Houston Methodist Transplant Annual Report 2013

2013 YEAR IN REVIEW

UNG KIDNEY PANCREAS HEART LIVER BONE ARROW LUNG STEM CELLS INTESTINE LUNG KIDNEY PANCREAS HEART LIVER BONE MARR SLET STEM CELLS LUNG BONE MARROW LUN KIDNEY HEART LIVER ISLET STEM CELLS INTE INE LUNG KIDNEY PANCREAS HEART LIVER BONELEADING MARROW MEDICINEISLET STEM CELLS INTESTINE ORGAN FAILURE UNGADVANCED KIDNEY PANCREAS HEART LIVER BONE AND TRANSPLANT MARROW ISLET STEM CELLS INTESTINE LUNG KIDNEY PANCREAS HEART LIVER BONE MARR OW ISLET STEM CELLS INTESTINE LUNG KIDN Y PANCREAS HEART LIVER BONE MARROW STEM CELLS INTESTINE STEM CELLS HEART L KIDNEY KIDNEY HEART LIVER STEM CELLS IS

A PROUD TRADITION OF EXCELLENCE, WITH A NEW NAME. The Methodist Hospital is now Houston Methodist Hospital. This new name reflects the pride in who we are and where we are from. Our commitment to advancing medicine with global impact begins in Houston, Texas, where we pioneer a better tomorrow through research, cutting-edge innovation and breakthroughs to rewrite the future of health.

THAT’S THE DIFFERENCE BETWEEN PRACTICING MEDICINE AND LEADING IT.

CONTENTS

10

13

9

16

LEADING MEDICINE: AN OVERVIEW

3

PULMONARY TRANSPLANT

8

RENAL TRANSPLANT

12

GASTROINTESTINAL CARE

16

LIVER TRANSPLANT

17

HEART TRANSPLANT

20

BONE MARROW & STEM CELL TRANSPLANT

24

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

MESSAGE FROM THE DIRECTOR With the many changes in health care delivery, there is a significant need for organizations like ours to deliver innovative care to patients with chronic organ failure as well as transplant patients. At the Houston Methodist J.C. Walter Jr. Transplant Center, we are uniquely suited to lead this advance as we move into our sixth decade of service.

This past year has been spent strengthening the underpinnings of our program and laying the foundation for our next phase of expansion. Our focus for the entire next phase will remain on the patient, who is the center of our activity. We also are designing ways to better serve all of our other customers, both external and internal.

As I look from my vantage point on Houston Methodist and the transplant center, I see a true commitment to honor our patients and their donors by giving back to the remarkable community of caregivers, referring physicians, nurses, social workers and health plan providers who entrust us with family members, patients and clients.

To this group we continue to give thanks and renew our long-lasting commitment to making patient care our central endeavor.

I also see the great strides we made this past year in establishing our translational research programs. Through partnership with the Houston Methodist Research Institute, as well as individual donors and foundations, we have made great discoveries in the areas of kidney and lung transplant biology, device therapy, liver care and diabetes treatment.

These advances are made possible by aligning our laboratories and great scientists with our state-of-the-art patient care activities, putting us at the forefront of true translational medicine.

You will see in this report that we are also making strides in bringing our innovation and newly made discoveries to others through publications, training and education.

We offer informative conferences on advances in transplantation management, fellowships for transplant physicians-in-training and a one-of-a-kind transplant coordinator training program, each enhanced by our intimate and inclusive patient and physician access to specialized treatment information and expertise.

We have expanded many programs and advanced the use of new tools, procedures and protocols, all in the spirit of healing those with organ failure and growing the pool of viable organs that can save the lives of patients in need.

A. Osama Gaber, MD, FACS

2

J.C. Walter Jr. Transplant Center

LEADING MEDICINE : AN OVERVIEW ABOUT J.C. WALTER JR. TRANSPLANT CENTER Houston Methodist J.C. Walter Jr. Transplant Center combines world-class clinical expertise, innovative research programs and state-of-the-art technology with a comprehensive, multidisciplinary approach to the treatment of end-stage organ failure and transplantation.

We strive to provide the highest-quality care and best clinical outcomes, and to advance knowledge and medical research. Our team is committed to educating the next generation of professionals and the public about organ failure management and organ and tissue transplantation.

