Department / Division:
Surgery / Cardiovascular and Thoracic Surgery

Address:
DUMC 3864
Durham, NC 27710

Appointment Telephone:
919-681-4760

Office Telephone:
919-681-4760

Fax Telephone:
919-681-4797

• MD, University of California, Los Angeles, David Geffen School of Medicine, 1984

• General Surgery/Cardiothoracic Surgery, Chief Resident, Duke University Medical Center, 1990-1991

• Lung Transplantation, Teaching Scholar, Barnes-Jewish Hospital, Washington University in St. Louis (Missouri), 1992

Clinical Interests:
Coronary artery revascularization; valve repair and replacement surgery; cardiothoracic transplantation (heart, lung, heart-lung); surgical treatment of emphysema and chronic pulmonary embolism

Research Interests:
As pulmonary transplantation has evolved into an effective therapy
for end-stage lung disease, the shortage of acceptable donor lung allografts has intensified.  Fewer than 20% of patients currently on the waiting list will receive a lung transplant in the coming year; and for every patient who does receive a lung transplant a potential recipient will die.  To address this problem, we are evaluating the feasibility of using swine as donors for humans, i.e. lung xenotransplant.

The immunologic barrier to transplantation of widely disparate
species (discordant xenotransplantation) involves natural immunity. In the unmodified model of pig to primate transplantation of heart or kidney, an organ graft is rapidly and violently rejected within minutes to hours.  In contradistinction we have shown that the pulmonary xenografts in unmodified recipients had prolonged function.  Additionally, whereas histopathologic analysis of heart and kidney xenografts reveals heavy deposition of IgM, C3, C5, and membrane attack complex (MAC), analysis of pulmonary xenografts reveals little IgM and complement deposition.  This suggests a lesser immunologic barrier exists to lung xenotransplantation as compared to heart or kidney xenografting.

The purpose of our studies is to define the immunologic barrier to
lung xenotransplantation, and to develop strategies to enable clinical application.  We are currently investigating the roles of natural xenoreactive antibody and complement activation in the development of xenograft rejection.  These studies are performed using an ex-vivo perfusion model of the swine lung and an in-vivo pig donor to baboon recipient model.  A variety of different techniques to deplete xenoreactive antibody and compliment are utilized in these studies.  In addition, transgenic swine have been designed to further lessen the immunologic barriers.  
These studies are designed to build the foundation for clinical application of xenotransplantation.

Representative Publications:
Reams BD, Davis RD, Curl J, Palmer SM. Treatment of refractory acute rejection in a lung transplant recipient with campath 1H. Transplantation. 2002 Sep 27;74(6):903-4. (2002) Abstract

Palmer SM, Davis RD, Hadjiliadis D, Hertz MI, Howell DN, Ward FE, Savik K, Reinsmoen NL. Development of an antibody specific to major histocompatibility antigens detectable by flow cytometry after lung transplant is associated with bronchiolitis obliterans syndrome. Transplantation. 2002 Sep 27;74(6):799-804. (2002) Abstract

Napolitano MA, Babyak MA, Palmer S, Tapson V, Davis RD, Blumenthal JA, . Effects of a telephone-based psychosocial intervention for patients awaiting lung transplantation. Chest. 2002 Oct;122(4):1176-84. (2002) Abstract

Lees CY, Briggs DJ, Wu X, Davis RD, Moore SM, Gordon C, Xiang Z, Ertl HC, Tang de CC, Fu ZF. Induction of protective immunity by topic application of a recombinant adenovirus expressing rabies virus glycoprotein. Vet Microbiol. 2002 Apr 2;85(4):295-303. (2002) Abstract

Lee W, Gaca JG, Edwards LA, Braedehoeft SJ, Parker W, Davis RD. Binding of polyreactive antibodies to self versus foreign antigens. Immunobiology. 2002 Mar;205(1):95-107. (2002) Abstract

Lau CL, Palmer SM, Howell DN, McMahon R, Hadjiliadis D, Gaca J, Pappas TN, Davis RD, Eubanks S. Laparoscopic antireflux surgery in the lung transplant population. Surg Endosc. 2002 Dec;16(12):1674-8. (2002) Abstract

Hadjiliadis D, Sporn TA, Perfect JR, Tapson VF, Davis RD, Palmer SM. Outcome of lung transplantation in patients with mycetomas. Chest. 2002 Jan;121(1):128-34. (2002) Abstract

Hadjiliadis D, Davis RD, Palmer SM. Is transplant operation important in determining posttransplant risk of bronchiolitis obliterans syndrome in lung transplant recipients? Chest. 2002 Oct;122(4):1168-75. (2002) Abstract

Gonzalez-Stawinski GV, Daggett CW, Lau CL, Karoor S, Love SD, Logan JS, Gaca JG, Parker W, Davis RD Jr. Non-anti-Gal alpha1-3Gal antibody mechanisms are sufficient to cause hyperacute lung dysfunction in pulmonary xenotransplantation. J Am Coll Surg. 2002 Jun;194(6):765-73. (2002) Abstract

