications post-trans-

plant, with an average rejection rate of just six percent.

Incompatible Transplants and Paired Exchanges

Since the programs established their comprehensive incompatible

renal transplant programs, over 90 patients have received kidney

transplants when they did not have a compatible live donor, via

ABO blood group incompatible transplants, transplants across a

positive crossmatch, or paired kidney exchanges.

Transplant Rate While on Waitlist

NewYork-Presbyterian OPO Region U.S.

Kidney

Columbia University

Deceased

Donors Only

Kidney

Weill Cornell

Deceased

Donors Only

0.41* 0.36* 0.19 0.20 0.20

0.23* 0.23* 0.12 0.13 0.14

0.37* 0.34* 0.19 0.19 0.20

0.25* 0.16* 0.12 0.12 0.14

*Statistically higher compared to U.S.

Patients at NewYork-Presbyterian Hospital are signiﬁcantly more likely to

receive a kidney transplant while on the waitlist than patients at other

hospitals regionally and nationally.

Suturing the anastomosis during

kidney transplant surgery.

▲

7/06-6/07 7/07-6/08 7/07-6/08 7/07-6/08 7/07-6/08

Source: SRTR Center and OPO Specific Reports, January 2009

Kidney

Partners in Care

Numerous specialty programs provide additional services to en-

sure the comprehensive depth and breadth of care:

A program with the Columbia University Department of Obstet-

rics and Gynecology provides women with specialized care in

fertility and pregnancy after kidney transplantation.

A program with the Columbia University Department of Derma-

tology specializes in treating skin cancer and other dermatologic

diseases in transplant patients.

The Live Donor Programs at both campuses are dedicated to the

health and well-being of potential live donors. These programs

advocate solely for donors and act completely independently of

the needs of recipients.

The program at NewYork-Presbyterian/Weill Cornell works in

seamless conjunction with the Rogosin Institute, one of the top

comprehensive renal disease programs in the nation. Transplant

operations take place in a dedicated transplant facility, while

patients receive medical care at the Rogosin Institute.

At NewYork-Presbyterian/Columbia, patients receive pre- and

post-surgical care at the Beverly and Arthur Shorin Comprehen-

sive Outpatient Transplant Center.

Outcomes

Since U.S. News & World Report began ranking nephrology,

NewYork-Presbyterian Hospital has been ranked in the top ten in

the nation every year. Even with a large volume of complex

cases, its programs’ outcomes surpass the national average.

The challenges of immunologic incompatibility have been mitigated by our ability

to perform multiple exchanges or incompatible transplants with antibody

removal techniques, so that patients who were otherwise relegated to

the waitlist are now receiving transplants far more quickly than ever before.

“

— Lloyd E. Ratner, MD, Director, Kidney & Pancreas Transplantation,

NewYork-Presbyterian Hospital/Columbia University Medical Center

For the most current data regarding renal transplant out-

comes, please visit www.ustransplant.org.

Source: SRTR Center and OPO Specific Reports, January 2009

Valerie Beckford, left,

received a kidney

from friend and

co-worker Jeanette

Martinez, right.

▲

0 20 40 60 80 100

Observed

Expected

Patient Survival Rate

96.95

95.64

Observed

Expected

94.33

92.25

NewYork-Presbyterian/Weill Cornell

1-year

3-years

0 20 40 60 80 100

Observed

Expected

Patient Survival Rate

96.67

96.40

Observed

Expected

91.18

91.42

NewYork-Presbyterian/Columbia

1-year

3-years

Kidney Transplantation

NewYork-Presbyterian Hospital/

Columbia University Medical Center

Presbyterian Hospital Building, 12th Floor

622 West 168th Street

New York, NY 10032

Phone: 212.305.6469

NewYork-Presbyterian Hospital/

Weill Cornell Medical Center

525 East 68th Street

New York, NY 10065

Phone: 212.517.3099

Emergency referrals and transfers: 800.NYP.STAT

Liver Disease and Transplantation

For patients with advanced organ failure, the Center for Liver Disease and

Transplantation provides comprehensive treatment including medical, radiologic,

and surgical care for the most complex and serious diseases.

12 Liver Transplantation

Examination of a donor liver that

was stored with machine preser-

vation.

▲

Overview

Protocols for early intervention and prevention of decompensation

are highly effective in treating many patients. Transplantation serv-

ices are available for patients in whom all other efforts fail.

The Center for Liver Disease and Transplantation (CLDT) performed

its 1000th transplant in 2008. The center’s outcomes consistently

meet or exceed the expected national average.

The center's uptown and downtown academic medical center loca-

tions are seamlessly integrated, with close collaboration among he-

patologists, gastroenterologists, hepatobiliary surgeons, diagnostic

and pathology experts, advanced practice nurses, social workers,

and patient support staff.

By improving access to transplantation, particularly in regions

such as New York that have longer waiting lists, living donor liver

transplantation may reduce patients' risk of dying by 20-40%.

