Baylor Regional Transplant Institute (BRTI), which oversees the transplant programs at Baylor University Medical Center at Dallas and Baylor All Saints Medical Center at Fort Worth, offers patients liver, kidney, pancreas, heart, lung, and blood and marrow transplantation programs and access to advanced transplantation research. BRTI is recognized around the world for its strength in translational research such as the testing of ideas and theories from the laboratory in the real world with patients.

Among current transplantation research projects are:

Immunosuppression and Drug Therapy

• BRTI researchers are working in collaboration with Jacques Banchereau, Ph.D., and Damien Chaussabel, Ph.D., at Baylor Institute for Immunology Research, to focus on the gene expression response to rejection and immunosuppression.
• Baylor researchers are working with those in 17 other transplant centers across the country to study the use of certain immunosuppressive drugs to reduce the recurrence of hepatitis C in liver transplant patients.
• Investigators are studying 16 immunosuppressive drugs to seek new or better combinations of the drugs that remain effective but with less severe side effects. Often because of Baylor's extensive transplant research program, patients benefit from new immunosuppressant medications three to five years before they become standard therapy. Baylor investigators are also studying pre-transplant and non-transplant hepatitis C, acute liver failure, and fungal infections.
• Researchers are also studying the impact of mycophenolate mofetil and the absence of steroid therapy on the recurrence of hepatitis C. The preliminary results of the study have already shown that it is safe to transplant patients without any use of steroids that can cause side effects including high blood pressure and diabetes.

Hepatic Tumor Registry

For the past several years, BRTI scientists have been working to create an international registry for liver cancer. The first report, published in 1998, showed that not only the size and number of cancer masses in the liver were important to the ultimate outcome after transplantation for liver cancer, but also the biological aggressiveness of the cells were of importance to predictions of survival.

• The registry is also allowing scientists to begin determining if the current limitations for liver transplantation in patients with liver cancer are appropriate. Working with the data in the registry, scientists have found that current limitations are more restrictive than they need to be. Both the maximum allowable size of the tumor mass and the maximum number of allowable masses in the liver can be increased with the same satisfactory outcome. Thus, more patients with liver cancer would have the possibility of liver transplant for a cure.
• Baylor scientists are collaborating with Thomas Gonwa, M.D., a nephrologist formerly on the medical staff at Baylor, who is now chief of nephrology at the Mayo Clinic in Jacksonville, FL, and two investigators at Tufts-New England Medical Center in Boston, MA, to show the ability to mathematically estimate the true kidney function. There are several mathematical formulas available, however Baylor researchers found that when comparing these formulas with the actual measured kidney function, these formulas are not accurate in liver transplant patients which can lead to mistakes in judging risks for patients for surgery and subsequent survival. Work continues with Andrew Levey, M.D., of Tufts-Medical Center, to develop a new formula that more accurately describes the renal function in patients with end-stage liver disease and liver transplantation.

Hepatitis Research

• Clinical research conducted by Baylor's Division of Hepatology and BRTI is focusing on new ways to help patients with chronic viral hepatitis due to hepatitis B or hepatitis C infections who do not respond to currently available antiviral drugs. Researchers are investigating several new agents that may prove useful for the treatment of both hepatitis B and C. New drugs that inhibit the ability of hepatitis viruses to replicate are also under study. Baylor researchers also are investigating immune modulatory drugs that may facilitate the hosts' ability to clear viral infections. One study of particular interest is testing a prodrug of one of the medications currently used for the treatment of chronic hepatitis C. Preliminary studies suggest that this compound targets the liver where the virus replicates and reduces the systemic toxicity of therapy, namely anemia.
• Several other studies are underway to develop treatment strategies to clear hepatitis C before liver transplant to prevent virus recurrence in the new graft and reduce the severity of recurrent infection.
• BRTI is leading a national multi-center study called The Pioneer study that will determine the best antiviral treatment strategy in patients with severely decompensated cirrhosis who are awaiting liver transplantation.
• Baylor researchers are participating in the Phoenix study, led by the Mayo Clinic, to examine the safety and efficacy of preemptive antiviral therapy following liver transplant compared to waiting until recurrent hepatitis has become established in the graft.
• BRTI is completing a large multi-center study to compare the impact of various immune suppressive regimens on hepatitis C virus recurrence after transplant. Though the data is preliminary, this study has already shown that corticosteroid, a historic mainstay of drug treatment to prevent rejection, can be avoided without danger and that this significantly reduces complications such as diabetes and hypertension that are so common after transplantation.

Diabetes

• Baylor researchers are conducting a study of islet cell transplantation, which has proved promising in Canadian studies. This provides people with diabetes new insulin-producing cells from a donor pancreas. Through this research, patients receive traditional immunosuppression medications to determine if they can become insulin independent. BRTI investigators also are coordinating with the Juvenile Diabetes Research Foundation to study genetics in diabetes patients.

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