TRAN S P LANTS P E R FOR M E D AT HOUSTON M ETHODI ST BY YEAR

1963 1968

39 TOTAL

3

14

HEART/ LUNG

22

KIDNEY/PANCREAS

OTHER COMBOS

1978

87

BEDS

16

INTERMEDIATE CARE BEDS

233

12 25 88

1993

87

1998

82

2003

2013 STAFF MEMBERS

40

1988

2008

INPATIENT TRANSPLANT STATISTICS

18

1973

1983

MULTI-ORGAN TRANSPLANTS

1

149 234 396

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

2014 TRANSPLANT GAMES OF AMERICA Houston Methodist was a sponsor of the 2014 Transplant Games of America, the multi-sport event that promotes organ donation by demonstrating, through sporting competition, that there is life after transplant. In 2012, Houston Methodist heart transplant recipient and Team Texas manager, Brian Gilliam, took more than 100 recipients, donors, family members and supporters to compete in the first games in Grand Rapids, MI. After winning more than 60 medals, Gilliam, along with Houston Methodist transplant coordinator, Donna Esposito, led the charge to bring the games to Houston and, after meeting with the Harris County-Houston Sports Authority and submitting a bid, the city was awarded the games that took place from July 11–15. Organ transplant recipients, living donors, bone marrow recipients and a limited number of corneal and tissue transplant recipients will compete in everything from track and field to basketball and ping pong. In the words of Brian Gilliam, “While we want to win, these games are about fellowship as much as competition. It’s just awesome.”

4

J.C. Walter Jr. Transplant Center

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

NOTABLE ACCOMPLISHMENTS •

•

•

•

•

•

•

•

Houston Methodist launched the first transplant coordinator training program for nurses.

The one-year curriculum covers the entire continuum of care, ensuring key skills are mastered by those who undertake the intricate task of managing transplant protocols and care.

Houston Methodist is one of only a few facilities that performs bloodless lung transplants, due to the degree of difficulty associated with bloodless surgeries. The transplant center also performs bloodless kidney and kidney-pancreas transplants.

Houston Methodist is the first center in the world to implant a total artificial heart for a patient with a cardiac malignancy.

The Houston Methodist transplant team performed a domino liver transplant in September to save the life of a 31-year-old mother with liver cancer. She received a liver from a living donor with amyloidosis, who then received a donated liver to treat his disease.

The Transplant Center celebrated 50 years of advances in organ failure and transplantation management at a three-day conference.

Featured speakers: ° Dr. Alan Langus, president of the American Society of Transplant Surgery ° Dr. Dan Salomon, president of the American Society of Transplantation ° Dr. Bruce Molitoris, president of the American Society of Nephrology The Graham Guerrero Lecture in urology transplantation honored the physician’s 30 years of service.

Featured speakers: ° Dr. Timothy Boon, chief of urology at Houston Methodist ° Dr. Stuart Flechner, professor of surgery at the Cleveland Clinic Lerner College of Medicine The Optum Health Spotlight Series hosted Leading Innovative Care in Transplantation: A Spotlight on Houston Methodist J.C. Walter Jr. Transplant Center. ° 150+ referring physicians, nurses and allied health professionals attended.

The Shared Care Summit targeted community-based medical professionals with sessions on the identification, treatment and management of advanced heart failure, highlighting LVAD care.

TRANSPLANT PATIENTS’ HOME •

Nora’s Home, honoring the memory of director Osama Gaber’s daughter, offers affordable lodging for transplant patients and their families who travel to the Texas Medical Center for treatment. Opened in 2013, it provides care, education and support in a loving, home-like environment. Visit norashome.org for more information.

NOTABLE AWARDS •

•

•

Xian C. Li, MD, director of the Immunobiology and Transplantation Research Center, was awarded two NIH grants totaling over $2 million to study the role of OX40 in T regulatory cell exhaustion, which impacts transplant tolerance.

Houston Methodist and Baylor College of Medicine (BCM) received a Roche Organ Transplantation Research Foundation award for a study titled, “Compositional Changes That Cause Weight Gain after Kidney Transplantation.”

Houston Methodist, BCM and Rice University were awarded a $1.3 million research grant for decision making in VAD therapy.

TRANSPLANT LEADERSHIP A. Osama Gaber, MD, FACS Director, Houston Methodist J.C. Walter Jr. Transplant Center George P. Noon, MD

Director, Transplant Executive Council

RENAL & PANCREAS TRANSPLANT

BONE MARROW TRANSPLANT

Richard Knight, MD, FACS

Helen Heslop, MD

Juan Gonzalez, MD

George Carrum, MD

Surgical Director, Kidney & Pancreas

CARDIAC TRANSPLANT & ASSIST DEVICES

Horacio J. Adrogué, Sr., MD

Matthias Loebe, MD, PhD, FACC, FCCP

Ashish Saharia, MD

Surgical Director

Associate Director, Kidney & Pancreas

Director, Adult Outpatient Clinic for Cell & Gene Therapy; Director, NMDP Collection Program

