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 CLDT

Center for Liver Disease and Transplantation
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February 2010 Dr. Kato and Orthotopic Liver Transplantation Profiled in NYT

Tomoaki Kato, MD
Tomoaki Kato, MD
The February 22, 2010 New York Times published an article about auxiliary partial orthotopic liver transplantation, in which a portion of a liver is transplanted into the body of a patient with liver failure, usually a child, and the patient's own (native) liver is retained in place. The transplanted liver supports the patient until the native liver recovers, and immune-suppressing drugs to protect the transplant from the patient's immune system are administered. Once the native liver recovers, immunosuppression is stopped and the transplant liver is attacked and absorbed by the immune system. The great benefit of the procedure is that the patient must only take immunosuppressant drugs until their own liver recovers, although not all cases of acute liver failure do recover, and those patients rely on their transplanted liver and require immunosuppression for life.

The Times article focused on the case of NYPH/Columbia Patient Jonathan Nuņez, whose liver failed at when he was eight months old. Tomoaki Kato, MD, then at University of Miami/Jackson Memorial Hospital, performed auxiliary partial orthotopic liver transplantation surgery on Jonathan in 2006. Jonathan is now a healthy four-year-old, who is immunosuppressant free. Dr. Kato, who came to Columbia's Center for Liver Disease and Transplantation in 2008, was highlighted in the article as one of the few surgeons who perform the lengthy and complex procedure.
February 2010 Exclusively at NewYork-Presbyterian Morgan Stanley Children's Hospital

Laparoscopic Approach Promises Dramatically Improved Recovery for the Organ Donor — Typically, a Parent Donating to Their Child

The laparoscopic liver retrieval is offered by Dr. Benjamin Samstein, Surgical Director of the Living Donor Liver Transplant Program, who first learned the technique from Daniel Cherqui of Hôpital Henri Mondor, Paris. Standard pediatric liver implantation is led by Dr. Tomoaki Kato, Surgical Director, Liver and Gastrointestinal Transplantation. The new surgical advance represents the latest chapter in a history of innovations in living organ donation by NewYork-Presbyterian/Columbia surgeons. Dr. Jean Emond, chief of transplantation, was a key member of the team that performed the first pediatric living donor liver transplantation in North America in 1989 while at the University of Chicago Medical Center. Dr. Lloyd Ratner, director of renal and pancreatic transplantation, performed the nation's first adult-to-adult laparoscopic living donor kidney transplant in 1995 while at Johns Hopkins Medical Center. Today more than half of kidney transplants are done with a living donor, and 80 percent of these are retrieved laparoscopically.

Read more about living donor liver retrieval and living organ transplantation at NewYork-Presbyterian Hospital/Columbia University Medical Center.
February 2010 Dr. James Guarrera Is PI in First-of-Its-Kind Liver Preservation Study

Machine Perfusion Outperforms Standard Cold-Storage Liver Preservation

James V. Guarrera, MD
James V. Guarrera, MD
Preserving organs on ice prior to transplantation, an approach known as cold storage or CS, has been the standard practice in liver transplant for 20 years. Now there is new evidence that a technique called hypothermic machine perfusion (HMP) may offer an improvement, according to the first-ever study comparing the impact of the two techniques on transplant outcomes. The phase I study was carried out by Dr. James Guarrera and his colleagues at NewYork-Presbyterian Hospital/Columbia University Medical Center. Unlike cold storage, which Dr. Guarrera describes as a static technique, HMP dynamically simulates "aliveness" by providing a continuous flow of oxygen and key nutrients to the liver while diluting and removing toxins and waste products.
January 2010 Brooklyn Woman on Brink of Death Thrives After Five Transplants

At the turn of the 2010 New Year, Fox News and the New York Daily News reported on the promising recovery of a patient who received an unprecedented five-organ transplant in May 2009.
The procedure was performed by a Columbia surgical team headed by Dr. Tomoaki Kato. The 22-year-old patient, Kristin Molini, was near death from a rare medical condition known as intestinal dysmotility when she received a new liver, stomach, pancreas, and large and small intestines in a 13-hour operation. The Columbia surgical team included three surgeons, two anesthesiologists, and four nurses. According to the article, only 300 such surgeries have been performed worldwide since the 1980s. "It's still a very uncommon surgery," said Dr. Kato, "This is considered very high-risk." Media coverage for the multiple transplant included Fox News (December 31, 2009) and the New York Daily News (January 1, 2010).
November 2009 Multi-Organ Autotransplantation

Prenatally Diagnosed Congenital Lung Lesions Transplant surgeons at NYPH/Columbia use autotransplantation to remove deeply embedded tumors involving the abdominal blood vessels, which would otherwise be considered inoperable. Autotransplantation is the removal and reimplantation of a patient's own organ (or organs). Unlike patients who receive organs from donors, patients undergoing autotransplantation do not have to wait for a donor to become available. They are not required to take immunosuppressant medications following surgery, as is the case with transplantation of donor organs.
September 2009 Multi-Organ Autotransplant Patient Starts Third Grade in Fine Shape

