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 liverresearch@stlukeshealth.org.

3

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: surgerynews@bcm.edu

editor-in-ChiefJohn A. Goss, MD

editorsScott C. Holmes, CMI

Ana María Rodríguez, PhD

© 2015 Baylor College of Medicine