Department of Medicine - Surgery - University of Minnesota

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From Left to Right: John R.Lake, MD, Professor of Medicine,Department of Medicine, WilliamD. Payne, MD, Professor of Surgery,Department of Surgery, Abinav(Abhi) Humar, MD, AssociateProfessor of Surgery, Departmentof SurgeryResearch Highlight: the liver transplant program at the university of minnesotaTThe Liver Transplantation Program at the University ofMinnesota has grown dramatically over the past eightyears, in terms of both clinical activity and academicproductivity. The program, which is led by John Lake, M.D, WilliamPayne, M.D, and Abhi Humar, M.D, has contributed seminal research tothe field of transplantation, which has had a major impact on transplantationof both children and adults. The research is focused on three mainareas: new sources of donor organs, new approaches to the managementof viral hepatitis in liver transplant recipients, and splitting of one liverto serve two recipients.First, while splitting of livers for two recipients has been used successfullyto serve one adult and one pediatric recipient, the real need is to be ableto develop ways to provide adequate liver to transplant to two adults. TheUniversity of Minnesota Liver Transplantation Program, and a study led byHumar, demonstrated that this can be done with good results. The majorfindings of this study were that both donor and recipient selections wereimportant, particularly recipient selection for the relatively smaller leftlobe liver graft. The University of Minnesota is now one of the most experiencedcenters for splitting livers for two adults.Second, in the early days of liver transplantation, the outlook for patientstransplanted for hepatitis B was poor, as recurrence of the infection wasalmost universal and half or more of the patients developed very aggressiveliver disease that led to death within a matter of several months.The uses of high doses of antibodies directed against the hepatitis B virusled to a marked improvement in the overall prognosis for patients transplantedfor hepatitis B and prevented re-infection of the new liver in themajority of patients. The problems with hepatitis B antibody preparationincluded extremely high-cost, significant side effects in the probabilitythat life-long administration of antibodies would be necessary.Over the past ten years, several new antivirals have been developed whichare affective against hepatitis B virus. The University of Minnesota LiverTransplantation Program has recently demonstrated that using combinationsof antiviral medication can obviate the need for high doses of antibodiesagainst the hepatitis B virus, thereby leading to much improved patientsatisfaction and substantially lower cost. It is anticipated that, in the nearfuture, this will become the standard method for preventing re-infectionof the transplanted livers with hepatitis B virus.Finally, the University of Minnesota, in general, has been a pioneer in theuse of live donors for all types of solid organ transplants including kidney,intestine, lung, as well as liver. The University of Minnesota Liver TransplantationProgram has contributed important knowledge of live donor livertransplantation in several ways. Perhaps the most significant has been inthe area of the use of live donors for transplantation for patients with hepatitisC. The University of Minnesota has published the best results obtainedto date regarding transplantation using live donors for patients with hepatitisC. The program has demonstrated that these patients have excellentsurvival and, most importantly, have significantly less severe recurrenceof hepatitis C. Like hepatitis B in the older days, the hepatitis C virus reinfectedthe new livers in almost 100 percent of cases.The significance of the University of Minnesota study is that if one canavoid post transplant complications and poor graft function, than onecan get excellent results using live donors for transplanting patients withhepatitis C. In fact, results using live donors for liver transplantation bythe University of Minnesota Liver Transplantation Program are among thevery best in the United States. The Liver Transplantation Program willcontinue its research in developing new and improved ways of providingliver transplantation to the many desperate people with both acute andchronic end-stage liver disease.47
Division of General Internal Medicinea passion for excellenceThe Divisions of General Internal Medicine at Abbott Northwestern,Hennepin County Medical Center, Regions Hospital, University ofMinnesota Medical Center, and the Minneapolis VA Medical Center48Wesley Miller, M.D.Division Directorwww.dom.umn.edu/gimhave developed an outstanding cohort of clinicians, educators,and investigators. The divisions share a passion for teaching students andresidents and for the delivery of evidence-based care. Each division has contributedin a major way to educational initiatives and has contributed significantly to theregional and national dialogue in teaching and research.Educational ProgramsDuring 2005, significant new educational activities and positions by generalinternal medicine faculty have included:Abbott Northwestern (ANW) SiteInternal Medicine Program Director: Robert Miner, M.D.Clerkship site coordinator: Laurel Drevelow, M.D.ANW continues to be successful in resident, fellow, and medical student educationin Internal Medicine. The hospital expanded support for the University fellowshipsin Cardiology and Gastroenterology during the past year. It was an important educationaladvance during the last year to make all of our residency conference presentationsavailable online as part of our Web site. Our hand-held computer projectusing Pocket PC technology for information access continues to advance and bevery important for patient care and learning.Hennepin County Medical Center (HCMC) SiteThe general medicine division has continued its excellent tradition of outstandingcare for patients and education of students and residents. This year, a hospitalistservice was initiated at HCMC led by former Chief Resident, Glen Varns, M.D.
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Department of Medicine - Surgery - University of Minnesota

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