Jerry D. Estep, MD, FACC

Elie Saber, MD

IMMUNOBIOLOGY RESEARCH CENTER

Medical Director

Brian Bruckner, MD

Associate Director, Mechanical Circulatory Support

HEART-LUNG TRANSPLANT

Co-Medical Director

Director, Center for Cell & Gene Therapy

Co-Medical Director

Living Donor Advocate

PROCUREMENT Hemangshu Podder, MD, PhD

David Bernard, MBA, MHA, FACHE

Medical Director

Co-Director, Living Donor Procurement

Thomas Kaleekal, MD

Richard E. Link, MD, PhD

Scott Scheinin, MD, FACS

Surgical Director

Thomas Kaleekal, MD

Medical Director

ECMO Brian Bruckner, MD

Surgical Director John Fetter, MD

Medical Director

INTESTINAL FAILURE PROGRAM Sherilyn Gordon Burroughs, MD, FACS

Director

Clinical Research

ADMINISTRATION

Jerry D. Estep, MD, FACC

PULMONARY TRANSPLANT

Linda Moore, RD

Dewei Ren, MD

Director, Thoracic

Medical Director

Director/Scientist Clinical Research

Director, Abdominal

Matthias Loebe, MD, PhD, FACC, FCCP

Surgical Director

Xian C. Li, MD

Brian James Dunkin, MD, FACS

Co-Director, Living Donor Procurement

LIVER TRANSPLANT R. Mark Ghobrial, MD, PhD, FACS, FRCS(Ed)

Vice President

Susan A. Zylicz, RN, BSN, MHA, CCTC

Transplant Administrator Anna Argyris

Research Administrator Julie Corkrean, RN, BSN, CCTC

Liver Transplant Manager Anthony Flores

Director, Houston Methodist Center for Liver Disease & Transplantation

Financial Manager

Victor Ankoma-Sey, MD

Recovery Operations Manager

Joseph S. Galati, MD, FACGT

Laurie Loza, RN, BSN, CCTC

Medical Director, Transplant Medical Director, Houston Methodist Center for Liver Disease & Transplantation

Howard P. Monsour, Jr., MD

Chief, Hepatology

Jordan Jeon, BA, CTBS, CPTC

Heart Transplant Manager Marty Martin, RN, BSN

Communication Center Manager

Lisa Yoder, RN, BSN, CCTC

Kidney & Pancreas Transplant Manager

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

TRANSPLANT FELLOWSHIPS PROVIDE HANDS-ON LEARNING & IMMERSION IN RESEARCH Organ transplantation is a unique field, demanding skills and ethical considerations that are specific to this area of medicine. Houston Methodist has a deep legacy in transplant. We are committed to training the next generation of surgeons in the latest tools, procedures, research and philosophies of transplant, ensuring excellence and safety for patients and donors, now and in the future.

The J.C. Walter Jr. Transplant Center offers world-class fellowships for surgeons interested in kidney, liver and thoracic transplant. In addition, we have applied for a pancreas transplant fellowship and expect it will be accredited soon.

Kidney and liver fellowships, which are accredited by the American Society of Transplant Surgeons, are open for the 2014 match through the National Residency Matching Program.

We offer the opportunity for one fellow per year in kidney and one in liver. A yearly slot for thoracic transplants is offered to cardiac surgeons who are finishing their cardiac training and wish to increase their exposure to transplantation in one of the largest thoracic programs in the country. It is a one-year extension to their cardiac training.

“With a large and vibrant transplant center, and some of the top transplant researchers in the country, Houston Methodist is able to offer excellent opportunities for hands-on learning and up-close exposure to research for those interested in the art and science of transplant,” said Osama Gaber, MD, director of the Houston Methodist J.C. Walter Jr. Transplant Center.

6

J.C. Walter Jr. Transplant Center

Fellows have close interaction with some of the nation’s top researchers, including Xian C. Li, MD, scientific director of the Transplant Immunology Program.

His lab studies the fundamental mechanisms of transplant rejection and tolerance.

John P. Cooke, MD, is the chair of the Department of Cardiovascular Sciences at the Houston Methodist Research Institute and the director of the Center for Cardiovascular Regeneration in the Houston Methodist DeBakey Heart & Vascular Center. His lab uses small molecules or stem cell therapies for vascular regeneration. Mauro Ferrari, MD, president and CEO of the Houston Methodist Research Institute, has founded several biomedical nanotechnology companies. His lab focuses on cell transplantation, regenerative medicine and tissue engineering, among other specialties. We are also currently recruiting for a national chair in outcomes research.

