The UT Southwestern Division of Surgical Transplantation offers a truly comprehensive and unique program of solid organ transplants, including the heart, liver, kidney, and lung. The program combines a multidisciplinary team approach to patient care with groundbreaking research aimed at expanding the donor pool and developing new methods to preserve and evaluate organs. In addition to being nationally recognized, the program has also been certified by the Centers for Medicare & Medicaid Services (CMS), ensuring continued access for North Texas patients facing end-stage organ failure.
The multidisciplinary approach is a vital component of the Division of Surgical Transplantation’s ongoing success. “With all disciplines being under the same roof, we are able to cross-fertilize to optimize patient care,” said Juan Arenas, M.D., Chief of the Division of Surgical Transplantation. “We’re up and running with a full team of physicians and surgeons fully integrated into one of the most sophisticated medical education and research centers in the country.”
UT Southwestern’s transplant programs offer world-class resources in the full range of related fields, from heart/ lung, kidney, and liver disease specialists and surgeons to experts in infection control and immunity and rejection medicine. Because UT Southwestern is an academic medical institution, patients have access to clinical trials both on campus and nationwide.
The multidisciplinary approach has organizational benefits as well. The UT Southwestern transplantation team is staffed with specially trained nurses for care, social workers who focus on patients’ social and psychological well-being, and clinical coordinators who follow the patient from the initial evaluation through the life of the organ. Financial coordinators assist with the financial aspects of the transplant process, from evaluation through postoperative care.
Transplant pharmacists specialize in designing, implementing, and counseling patients on individualized drug regimens. Dietitians provide nutritional support. Each patient’s unique team of experts is led by a dedicated coordinator who serves as a point person to help identify and resolve any issues and track all aspects of the experience.
The Division of Surgical Transplantation also focuses on organ donors, not just recipient patients. “In the North Texas region, the majority of organs donated for transplant come from families who donate their deceased loved one’s organs,” said Dr. Arenas. “Our main objectives are to educate the public on organ donation and optimize utilization of donated organs. We want to move past the idea that the number of donors is fixed, while the number of patients who need transplantation is constantly growing.”
According to the Organ Procurement and Transplantation Network (OPTN), surgeons in the U.S. performed more than 26,000 solid organ transplants last year, while the waiting list grew to more than 110,000.
In light of such an imbalance, the transplantation team also is working to make sure every organ donated is optimized through new means of preserving and evaluating organs donated after cardiac death (DCD). Most deceased donor transplants result from brain-death cases, so obtaining organs from donors after cardiac death can increase the supply of needed organs. “We’re developing techniques to minimize damage to DCD organs and to identify and avoid using organs that are not functional,” Dr. Arenas said.
Dr. Arenas credits advances in the preservation of donor organs’ functionality pioneered by Michael Jessen, M.D., Chair of Cardiovascular and Thoracic Surgery, and Matthias Peltz, M.D., Assistant Professor of Cardiovascular and Thoracic Surgery, with potentially expanding the pool of transplantable organs. Additionally, research by Christopher Lu, M.D., Professor of Internal Medicine and Director of Renal Transplantation, aims to identify markers that predict successful organ grafts, preventing transplantation of damaged organs and, at the same time, expanding the pool of organs from marginal donors.
Liver transplant program expands access, options for patients
Achieving certification from the Centers for Medicare & Medicaid Services (CMS) in 2010 marked a major milestone for the UT Southwestern University Hospitals’ liver transplant program.
The liver transplant program is now certified by the Centers for Medicare & Medicaid Services.
Because CMS oversees Medicare and Medicaid programs and decides whether to cover a program’s services, certification is a crucial step to ensure access for patients in need. In addition, many other insurers base their coverage on the CMS certification.
The certification, Dr. Arenas said, further validates the UT Surgical Transplantation Division’s differentiated approach to providing options to end-stage organ failure patients. UT Southwestern’s collaborative approach incorporates gastroenterologists, hepatologists, radiologists, hepatobiliary surgeons, pathologists, and more.
“We have a campus-wide partnership for liver cancer patients, which includes medical and surgical oncologists from the National Cancer Institute–designated Harold C. Simmons Cancer Center,” Dr. Arenas said. “Our multidisciplinary approach enables the collaboration that consolidates relevant expertise and knowledge from across the campus and translates it into clinical outcomes for real patients.”
UT Southwestern physicians treat liver disease in conjunction with ongoing research programs, allowing them to offer patients the most advanced diagnostic evaluations and treatment available.