In living donor liver transplantation, up to 60% of a donor's liver

may be removed for an adult transplant, and up to 20-25% for a

child recipient. The donor's liver regenerates to its original size in

several weeks, and donors return to normal activity within about

a month.

The National Living Donor Assistance Center (NLDAC), established

by the U.S. Health Resources and Services Administration (HRSA),

provides financial assistance for travel, lodging, and meals to

those who want to donate an organ and would otherwise not be

able to afford these expenses.

Living Donor Liver Transplantation

Microscopic comparison

of normal liver biopsy

(left) with hepatocellular

carcinoma (right) .

▲

Innovations

The Center for Liver Disease and Transplantation (CLDT) is com-

mitted to understanding and extending the limits of organ

transplantation in order to provide the greatest number of trans-

plants possible with a limited organ supply.

Numerous clinical trials have yielded methods to reduce the size

of tumors, and in so doing, render patients eligible for trans-

plantation. Among patients with unresectable localized cancer

who have undergone transplantation, the five-year survival rate

is 75-80%.

Living Donor Transplantation

Dr. Emond was a member of the team that pioneered living

donor liver transplantation, which is now considered one of the

most important advances in the treatment of severe liver dis-

ease. Approximately 15-20% of the center's transplant patients

currently receive a liver from a living donor.

Partial Liver Transplantation

NewYork-Presbyterian Hospital was one of the first institutions

to perform split liver transplantation. This procedure now ac-

counts for a substantial proportion of liver transplants in the

U.S., primarily in children.

Organ Preservation

The CLDT has completed a pilot study in machine perfusion to

improve organ preservation between procurement and transplan-

tation. By better protecting the donor organ and preventing dam-

age that can occur between harvesting and transplantation,

surgeons can safely use a wider range of organs with excellent

outcomes. The next step of this study involves repairing and trans-

planting organs that would otherwise have been considered un-

usable, but that are safe and effective after treatment.

Multi-Organ Transplantation

The Hospital has extensive experience in performing combined

liver-kidney transplantations. Approximately 5% of the trans-

plant volume consists of combination procedures. In the sum-

mer of 2007, one pediatric patient received five organs in a rare

multi-organ transplant operation, reflecting the Hospital’s expert

capabilities.

Transplantation for Patients with Liver and Bile Duct Cancer

The CLDT has established a new protocol to perform transplanta-

tion in patients with hilar cholangiocarcinoma. In this experi-

mental protocol, patients receive chemoradiation to eliminate

systemic malignant cells, followed by transplant. Early results

are promising, with no patients having tumor recurrence after

orthotopic liver transplantation. This compares favorably with

the recurrence rate of cholangiocarcinoma after medical or sur-

gical therapy.

Top: Cirrhotic liver stained with trichrome stain. Diffuse

scarring (excess collagen) appears blue; rounded

regenerative nodules (hepatocytes) appear red.

Bottom: In auxiliary partial orthotopic liver transplanta-

tion (APOLT), a partial donor liver provides support

while the native liver recovers.

Liver

▲

Partial Liver Transplantation for Acute Liver Failure

Patients with fulminant hepatic failure traditionally have had

limited options: timely recovery of the native liver with medical

management, or liver transplantation. Having revamped a proce-

dure that was largely abandoned in the 1980’s, transplant sur-

geons at NewYork-Presbyterian/Columbia are now able to offer

patients an important alternative. In auxiliary partial orthotopic

liver transplantation (APOLT), the surgeons resect part of the fail-

ing native liver and attach a partial donor liver to it. The donor

liver supports the patient during recovery, clearing toxins and

preventing brain injury. In the majority of patients, the native liver

recovers with this support. Immunosuppressant medication can

then be withdrawn, and the donor liver withers in most patients.

Although partial liver transplantation is particularly suited to chil-

dren because the regenerative capacity of their livers is optimal,

this technique may also be applied in young adults. In studies it

has proven highly successful, with 100% of patients surviving at

the time of this publication. Over half of patients have com-

pletely withdrawn from immunosuppression and the remainder

are in the process of withdrawal. One patient required surgical

removal of the donor liver. NewYork-Presbyterian Hospital is one

of only a few hospitals worldwide with the expertise to perform

partial liver transplantation.

14 Liver Transplantation

Regina Williams with her son, Paul Mladineo, who

donated part of his liver when his mother experi-

enced liver failure due to autoimmune disease.

“Paul and I are doing great. Our livers are functioning

perfectly,” says Williams.

▲

Research

Clinical innovation and scientific progress constitute the core of

the Center for Liver Disease and Transplantation’s mission. The

CLDT participates in multiple government- and industry-funded

clinical research studies at any given time. Patients at the CLDT

have the opportunity to receive treatments that are available in

few or no other centers. The Hospital is also a major center for

the study of outcomes for liver disease treatment and liver trans-

plantation.

Many of the CLDT’s 40-plus studies address hepatitis C, which is

the leading indication for transplantation and a major cause of

organ failure after transplantation.

The CLDT is a leader in the multi-center Adult to Adult Living-

donor Liver Transplant (A2ALL) study, a NIH sponsored trial to in-

vestigate the outcomes of living donor transplantation.

