UCSF is at the forefront of the laboratory-to-bedside success story for transplantation, with a robust and rigorous research program that directly contributes to overall advances in this field. UCSF faculty members regularly receive competitive grants from the National Institutes of Health for transplant research in a variety of areas, including clinical trials.
“I went into transplant surgery because it was the most interesting, challenging and rewarding field — with research work and clinical work particularly pertinent to each other,” says Nancy Ascher, MD, PhD, chair of the Department of Surgery and a transplant surgeon. “At UCSF, we take what we learn through research in basic science and clinical trials, and we use it to improve patient care. This is translational medicine, and it is the very center of what we are doing in our transplant program.”
Leaders in the Transplant Field
UCSF basic science and clinical researchers are leaders in the transplant field, pursuing studies on a variety on issues that affect patient outcomes — from preservation, utilization and allocation of organs to surgical techniques, pre- and post-transplant care, pharmaceutical development, and the role of the immune system in organ rejection. Among the current UCSF research initiatives are:
- Living donors for liver and kidney transplants: The shortage of donor organs is a major obstacle to the success of transplant science. Chris Freise, MD, is leading a team that is achieving significant advances in the use of laparoscopic surgery to remove kidneys from living donors. This technique uses a small surgical incision and is much more comfortable for the patient, opening the door for more donors. UCSF is a national leader in research on liver donation from living donors.
- Islet cell transplantation: UCSF research teams are conducting several major clinical trials of this procedure under the leadership of transplant surgeons Andrew M. Posselt, MD, PhD, and Peter Stock, MD, PhD. In this procedure, islet cells are extracted from the pancreas of a deceased donor and injected into a patient with severe type 1 diabetes, in hopes of pushing back the disease. Islet cells normally produce insulin, which regulates glucose, but in people with type 1 diabetes, islet cells do not perform this function. Islet cell transplantation shows tremendous potential as a successful treatment for type 1 diabetes.
- Immune system response and organ rejection: Today’s transplant successes would not be possible without immunosuppressive medications, which stave off the immune system’s rejection of donor organs. But the lifesaving medications have long-term risks and uncomfortable side effects. In one study, UCSF researchers are looking at the development of safer drugs to prevent rejection and provide alternatives to immune suppressants. Led by Qizhi Tang, PhD, the team is investigating whether the body’s natural process for regulating its immune system, which is attributed to T-regulatory cells, can be harnessed to prevent transplant rejection. In a national study led by Sandy Feng, MD, PhD, researchers are investigating the effect of gradual withdrawal of immunosuppressive medications on the health of a select group of liver transplant patients who appear to be less prone to organ rejection. Preliminary results are encouraging, and the research is continuing. The overall goal of the study is to identify some type of biomarker that can determine whether a transplant patient will need the medications. In studies led by Flavio Vincenti, MD, UCSF researchers are receiving international attention for their development of less risky nonsteroid immune suppressants to combat organ rejection.
- Bridge to transplant for lung patients: Patients with acute respiratory failure who are candidates for a lung transplant often die before donor organs are found or readied for surgery. UCSF is a leader in the use of an external breathing machine that acts as a bridge to transplant, keeping lung patients alive until the procedure is possible. UCSF research shows that treating lung transplant patients with extracorporeal membrane oxygenation, or ECMO, is a viable therapy much earlier in the course of disease than previously thought, thereby providing more time to locate donor organs. UCSF is a global leader in keeping patients healthy on ECMO for weeks or even months.
- Transplants for HIV-positive patients: UCSF has pioneered successful kidney, liver and pancreas transplant procedures in HIV-positive patients, who were once considered poor candidates for transplant because of their declining health and weakened immune systems. With many HIV-positive people now living longer, healthier lives, thanks to antiretroviral therapy, UCSF has looked at the potential of transplantation for these patients. Results of a clinical trial conducted by Peter Stock, MD, PhD, showed that transplantation is a viable option for HIV-positive people with organ failure. Ongoing research is investigating the immune system response of post-transplant HIV-positive patients and the potential for heart and lung transplants in HIV-positive patients.
Christopher E. Friese, MD, FACS
Other Promising Studies
Among many other studies, UCSF researchers are investigating a blood or urine test to identify organ rejection that would be less invasive than a tissue biopsy, and they also are investigating the development of an implantable, artificial kidney with the potential for eliminating the need for dialysis.
“The physicians and scientists who come and stay at UCSF are those who are looking for the next generation of medical and surgical advances — the new, exciting things,” says John Roberts, MD, chief of the UCSF Transplant Service. “In the UCSF environment, they can advance an idea, figure out how to make it work and see progress. We support developing and implementing new strategies.”