By Michael de Vera, MD, Chief, Division of Transplant Surgery, LLUSM
“To make man whole” is inherently the mission of the Loma Linda University Health (LLUH) Transplant Institute (TI). Loma Linda University has had a long and rich history in organ transplantation. The first successful kidney transplant in the U.S. was performed by Dr. Joseph Murray in 1954 in Boston, and one of his research fellows, vascular surgeon Louis L. Smith ’49, performed the first kidney transplant in the Inland Empire in April 1967 at the old hospital where Nichol Hall now stands. In 1992, the Loma Linda Transplant Institute was formally created. Transplantation at LLU has grown considerably since Dr. Smith’s first kidney transplant and the first pancreas and liver transplants at the TI done in 1993.
The Transplant Institute oversees the abdominal transplant programs at LLUH: liver (adult), kidney (adult and pediatrics), and pancreas (adult). To date, 3,561 kidney, 955 liver, and 255 pancreas transplants have been performed at LLU Medical Center, and our surgeons perform over 100 liver, over 200 kidney (including 40–50 living donor transplants and around 10 pediatric transplants), and approximately 10 pancreas transplants per year, making our program one of the largest in Southern California.
The organizational structure of the TI crosses through departments, allowing the service line to deliver the most efficient and highest quality care to pre- and post-transplant patients. The transplant surgeons and physicians are hired directly into the Institute while maintaining academic ties with the departments of surgery and internal medicine. The TI has six transplant surgeons, six transplant hepatologists, and four transplant nephrologists, in addition to five physician extenders who staff our outpatient clinics and two nurse practitioners (NP) who cover our inpatient hepatology and transplant surgery services. Six NPs from Advance Practice Services also cover inpatients. Our satellite clinics at Riverside University Health System, Murrieta, Palm Springs, Orange County, and in particular Las Vegas, have contributed to the significant growth of the liver transplant program. Over 2,000 new patients with liver disease are seen at the Transplant Institute every year. The kidney transplant program has also grown significantly, with more than 2,000 new patients being referred to the TI for kidney transplantation every year.
Our transplant surgeons, led by myself (director of TI and surgical director, liver transplantation), include Arputharaj Kore, MD; Charles Bratton, MD (surgical director, kidney/pancreas transplantation); Minh-Tri Nguyen, MD, PhD; Jakub Woloszyn, MD; and Pratik Mehta, MD. I also perform open/laparoscopic liver resections and pancreatectomies. The American Society of Transplant Surgeons recently approved our transplant surgery fellowship, and we matched our first fellow to start a two-year fellowship training beginning in July 2021. The transplant surgery service plays an important role in general surgery residency training. Fourth- and first-year Loma Linda residents rotate through the service. Third-year medical students rotate through transplant during their general surgery clerkship.
Our transplant hepatologists, led by Michael Volk, MD, MSc (medical director, liver transplantation), include Khaled Selim, MD; Mina Rakoski, MD; Jason Cheng, MD; Michael Lin, MD; and Brian Lee, MD. In addition to transplant services, the hepatologists also provide full general hepatology services and management of liver diseases and malignancies. The transplant nephrologists are led by Rafael Villicana, MD (medical director, kidney/pancreas transplantation), and include Thanh Hoang, MD, and Rangwasee Rattanavich, MD. Surakshya Regmi, MD, is our first American Society of Transplantation–approved transplant nephrology fellow and will be formally joining the faculty when she completes training in January 2021.
The TI faculty is active in clinical research, cumulatively publishing over 30 papers and abstracts in 2019–2020. We have multiple industry-sponsored clinical trials, including a study on immune tolerance, which allows living donor kidney recipients to be weaned off immunosuppression. Myself, Dr. Nguyen, and Abigail Benitez, PhD, run the Transplant Immunology Laboratory and oversee translational research studies looking into human biomarkers predictive of post-transplant allograft dysfunction and organ rejection. Drs. Volk and Rakoski have a $1 million grant funded by the Patient-Centered Outcomes Research Institute focusing on palliative care in advanced liver disease. The TI is one of the leading centers in the U.S. that transplants organs from hepatitis C positive donors to naive patients and has clinical trials underway in liver and kidney transplantation.