On September 9, 2009, New York Newsday published a follow-up story about Heather McNamara, whose multiple-organ autotransplant and tumor removal was performed by Dr. Tomoaki Kato during February, 2009. Heather had lost her pancreas, stomach, and spleen, which were too damaged by her tumor to be reattached, leaving her diabetic, more prone to infections, and dependent upon pre-digested food for her nutrition. The article reported that the seven-year-old, who started third grade on September 8, looked and acted like a normal, healthy girl. Dr. Steven Lobritto, who was interviewed for the article, reported that her prognosis is good, "She's a robust kid," he said. "She's right on target."
August 2009 CLDT Emergency Liver Transplant Profiled by NYT

The August 18, 2009 The New York Times profiled an emergency liver transplant in an American patient who became ill while traveling overseas. The procedure, which faced tremendous odds, was coordinated and performed by the Center for Liver Disease and Transplantation (CLDT).
June 2009
Robert S. Brown, Jr., MD
Robert S. Brown, Jr., MD
Comments from Dr. Robert S. Brown, Jr. were included in a June 22, 2009 Reuters article about possible reasons for Apple CEO Steve Jobs' recent liver transplant. If the tumor migrated to the liver from the pancreas, a liver transplant may be an effective treatment, said Dr. Brown, who continued, "Our experience after a liver transplant is a return to normal function."
June 2009 NYP/Columbia Offers Artificial Liver Device as Part of
Ongoing Trial


The Extracorporeal Liver Assist Device, or ELAD®, is the first artificial organ for liver patients that uses immortalized human liver cells. The Center for Liver Disease and Transplantation (CLDT) at NewYork-Presbyterian Hospital/Columbia University Medical Center is one of a few centers in the U.S. offering the device. The bedside system treats blood plasma, metabolizing toxins and synthesizing proteins just like a real liver does. The study is evaluating the effectiveness of the system in supporting patients' lives until a liver transplant becomes available. "We're also interested to see if it can relieve the burden on the patient's liver enough so that it can regenerate and regain some of its function," says Robert S. Brown, Jr., MD, MPH, site principal investigator.

Read more.
June 2009 Dianne L. LaPointe-Rudow, DNP, has been appointed to a three-year term as a councilor-at-large for the American Society of Transplantation (AST). She will serve until 2012.
March 2009 In March, 2009, Dr. Robert S. Brown, Jr. was the featured expert in a news story on the extracorporeal liver-assist device (ELAD). He noted that, unlike previous attempts at an artificial liver, the ELAD uses human liver cells to metabolize toxins and synthesize proteins. The interview has aired on eight ABC and NBC affiliate stations across the country.
February 2009 Dr. Kato Leads Historic Surgery Resulting in Successful Removal of "Inoperable" Abdominal Tumor

Removing a tumor from a 7-year-old girl's abdomen during a 23-hour surgery on February 6, 2009, Tomoaki Kato, MD, and a team of seven surgeons and eight additional clinicians removed multiple organs from the girl's abdomen. The team removed small and large intestines, liver, pancreas, spleen and stomach, while three separate surgical teams worked to excise the tennis ball-sized tumor, which was tangled around vital organs and essential blood vessels. After removing the tumor, the team re-implanted the liver, small and large intestines. However, the girl's pancreas, spleen and stomach — non-vital organs that had been compromised by the tumor — were unsuitable for re-implantation. The surgery is the first reported case of its kind in the world. The story was covered by New York Newsday, CNN TV, WCBS TV, NY1 TV, and 1010 WINS radio New York. Read more.

December 2008 Liver Transplant Milestone Celebrated

Liver Transplant Milestone Celebrated
For the celebration of the center's 1000th liver transplant, clinical and administrative staff folded 1000 origami paper cranes.
Transplant recipients, donors and their families reunited with the NewYork-Presbyterian/Columbia liver transplantation team on Dec. 15, 2008, to celebrate surpassing the milestone of 1,000 successful transplants. Present for the event were Drs. Jean Emond and Robert Brown; clinical director Dianne Lapointe-Rudow, DNP, Elaine Berg from the New York Organ Donor Network; and several transplant recipients, who spoke about their experiences.

WABC-TV and WCBS Radio both interviewed Dr. Emond, who discussed how advances like living organ transplantation have helped save lives. ABCNews.com and HealthNewsDigest.com also reported on the event.

Read the NewYork-Presbyterian Hospital press release.
April 2008 New Life for Children with Liver Failure

New Life for Children with Liver Failure If a child suffers from a serious liver disorder, treatment by a multidisciplinary center with vast medical and surgical experience can make the difference between an excellent or poor quality of life, or between life and death. At the NewYork-Presbyterian/Columbia Center for Liver Disease and Transplantation, outcomes far surpass the national average, with 92% of children surviving at one year, 89% surviving at two years, and 88% surviving at three years after liver transplantation. But short-term survival is not the goal. If a child lives only one or two years, that is not a successful transplant. Our goal is for every child to live a normal life well into adulthood.
April 2008 Preventing and Treating Adult Liver Disease

