Liver Transplant

Research

Transplant Rehabilitation Research
UCSF Medical Center's transplant service and the Department of Physiological Nursing actively support research related to rehabilitating patients before and after transplant. Under the direction of Patricia Painter, Ph.D., we have several ongoing studies in this area.

The first study determined that exercise training following kidney transplant is not only safe but effectively optimized physical functioning. At one year, patients who participated in regular exercise had significantly higher levels of physical functioning and quality of life than those not involved in regular exercise. Those who remained inactive had exercise capacity a year after transplant that was not much better than patients on dialysis.

We are now enrolling liver transplant recipients to study the effects of diet and exercise on body composition, exercise capacity and cardiovascular risk.

Another of our studies found that patients withdrawn from prednisone within five days of transplant had great gains in exercise capacity and quality of life specifically physical functioning and energy/fatigue scores and had larger muscle fibers and muscle strength compared to those remaining on prednisone. We also are involved in studies to increase exercise capacity and quality of life in patients treated with dialysis before transplantation.

Basic Research

• Dendritic Cells and the Immune Response
  UCSF researchers are genetically modifying treelike (dendritic) cells, which normally stimulate the activity of T- and B-lymphocytes, to instead inhibit the immune response in mouse models. The modified cells will be administered in conjunction with other immunosuppressive agents, including FTY720 and sirolimus, in an attempt to improve tolerance to transplantation. Researchers also are investigating the use of dendritic cell-based vaccines for the prevention and treatment of mouse models of hepatocellular carcinoma.
  For information, contact Dr. Sang-Mo Kang at (415) 353-1551.
• Monitoring Rejection
  Currently, taking a tissue sample (biopsy) is the only effective way to diagnose rejection of a transplanted organ. UCSF researchers on the kidney transplant service are working to develop immunologic status tests (assays) that correlate well with rejection risk. They also are examining whether the presence of donor-derived DNA in either the blood or urine of kidney transplant recipients correlates with organ rejection or other clinical events.
  For information, contact Dr. Ryo Hirose at (415) 353-1551.
• Skin Cancer in Renal Transplant Recipients
  Skin cancer is extremely common in transplant patients. UCSF researchers will correlate a questionnaire-based study of risk factors in transplant patients with a study of genetic changes observed in unaffected skin, premalignant and malignant lesions. This work will be complemented by experiments in transgenic mice that have a tendency to develop squamous cells cancers of the skin.
  For information, contact Dr. Ryo Hirose at (415) 353-1551.
• Pathophysiology of Focal Segmental Glomerulosclerosis (FSGS)
  Working in a mouse model, researchers are studying the circulating factor thought to be the causative agent of the common kidney disease, FSGS. A clinical component of this study addresses the use of packed red blood cells (plasmapheresis) in treating FSGS.
  For information, contact Dr. Flavio Vincenti, (415) 353-1551.

Clinical Research

• Transplantation in HIV-Positive Patients
  UCSF transplant surgeon Peter Stock has been awarded a $3 million grant to study the feasibility, safety and efficacy of performing solid organ transplants in patients who are stable and infected with HIV. Increasing numbers of HIV-infected people are confronted with end-stage liver and kidney disease, according to Stock. The State of California-funded Phase I pilot study, which will collect data on HIV-positive transplant recipients, is a response to the longer healthier lives that HIV-positive individuals can live with highly active antiretroviral therapy (HAART). Researchers will study the effect of HIV on the immune response against transplants, the effect of immunosuppressive drugs on HIV disease, and the complex interactions between immunosuppressive and antiretroviral medications.
  For more information, contact Dr. Peter Stock at (415) 353-1551.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007