“We are honored to be able to offer surgeons an excellent education in an environment that promotes respect, integrity and compassion for patients and donors who come to us for care,” said Gaber.

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

BREAKING NEW GROUND IN LUNG TRANSPLANTATION The Houston Methodist J.C. Walter Jr. Transplant Center continues to be a national leader in lung transplantation with one of the top five largest volumes of lung transplants in the country.

This level of experience provides the center’s physicians and other health professionals with the skill to expertly handle complex lung transplants and to achieve the excellent outcomes associated with high-volume clinics.

We also have the experience that allows us to safely handle a higher level of risk, accepting patients who would not be served at other centers because of associated comorbidities.

TOP 5

IN THE NATION IN VOLUME IN 2013

“We will perform bloodless transplants for certain patients, most of whom have been refused transplantation at other institutions. It’s rewarding to practice at an institution that will go the extra mile for patients and that embraces the knowledge, skill and experience to take on the most complicated cases.”

Scott Scheinin, MD, FACS surgical director, pulmonary transplant

8

J.C. Walter Jr. Transplant Center

BLOODLESS LUNG TRANSPLANTS : A SURGICAL BREAKTHROUGH A growing body of research shows that blood transfusions themselves can cause complications such as sepsis or circulatory overload. Surgeons like Scott Scheinin, MD, surgical director of the lung transplant program, are therefore limiting the amount of blood transfused by perfecting pre-operative management, surgical techniques and operating room protocols to prevent any unnecessary blood loss during even the most complicated procedures, including lung transplant.

Some of those cases involve Jehovah’s Witness patients whose beliefs prevent them from accepting any blood transfusions during surgery.

“We will perform bloodless transplants for certain patients, most of whom have been refused transplantation at other institutions. It’s rewarding to practice at an institution that will go the extra mile for patients and that embraces the knowledge, skill and experience to take on the most complicated cases,” said Scheinin.

As part of the bloodless procedure, the patient is given medications to stimulate blood cell production.

During surgery, blood that might be discarded as medical waste is rerouted through a cell salvage machine that washes and filters the blood. It is then sent back into the patient’s circulatory system. We also use the technique of acute normovolemic hemodilution to help conserve the patient’s blood. We have been able to provide 14 patients with bloodless lung transplants to date.

LUNG TRANSPLANTS: THREE-YEAR PATIENT SURVIVAL 100

HMH Actual HMH Expected

95 90 85 80 75 70 65 60 65 60

Jan 10

Jul 10

Jan 11

Jul 11

Jan 12

Jul 12

Jan 13

Jul 13

Jan 14

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

PIONEERING NEW TRANSPLANT OPTIONS TO INCREASE THE DONOR ORGAN POOL Much has been done to educate the public on the value of organ donation. Still, patients die waiting for organs that never come. In some cases, donated organs are not medically suited for transplant due to pre-terminal injury, ischemia or other characteristics of the organ.

Matthias Loebe, MD, is spearheading a program in which borderline donated lungs are to be “reconditioned” using a process of ex vivo lung profusion (EVLP). By pumping nutrients and oxygen through the donated lungs, we can reverse previous damage to the lungs and make them suitable for transplant, thus expanding the reach of donated organs for patients on the waiting list. We hope to begin a clinical trial soon to begin testing this life-saving therapy.

Soma Jyothula, MD, is also spearheading a new technique that may expand the donor pool. This includes working with organs that have been donated after cardiac death (DCD).

“Donation after cardiac death occurs when the family of a terminal patient decides to withdraw life support and agrees to donate the patient’s organs,” said Jyothula. This is a common practice for kidneys and livers, yet it is a relatively new procedure in lung transplantation. Very few institutions utilize lungs from DCD donors. Most transplant centers accept organs only from donors with cardiac function after declaration of brain death. Jyothula and Dewei Ren, MD, have worked with the team of pulmonologists, surgeons, transplant and recovery coordinators, and organ procurement organizations to establish a working protocol that could allow successful use of these organs.

This new process can potentially lead to expanding the number of lungs available for those awaiting lifesaving organs for survival. Houston Methodist is in the early stages of developing this program.

10

J.C. Walter Jr. Transplant Center

“Physicians and researchers at Houston Methodist are looking for new techniques to ensure that all donated organs are viable for transplant.”

Matthias Loebe, MD, PhD, FACC, FCCP, surgical director, thoracic transplant

DISCOVERING INNOVATIVE TREATMENTS TO MANAGE LUNG FAILURE The number of people with chronic lung conditions is increasing. Houston Methodist’s advanced lung disease program is multidisciplinary, tailoring treatment to individual patient’s needs and disease progression. “We provide innovative treatments that may help delay the need for a lung transplant or offer treatment options to patients not eligible for transplantation,” said Neeraj Sinha, MD, of the pulmonary transplant team.

