abdominal transplant · antibodies in transplant rejection, the effect of single nucleotide...
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The Michael e. DeBakey DeparTMenT of Surgery
inSiDe2 Asian Center Offers Care for Liver Disease
2 Annual Report Statistics3 New Trial for Hepatitis C
3 Liver Therapy Lab Promotes Change
ISSue 1 2015
aBDoMinal TranSplanT
Kidney stones afflict almost 10% of the US population and result in very substantial
morbidity and mortality. Because almost 30 million persons are at risk, stone diag
nosis and treatment consume billions of dollars in US healthcare expenditures each
year. Many stone patients have relatives who suffer from the disease; more than 50% of stone
risk may be inherited. Despite this, remarkably little is known about the genes that affect stone
risk. The principal goal is to explore these genes using a genome wide approach, leveraging clinical
experience and the great strengths in molecular genetics at BCM. Ultimately, the hope is to offer
patients more sophisticated personalized stone prevention strategies by incorporating specific genetic
risk factors into the diagnosis and treatment equation.
proBing The Molecular geneTicS of papillary renal
cell carcinoMa uSing Murine MoDelSDr. Richard Link’s laboratory team is using genetic engineering
techniques to target specific genes implicated in papillary renal cell carcinoma in mice. They are also searching for new causative
genes using mobile elements called transposons to introduce kidneyspecific tagged mutations into the mouse genome. The
ultimate goals are to develop clinically relevant mouse models in which to test new renal cell carcinoma treatments and identify
and characterize new genes and pathways contributing to tumor development.
Dr. Link also has an active interest in clinical outcomes research and in improving the teaching of minimally invasive surgery to residents and
fellows. Over the past decade, the standard of care for treating kidney cancer has dramatically shifted from open to robotic surgery. It is now
absolutely essential for urology trainees to achieve competency in robotic renal surgery. For these trainees, developing sophisticated spatial awareness
within a virtual reality environment is critical to address renal tumors. Dr. Link’s group is developing approaches to transform standard preoperative imaging
data into digital and 3D printed patientspecific anatomic models to teach these skills. This structured curriculum may shorten the learning curve and improve
patient outcomes.
exploring The genoMic BaSiS for kiDney STone riSk
Dr. Richard Link was born in New Britain, Connecticut and obtained his undergraduate degree at Yale University in 1989. He then attended the Stanford University School of Medicine in Palo Alto, California, where he received an MD degree and a PhD in Molecular and Cellular Physiology in 1997.
After graduate school, Dr. Link pursued residency training in Urology in the Scott Department of Urology, Baylor College of Medicine (BCM) from 1997 through 2003. He then spent two years at the Johns Hopkins Hospital in Baltimore, Maryland as the Endourology and Laparoscopy Fellow under Dr. Louis Kavoussi, a noted pioneer in urologic laparoscopic surgery.
In 2005, Dr. Link returned to BCM and Houston as Associate Professor of Urology and Director of the Division of Endourology and Minimally Invasive Surgery. At BCM/St. Luke’s, he is the primary surgeon for laparoscopic donor kidney procurement. At the Methodist Hospital, he serves as Deputy Chief of Service for Urology, Site Director for the BCM Urology Residency Program and Medical Director of the 3rd floor Main OR. He is also Program Director of the BCM Minimally Invasive Urologic Surgery Fellowship and Director of the Comprehensive Kidney Program in Urology.
Dr. Link specializes in the application of minimally invasive approaches to treat urologic disease. His particular focus is the use of laparoscopic, roboticassisted and percutaneous techniques to treat kidney tumors, renal and ureteral
obstruction and prostate cancer. He teaches these techniques at a national level to other urologists through the American Urologic Association, Office of Education. He also has an interest in the management of complex renal stone disease and laparoscopic kidney donor surgery for transplantation. He has been an pioneer in the development of laparoendoscopic single site donor nephrectomy, a less invasive laparoscopic technique in which the donor kidney can be removed via a single, small periumbilical incision. In partnership with Dr. Sreedhar Mandayam (BCM nephrology), Dr. Link directs the BCM Comprehensive Stone Clinic, which provides a place for complex stone patients to be evaluated and treated in a multidisciplinary manner. This is the first “metabolic stone” clinic in Houston and provides a state of the art tertiary referral center for both urologists and primary care physicians.
