Departments / Divisions
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Surgery /
Cardiovascular & Thoracic
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Immunology
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Pathology
Address
DUMC 3392
Durham, NC 27710
Appointment Telephone
919-684-4694
Office Telephone
919-684-4694
Fax Telephone
919-681-7524
Training
- MD, Duke University School of Medicine, 1992
Residency
- General Surgery, Duke University Medical Center, 1992-2001
- Thoracic Surgery, Duke University Medical Center, 2001-2004
Other Training
- PhD, Immunology, Duke University Medical Center, 2000
Clinical Interests
Cardiopulmonary transplantation (heart, lung and heart-lung transplantation), transplant immunology, adult cardiac surgery including CABG and valvular surgery
Research Interests
Introduction
The increasing number and the improvement in the success of heart and lung transplantation in recent years make now the most exciting time to be involved in research related to the scientific issues surrounding this field. Among those issues, two problems are currently recognized to be the major impediment to the optimal application of transplantation in patients with end-stage cardiopulmonary disease. First, there is a lack of consistent long-term graft survival, which is constrained by the current immunosuppressive regimen and its side effects; compared to other solid organ transplants, lung and heart-lung allografts are particularly susceptible to this problem. Second, there is a dire shortage of donor organs; although this problem is especially pronounced in lung and heart-lung transplantation, it is also seen in transplantation of other organs. The Duke Cardiopulmonary Transplantation Laboratory addresses both of these problems and examines the factors associated with chronic allograft failure as well as the approaches aimed at circumventing the donor organ shortage.
The Problems
Clinical lung transplantation has only recently begun to consistently enjoy some short-term success. Compared to other solid organ transplants, however, the long-term survival is still limited. For example, the 5-year patient survival rate for primary transplants, according to the October 2004 Organ Procurement and Transplantation Network data, is only 43.9% for pulmonary allografts and 70.6%, 70.3%, and 67.2% for cardiac, cadaveric renal, and hepatic allografts, respectively. Chronic rejection, specifically in the form of bronchiolitis obliterans, appears to be the predominant factor contributing to the poor long-term survival of lung transplant recipients.
Despite the less than optimal long-term outcome today, there has undoubtedly been a gradual improvement in the overall success of lung transplantation in recent years; and with this success comes more demand for organ donors. For example, the waiting list for heart transplantation in October of 2004 is just under 3400 long while that for lung transplantation is over 3900. Furthermore, the median waiting time for lung transplantation during 2001-2002 ranges from 636 to 834 days, depending on the recipient ABO blood type.
Focus of Scientific Research
In searching for solutions to these problems, our laboratory now focuses on three main areas of scientific investigation within the field of cardiopulmonary transplantation:
(1)Mechanisms underlying the chronic rejection, especially that of lung and heart-lung allografts,
(2)Induction of immunologic tolerance to reduce the morbidity and improve the long-term survival of heart and lung transplantation, and
(3)Xenotransplantation, with the ultimate goal of alleviating the problem of donor organ shortage but the more immediate goal of gaining general knowledge about transplantation immunobiology using this exciting experimental model.
Our current work in these three areas is described briefly below:
(1) Chronic Rejection of Pulmonary and Cardiopulmonary Allografts
Chronic rejection can occur months to years after a transplant when a graft escapes hyperacute and acute rejection, which are typically mediated by humoral and cellular components, respectively. For pulmonary allografts, chronic rejection is typically manifested histologically in the form of bronchiolitis obliterans, a process in which the small airways are severely narrowed from subepithelial fibrosis.
The incidence of bronchiolitis obliterans in lung and heart-lung transplant patients has remained relatively constant despite the development of newer therapeutic agents that successfully prevent alloimmunity in other organ transplants. Thi
Industry Relationships and Collaborations (
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This faculty member has no reported relationships with industry.