• The Advanced Lung Disease Clinic offers specialized care to patients with complex lung diseases including idiopathic pulmonary fibrosis, collagen vascular disease, sarcoidosis, COPD and bronchiectasis.

• The Pulmonary Hypertension Clinic provides state-of-the-art diagnostic evaluation and therapy for patients with primary and secondary pulmonary hypertension.

SAVING LIVES THROUGH PULMONARY TREATMENTS For patients with severe respiratory failure, extracorporeal life support (ECLS), also known as extracorporeal membrane oxygenation (ECMO), is an advanced, lifesaving treatment in which the patient’s blood is passed through a machine that helps oxygenate the blood while waiting for the lungs to heal or while the patient awaits a lung transplant.

Navigational bronchoscopy is a relatively new bronchoscopic diagnostic technique that uses CT data to help navigate biopsies and improve the quality of diagnosis. Typically used for diagnosing smaller lung nodules, this technique helps diagnose lung cancers early using outpatient bronchoscopy, which helps save lives. It also helps avoid costly hospitalizations and open surgery. “We are very pleased to be one of the leading centers for this treatment,” says Babith Mankidy, MD, of the Houston Methodist pulmonary transplant staff.

Endobronchial valves are devices that are placed in airways to help plug persistent airleaks and broncho-pleural fistulas.

Houston Methodist is able to offer this investigational treatment under the FDA’s humanitarian device exemption process, providing relief to patients who have spent weeks waiting for these leaks to heal on their own.

Our specialists also have expertise in interventional bronchoscopy procedures including navigational bronchoscopy, endobronchial ultrasound, placement of tracheal and endobronchial stents, endobronchial valves and other advanced airway procedures.

“Our objective is to provide comprehensive, state-of-the-art pulmonary care to patients with advanced lung disease. This includes supporting them through diagnosis, treatment, follow-up and transplant, if needed. We are fortunate in being able to bring together the clinical resources, multidisciplinary teams, infrastructure, academic and administrative support to provide the best possible care and quality of life for our patients,” said Thomas Kaleekal, MD, medical director of the lung transplant program.

“The center treats all patients with lung disease regardless of their need for transplant.

Our physicians tailor care to each patient’s disease progression.

The care is multidisciplinary, organized around a core team that extends to all disciplines needed to care for the patient.”

Thomas Kaleekal, MD medical director, pulmonary transplant

98

LUNG TRANSPLANTS IN 2013

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

DELIVERING BETTER OUTCOMES IN RENAL TRANSPLANT Houston Methodist is one of the largest multi-organ transplant centers in the country. We are also one of the largest kidney transplant centers in the region In 2013, we provided 176 kidney transplants and 22 kidney-pancreas transplants to patients waiting for a new chance at life.

This experience gives us the expertise to perform some of the most advanced kidney transplant procedures and provides a good base to conduct outstanding research that will drive the practice forward.

SUPERIOR EXPERTISE MAKES TRANSPLANTATION EASIER ON DONORS AND RECIPIENTS ORGAN SWAPS The transplant teams at Houston Methodist are able to participate in the advanced logistics of nationwide organ swaps to ensure that our patients receive the kidneys they need.

Because kidneys can come from living donors, friends or family can offer kidneys to those who have matching blood types. If a patient has a donor whose blood type does not match, the donor and recipient are entered into a nationwide database that greatly maximizes the use of potential donors. The entire pool of potential donors and recipients is analyzed, and matches are made to accommodate compatibility.

SINGLE SITE DONOR NEPHRECTOMY Our surgeons also do everything they can to make potential donors as comfortable and safe as possible during and after donation.

12

J.C. Walter Jr. Transplant Center

Houston Methodist has one of the largest series of laparoendoscopic single site donor nephrectomies in the world. These minimally invasive surgeries require fewer incisions and result in very little scarring. We have conducted more than 200 single site surgeries for people willing to offer a kidney for donation.

Our surgeons have also published results on safety, blood loss and ischemic time associated with a single site technique compared to the traditional method, demonstrating proven safety and a low complication rate comparable to a more open technique.

During the procedure, the surgeon makes an approximately two-inch incision near the navel. Through that single incision, the team delicately dissects the major blood vessels from the kidney, preserves the area from which the kidney is taken and removes the kidney.

“We understand the enormity of performing an operation on a perfectly healthy person who is taking on the risk of surgery simply to benefit a friend or family member. We want to make the process as painless as possible for these generous donors, just as if they were our own family.�

Wesley Mayer, MD, urologist and laparoscopic surgeon

13

KIDNEY SWAPS IN 2013 “Swaps can grow to huge numbers of people, and it takes experience and exceptional logistics to make them work.