Current Clinical Trials:



Solid Organ Transplantation in HIV: The primary aim of

this observational trial is to evaluate the safety and efficacy

of solid organ transplantation in patients with HIV disease;



Boceprevir (SPRINT 2): A phase 3 safety and efficacy

study of boceprevir in previously untreated patients with

chronic hepatitis C genotype 1;



Telaprevir (Vertex 111): A randomized study of stopping

treatment at 24 weeks vs. continuing treatment to 48

weeks in treatment naive patients with genotype 1 hepati-

tis C who achieve an extended viral response (eRVR) while

receiving telaprevir, pegylated interferon and ribavirin;



Rimonabant (NASH): A placebo controlled trial to study

rimonabant treatment in non-diabetic and type 2 diabetic

patients with nonalcoholic steatohepatitis;



Adefovir Plus Vaccination: Determining the efficacy of

adefovir dipivoxil (ADV) and vaccination in recipients of liv-

ers testing positive for hepatitis B core antibody;



HBV Inflammatory Markers: Assessment and clinical

utility of non-invasive parameters of inflammatory activity

in chronic hepatitis B;



Gilead-0108: Double-blind, multi-center, randomized

study comparing tenofovir disoproxil fumarate, emtric-

itabine plus tenofovir disoproxil fumarate, and entecavir in

the treatment of chronic hepatitis B subjects with decom-

pensated liver disease;



Live Donor Education: Increasing liver donation through

peer-developed education: baseline survey (HRSA);



ALF Adult: A multi-center study of acute liver failure in

adults;



Liver Perfusion: Hypothermic machine preservation of

liver grafts for transplantation;



A2ALL Cohort Study: Adult-to-adult living donor liver

transplantation cohort study;



A2ALL LADR: Low accelerating dose regimen of pegy-

lated interferon and ribavirin pretransplant, to eliminate

post transplant hepatitis C virus recurrence;



ELAD: A bioartificial liver assist device for patients with

acute or chronic liver failure.

Patient Care

The Center for Liver Disease and Transplantation offers the

full spectrum of services to patients with liver disease, from con-

sultations on all forms of benign and malignant liver disease,

to antiviral therapies for hepatitis B and hepatitis C, to transplan-

tation.

Patients co-infected with hepatitis C or HIV may also receive

transplant services at the CLDT, as can patients with cancer of

the bile ducts. NewYork-Presbyterian Hospital is one of very few

institutions to provide these options.

The CLDT is committed to providing care to patients and will

work to assist them with their financial needs.

Living donor liver transplantation

▲

Our surgical team has become expert at assessing the quality and properties of different

types of organs — deceased standard criteria donor, deceased extended criteria organs,

or living donor — and can determine which patient will most benefit from each one.

“

— Dianne LaPointe-Rudow, DNP, Senior Transplant Coordinator and Clinical Director of the Living

Donor Liver Transplant Program, NewYork-Presbyterian Hospital/Columbia University Medical Center

For the most current data regarding liver transplant outcomes,

please visit

www.ustransplant.org.

Living Donor Recipient Criteria:

A potential live donor liver transplant recipient must:



Meet the current listing criteria for liver transplant;



Be listed with OPTN/UNOS;



Be informed of the risks/benefits, alternative treatments and

outcomes for living donor and deceased donor transplantation;



Sign consent to have potential donors evaluated for living

donation.

2007 One-Year Patient Survival at New York Transplant Centers

(percentage of patients survivng one year)

NYPH-CUMC Other Centers

Source: OPTN/SRTR 2007 Annual Report

Outcomes

The Center for Liver Disease and Transplantation has the highest

survival rate while on the waiting list, and the shortest waiting

time, in the New York State region. According to SRTR data from

2007, the Center’s waiting list mortality rate is 7%, compared

with 13% at the other four regional transplant centers. This is

even better than expected when adjusted for the severity of pa-

tients’ illness while on the waiting list.

From January 2004 to June 2006, the CLDT had a 98% survival

rate for the 267 adults, and 97% survival rate for the 43 children

on whom it performed liver transplants; the national rate was

96%. In that period, the one-year post-transplant survival rate

was 88% for adults (87% nationally) and 94% for children.

Liver

Liver Disease and Transplantation

NewYork-Presbyterian Hospital/

Columbia University Medical Center

Presbyterian Hospital Building, 14th floor

622 West 168th Street

New York, NY 10032

Phone: 877.LIVER.MD

NewYork-Presbyterian Hospital/

Weill Cornell Medical Center

1305 York Avenue, 4th floor

New York, NY 10065

Phone: 646.962.LIVER

Emergency referrals and transfers: 800.NYP.STAT

Lung Transplantation

Lung transplantation can prolong and dramatically improve quality of life for patients

with severe end-stage, non-malignant pulmonary disease and no alternative treatment

options. The majority of patients return to work, school, and other activities within

three to six months of surgery.

16 Lung Transplantation

Chest X-ray showing chronic

obstructive pulmonary disease (COPD).