Dr. Link’s laboratory studies focus on the impact of molecular genetics on urologic disease.
MiniMally invaSive approacheS
richarD e. link, MD, phD associate professor and Director of the Division of endourology and Minimally invasive Surgery Scott Department of urology, Baylor college of Medicine
Located in Sugar Land, the BCM Asian Center offers general gastroenterology and hepatology services for patients with
GI symptoms, reflux, colon problems, colon cancer, hepatitis A, B and C, and other liver diseases. Working closely with our transplant team in the Texas Medical Center, Asian Center Director, Charles Gia Phan, MD, uses upper endoscopy, colonoscopy, and sigmoidoscopy to evaluate patients for liver transplantation. With a staff that speaks both English and Vietnamese, and through collaboration with a top transplant center, the Asian Center offers care to the diverse patient population characteristic of Sugar Land and Houston.
Dr. Phan, Assistant Professor of Surgery, received his doctorate degree in medicine from the Medical College of Wisconsin in 1992. After his internal medicine residency, he completed a fellowship in gastroenterology at the University of California, Irvine in 1998. One of his areas of interest is viral hepatitis, a disease prevalent in the
Asian community. In addition, Dr. Phan is dedicated to advancing and communicating knowledge about hepa titis B to
encourage prevention and effective management of the disease.
aSian cenTerofferS care for
liver DiSeaSe
Peter Jindra, PhD, Assistant Professor of Surgery, specializes in transplant diagnostic testing and is the Assistant Laboratory Director in the Immune Evaluation Laboratory at BCM. He is certified by the American Board of Histocompatibility and Immunogenetics. His research interests include the role of antiHLA antibodies in transplant rejection, the effect of single nucleotide polymorphisms on bone marrow transplant outcomes, and the expression and function of microRNA in lymphocytes and murine models of transplantation.
charleS gia phan, MD
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Please WelcomeDr. aBBaS rana Abbas Rana, MD, Assistant Professor of Surgery, was born and raised in Arizona. An Alpha Omega Alpha (AΩA) graduate from the University of Pittsburgh School Of Medicine, Dr. Rana completed residency training in general surgery at Columbia University in New York City, and fellowship training in transplantation at the University of California, Los Angeles. Dr. Rana joined the Division of Abdominal Transplantation in the Department of Surgery at BCM in May.
Dr. Rana is an accomplished outcomes researcher with over 20 published articles in esteemed journals. His expertise is in liver and kidney transplantation and in surgery for malignant and nonmalignant conditions that affect the liver, gallbladder, and bile ducts.
Please WelcomeDr. peTer JinDra
peTer JinDra, phD
aBBaS rana, MD
annual reporTBcM abdominal Transplantation clinical DataJanuary 1 - December 15, 2014 Transplant volumeliver 2014Baylor St. Luke’s Medical Center 53Texas Children’s Hospital 32VA Medical Center 12
Total 97
kidney 2014Baylor St. Luke’s Medical Center 65 (48 DD / 17 LD)Texas Children’s Hospital 13 (7 DD / 6 LD)
Total 78
DD = Deceased Donor; LD = Living Donor
Our clinical research unit at Baylor St. Luke’s Medical Center, Advanced Liver Therapies, will conduct clinical trials of an all oral regimen of antiviral drugs in patients with chronic hepatitis C virus (HCV) infection who are awaiting orthotopic liver transplantation (OLT) or have recurrent HCV infection of their transplanted livers. Since most patients on the waiting list for OLT have decompensated cirrhosis, they are ineligible for antiviral therapy that contains pegylated interferon. The use of interferon in patients with decompensated cirrhosis has resulted in deterioration, lifethreatening infections, and death. The recurrence of HCV infection after OLT significantly reduces both allograft and patient survivals. Indeed, up to 25% of the patients may progress to decompensated cirrhosis within 27 years postOLT.