“We meet weekly to discuss patients with liver cancer at a multidisciplinary level,” Dr. Arenas said. “From these meetings we establish protocols that enable us to give patients every option—medical, surgical, and transplantation—for the treatment of their liver cancer.”
Kidney transplantation nears next frontier
Having pioneered kidney transplantation in Texas by performing the first-ever conducted in the state in the 1960s, UT Southwestern surgeons are again at the forefront with robotic laparoscopy technology.
Dr. Arenas performed the area’s first robotically assisted kidney removal from a living donor and hopes to soon use the technology to both retrieve and transplant a kidney. Robotic laparoscopy offers more precision for surgeons and helps diminish recovery time for donors, he said. “Robotically assisted transplantation offers the same advantages to the recipient as it does to the donor—shorter recovery, less scarring, and less discomfort,” Dr. Arenas said.
Before coming to UT Southwestern in 2007, Dr. Arenas developed a robotically assisted living donor nephrectomy program at the University of Michigan. He said technology advancement has been the only obstacle to applying the robotic laparoscopy technology to actual transplantation.
UT Southwestern’s lung transplant patients have the highest one-year survival rate in the region
The multidisciplinary approach to lung transplants at UT Southwestern has led to consistent—and continued—excellence, both in the region and in comparison to other institutions across the country.
“At 87 percent, our one-year survival rate is nearly 20 percentage points higher than other facilities in the area and is above the national average,” said Fernando Torres, M.D., Associate Professor of Internal Medicine and Director of the Lung Transplant Program.
Dr. Torres is a leader in the field of lung transplantation and serves on numerous national transplant committees. Not only does the team participate in multicenter clinical trials, it also designs clinical research.
UT Southwestern physicians in the lung transplant program have completed specialized training in the care of these complex patients. And, in conjunction with their colleagues in the Division of Surgical Transplantation, the multidisciplinary team approach creates a close relationship with patients, providing both compassionate and cutting-edge care to an increasing number of transplant recipients.
“Due to the unprecedented growth of the lung transplant program, we have more than doubled our staff in the past year,” said Dr. Torres. “This has allowed us to streamline our referral process and decrease wait-times, even in the face of this growth. Our combination of superior outcomes and the experience that comes with increased transplant volume places us in a position to be the leader in lung transplant for the region.”
Increased access to one of the best heart transplant programs in the country
UT Southwestern Medical Center’s heart transplant outcomes are among the best in the country, and the program—which was established more than 20 years ago—boasts numerous physicians now certified in the new American Board of Internal Medicine subspecialty of Advanced Heart Failure and Transplant Cardiology.
“The heart transplant program at UT Southwestern is active and growing,” said Mark Drazner, M.D., Professor of Internal Medicine and Medical Director of the Heart Failure, Left Ventricular Assist Devices (LVADs) and Cardiac Transplant Program. “It’s among the best in the country, and it’s a resource for the community.”
Dr. Drazner and his team have been proactively reaching out to area physicians to ensure that UT Southwestern’s services are known. Internally, leaders have hired more staff and physicians and streamlined referral procedures.
“We’ve made a large effort to make the process easier for cardiologists to refer patients who have advanced heart failure to UT Southwestern,” Dr. Drazner said. “We provide excellent care for the patients and are also committed to providing excellent service for their physicians.”
Growth in the LVAD program has allowed UT Southwestern to help patients who may not have qualified for transplant in the past by giving them more time to meet the requirements needed for transplantation.
“The LVAD program can allow the obese patient to lose weight or buy time for the sick patient to get well enough for transplant,” Dr. Drazner said.
“The program achieves much of its excellence through strong multidisciplinary efforts involving cardiologists, surgeons, nurses, therapists, and a wide range of hospital personnel across a broad array of specialties,” said Michael Jessen, M.D., Chair of Cardiovascular and Thoracic Surgery. “This team approach sets the program apart from many others and is a critical factor behind the superior outcomes that the heart transplant and LVAD programs have enjoyed.”
Four UT Southwestern physicians have already received certification in Advanced Heart Failure and Transplant Cardiology. In addition to Dr. Drazner, David Markham, M.D.; Pradeep Mammen, M.D.; and Joseph Mishkin, M.D., all passed the new subspecialty board examination in December.
“I believe we have the largest contingent of board-certified physicians in this field at any single institution in Dallas, and possibly the state of Texas,” Dr. Drazner said. “That’s an additional sign of our expertise to handle trusted patients who need second opinions and evaluation for the most modern types of heart failure therapies.”