Having many large centers participate in the national registry is a substantial step forward for organ donation.�

Wadi Suki, MD, FACP, director of the nephrology training program and co-director of the kidney transplant program

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

IMPROVING POST-TRANSPLANT PROTOCOLS FOR BETTER PAIN MANAGEMENT Pain management is also an area we are interested in improving for our donors. We have several ongoing research studies looking at methods to control pain without the reliance on heavy narcotics. Through this research, we ultimately hope to decrease the amount of pain that patients experience and allow them to leave the hospital earlier.

RESEARCH FOR RECIPIENTS Our renal experts are studying ways to prevent a particularly difficult type of rejection after kidney transplant known as antibody-mediated rejection.

Because rejection is initiated in the bone marrow, this type of rejection demands a very specific type of treatment.

A research team led by Osama Gaber, MD, director of transplantation, and Richard Knight, MD, surgical director, kidney and pancreas transplant, is looking at repurposing a drug that is approved for multiple myeloma – a cancer of the bone marrow – and testing it as a treatment for antibody-mediated rejection.

Another area of research interest to our team is an opportunistic infection called the BK virus, which can be deadly to a kidney transplant recipient, but typically undetectable to anyone who is not immunosuppressed.

A member of the polyomavirus, it attacks the kidney and urinary tract and can lead to kidney failure.

The team led by Knight is researching new medical regimens to attack the virus while maintaining protection for the patient’s new kidney.

KIDNEY TRANSPLANT: ONE-YEAR PATIENT SURVIVAL 100

HMH Actual National

98 96 94 92 90 88 86 Jan 10

14

Jul 10

J.C. Walter Jr. Transplant Center

Jan 11

Jul 11

Jan 12

Jul 12

Jan 13

Jul 13

Jan 14

“Treatment of the BK virus demands a delicate balance between the potential for rejection and the need to reduce immunosuppression.”

Richard Knight, MD, FACS, surgical director, kidney and pancreas

176

KIDNEY TRANSPLANTS IN 2013

“Cell-mediated rejection is a well-understood process in which white blood cells attack the graft. Antibody-mediated rejection is a very different animal in which B-lymphocytes and plasma cells are the culprits.�

Wadi Suki, MD, FACP director of the nephrology training program and co-director of the kidney transplant program

67

LIVING DONOR TRANSPLANTS IN 2013

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

DELIVERING BETTER OUTCOMES: BLAZING NEW TRAILS IN FIGHTING INTESTINAL FAILURE Houston Methodist Hospital has the only comprehensive treatment program available in Texas for patients with intestinal failure, a complex disorder that results in an inability to absorb the nutrients patients need for survival.

If it is not properly diagnosed and treated, it can be deadly.

A high level of expertise is needed to effectively support patients with this debilitating disease. Houston Methodist has developed a complete program, offering dietetic, medical and surgical support, and we conduct basic and clinical research to find more effective treatments with fewer complications.

DIETETIC AND MEDICAL TREATMENT Many patients with intestinal failure depend on a feeding and hydration system called total parenteral nutrition (TPN) to sustain their lives. TPN provides all of the patient’s nutrients through a catheter in the arm, groin, neck or chest. Long-term use of TPN can cause severe side effects, including bone disorders, vascular thrombosis, central line infections and liver cirrhosis.

“Patients with intestinal failure on TPN require very intense and constant monitoring, demanding repeat office visits and hospital admissions. The disease takes a huge toll on a patient’s quality of life.

Our goal is to rehabilitate a patient’s intestinal function and eliminate the need for TPN and its devastating effects,” said Sherilyn Gordon Burroughs, MD, director of the Intestinal Failure and Rehabilitation Clinic.

RESEARCH Our patients have access to novel drugs, such as teduglutide, a GLP-2 agonist, that was granted orphan drug status by the FDA in December 2012 to help improve nutrient absorption in the small bowel. We are also partnering with pharmaceutical companies to expand new clinical studies, and we have access to the outstanding facilities of the Houston Methodist Research Institute, where we conduct research with a goal of reducing the need for TPN.

SURGERY Our surgical arm provides revisional surgery, when possible, to add bowel for patients with a short gut due to previous bowel resection or congenital conditions. We also offer serial transverse enteroplasty, a lengthening of the bowel that is done by using a surgical stapler to extend the absorptive area of the bowel. Both of these techniques effectively increase the time food has contact with the intestine, improving chances for absorption.