▲

Overview

Widely regarded as the preeminent center for lung transplanta-

tion in the New York tri-state area, the Center for Lung Disease

and Transplantation at NewYork-Presbyterian/Columbia Univer-

sity Medical Center has the highest three-year survival rate

among the U.S. News & World Report Honor Roll Hospitals. Its

patient volume has dramatically risen during the last seven years,

earning the program a position in the top five programs in the

nation in 2007.

Comprehensive, coordinated, multidisciplinary care is provided to

patients with every type of lung disease. To avoid transplantation

whenever feasible, patients are evaluated with second opinion

consultations for eligibility in the interstitial lung disease pro-

gram, the pulmonary hypertension program, adult cystic fibrosis

program, lung volume reduction program, or for eligibility in

new clinical trials. These options can effectively treat certain

conditions with less invasive alternatives, or offer therapies that

serve as a bridge to lung transplantation, delaying the need to

perform this difficult treatment option.

Specialized programs within or affiliated with the Center for

Lung Disease and Transplantation include:



The Jo-Ann F. LeBuhn Center for Chest Disease;



High Risk Lung Assessment Program;



Thoracic Oncology Program;



Interventional Bronchoscopy and Endobronchial Therapy

Program, for the treatment of endobronchial tumors or

tracheobronchial obstructions.

For patients who progress to end-stage lung failure, transplanta-

tion is offered when the expected survival with their native lungs

is one to two years.

ISM/Phototake

Innovations

Since 1986, lung transplant research has been dedicated to im-

proving outcomes in life-threatening lung diseases. Studies at

the Center for Lung Disease and Transplantation continue to

improve treatment options, prevent or delay the progression of

serious lung diseases, and improve the quality of life and sur-

vival for patients. These achievements have been most notable

in the areas of emphysema, idiopathic pulmonary fibrosis, pul-

monary arterial hypertension, and cystic fibrosis.

The Center has pioneered the use of minimally invasive lung

volume reduction (LVR) surgery as well as bronchoschopic LVR

for patients with emphysema. It also uses video-assisted thoracic

surgery (VATS) for both diagnostic and therapeutic interventions

for a number of chest problems that previously required large,

open surgical incisions.

Through laboratory research and participation in multi-center

clinical trials, the Center’s physicians continue to drive progress in

lung transplantation. New immunosuppressive drugs and drug

combinations are increasing the longevity of the transplanted

organ, and decreasing side effects associated with therapy. Ther-

apeutic regimens to prevent and treat infections are also being

investigated. The researchers are investigating methods for pre-

serving donor lungs for a longer period of time before they must

be transplanted into the recipient. Additionally, lung transplant

program clinical investigators are focusing on identifying specific

factors in patients that may help determine the optimal timing of

transplantation.

Understanding Rejection after Transplantation

The Lung Transplant Program is in the vanguard of addressing

the most significant risks to lung transplantation patients:

rejection of the donor organ and infections. Although medical

regimens can successfully protect patients against acute organ

rejection that occurs usually in the first year following transplant

surgery, chronic rejection slowly and steadily undermines the

health of over half of lung transplant patients during the first five

years after transplantation.



Research at NewYork-Presbyterian/Columbia has shed light on

the important role of gastro-esophageal reflux (GER) as one of

the causes of chronic lung graft dysfunction, also known as

chronic rejection.



Researchers at the Center have recently discovered the role

played by a pair of protein receptors in the immune system’s

ability to develop tolerance to a new organ. Their work is part

of an ongoing investigation into why and how transplanted

organs are rejected by the body so that new and improved

methods for protecting a transplanted lung can evolve.



The Center is testing new immunological surveillance tech-

niques to enable the diagnosis of more subtle forms of rejec-

tion earlier than ever before, which ultimately could improve

lung transplant patients’ quality and length of life.

Chest X-ray, front view,

of a 25-year-old woman

with pulmonary sarcoidosis.

▲

Lung

Main Disease Indications

For Transplantation



Interstitial Lung Disease



Cystic Fibrosis



Chronic Obstructive Pulmonary Disease



Pulmonary Hypertension and Sarcoidosis

ISM/Phototake

18 Lung Transplantation

Research

Current clinical studies in lung transplantation include:



The use of inhaled cyclosporine versus placebo to prevent the

development of chonic lung rejection after lung transplantation;



Comparison of a Tacrolimus/Sirolimus/Prednisone Regimen

versus Tacrolimus/Azathioprine/Prednisone Immnosuppressive

Regimen in Lung Transplantation after Lung Transplantation;



Genetic Analysis to Predict Rejection of Lung Transplants

(LARGO Study): Utilizing microarray analysis techniques to

determine peripheral blood gene expression, this study fo-

cuses on the prediction of acute rejection after lung transplan-

tation;



Lung Transplant and Hypogammaglobulinemia: Evaluating the

safety and efficacy of intravenous immunoglobulin in patients

with hypogammaglobulinemia after lung transplantation;



Role of Activated Protein C in Early Acute Respiratory Distress

Syndrome: Determining whether levels of activated protein C

after lung transplantation are associated with lung allograft

function;



Molecular Monitoring after Solid Organ Transplantation: Ex-

amining which genes are active in patients undergoing lung

transplantation;



Pathogen Discovery in Chronic Lung Disease: Analyzing the

microbes present in patients after lung transplantation;



Genetic Predictors of Primary Graft Dysfunction after Lung

Transplantation.

