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Innovation in Transplantation

A Montefiore transplant team at work.

Top-ranked Montefiore Einstein center brings lifesaving options to every patient in need

By Emily Weisgrau

It’s not easy for a doctor to take on the role of a patient, but it happened seven years ago when Hanan Rotem, M.D., received a liver cancer diagnosis.

After attending medical school in his native Israel, Dr. Rotem became a resident at Montefiore Medical Center in 1975 and stayed on for 21 years to build a practice in obstetrics and gynecology. Transplantation was completely unfamiliar to him—until he suddenly found himself needing it.

“I had a scan done, and there was a suspicious mass,” he says, so he took the results to Daniel Berkowitz, M.D., a trusted friend and Montefiore gastroenterologist. Dr. Berkowitz told Dr. Rotem that he would need a liver transplant, and he recommended the Montefiore Einstein Center for Transplantation as the preferred choice.

It’s a point of pride to work in a center that brings both compassion and action to a community in need. We are the only transplant center that guarantees free transplant medication in the first year post-treatment.
— Dr. Milan Kinkhabwala

Success Built over the Decades

The Montefiore Einstein Center for Transplantation is one of the longest-running transplant centers in the world, having carried out its first transplant—involving a kidney—in 1967. It now performs as many as 400 adult and pediatric transplants each year, including combined kidney-pancreas and heart-lung transplants, and boasts an enviable survival record.

The center consistently ranks as the country’s best center for liver transplant survival. It also has the best heart, liver, and pancreas transplant survival rates in New York State, including a 100% survival rate for live-donor liver transplants and a 100% one-year survival rate for pediatric kidney and heart transplants.

Today, the center has become “one of the most comprehensive multiorgan transplant centers in the region,” says Milan Kinkhabwala, M.D., F.A.C.S., chief of transplantation surgery and director of abdominal transplantation at Montefiore and professor of surgery and of medicine at Einstein. In most cases, Montefiore’s transplant outcomes are superior to regional and national outcomes because, according to Dr. Kinkhabwala, “We have an extremely patient-centric approach. We have a view that these patients are our patients for life, so we remain deeply committed to their overall well-being and recovery.”

The center has established impressive social supports that increase patients’ odds of a healthier life pre- and post-transplant. With approximately 85% of patients across Montefiore relying on Medicare, Medicaid, or both, the hospital welcomes many individuals who lack financial resources, are facing immigration challenges, or do not have familial donors, among other complications to treatment. Through an integrated infrastructure of psychosocial, clinical, and social-service team members, the transplant center is breaking down barriers and building the support structure these patients need.

“We do everything we can—from providing housing to transportation to family counseling—to stand with our patients,” Dr. Kinkhabwala says. “It’s a point of pride to work in a center that brings both compassion and action to a community in need. We are the only transplant center that guarantees free transplant medication in the first year post-treatment, for example. We want our patients to focus on getting healthy, and we’re here to help support that journey.”

Donor organs are critical to transplantation success, and New York has a particularly long waiting period; at any one time, Montefiore has approximately 1,500 patients across the region seeking a healthy kidney or liver. To increase organ availability, Montefiore has instituted a robust living-donor program for kidney and liver transplants, and it also offers innovative “bloodless” lung and heart-lung transplant surgical approaches to avoid blood transfusions (opening opportunities for patients with religious or medical restrictions), as well as other, more-traditional kidney and liver transplants.

“Many people don’t make it because there aren’t available organs. That’s a huge problem,” Dr. Kinkhabwala says. “We’re developing novel solutions so we can offer more options and opportunities for a healthy life.”

Husband-and-wife surgical duo Milan Kinkhabwala, M.D., and Sarah Bellemare, M.D.

Innovative, Lifesaving Options

After his diagnosis, Dr. Rotem began seeing Montefiore and Einstein’s Juan Rocca, M.D., surgical director for kidney transplantation, and Sarah Bellemare, M.D., an assistant professor of surgery at Einstein who specializes in gastrointestinal (liver and pancreas) cancer, liver transplants, and hepatobiliary surgery. Dr. Bellemare leads the adult liver transplant team along with Dr. Kinkhabwala, her husband.