16

J.C. Walter Jr. Transplant Center

“Patients with intestinal failure require very intense and constant monitoring, demanding repeat office visits and hospital admissions.

The disease takes a huge toll on a patient’s quality of life. Our goal is to rehabilitate a patient’s intestinal function and eliminate the need for TPN and its devastating effects.”

Sherilyn Gordon Burroughs, MD, FACS, director of the Intestinal Failure and Rehabilitation Clinic

PANCREATIC RESECTION Houston Methodist Hospital’s highly advanced imaging capabilities help surgeons plan resections in a way that safely preserves more healthy tissue. In addition, expertise using new surgical instrumentation helps reduce blood loss and decrease operating times, lessening the need for blood transfusions and their associated complications.

The average blood loss for removing the head of the pancreas at Houston Methodist was only 400 cc in 2012, and the average operating time of three hours is less than half the average published time.

“What used to be one of the more dangerous surgeries not long ago, pancreatic resection, is now as safe as everyday operations like coronary bypass or hip replacement.”

Wade Rosenberg, MD, pancreatic surgeon

PROVIDING PERSONALIZED CARE FOR SPECIAL CASE LIVER PATIENTS The Houston Methodist Center for Liver Disease & Transplantation is an experienced, high-volume center for patients with a wide variety of liver diseases, from benign tumors to liver cancer to fatty liver disease.

EXPANDING TREATMENT OPTIONS FOR PATIENTS

Specialists at the center regularly treat patients with hepatitis C, cirrhosis, fatty liver disease, benign liver tumors, metastatic colorectal liver cancer and primary liver cancers including cholangiocarcinoma, or cancer of the bile duct, and hepatocellular carcinoma (HCC), the most common form of liver cancer.

“We are working with colleagues at MD Anderson Cancer Center to expand the indications for treatment of liver cancer,” said Mark Ghobrial, MD, director of the Houston Methodist Center for Liver Disease & Transplantation.

A WIDE RANGE OF CARE WITH MULTIDISCIPLINARY EXPERTISE Depending upon the patient’s unique diagnosis, treatments range from medication to radiological interventions to surgical resection and transplant. Our surgeons are experienced in performing whole organ, domino liver, split-liver and multi-organ transplants. To date we have performed one of the largest series of combined lung-liver transplants.

Houston Methodist works with patients in a multidisciplinary setting, providing teams of oncologists, hepatologists, radiologists, interventionalists, transplant surgeons and intensive care specialists. The center provides multi-review panels for each patient’s personalized treatment.

Physicians at Houston Methodist are employing the use of innovative medications that work faster and more effectively on hepatitis C, a virus that is a known cause of liver disease. The center also has an established and recognized collaborative cholangiocarcinoma program, which has resulted in transplanting a large number of patients that previously would not have had the option of transplantation.

"Traditionally, centers will perform a transplant only in patients with tumors of four to five centimeters," Ghobrial said. Our center has expanded its efforts to patients with large HCC tumors, some larger than six centimeters in diameter, that are outside UCSF criteria.

"We have high survival and low recurrence rates after transplantation in these patients," says Ghobrial.

“We are committed to each patient’s care. This focus has translated into excellent outcomes, low recurrence rates and the privilege of working with patients with all types of liver disease. Our goal is to get our patients back to productive, fruitful lives as quickly as possible," Ghobrial emphasizes.

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

LEADING INNOVATION IN LIVER TRANSPLANTATION DOMINO LIVER TRANSPLANTS : SAVING TWO LIVES WITH ONE DONATION In 2013, Houston Methodist Hospital joined a small group of leading hospitals around the world that have performed successful domino liver transplant surgeries. A domino liver transplantation allows two patients to receive a new liver from a single donation.

At Houston Methodist, a new liver and heart recipient – a 60-year-old male suffering from amyloidosis that attacked his liver and heart – donated his liver to a 30-year-old woman with cholangiocarcinoma, a rare form of liver cancer.

Although the patient with cholangiocarcinoma had a good chemotherapeutic response, the strict rules that govern organ allocation presented a barrier.

“If we had waited for her liver to deteriorate to the point of transplantation qualification, her cancer would have metastasized beyond treatment,” said Howard P. Monsour, Jr., MD, chief of hepatology and associate professor of medicine.

Only a small percentage of patients with amyloidosis will manifest the disease, which provides the rationale for using these livers for transplantation.

“While the diseased liver was not working for the amyloidosis patient, we determined it was a viable organ for the patient with cholangiocarcinoma. It will take 20 to 30 years to develop amyloidosis, if at all. If that occurs, the patient can get another liver transplant. In this instance, it was really the only option for saving her life,” said Mark Ghobrial, MD, director of the Houston Methodist Center for Liver Disease & Transplantation.