Indications for Referral

Chronic Obstructive Pulmonary Disease

Guideline for Referral



BODE index >5

Guidelines for Transplantation



Patients with a BODE index of 7-10;



Chronic progressive hypercapnia or hospitalization for

exacerbation associated with acute hypercapnia;



Pulmonary hypertension and/or cor pulmonale despite oxygen

therapy;



FEV1 <20% with DLCO <20% or homogeneous disease.

Idiopathic Pulmonary Fibrosis

Guidelines for Referral



Histologic or radiographic evidence of UIP irrespective of vital

capacity in patients with idiopathic disease;



Histologic evidence of fibrotic NSIP.

Guidelines for Transplantation



Histologic or radiographic evidence of UIP in idiopathic

disease or fibrotic NSIP and any of the following:



A DLCO of <39% (UIP) or <35% (NSIP) predicted;



A 10% or greater decrement in FVC or 15% decline in DLCO

during six months of follow-up;



A decrease in pulse oximetry below 88% during a 6MWT;



Honeycombing on HRCT.

Cystic Fibrosis

Guidelines for Referral



FEV1 <30 percent of predicted or rapid decline in FEV1,

particularly in young female patients;



Increasing frequency of exacerbations or exacerbation requir-

ing ICU hospitalization;



Recalcitrant and/or recurrent pneumothorax;



Recurrent hemoptysis not controlled by embolization.

Guidelines for Transplantation



Oxygen-dependent respiratory failure;



Progressive hypercapnia;



Pulmonary hypertension.

Pulmonary Arterial Hypertension

Guidelines for Referral



NYHA functional class III-IV, irrespective of therapy;



Rapidly progressive disease;



Pulmonary veno-occlusive disease and PCH;



Endarterectomy candidates.

Guidelines for Transplantation



Persisting NYHA class III or IV on medical therapy;



Failing therapy with IV epoprostenol or equivalent;



Cardiac Index <2 L/min/m2;



Right atrial pressure >15 mm Hg.

CT scan of the thorax, axial section, showing pulmonary cystic fibrosis.

Opacities that are annular (ring-like) and dispersed in parallel lines

(tram-lines) correspond to dilations of the bronchi.

▲

Reference: Orens, JB; Estenne, M; Arcasoy, S, et al. International Guidelines for the

Selection of Lung Transplant Candidates: 2006 Update – A Consensus Report from the

Pulmonary Scientific Council of the International Society for Heart and Lung

Transplantation. J Heart Lung Transplant 2006;25:745-55.

ISM/Phototake

Lung

Patient Care

Specialized multidisciplinary programs are able to provide alter-

natives to transplantation for many patients as well as help treat

other important medical problems that develop or co-exist in

patients with advanced lung disease. Some examples include

pulmonary hypertension and right heart failure, coronary artery

disease, osteoporosis, and malnutrition.

Those who do undergo lung transplantation benefit from the

breadth and depth of the Hospital’s clinical and academic

expertise and the Center’s commitment to improved outcomes:



Surgical refinements have reduced the size of the incision

required during transplantation.



Recent progress in anesthesia, surgical techniques and post-

operative care have dramatically shortened the time patients

spend in the hospital—an average of 12 to 14 days, down

from an average of 20 days.



Most transplant surgeries are now performed without using

the heart-lung bypass machine, sparing patients from associ-

ated postoperative complications.



The risk of postoperative rejection is minimized with the

newest, most advanced anti-rejection regimens.

Outcomes

The Center for Lung Disease and Transplantation at NewYork-

Presbyterian/Columbia has the highest three-year survival rate

among the U.S. News & World Report Honor Roll Hospitals.

Between July 1, 2001 and December 31, 2007, the program per-

formed 243 lung transplants, with a one-year survival rate of

92%, compared to 82% nationally, and a four-year survival rate

of 72%. The program’s 30-day survival rate for the same time

period is 98%.

Lung Transplantation

NewYork-Presbyterian Hospital/

Columbia University Medical Center

Presbyterian Hospital Building, 14th Floor

622 West 168th Street

New York, NY 10032

Phone: 212.305.7771

Emergency referrals and transfers: 800.NYP.STAT

NewYork-Presbyterian Hospital has taken a leadership

role in perfecting techniques and patient selection crite-

ria for lung transplantation in patients with cystic fibro-

sis (CF). As a result, the Hospital is home to the largest

CF lung transplant program in the New York metropoli-

tan area. Although current management strategies

reasonably control the disease into adulthood in most

pediatric patients, lung transplantation offers extended

survival in patients with advancing disease who have

severe and irreversible airflow obstruction. The Hospital

has also expanded the program to include patients

under the age of 18 years. Transplanted patients with

cystic fibrosis may now undergo subsequent transplan-

tation if their grafts fail.

