Advances in Transplantation

In this Q&A with Consult QD, Charles M. Miller, MD, Enterprise Director of Transplantation at Cleveland Clinic’s Transplant Center, provides an update on the recent developments in transplantation across the centers in the U.S. and Abu Dhabi.

Q: You recently assumed the position of Director of Cleveland Clinic’s Transplant Center. Please tell us about the center’s goals and your current role?

A: The aspirational goal of Cleveland Clinic’s Transplant Center is to be the global leader in saving and restoring lives through transplantation.

Our purpose is to create a global approach to honor the gift of life by providing the highest quality transplant care, research and education across all of our locations.

We share protocols, advice and new ideas and developments between each of the institutes of the Enterprise Transplant Center and my job is to try to make it as much a level playing field as possible, taking into account cultural and logistical factors.

Q: What are some of your team’s most recent transplant achievements in Cleveland?

A: Our team recently performed a very successful uterine transplant from a deceased donor, which is different than what other programs have been doing. This was a great team effort between Cleveland Clinic’s Transplant Center, Digestive Disease & Surgery Institute and Ob/Gyn & Women’s Health Institute. The progress of the patient has been smooth. Other programs have recently shown that insemination and pregnancy can be safe as soon as six months after transplant.

We also performed a face transplantation procedure in 2017 and it went beautifully. These procedures are all categorized as vascularized composite allografts. The Department of Plastic Surgery is also working to establish a limb transplant program and is working up potential candidates.

In December 2017, our team performed the first successful liver transplant from a living donor for a patient with unresectable colonic metastasis who had failed all other means of treatment. The patient is doing very well.

Q: What is the current focus of work being done at Cleveland Clinic Florida?

A: In four short years, we have built a highly dynamic multiple organ transplant program with superb results. In 2017, Cleveland Clinic Florida performed a total of 196 transplants — 21 heart, 51 liver and 122 kidney transplants. Recently, we recruited Jason M. Vanatta, MD, from the University of Memphis to be the Director of abdominal organ transplantation — a superb surgeon to lead that program who will take the program to the next level.

Andreas Tzakis, MD, who pioneered transplantation in Florida and was the visionary force for transplantation in Weston, has become an Emeritus Director for Cleveland Clinic’s Transplant Center. He will be working alongside me and Jason to continue to build the program in Florida, the uterus transplant program in Cleveland, and help with development and innovation.

Q: The first heart transplant, liver, lung and kidney transplants were recently performed in Cleveland Clinic Abu Dhabi successfully. What does this accomplishment mean for transplant medicine in the region?

A: Living donor renal transplantation has been performed sporadically for a number of years in Abu Dhabi. In 2017, the kidney transplant team at Cleveland Clinic Abu Dhabi began performing transplants and have so far performed seven procedures; four from living donors and three from deceased donors.

This became possible in 2017, when new legislation on brain death was ratified in the United Arab Emirates (UAE). Since then, there have been four actual deceased donors in which multiple organs were procured and transplanted. The first deceased donor at Cleveland Clinic Abu Dhabi provided two kidneys and a heart, which made it possible to perform the first heart transplant in the UAE.

Just a month later, another UAE deceased donor provided a liver and a kidney for transplantation into two patients at Cleveland Clinic Abu Dhabi. And finally, another deceased donor provided lungs and kidneys leading to the first lung transplant in the UAE at CCAD. All of these were highly successful and in short, transplantation has a bright future in the UAE.