Northwestern University Feinberg School of Medicine

Comprehensive Transplant Center

Overview

Clinical and experimental solid organ transplantation at Northwestern University was initiated in the late 1950's when Tom Starzl was a faculty member and was performing the first liver transplantation in the canine model. In the early 1960's, a clinical kidney transplant program developed, first by Barry Kahan and then by James Wolf, This included cadaveric and living-related kidney transplantation. During this stretch preceding the directorship of Frank Stuart, only 25 to 35 kidney transplants were performed. Since Dr. Stuart's directorship, the transplant program steadily grew. Close to 140 kidney transplants were performed in 1999 at Northwestern Memorial Hospital. Northwestern Memorial Hospital performs laparoscopic live donor nephrectomy since 1997, and is the most active laparoscopic donor program in Illinois. Northwestern Memorial Hospital has the largest listing of patients for kidney transplant in Illinois. The liver and pancreas transplant program, both initiated in 1993, have seen consistent increases in activity. In 1997, the transplant program at Ann & Robert H. Lurie Children's Hospital of Chicago (Lurie Children's) joined with that at Northwestern Memorial Hospital to create a combined transplantation initiative. Michael Abecassis, MD, MBA, assumed leadership of the Division in 2004. Under his direction, the volume of transplants performed at Northwestern Memorial Hospital has continued to rapidly increase.

The combined transplant institute of Northwestern Memorial Hospital and Lurie Children's stands to serve as a single resource for the expertise related to transplantation procedures and ensure life long follow-up care for patients. A major goal of the combined transplant institute is to share innovations, resources, and knowledge required for transplantation while at the same time ensuring that children and adults will be care for in specialized environments especially designed for each patient population translating into excellent patient and graft survival for renal and extra-renal transplants. The most immediate effect of the creation of this transplant institute was the establishment, under Dr. Whitington's direction, of an active liver transplant program at Lurie Children's. 'The surgical' aspect of the liver transplant program at Lurie Children's is under the direction of Dr. Riccardo Superina, a well-established pediatric transplant surgeon. The transplants being performed at Lurie Children's have included a growing number of living donor liver transplants. These donor operations are performed under the direction of Dr. Michael Abecassis and the adult transplant team at Northwestern Memorial Hospital. The implantation procedure is then performed under Dr. Superina's direction at Children's Memorial Hospital. Since establishment of the Lurie Children's program, the overall number of liver transplants being performed under the auspices of Northwestern University, in general, has rapidly grown.

With the development of a combined transplant program, we now offer a two-year fellowship including operative experience in multi-organ procurement, living donor nephrectomy, adult and pediatric kidney transplantation, pancreas transplantation, and adult and pediatric liver transplantation. There is exposure to vascular access surgery, as well as general surgical procedures in the dialysis patient population and in transplant patients. Involvement in hepatobiliary surgery in both adult and pediatric patients is also offered.

Transplant Service Organization

The Division of Transplantation is a component of the Department of General Surgery within the Northwestern University Medical School, which is part of Northwestern University. The Service is comprised of a Division Chief (Dr Michael Abecassis) and seven additional full-time faculty members (Jonathan P. Fryer, MD, Joseph R. Leventhal, MD, PhD, Juan Carlos Caicedo, MD, Daniela Ladner, MD, MPH, and Jason Wertheim, MD, PhD, Nitin Katariya, MD, and Felicitas Koller, MD). The attending transplant surgeons rotate responsibilities for inpatient, outpatient and organ procurement services. There are three general surgery residents assigned to the Service. The Transplant Service is supported by six inpatient transplant nurse clinician specialists, three kidney transplant coordinators, and two outpatient nurse clinician specialists.

The fellows are responsible to be on daily morning work rounds and afternoon teaching rounds. As the year progresses, they are increasingly responsible in decision- making and by the end of the first year, they are able to formulate and implement plans of care for each patient. They are also responsible for seeing the patients in our outpatient transplant clinic twice a week, as well as performing outpatient procedures, such as liver biopsy, large volume paracentesis, when required. The Division of Transplantation has priority operating time seven days per week for conduct of kidney transplantation. The Division also has three elective operating days per week set aside solely for vascular access procedures.

The Transplant Service has primary responsibility for all operative procedures. These include: kidney and kidney/pancreas transplantation, liver transplantation, vascular access, peritoneal dialysis catheters, and all general surgical procedures on transplant and dialysis patients. Living donor nephrectomies are also performed on a transplant service. The fellow is expected to perform the vast majority of all transplant operative procedures. Immunosuppression is managed solely by the Transplant Service from the time of intra-operative administration and daily thereafter. Transplant patients who are readmitted for care of medical complications are admitted to the Transplantation Service. Occasionally, an immunologically stable transplant patient who is having a specialty service procedure, such as cardiology, may be admitted onto the Medicine Service with significant input in medical management from the Transplant Service. The transplant fellow will lead the inpatient rounding team with guidance and input from the attending transplant surgeons. Nephrologists and gastroenterologist provide input primarily consultative services, but they do no write orders while patients are on the Transplant Service.