Expertise in Cystic Fibrosis

0 20 40 60 80 100

Observed

Expected

National

Patient Survival Rate

80.46

66.83

67.14

3 Year

0 20 40 60 80 100

Observed

Expected

National

Graft Survival Rate

77.94

64.91

64.86

3 Year

The exponential growth of the lung transplant program offers life-enhancing options to hundreds

of critically ill patients each year. Their quality of life is immediately improved after transplantation.

“

— Selim M. Arcasoy, MD, FCCP, FACP, Medical Director, Lung Transplantation Program,

NewYork-Presbyterian Hospital/Columbia University Medical Center

Source: SRTR January 2009 Report.

For the most current data regarding lung transplant

outcomes, please visit www.ustransplant.org.

Pancreas Transplantation

Whole organ pancreas transplantation is a viable and preferred option for patients with

type 1 diabetes and end-stage renal disease.

20 Pancreas Transplantation

Islet cells

▲

Overview

Transplantation restores normal sugar control, allowing the

majority of type 1 diabetic patients to stop using insulin.

When performed in conjunction with renal transplantation,

pancreas transplantation protects the new kidney from the

damage caused by diabetes. In some patients, it slows the

progression or even reverses some of the secondary compli-

cations of diabetes. Overall, when successful, pancreas

transplantation is much better than insulin therapy in im-

proving quality of life, and in prevention of morbidity and

mortality.

Patients with hypoglycemic unawareness, or ‘brittle dia-

betes,’ may be appropriate candidates for pancreas trans-

plantation regardless of the need for kidney transplantation,

despite the potential complications of immunosuppression.

In such cases, pancreas transplantation can “cure” their dia-

betes and protect the native kidney.

A small subset of patients with type 2 diabetes may also be

candidates for pancreas transplantation.

During the last six years, outcomes in pancreas transplanta-

tion have improved markedly due to advancements in im-

munosuppressant regimens and the increased use of enteric

drainage of pancreatic secretions. Enteric drainage allows

the pancreas to be connected to the intestine instead of the

bladder, where pancreatic secretions can cause significant

inflammation and toxicity.

Surgeons at NewYork-Presbyterian/Weill Cornell have been

performing pancreas transplantation since 1996. Outcomes

have generally met or exceeded the national average. UNOS

approved pancreas transplantation at NewYork-Presbyter-

ian/Columbia in January 2008; it is expected that NewYork-

Presbyterian/Columbia’s premier kidney transplant program

will facilitate rapid growth of the new pancreas transplanta-

tion program, which will overlap both in its patient popula-

tion and its surgical and medical expertise.

Type 1 diabetes with renal failure



Pancreas after kidney transplantation (PAK);



Simultaneous kidney/pancreas transplantation (SPK).

Type 1 diabetes without renal failure (PTA)



Extremely brittle;



Hypoglycemic unawareness;



Progressive secondary complications despite

optimal insulin regimen.

Type 2 diabetes



Phenotypic Type 1;

•

Thin;

•

Early onset;

•

Persistent C-peptide;



Decreased insulin production.

Indications for Pancreas Transplantation

Innovations

The first successful islet cell transplantation in the tri-state area

was carried out at NewYork-Presbyterian/Weill Cornell in 2004.

Tolerance

Both centers have been conducting research to promote immuno-

logic tolerance in pancreas transplant recipients, working towards

the goal of complete freedom from immunosuppressant medica-

tions after transplantation.

Steroid Avoidance

With gene-based therapies and steroid-avoidance protocols now

in place, patients at both centers receive highly personalized im-

munosuppressant therapies that permit lower steroid doses or

steroid-free protocols.

Research



Tolerance induction to islet transplantation using primed or

non-primed UVB irradiated dendritic cells (human antigen

presenting cells) with brief peritransplant immunosuppression;



The development of a new intramuscular site for islet

transplants using an alginate scaffold impregnated with

angiogenic, antiapoptotic, and immunosuppressant factors;



Development of the use of PET techniques to visualize and eval-

uate the function and viability of pancreatic islets in humans and

in experimental models for diagnostic and prognostic use.

Pancreas

Candidates for solid organ

pancreas transplant

(but not islet)



Patients with large body habi-

tus (>180 lbs) or large insulin

requirements;



Patients with life threatening

diabetes;



Patients receiving a simultane-

ous kidney.

Candidates for islet

transplant

(but not solid organ)



Small BMI patients who do not

want invasive procedure;



Patients with life threatening

diabetes with high cardiac

risks.

▲

After simultaneous kidney-

pancreas transplants at

NewYork-Presbyterian/

Weill Cornell in 1999,

Glenda Daggert has no

symptoms of the diabetes

that once threatened

her life.