Preventing and Treating Adult Liver Disease The Center for Liver Disease and Transplantation offers a full spectrum of services to patients suffering from all forms of liver disease, from walk-in office consultations, to antiviral treatment for Hepatitis C and Hepatitis B, to liver transplantation. In a trend that reflects the rising obesity epidemic, physicians at the center are seeing increasing numbers of patients with non-alcoholic fatty liver disease, a condition associated with obesity. While non-alcoholic fatty liver disease is clearly on the rise, undetected viral hepatitis C infection accounts for about 50% of the center's patients with chronic liver disease. Alcoholism accounts for the next largest group of patients at the center, which is noted for its comprehensive, multidisciplinary treatment program.
March 2008 On March 27, Fox Business ran a Schering-Plough Corporation press release regarding the U.S. Food and Drug Administration approval of label revisions for peginterferon alfa-2b and ribavirin, as a combination therapy for chronic hepatitis C. Robert S. Brown Jr., MD, MPH, was co-principal investigator in the study leading to the label revision, WIN-R. The release was picked up by the Biloxi Sun Herald, and CNN/Money.
November 2007 Robert S. Brown, Jr., MD, provided comments for a November 14, 2007 New York Times article about four transplant recipients in Chicago who contracted H.I.V. from an organ donor, the first known cases in more than a decade of the virus being spread by organ transplants. The organs also gave all four patients hepatitis C, in the first reported instance of the two viruses being spread simultaneously by a transplant. "It still remains that the biggest risk for patients on the transplant list is being on the list and not receiving an organ," Dr. Brown said, "there is always a drive toward better testing, but if it leads to more organ wastage, we'll probably hurt more people than we help...what I tell my patients is, the likelihood of being infected with HIV or hepatitis in that small window of time is incredibly small, and the risk of dying on the waiting list is not incredibly small." The story was picked up by the Akron Beacon Journal.
2007 Multimodality Approach Improves Outcomes in Hepatocellular Carcinoma

With nationally and internationally recognized authorities in established modalities as well as experimental techniques, the treatment team for hepatocellular carcinoma and hilar cholangiocarcinoma at the Center for Liver Disease and Transplantation at NewYork-Presbyterian Hospital/Columbia University Medical Center is setting new standards for patient outcomes—including long-term survival—in resection, adjuvant therapies, and transplantation.
2007 New Drugs, Dosing Highlight New Approaches to Hepatitis C

The Center for the Study of Hepatitis continues to be actively involved in both clinical and basic science research in an effort to identify new treatments for patients infected with the hepatitis C virus (HCV). A multidisciplinary approach is central to efforts at the Center, which is a collaborative endeavor of Weill Cornell clinicians and researchers at NewYork-Presbyterian Hospital along with colleagues at NewYork-Presbyterian Hospital/Columbia University Medical Center and researchers at Rockefeller University.
2007 Liver Transplantation: Better Preservation of Donor Organs May Enable More Transplants

As advanced as the field of organ transplantation has become, several important challenges remain. Of these, the availability of donor organs stands paramount. Among those with end stage liver disease, over 17,000 patients wait for a donated liver every year in the U.S., but fewer than 6000 receive one, and about 1800 people die while on the waiting list. As a result, researchers are avidly working to find ways to safely use as many potential donor organs as possible, including organs that once may have been considered "imperfect."

2006 Living Donor Liver Transplantation Saves Lives

Living Donor Liver Transplantation Saves Lives At this time there are eight patients on the waiting list for every available liver — and many patients are considered too sick or too old to even get a place on the list. To address this serious shortage, the Center for Liver Disease and Transplantation (CLDT) is pioneering methods of increasing access to liver transplantation. Living donor liver transplantation offers one solution.

May 2006 Largest U.S. Hepatitis C Trial Provides Insight into Optimizing Treatment for Patients

Dr. Robert Brown is Co-Principal Investigator of the WIN-R trial, the largest hepatitis C study ever conducted in U.S. patients. The community-based study which involved more than 4,900 patients at 225 centers across the United States, showed significantly better outcomes with weight-based dosing. The study findings were reported at the Digestive Diseases Week (DDW) annual meeting, May 20-25, 2006, at the Los Angeles Convention Center. Dr. Brown and the study's Principal Investigator, Dr. Ira Jacobson of Weill Medical College of Cornell University, are co-directors of New York-Presbyterian Healthcare System's Liver Clinical Trials Network (LCTN). Click here to read the press release on study presentation at the Digestive Diseases Week.

February 2003 Dr. Brown Presents First Data on Living Donor Liver Transplant

Procedure shown to be safe for donors and recipients

Robert S. Brown, Jr., MD, MPH is the principal author of an article entitled "A Survey of Liver Transplantation from Living Adult Donors in the United States," published as a Special Article in the February 27, 2003 issue of the New England Journal of Medicine. The article is the first to present comprehensive data on adult to adult living donor liver transplantation (LDLT) in this country, with responses from 84 of the 122 programs now doing LDLT. Those 84 centers performed more than 90 percent of all cadaveric liver transplants (transplants that use organs harvested from someone who has died) in the U.S. in 1999 and 2000. Columbia University Medical Center has one of the nation's most active and outstanding living donor liver transplant programs.


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