Dr. Bellemare began working in transplant medicine, with a focus on liver transplantation, late in her residency at the University of Montreal after discovering the dramatic results that a transplant can achieve. “You take people with yellow complexions, with a lot of fluid in the abdomen, and then see them after a transplant and they look healthy again,” she says. “They are able to enjoy life.”

Dr. Bellemare knew that a new liver would allow Dr. Rotem to enjoy many more years of life. Dr. Rotem was hopeful—and that hope turned to reality. “My surgery went smoothly,” he remembers. “After a few days I was back home. And after a few weeks I was back on the tennis court.”

The transplant center team prides itself on bringing cutting-edge, lifesaving options to every patient in need. The team’s living-donor program for kidneys and livers “offers a way for people to get transplants more quickly, before they get too sick,” Dr. Kinkhabwala says.

People told me that many places rejected them for organ donation because they were considered at high risk for failure. But Dr. Kinkhabwala’s team accepted them.
— Dr. Hanan Rotem

Fueled by family and friends of patients as well as by anonymous living donors, the living-donor program reduces the gap between the hundreds of thousands of patients in the United States waiting for a kidney or liver and the number of organs available. While saving patients’ lives, donors don’t endanger their own; people can live perfectly functional lives with just one kidney, and the liver is the body’s only organ that can regrow when a section of it is removed.

Montefiore is also among the first health centers to demonstrate that surgeons can safely transplant livers infected with hepatitis C into “naive” (uninfected) patients. Performing such a transplant first on a critically ill 21-year-old, the transplant team replaced the patient’s organ with an infected liver and then gave the liver recipient the hepatitis C drugs ledipasvir and sofosbuvir. This innovation saved the young patient’s life—and thousands more since then. The approach is now becoming standard practice around the country, increasing the pool of donor organs available at any given time.

Dr. Kinkhabwala says he hopes that organ transplants will one day be obsolete. Instead, scientists will be able to “grow” new tissues and organs for patients using stem-cell therapy, which Einstein and other research center teams are now studying.

Dr. Bellemare, center, and Dr. Kinkhabwala discuss upcoming surgeries with members of the Montefiore Einstein Center for Transplantation.

Reaching the Next Level

In the days immediately following his successful surgery, Dr. Rotem walked through the ward and talked with other hospitalized transplant patients. “Again and again, people told me that many places had rejected them for organ donation because they were considered at high risk for failure. But Dr. Kinkhabwala’s team accepted them.”

His admiration and gratitude motivated Dr. Rotem to donate to the transplant center, beginning in 2016. “The decision was a simple one for me,” he says. “They are providing excellent surgical and medical care.”

Dr. Rotem especially hopes his philanthropy will make more organs available to people who need them. “I compare it to a factory that’s not operating at full capacity,” he says. “Here and at transplant centers everywhere, more people are on waiting lists than should be.”

Donations like Dr. Rotem’s will also help fund patients’ care during hospitalization and after treatment, and underwrite research on alternatives to transplants. “Charitable giving provides us with the tools to reach the next level in terms of innovation and academic promise,” Dr. Kinkhabwala says. “Only by working together can we hope to bring lifesaving therapy to every patient in need.”

Help for Kidney Recipients With COVID-19

In the spring of 2020, Montefiore’s hospital beds were full of COVID-19 patients. The transplant team found that kidney transplant recipients had a mortality rate of 20 percent, while the general population’s death rate from COVID-19 was about 1 percent.

The center’s doctors attributed the alarming difference to transplant recipients having to take immunosuppressive drugs to prevent their bodies from rejecting their organs, and many also having coexisting health problems. So the team tried a different treatment approach for kidney recipients with COVID-19, which included withholding certain medications while administering others.

Their findings, described in a letter published in The New England Journal of Medicine, revealed promising results: “Kidney-transplant recipients with COVID-19 [now] had less fever as an initial symptom … and more rapid clinical progression than persons with COVID-19 in the general population.”

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