Transplant Medicine

Ospedale San Raffaele

key figures 

CLINICAL SERVICES:

  • Kidney Transplantation
  • Pancreas Transplantation
  • Islet Transplantation
  • Treatment of Pathological Obesity

PROCEDURES PERFORMED PER YEAR: 69

The organ transplantation activity of the San Raffaele Research Hospital began in 1985, thanks to the close collaboration between the Medicine and Surgery Units for the launch of the kidney and pancreas transplant programme in the diabetic patient. The first kidney-pancreas transplant in Italy was also performed in the same year. The launch of the Nephrology and Dialysis Unit later, allowed to expand the activity to nephropathies of non-diabetic origin.

The opening of the pancreatic islet isolation laboratory in the 1980s allowed the launch of the Langerhans islands transplantation programme in humans in 1989. In the same year, the first pancreatic islet transplant was carried out, for which the San Raffaele Research Hospital is the leading centre in Italy and Europe even today.

The surgical activity related to transplants is coordinated by Dr. Carlo Socci, Head of the Transplantation and Metabolic Surgery Unit. Meanwhile, the Transplantation Medicine Unit is accountable for the internal aspects of transplantation activities (patient entry, peri and postoperative clinical monitoring). Alongside the transplant activity, within the San Raffaele Hospital, an organ collection activity coordinated by the Neuro-reanimation service has also developed over time. All the transplant activity is naturally supported by the numerous services present inside the Hospital.

 

treatmentS

Beta cell replacement (pancreas and islet transplantation)

Pancreas and islet transplantations are aimed at substituting insulin therapy in type 1 diabetic patients or in insulin-treated type 2 diabetic patients. One of the limits to the broad application of these techniques is the necessity to treat patients with immunosuppressant therapy for life. Immunosuppression therapy exposes patients to several risks. The rate of success is high, reaching 80% insulin-independence with the pancreas and 60% with the Islets. We aim at identifying the immunosuppressive regimens with the most favourable risk-benefit ratio for patients undergoing beta cell replacement. Furthermore, beta cell replacement plays a positive role on diabetes-related complications (e.g. diabetic nephropathy, retinopathy, diabetic bone disease).

Main Pathologies Treated:

  • Type 1 diabetes or type 2 insulin-treated diabetes

Kidney Transplantation

Kidney transplantation is proposed to patients with end stage renal failure, requiring dialysis treatment. The procedure is now available also to patients in the pre-uremic state, before starting dialysis. The procedure can be performed with organs coming from cadaver donors and with organs coming from living donors (relatives, close friends etc.). we have recently developed and implemented a clinical protocol of pre-transplant desensitization that allows to preform kidney transplantation across the blood group barrier (AB0 incompatibility), allowing kidney donation also from related donors AB0 incompatible with the recipients. Our Unit participates in multicentre randomized clinical trials to assess the efficacy of novel drugs to tackle cytomegalovirus (CMV) and BK virus infections. Our efforts are also directed at identifying predictors of progression to BK virus-associated nephropathy.

Post-transplantation diabetes (PTDM) is another complication that may severely affect both short- and long-term outcomes of kidney transplant recipients in terms of graft and patient survival. The Unit is developing research protocols to assess the efficacy of prevention strategies as well as the efficacy and safety of different therapeutic approaches to improve metabolic control and long-term outcomes. Our Unit, in collaboration with the Transplant and Metabolic/Bariatric Surgery Unit, is also assessing the role of hypothermic machine perfusion in the prediction of postoperative kidney transplantation outcomes. In tight collaboration with the Surgical Unit we have developed a clinical protocol to treat obese patients before transplantation, thus allowing these patients to enter the waiting list for kidney transplantation.

Main Pathologies Treated:

  • End stage renal diseases

Metabolic surgery

Morbid obesity may contraindicate transplant surgery. On the other hand, weight gain and obesity are frequent after organ transplantation, due to several factors including immunosuppressive drugs and psychological factors. The presence of obesity increases the risk of PTDM and adverse outcomes in transplant recipients. In collaboration with the Transplant and Metabolic/Bariatric Surgery Unit, our Unit is studying the role of weight loss surgery in the management of kidney transplant candidates and recipients.

Sarcopenic obesity (SO), i.e. obesity with reduced muscle mass/strength, is associated with increased morbidity/mortality and metabolic derangements. In collaboration with the Transplant and Metabolic/Bariatric Surgery Unit, we are developing protocols to dissect the mechanisms underlying SO and identify biomarkers for diagnosing and monitoring the condition.

Main Pathologies Treated:

  • Obesity