▲

Patient Care

The northeast region of the U.S. has been consistently under-

served as far as access to pancreas transplantation, with rela-

tively few centers serving a disproportionately large metropolitan

population. The expanding programs at NewYork-Presbyterian

Hospital now provide much-needed access to patients with dia-

betes in the New York metropolitan area, particularly those with

the most complex medical and surgical challenges. NewYork-

Presbyterian/Columbia works in close collaboration with the

Naomi Berrie Diabetes Center, the leading diabetes center in the

metropolitan area.

In addition to its transplantation options, NewYork-Presbyter-

ian/Weill Cornell offers a novel surgical alternative, an intestinal

switch operation, and both centers maintain active metabolic sur-

gery programs, which hold promise for reversing type 2

diabetes.

Pancreas transplantation can save lives, in particular for type 1

diabetics who have advanced secondary complications of diabetes

such as renal impairment.

“

—Sandip Kapur, MD, FACS, Chief, Division of Transplant Surgery,

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

Axial view of pancreas, which is

marked by the arrow.

“

22 Pancreas Transplantation

Pancreas Transplantation

NewYork-Presbyterian Hospital/

Columbia University Medical Center

Presbyterian Hospital Building, 12th Floor

622 West 168th Street

New York, NY 10032

Phone: 212.305.6469

NewYork-Presbyterian Hospital/

Weill Cornell Medical Center

525 East 68th Street

New York, NY 10065

Phone: 212.517.3099

Emergency referrals and transfers: 800.NYP.STAT

Islet Transplantation

Transplantation of pancreatic islet cells into patients with type 1

diabetes offers the possibility of reversing the disease without

the need for major surgery. Even partial islet function in patients

with hypoglycemic unawareness, or “brittle diabetes,” can sig-

nificantly improve the management of this disease and abolish

hypoglycemic unawareness.

In this procedure, islet cells obtained from the pancreas of one or

two deceased donors are infused via catheter into the recipient’s

liver, where they act as a back-up pancreas, producing insulin

and regulating blood sugar. When this is performed with the

patient’s own cells (autotransplantation), the success is very

high, and such patients avoid developing diabetes after pancre-

atic resection. This contributes significantly to their long-term

prognosis.

Cutting-edge research at NewYork-Presbyterian/Weill Cornell has

developed a systemic gene therapy that a) eliminates the need

for immunosuppressant medications to protect islet grafts,

b) restores tolerance, and c) facilitates regeneration, in animal

models. To reduce the volume of islet cells needed for successful

transplantation, the researchers developed a novel anti-oxidant

therapy that optimizes islet isolation and improves their post-

transplant function. The program has successfully reversed dia-

betes in animal models without the use of immunosuppressants

after transplantation. Continued work on these therapies holds

considerable promise for transcending challenges to pancreatic

transplantation, and for extending the long-term durability of

islet transplantation in people.

At NewYork-Presbyterian/Columbia, a team has been conducting

islet transplantation research since 1976. It is one of ten regional

islet resource centers in the U.S. that isolate and transplant islet

cells to treat type 1 diabetes as part of a limited FDA protocol.

At this time, the team is investigating a new method of islet cell

transplantation by impregnating islets into pretreated, non-reac-

tive scaffolds, along with agents to attract blood vessels and

repel rejecting cells. When the treated scaffolds are placed into

abdominal muscles and injected with pancreatic islets, experi-

mentally induced diabetes is reversed in animal models. Both

centers will perform autotransplantation for patients undergoing

pancreatic resection for pancreatitis as part of a broad program

in islet transplantation.

Three types of whole organ pancreas transplantation:

Pancreas transplantation alone as a cure for type 1 diabetes;

Pancreas transplantation combined with kidney transplantation;

Pancreas transplant following live-donor kidney transplantation.

PATIENT

CARE

PEDIATRIC KIDNEY TRANSPLANTATION

NewYork-Presbyterian

Morgan Stanley Children’s Hospital

3959 Broadway, Suite 701

New York, NY 10032

Please call: 866.697.7755

NewYork-Presbyterian

Komansky Center for Children's Health

525 East 68th Street

New York, NY 10065

Please call: 646.962.4324

PEDIATRIC LIVER AND INTESTINAL REHABILITATION

AND TRANSPLANT PROGRAM

NewYork-Presbyterian

Morgan Stanley Children’s Hospital

3959 Broadway – 7th Floor

New York, NY 10032

Please call: 866.697.7755

PEDIATRIC CARDIAC TRANSPLANT PROGRAM

NewYork-Presbyterian

Morgan Stanley Children’s Hospital

3959 Broadway – 2 North

New York, NY 10032

Please call: 866.697.7755

PEDIATRIC LUNG TRANSPLANT PROGRAM

NewYork-Presbyterian

Morgan Stanley Children’s Hospital

3959 Broadway, Suite 701

New York, NY 10032

Please call: 866.697.7755

International Physicians and Patients

Please visit www.nyp.org/international

Each year, thousands of patients from all over the world travel to

NewYork-Presbyterian Hospital.