To help meet the unmet needs of our patients, we will participate in the ALLY1 phase 3 clinical trial to determine the safety and efficacy of the combination of the drugs daclatasvir, sofosbuvir, and ribavirin for 12 weeks in both pre and postOLT patients with HCV infections, regardless of genotype. The trial is sponsored by BristolMeyersSquibb.
Daclatasvir and sofosbuvir (Figures) inhibit the replication of HCV at 2 distinct sites: NS5A and NS5B. The complementary actions provide potency and prevent viral resistance. The mechanism(s) of ribavirin is poorly understood, but increases the probability of curing the HCV infection.
John M. Vierling, MD, professor of surgery and medicine, is the principal investigator for the trial. For inquiries about the study please call 8323558966 or send a message to [email protected].
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John M. Vierling, M.D., FACP, FAAASLD, Professor of Surgery, is the Director of Advanced Liver Therapies
at Baylor St. Luke’s Medical Center, a study site for several phase 3 therapeutic trials reported at the annual
meeting of the American Association for the Study of Liver Diseases held in Boston, November 711. AASLD is
the premier international society promoting the science and practice of hepatology and liver transplantation.
Our Department’s transplant hepatology group was well represented by individual presentations by Dr. Prasun Jalal
and Dr. Gagan Sood and 5 presentations by Dr. Vierling and colleagues on advancements in antiviral therapies for chronic
hepatitis C. Dr. Vierling also conducted an Early Morning Workshop with Prof. Christian Strassburg from the University of
Bonn, Germany to provide an update on autoimmune hepatitis.
Of note was the POISE trial of obeticholic acid therapy for primary biliary cirrhosis (PBC). Obeticholic acid is the first new therapy for
PBC in the last 40 years and a new drug application will be filed with the FDA soon. The final results of the POISE trial were presented at
AASLD and were very encouraging.
What’s in a name?The liver team is also leading an ambitious international initiative to formally
change the name of PBC from “primary biliary cirrhosis” to “primary biliary cholangitis.” The rationale behind the proposal to remove the word “cirrhosis”
from the name is that “cirrhosis” is stigmatizing and is only present in a minority of patients when diagnosed. With therapy, 80 to 85% may never develop
cirrhosis. The proposed name change also better defines the disease and should ultimately help patients, providers, and advocates move toward the next major
advances in managing this disease.
neW Trial for hepaTiTiS c
Dr. vierling’S aDvanceD liver
Therapy laB proMoTeS change
Sofosbuvir is a potent nucleotide nS5B polymerase inhibitor.illustration by Scott holmes, Surgical research core.
Daclatasvir is an hcv nS5a replication complex inhibitor.
John M. vierling, MD, facp, faaaSlD
clinicS & cenTerS
chi ST. luke’S healTh–Baylor ST. luke’S
MeDical cenTer
aBDoMinal TranSplanT anD liver DiSeaSe clinic
Baylor Clinic6620 Main, Suite 1450
Houston, TX 77030
aBDoMinal TranSplanTAppointments: 877.685.0361
Liver Transplant: 832.355.6461Kidney Transplant: 832.355.3128
liver DiSeaSe clinicMain Number: 832.355.1400
New Patients: 832.355.1471Followup Patients: 832.355.1495
TexaS chilDren’S hoSpiTalTranSplanT ServiceS
Clinical Care Center, 11th Floor6701 Fannin Street
Houston, Texas 77030Appointments: 866.683.8032
For referral or other information: 832.822.1551
aSian cenTer16659 Southwest Freeway, Suite 175
Sugar Land, Texas 77479 Appointments: 281.277.2213
Michael e. DeBakey va MeDical cenTerliver TranSplanT
2002 Holcombe BoulevardHouston, Texas 77030
Appointments: 713.791.1414, Ext. 6524
The Abdominal Transplant Newsletter is a publication of The Michael e. DeBakey Department of Surgery at Baylor College of Medicine.
To be added to the Newsletter email database please write to:Scott Holmes, CMI
One Baylor Plaza, MS: BCM390Houston, Texas 77030
or email: [email protected]
editor-in-ChiefJohn A. Goss, MD
editorsScott C. Holmes, CMI
Ana María Rodríguez, PhD
© 2015 Baylor College of Medicine