VCU Department of Surgery | About the Department

Having been pioneered by the late Dr. David Hume and further developed by Dr. H. M. Lee, the Hume-Lee Transplant program at Virginia Commonwealth University's Medical College of Virginia Hospitals has existed since 1957. The Clinical Transplant program includes hepatic, renal and pancreatic transplantation. Four experienced Abdominal Transplant Surgeons; a Transplant Nephrologist, a Transplant Hepatology Group, and one Immunologist supervise it. The Thoracic Organ Transplant program is maintained by the Division of Cardiac Surgery and is a separate entity.

CLINICAL PROGRAMS
A geographically separate 27 fully monitored, intermediate care step-down unit and 4-bed dedicated transplant ICU exists for the specialized care of renal, hepatic, and pancreatic transplant recipients, with an appropriately trained specialty nursing service available. The Clinical Transplant Service performs approximately 70 cadaveric renal transplants and 50 living donor renal transplants, 60 to 70 liver transplants, and 6 to 12 simultaneous kidney pancreas transplants per year. Approximately 600 surgical procedures are performed on transplant and dialysis patients each year, including dialysis access surgery, parathyroidectomy, preparatory surgical procedures in anticipation of renal transplantation (i.e., bi-nephrectomy, parietal cell vagotomy, etc.), living donor nephrectomy, as well as a number of general surgical procedures related to conditions resulting from the transplant itself or the recipients, or for complications arising in the dialysis and endstage liver disease patient populations. An additional 30—40 cadaver donor multiorgan procurements/year also are performed by our service.

VCU's MCV Hospital's Liver Transplant program began in 1984. Since that time over 700 liver transplantations have been done with an actuarial one-year patient survival in the range of 85%. The Transplant Service is manned by the Clinical Transplant Fellow, a PGY-III, 2 PGY-IIs and PGY- I residents, 2 Nurse Practioners, a dedicated Clinical Pharmacist, and one or two medical students. Six liver transplant coordinators and six kidney transplant coordinators are also assigned to this service full time. For the PGY-III "Chief " resident, this is an 8-week rotation on a very busy operating service, where he/she is introduced for the first time to vascular surgical technique. While serving as an Operating Surgeon on 40 to 50 vascular access procedures, as well as a number of peritoneal access procedures, general surgical procedures in the dialysis and transplant population in the same high-risk patient population, the Chief Resident will gain vast experience. His/her role as assistant on liver, renal and pancreatic transplant procedures is invaluable to surgical education in terms of technique and development of patient care skills, and clinical surgical judgment. Although this rotation is one of the most demanding in residency, most residents consider it to be one of the most important in terms of their surgical growth and development. We also have an ASTS-Approved (liver, kidney) two-year Transplant Surgical Fellowship in continual operation since the 1960s.

RESEARCH OPPORTUNITIES
In addition to clinical responsibilities, the Transplant Surgical Fellow and surgical residents have the opportunity to participate in clinical and basic experimental transplantation and transplant immunology.

Dr. Robert A. Fisher, Director of Transplant Research, has a number of ongoing exciting research opportunities involving small animal cardiac, hepatic, renal and small bowel transplantation models looking at tolerance, and experimental and clinical hepatocyte transplantation for fulminate hepatic failure. Other basic science research looks at cytokines, pancreatic allograft immunological interactions and cytomegalovirus infection. Clinical research is ongoing defining the immunology and clinical behavior of cadaveric cryopreserved venous allografts for lower extremity arterial revascularization. We currently have two NIH grants (total $5 million) to study living donor liver transplants and liver cancer.

The Tissue Typing and Immunology Laboratories, in addition to supporting and participating in all of the above projects, is directly involved in research dealing with histocompatibility, lymphocyte subsets, antithymocyte globulin, serological reactions to transplantation and the field of antigens and antibodies.

The Division of Transplantation Surgery has undertaken protocols in the pediatric liver transplant population and conducting the necessary research in organ preservation to further develop the non-heart beating cadaver donor program. All members of the transplant team are involved in ongoing clinical trials designed to evaluate newer immunosuppressive and pro-coagulant agents, and antilymphocyte preparations in the renal, hepatic and pancreatic transplant populations. Extensive laboratory facilities, full-time Ph.D. Molecular Biologist, technicians, and local and federal grants support basic research activities.