Judy Evans, RN, MBA (executive director of TI); Erin Wells, RN (clinical director, liver transplantation); Janet Williams, RN (clinical director, kidney/pancreas transplantation); and Melissa Robinson (quality/research director) supervise approximately 90 TI support staff of transplant coordinators, social workers, quality and financial coordinators, medical assistants, and other ancillary personnel that take care of thousands of our patients. In 2017, we celebrated the 50th anniversary of transplantation at Loma Linda. We look forward to many more years of service to fulfill the mission of Loma Linda University Health.
Dr. de Vera is Professor of Surgery and Chief of Transplant Surgery. He has been the Director of the LLUH Transplant Institute since 2010.
TRANSPLANT SURGERY FACULTY SPOTLIGHTS:
Michael L. Volk, MD
Dr. Volk is the Robert and Gladys Mitchell Professor of Medicine and chief of gastroenterology and hepatology. He also serves as medical director of liver transplantation at the Transplant Institute. Dr. Volk is triple board certified in transplant hepatology, gastroenterology, and internal medicine, and has been frequently selected by Best Doctors as among the top hepatologists in the country.
Prior to moving to Loma Linda, Dr. Volk was director of the liver tumor program at the University of Michigan. He is a former Robert Wood Johnson Clinical Scholar, with a funded research program that focuses on management of cirrhosis and organ allocation for liver transplantation. He has published more than100 research articles, reviews, and book chapters. Since joining the TI in 2015, Dr. Volk has helped quadruple liver transplant volumes to over 100 per year. He has established numerous satellite clinic locations, including a Loma Linda clinic in Las Vegas.
In his free time Dr. Volk enjoys hiking and biking with his wife, Corrie, and two boys, Alexander and Sebastian.
Charles Bratton, MD
Dr. Bratton, associate professor of surgery, joined the Transplant Institute in 2017 as a senior abdominal, multi-organ transplant surgeon. Dr. Bratton is the surgical director of the kidney-pancreas program, also overseeing the living donor and pediatric kidney transplant programs. He obtained his transplant surgery fellowship training at Beth Israel Deaconess and was at the Medical University of South Carolina for 12 years prior to his arrival at Loma Linda. His clinical interests include liver transplantation, living donor kidney transplantation, paired donor exchanges, and desensitization and ABO-incompatible kidney transplantation.
He has been instrumental in the growth of the kidney transplant program and recently spearheaded a record eight-person kidney transplant living donor chain at LLU Medical Center. Dr. Bratton also leads the pancreas transplant program and has expanded transplantation to selected patients with type 2 diabetes mellitus, making Loma Linda one of only a few centers in the U.S. to perform this practice. His research interests include the study of novel immunosuppressive agents and health disparities in transplantation.
Dr. Bratton’s passion is for the Transplant Institute to be a dynamic, multifaceted, and patient-centric program, aligned with the mission of LLU Health, that seeks to optimize transplant opportunities and provide exceptional care for each patient through innovative approaches.
Rafael Villicana, MD
Dr. Villicana is a native Southern Californian who grew up in Hacienda Heights. He attended Michigan State Medical School followed by an internal medicine residency at Mayo Clinic, Minnesota. Dr. Villicana continued his training in general nephrology followed by another fellowship in transplant nephrology at the University of California, San Francisco. He spent about a decade at Cedars-Sinai Medical Center as associate medical director of the kidney transplant program before his recruitment to join the faculty at the Transplant Institute in 2016.
As medical director of the kidney transplant program, Dr. Villicana has been instrumental in doubling the transplant volumes at LLU Medical Center and in markedly increasing kidney transplant referrals. The TI is now one of the larger kidney transplant programs in Southern California. Dr. Villicana participates in the general nephrology postgraduate training program and has initiated a transplant nephrology fellowship program that is accredited by the American Society of Transplantation. He has published on numerous topics within the field of transplantation, including immunosuppression and incompatible transplantation.
Dr. Villicana enjoys spending time with his wife, Mila, and their two daughters. He is an avid dog lover, and his hobbies include soccer and traveling.