Our International Services staff provides personalized attention and

makes international patients and their families feel comfortable during

their stay with us. Our managers, coordinators and financial counselors

speak many languages and assist patients with a variety of details such

as scheduling physician appointments, escorting patients to procedures,

requesting second medical opinions, providing information about lodg-

ing and other medical and non-medical services. The first step to learn-

ing more about our services at NewYork-Presbyterian Hospital is to

contact our International Services Office at:

INTERNATIONAL SERVICES

NewYork-Presbyterian Hospital/Columbia University Medical Center

177 Fort Washington Avenue

Milstein Hospital Building 9 Central

New York, NY 10032

Phone: +1 212.305.4900

Fax: +1 212.342.5393

E-mail: internationalservices@nyp.org

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

525 East 68th Street

Greenberg Pavilion 1-503

New York, NY 10065

Phone: +1 212.746.4455

Fax: +1 212.746.4777

E-mail: internationalservices@nyp.org

NewYork-Presbyterian

Pediatric Transplantation Programs

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

Visitor's Entrance

Accessible Entrance

Emergency

Information Desk

Visitor Parking

Subway Entrance

Bus

Elevators

K Wing & F Wing, oors 2-9

Greenberg Pavilion

M Wing

N Wing

Payson Pavilion

Starr Pavilion, J Corridor & L Corridor

Whitney Pavilion

Hospital information:

212.746.5454

Legend

reviRtsaE reviRtsaE

Helmsley

Medical

Tower

505

520

1305

411

450

449

525

530

535

Weill

Cornell

Medical

College

Greenberg

Pavilion

NewYork-Presbyterian

Annex

Weill

Greenberg

Center

Stich

Building

Valet

Drop-o

Emergency

Starr

Pavilion

Memorial

Sloan

Kettering

Cancer

Center

Rockefeller

University

E 71st St

evirDRDF

E 69th St

E 70th St

E70tht

6tht

E 67th St

wotnw

d/nw

otpu

subnwotpu

1315

Additional Medical Oces

Weill Cornell Medical Assoc. Eastside

201 East 80th Street

Weill Cornell Medical Assoc. Westside

12 West 72nd Street

Iris Cantor Women’s Health Center

425 East 61st Street

Weill Cornell Imaging

416 East 55th Street

425 East 61st Street, 9th Floor

520 East 70th Street, lobby level

1305 York Avenue, 3rd Floor

FDR Exit

subnwotpu

E 72nd St

428

M15

M72 M30

M31

M15

M66

1320

Medical

Oces

at NewYork-Presbyterian

440

Baker Pavilion / F Wing, oors 9-24

First Avenue

Valet

First Avenue

York Avenue York Avenue

Sotheby’s

Baker Pavilion / F Wing, oors 9-23

Hospital

for

Special

Surgery

Oxford

Medical

Oces

Kips Bay

Medical

Oces

Phipps

House

Medical

Oces

1300

445

Olin

Hall

Fort Washington Garage

Broadway

Chapel

Service Building

NY State

Psychiatric

Institute

RiversideDrive

Milstein

HospitalBuilding

Herbert

Irving

Pavilion

HammerHealth

SciencesCenter

W 168th St

NeurologicalInstitute

Columbia

Pediatric

DentalClinic

Mailman

School

ofPublic

Health

NYSPI-

Kolb

Research

Bldg.

Harkness

Pavilion

College of

Physicians

and Surgeons

Black

Building

FortWashingtonAve(IrvingCancerCenterWay)

Armory

School of

Nursing

W 168th St

Broadway

W 168th St

W 167th St

W 166th St

St.NicholasAve

Tower

Morgan Stanley

Children’s

Hospital

NYPH

The Garden

NYC

Dept of

Health

ACN

Clinic

Urgent

Care

Presbyterian Building

Broadway Entrance

Emergency

Broadway

Subway

Irving Cancer

Research Center

Mitchel

Square

Park

Audubon Ave

Lasker

Biomedical

Research

Building

AIM

Russ Berrie Medical

Science Pavilion

Central

Audubon Ave

Bard

Hall

Vanderbilt Clinic

Presbyterian

Building

Presbyterian

Building

HavenAve

W165thStW165thStW165thSt

Eye Institute

Research

Annex

Emergency/

Emérgencia

School of

Dental and

Oral Surgery

Audubon

Ballroom

Building

Vanderbilt Clinic

North

St.NicholasAv

Visitor's Entrance | Entrada de las Visitas

Accessible Entrance | Entrada Accesible

Emergency | Emergéncia

Visitor Parking | Estacionamiento para las Visitas

Valet Parking | Estacionamiento Atendido

Subway Entrance | Subterráneo

Bus | Autobus

Information Desk | Información

Elevator | Elevadores

Restrooms | Baños

Legend

NewYork-Presbyterian Hospital/Columbia University Medical Center

Hospital Information 212.305.2500

NON-PROFIT ORG.

U. S. POSTAGE

PAID

NEW YORK, NY

PERMIT NO. 1043

New York residents may enroll in the Donate Life Registry to give legal consent for the recovery of organs and

tissues for transplantation and research. Contact the New York Organ Donor Network at www.donatelifeny.org.

333 East 38th Street

New York, NY 10016

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