This section has a long, successful history and offers the latest advancements in the field. In liver transplantation, the program offers living-related and living-unrelated donor, reduced-size liver, split liver and dual-organ transplantation. Faculty offer both laparoscopic and “mininephrectomy” kidney donor procedures. Transplant surgeons are leaders in islet cell transplantation and have the largest pancreas transplant program in the region. Surgeons in this section are leaders in research and offer a nationally recognized, two-year American Society of Transplant Surgeons-certified fellowship.
Section of Transplant Surgery | 2020 Annual Report
The comprehensive kidney transplant team at the Washington University and Barnes- Jewish Transplant Center provides expertise and exceptional care throughout the entire transplant process. The team consistently performs over 250 kidney transplants per year—the highest clinical volume in the state of Missouri and one of the highest in the nation. Last year, the center celebrated its 10,000th transplant, a living-donor kidney transplant.
Jason Wellen, MD, MBA, is Director of Kidney and Pancreatic Transplantation at the Transplant Center. Wellen completed fellowship training in abdominal transplant surgery at Washington University School of Medicine and earned a master of business administration from Washington University’s Olin Business School. He currently serves as co-chair of the Business Practice Services Committee for the American Society of Transplant Surgeons, and as Surgical Representative of Perioperative Services at Barnes-Jewish Hospital.
The National Kidney Foundation (NKF) recognized Wellen and Washington University nephrologist Tarek Alhamad, MD, with their highest honor, the Award of Excellence, at the 33rd annual NKF Gift of Life Gala.
“It is incredible to be recognized by your peers, and referring physicians,” Wellen says of the
award. “It is an honor that they trust us with their patients.”
Wellen specializes in minimally invasive surgical techniques, such as laparoscopic donor nephrectomy, which often result in shorter recovery time, shorter hospital stay, smaller incisions and fewer post-operative complications for the donor.
Transplant and HPB-GI surgeon Adeel Khan, MD, MPH, brings cutting edge robotic surgical skills to kidney transplant surgery. Robotic surgery has similar advantages to laparoscopic procedures, such as improved visualization, a minimally invasive approach and shorter recovery times for patients. Khan completed a fellowship in Advanced Robotic HPB Surgery at Carolina’s Medical Center in 2017, and received fellowship training in Abdominal Transplant Surgery at both Baylor University Medical Center and Washington University School of Medicine in St. Louis.
In addition to offering expertise in the most advanced procedures, the kidney transplant team is conducting clinical trials to improve the mechanisms of immunosuppression. Short- and long-term organ rejection rates following a kidney transplant at the Washington University and Barnes-Jewish Transplant Center are consistently below the national average, and innovative immunosuppression protocols continue to minimize drug side effects and reduce the risk of rejection.
2020 Highlights
CLINICAL
As director of liver transplant at Barnes-Jewish Hospital and St. Louis Children’s Hospital, Maria B. Majella Doyle, MD, MBA, leads the Pediatric Liver Care and Transplant Center team in performing transplants for children with acute liver failure, liver cancers including hepatoblastoma and hepatocellular carcinoma, and metabolic disorders. In the past year, the center has introduced domino liver transplant for patients with maple syrup urine disease. Domino liver transplant takes a liver that does not work for one person due to metabolic disorder, and transplants the liver to a person without that disorder. The Pediatric Liver Care and Transplant Center provides comprehensive evaluation, treatment and care for children with all forms of liver disease.
RESEARCH
One of the biggest problems facing liver transplant surgeons is fatty infiltration of the donor organ (hepatic steatosis), a condition that is increasingly common with obesity and diabetes on the rise in the U.S. population. Steatosis makes it more challenging for an organ to withstand ischemia-reperfusion injury following transplantation. Transplant surgery researchers are investigating and developing solutions for the problems facing transplant surgery. Professor of Surgery Jae-Sung Kim, PhD, is researching the roles of mitochondria and autophagy in ischemic liver injury, and developing therapeutic strategies to reduce ischemia reperfusion injury in fatty livers. Brian Wong, PhD, is researching the role of lymphatic vessels in solid organ rejection and developing novel therapeutics to improve patient outcomes.
EDUCATION
The Abdominal Organ Transplant Fellowship Program is a nationally recognized two-year program certified by the American Society of Transplant Surgeons (ASTS). The program is among a select few to offer combined training in transplant and hepatobiliary surgery, as well as vascular access procedures. Since 2005, more than half of the program’s fellows have been women— an historically underrepresented demographic in transplant surgery. Program Director Maria B. Majella Doyle, MD, MBA, is a leader in the field, and is Chair of the Vanguard Committee of the ASTS and Treasurer of the Americas Hepato-Pancreato-Biliary Association. William Chapman, MD, Transplant Surgery Section Chief, describes Doyle as a mentor and role model to surgical trainees.
Approximately 10% of donor livers are suspected to be unsuitable for transplant after recovery and end up being discarded. An additional pool of livers is never recovered because they are believed to be too marginal for transplant. These unused livers represent a significant number of organs that could potentially be utilized for life-saving procedures. Transplant surgeons at Washington University School of Medicine are among the first in the country to investigate a method for organ preservation in clinical trials that may increase the number of usable livers.
Transplant Section Chief and Eugene M. Bricker Chair of Surgery William Chapman, MD, is principal investigator on a clinical trial using normothermic machine perfusion to reduce the number of discard- ed orphan livers. Normothermic machine perfusion provides an organ with a blood-based, oxygenated, nutrient-rich perfusate during the period between recovery and transplantation. This reduces the risks of lactic acid buildup and ischemia-reperfusion injury in the donor liver.
The clinical trial is a collaboration between the School of Medicine, Mid-America Transplant and OrganOx Ltd. Using normathermic machine perfusion, liver transplant surgeons—including Chapman, Maria B. Majella Doyle, MD, MBA, Adeel Khan, MD, MPH, and Jason Wellen, MD, MBA—will perfuse the organ over a four- to six-hour period rather than keeping it in cold storage prior to transplantation.
“This combines research to salvage organs not currently being used with clinical use to reach patients who otherwise wouldn’t be transplanted,” Chapman says of this study, which is funded by the Mid-America Transplant Foundation.
Other trials using OrganOx normothermic perfusion technology have completed patient accrual and are under FDA review. Because of strong partnerships with Mid-America Transplant, Washington University is the lead accrual site for these trials in the United States.
The future studies will aim to extend the use of normothermic machine perfusion to include livers donated after cardiac death. These organs are particularly challenging, as they can undergo a period of extended warm ischemia prior to recovery. The Transplant Center provides comprehensive, responsive and personalized care and has an average time before reperfusion lower than the national average. Investigations into normothermic perfusion could allow expert transplant surgeons to extend their care to more patients by expanding the number of usable livers for transplantation.