Baylor Scott & White Simmons Transplant Institute shares experience and expertise at WTC

Baylor Scott & White Research Institute investigators and clinicians on the medical staff at Baylor University Medical Center (Baylor Dallas), part of Baylor Scott & White Health, were a dominant presence at the recent World Transplant Congress (WTC) held Aug. 2 through 6 in San Francisco.

Several of the Baylor Scott & White transplant team’s oral presentations focused on the use of normothermic regional perfusion (NRP) in procuring organs donated after circulatory death (DCD). Since 2021, Baylor Scott & White has been a leader in promoting the expansion of DCD donation in the United States. Normothermic regional perfusion, which utilizes ECMO technology, allows for in situ perfusion of the liver, heart and other organs.

To date, no studies out of the United States have been published directly comparing outcomes of DCD donor livers procured through NRP and livers procured after brain death, which has been considered the gold standard for liver transplant. At Baylor Dallas, the outcomes of these two groups were found to be similar. But beyond that, NRP has allowed clinicians to use liver grafts for patients who are lower on the waiting list, expanding access to transplant while maintaining excellent quality outcomes.

The BSWH team presented data on the utilization of livers from abdominal NRP DCD donors that also undergo rapid lung recovery, a scenario other programs have struggled with. Baylor Dallas has had great success with 70 percent utilization of DCD livers, coupled with excellent recipient outcomes from this donor cohort.

The team also shared the financial implications of starting and maintaining an NRP program. They showed that NRP has been the main driver in the volume increase in liver transplant at Baylor Dallas. Because of the increase in volume, there has been a minimal impact on contribution margin per case and a positive impact on overall contribution margin.

As an invited speaker, Anji Wall, MD, PhD, FACS, an abdominal transplant surgeon on the medical staff at Baylor Dallas, spoke on how to standardize and develop expertise in NRP technology to ultimately make it the standard for DCD organ procurement in the United States.

“What we have been able to do at Baylor Dallas is somewhat unique and really exciting,” she says. “We have been successful in large part because of the excellent multidisciplinary team of thoracic surgeons, abdominal surgeons, ICU and OR staff, and cardiac perfusionists that have put this together. The perfusionists are phenomenal, making modifications to the devices based on what we see clinically. Our amazing team allows us to perform the NRP procedures even when there are complications or complexities in a case.

“We’ve shown an NRP program can be built and sustained in the U.S. at a transplant center, but we’ve also collaborated with our regional OPOs to make NRP the standard procedure for DCD donation, not just at our hospital but in our region,” Dr. Wall continues. “What we have done in region 4 could be done nationwide, further expanding opportunities for organ donation and transplantation.”

Additional invited speakers and oral presentations from the Baylor Dallas transplant team included:

Sumeet Asrani, MD, MSc, Chief of Hepatology and Liver Transplantation at Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute, spoke to the Medical Director Forum on program development by leveraging technology to provide efficient, value-based care.

Amar Gupta, MD, FACS, FRCS(C), Surgical Director of Liver Transplantation, Baylor Dallas, reported on 50 consecutive robotic donor right hepatectomies for living donor liver transplantation, the largest series to date from a single North American center. The results showed that this complex and sensitive operation can be safely performed at a moderate volume program with excellent donor and recipient outcomes.

Bashoo Naziruddin, PhD, director of the Islet Cell Laboratory at Baylor Dallas, and his team presented on a recently developed novel method to generate insulin-producing organoids from the left-over tissue during pancreatic islet isolation procedure. Gene expression analysis of the insulin-producing organoids revealed close similarities to pancreatic islets. This methodology has the potential to provide an unlimited source of self-derived islet organoid tissue to replace islet cells or supplement autologous islet cell transplantation after pancreatectomy. To date, the Baylor Dallas islet transplant program, one of the largest in the country, has performed 258 total pancreatectomies followed by autologous islet transplants since its inception in 2006.

For the first time, uterus transplantation had its own dedicated session at WTC. Out of three invited talks, Baylor Dallas gave two. Liza Johannesson, MD, PhD, medical director of uterus transplantation at Baylor Dallas, spoke on the current state and future direction of uterus transplant, and Ann D Kataria, PharmD, BCPS presented the unique aspects of immunosuppression management in uterus transplant, including Baylor Dallas’ protocol and implementation of novel strategies. Both presentations provided a well-balanced overview of the challenges and successes of the procedure.

Dr. Kataria, who was named a Fellow of the American Society of Transplantation at the WTC, also presented practice-based examples and implementation strategies for successful utilization of a transplant recipient adherence monitoring and management tool.