Progress ReportReports of the Clinical Vice Chairmen

Transplantation
Jean C. Emond, MD

Jean C. Emond, MD Vice Chair, Operations & Quality Management Clinical Vice Chair, Transplantation

The NewYork-Presbyterian Transplant Institute, a cooperative venture with Weill Cornell Medical Center, is one of the nation's premier centers providing comprehensive services for patients needing heart, kidney, pancreas, lung, and liver transplantation. As 2005 ends, we anticipate being the third largest multiorgan transplantation center in the nation, having achieved our 2009 growth target four years early.

In September 2004, we performed the first combined heart-liver transplant in the New York region. Sixteen physicians, nursing professionals, and perfusion technicians were involved in the operation, which required extensive collaboration among teams specializing in pre-transplant treatment, transplantation surgery, and post-transplant care. Only a handful of these procedures have been attempted worldwide.

The Institute is known for its multidisciplinary approach to patient care, and continues to set new benchmarks for long-term survival. Our surgeons are leaders in pediatric transplants and high-risk cases. Our heart transplantation program is now one of the largest and most active in the world and our survival rates at the one- and three-year mark exceed national averages.

With funding from industry partners, government agencies, foundations, and private individuals, the Institute is making significant advances in transplant technology, developing more effective immunosuppressant medications and devising better overall health-maintenance strategies for transplant patients. And in the next five years, we hope to be a world-class teaching facility, training residents and surgeons in patient management and new surgical techniques.

All of our transplantation units are making exceptional progress. We have integrated our heart failure and heart transplantation units to provide comprehensive care for patients on mechanical-assist programs who are awaiting heart transplants.

Our Lung Transplant program continues to grow, with three new faculty members joining the medical and surgical team in the last two years. Our surgeons currently performing over 40 transplants a year and oversee one of the most active lung transplant programs in the nation. We also maintain an active heart-lung transplant program, performing over 30 dual transplants per year.

The National Emphysema Treatment Trial showed that lung volume reduction surgery (LVRS) can extend lifespan and provide a better quality of life for certain patients. We are now conducting a follow-up study on a minimally invasive version of this procedure.

The Institute now maintains one of the finest Liver Transplant programs in world, performing 100 transplants and caring for over 1,000 patients a year; a quarter of these are children. Our physicians are engaged in a broad range of basic translational and clinical research, with over 40 clinical trials in progress.

In his second year as director of our Kidney Transplant Program, Lloyd Ratner, MD, has almost doubled the size of our renal transplant program performing 21 transplants during the month of April. Living donors now provide most of the kidneys used for transplant. A similar growth trajectory has occurred at Weill Cornell with the addition of one of our graduates from the Columbia fellowship in transplantation joining the Cornell faculty in July 2005. New York Presbyterian will perform nearly 400 renal transplants this year.

Dr. Ratner was the first in the world to perform successful donor nephrectomy using the laparoscope over a decade ago. He has pioneered aggressive programs in immunology permitting patients to receive organs from donors with incompatible blood types. Virtually all our living donors are offered the option of laparoscopic nephrectomy, a minimal-access procedure that leaves a smaller scar and results in a faster recovery. The Institute is uniquely suited to perform the two-way kidney swap, allowing two donors to trade kidneys for respective loved ones. This innovative procedure, requiring four operating rooms, can be done when a friend or family member willing to provide a kidney does not have the recipient's blood and tissue type.

Pending approval from UNOS, surgeons at NewYork-Presbyterian Hospital will begin offering pancreatic transplantation for patients with kidney failure and Type I (juvenile) diabetes. Our whole-organ transplant program for the pancreas is the largest in the state of New York, and one of the largest in the northeast.

With the assistance of the Juvenile Diabetes Research Foundation (JDRF) and the National Institutes of Health (NIH) we are actively involved in islet cell research as a potential cure for Type I diabetes.

In the coming year, we will expand our services in Pediatric Transplantation and launch a program to address intestinal failure in children.