Gaca JG, Lesher A, Aksoy O, Ruggeri ZM, Parker W, Davis RD. The role of the porcine von Willebrand factor: baboon platelet interactions in pulmonary xenotransplantation. Transplantation. 2002 Dec 15;74(11):1596-603. (2002) Abstract

Gaca JG, Lesher A, Aksoy O, Gonzalez-Stawinski GV, Platt JL, Lawson JH, Parker W, Davis RD. Disseminated intravascular coagulation in association with pig-to-primate pulmonary xenotransplantation. Transplantation. 2002 Jun 15;73(11):1717-23. (2002) Abstract

Davis RD, Marshall JG, Baumgartner JC. Effect of early coronal flaring on working length change in curved canals using rotary nickel-titanium versus stainless steel instruments. J Endod. 2002 Jun;28(6):438-42. (2002) Abstract

Burfeind WR, Glower DD, Davis RD, Landolfo KP, Lowe JE, Wolfe WG. Mitral surgery after prior cardiac operation: port-access versus sternotomy or thoracotomy. Ann Thorac Surg. 2002 Oct;74(4):S1323-5. (2002) Abstract

Palmer SM, Drew RH, Whitehouse JD, Tapson VF, Davis RD, McConnell RR, Kanj SS, Perfect JR. Safety of aerosolized amphotericin B lipid complex in lung transplant recipients. Transplantation. 2001 Aug 15;72(3):545-8. (2001) Abstract

Palmer SM, Baz MA, Sanders L, Miralles AP, Lawrence CM, Rea JB, Zander DS, Edwards LJ, Staples ED, Tapson VF, Davis RD. Results of a randomized, prospective, multicenter trial of mycophenolate mofetil versus azathioprine in the prevention of acute lung allograft rejection. Transplantation. 2001 Jun 27;71(12):1772-6. (2001) Abstract

Klyn SL, Cummings DE, Richardson BW, Davis RD. Reduction of bacteria-containing spray produced during ultrasonic scaling. Gen Dent. 2001 Nov-Dec;49(6):648-52. (2001) Abstract

Jackson A, Palmer S, Davis RD, Pappendick A, Pearson E, Savik K, Ormaza S, Hertz M, Dacey M, Miller L, Reinsmoen NL. Cytokine genotypes in kidney, heart, and lung recipients: consequences for acute and chronic rejection. Transplant Proc. 2001 Feb-Mar;33(1-2):489-90. (2001) Abstract

Holzknecht ZE, Coombes S, Blocher BA, Plummer TB, Bustos M, Lau CL, Davis RD, Platt JL. Immune complex formation after xenotransplantation : evidence of type III as well as type II immune reactions provide clues to pathophysiology. Am J Pathol. 2001 Feb;158(2):627-37. (2001) Abstract

Hadjiliadis D, Tapson VF, Davis RD, Palmer SM. Prognostic value of serum carcinoembryonic antigen levels in patients who undergo lung transplantation. J Heart Lung Transplant. 2001 Dec;20(12):1305-9. (2001) Abstract

Gonzalez-Stawinski GV, Yu PB, Love SD, Parker W, Davis RD Jr. Hapten-induced primary and memory humoral responses are inhibited by the infusion of anti-CD20 monoclonal antibody (IDEC-C2B8, Rituximab). Clin Immunol. 2001 Feb;98(2):175-9. (2001) Abstract

Garantziotis S, Howell DN, McAdams HP, Davis RD, Henshaw NG, Palmer SM. Influenza pneumonia in lung transplant recipients: clinical features and association with bronchiolitis obliterans syndrome. Chest. 2001 Apr;119(4):1277-80. (2001) Abstract

Gaca JG, Lee W, Aksoy O, Braedehoeft SJ, Gonzalez-Stawinski GV, Parker W, Davis RD. Evidence for polyreactive xenoreactive antibodies in the repertoire of human anti-swine antibodies: the 'next' humoral barrier to xenotransplantation? Transpl Immunol. 2001 Oct;9(1):19-27. (2001) Abstract

Chen EP, Bittner HB, Akhter SA, Koch WJ, Davis RD. Myocardial function in hearts with transgenic overexpression of the G protein-coupled receptor kinase 5. Ann Thorac Surg. 2001 Apr;71(4):1320-4. (2001) Abstract

Cen YY, Glower DD, Landolfo K, Lowe JE, Davis RD, Wolfe WG, Pieper C, Peterson B. Comparison of survival after mitral valve replacement with biologic and mechanical valves in 1139 patients. J Thorac Cardiovasc Surg. 2001 Sep;122(3):569-77. (2001) Abstract

Daggett CW, Yeatman M, Lodge AJ, Lawson JH, Chen EP, Srinivasan M, Van Trigt P, Byrne G, Logan J, Platt JL, Davis RD. Genetically engineered porcine lungs in a human xenotransplantation model. Jour. of Thorac. and Cardiov. Surg, in press.