“There has been a national push to use more of these so-called ‘marginal organs.’ If we can catch these cancers early, I believe we can save many more lives through domino transplants,” said Monsour.

LIVER TRANSPLANT: ONE-YEAR PATIENT SURVIVAL 100

HMH Actual National

95 90 85 80 75 70 65 60 Jan 10

18

Jul 10

J.C. Walter Jr. Transplant Center

Jan 11

Jul 11

Jan 12

Jul 12

Jan 13

Jul 13

Jan 14

“This is a 12-hour-plus procedure that involves a large transplant team of 4 liver surgeons, 2 cardiac surgeons, 2 anesthesia teams, 2 perfusion teams, 2 procurement teams, 6 transplant coordinators and at least 10 operating room nurses. It is a very rare procedure.”

Mark Ghobrial, MD, PhD, FACS, FRCS(Ed) director, Houston Methodist Center for Liver Disease & Transplantation

70

LIVER TRANSPLANTS

LIVER TRANSPLANT WAIT LIST SINCE 2009 WAIT LIST AT END OF YEAR:

2009 2010 2011 2012 2013

Organ recipient Tiffany Schwantes visits organ donor Vernon Roberson at Houston Methodist Hospital. Roberson received a new liver and heart and donated his liver to Schwantes in a domino transplant.

Mayra Beltran Š Houston Chronicle. Used with permission.

176 211 243 264 310

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

ADVANCING HEART FAILURE TECHNOLOGY : LEADING TRANSPLANT CARE HEART TRANSPLANT AND ADVANCED HEART FAILURE

“Our advanced heart failure team is committed to pushing the field of heart failure research and treatment forward,” said Jerry D. Estep, MD, medical director, heart transplant and LVAD program. “We pursue promising new ideas, and we use novel approaches with existing technology to improve care and outcomes for patients. The Shared Care program is a good example.”

Heart transplant is one of many options available to treat advanced heart failure. The limited supply of donor organs is a catalyst, pushing physicians and researchers at Houston Methodist to adopt new and more effective ways to free patients from the burdens of heart failure.

SHARED CARE

The advanced heart failure team at Houston Methodist Hospital is a collaboration between the J.C. Walter Jr. Transplant Center and the DeBakey Heart & Vascular Center. The focus of the team is to continually improve treatments for patients with heart failure, using medical and mechanical intervention, either as therapy or bridge to transplant.

“We can now offer a comprehensive program for patients with advanced heart disease, thanks to our multidisciplinary team and our innovative technologies.

Now there is hope where there wasn’t any before.”

To facilitate this effort, Houston Methodist hosted a Shared Care Summit Meeting, designed for physicians and other health care professionals who are committed to treating LVAD patients in their communities.

The advanced heart failure team provided hands-on education at Houston Methodist’s MITIE lab, complete with demonstrations using a volunteer LVAD patient.

“The goal is to create partnerships with providers from the region – and eventually the world – during all three stages of LVAD care – pre-intervention, intervention, and long-term follow-up care,” said Brian Bruckner, MD, surgical director, ECMO, and associate director, mechanical circulatory support. “We believe this can become a best practices model.”

As heart failure therapies continue to improve, more and more patients are able to go home with lifesaving mechanical assist devices such as the left ventricular assist device (LVAD).

Estep and his colleagues are creating ways to allow cardiologists to remotely monitor their patients, post-procedure, in the patient’s own home.

80

63

62

60

56 51

48

45

40

38

58

40 35

All Surgical VAD Implants

35 26

20

Matthias Loebe, MD, PhD, FACC, FCCP surgical director, thoracic transplant 0

20

J.C. Walter Jr. Transplant Center

2008

2009

2010

2011

Long Term LVAD/TAH

2012

2013

HEALING BEYOND MEDICINE Houston Methodist is a place of healing, and real healing takes more than just medicine, research and technology – it takes heart. It addresses each patient as a whole person, not just a number.

Timothy Lewis, 48, was admitted on Dec. 3, 2013, with end-stage congestive heart failure. His cardiovascular team quickly determined that he needed a transplant. He was implanted with an intra-aortic balloon pump, an advanced measure that would support his cardiac function while he was on the donor list.

As his family kept vigil at his hospital bedside, plans for an imminent family celebration were reevaluated.

Lewis’s youngest daughter, Lolaycia, was planning her wedding for March 2014, and she wanted her father to walk her down the aisle. Knowing that transplant prospects were uncertain, Lolaycia changed the wedding date and location. On December 22, Lewis was there to see his daughter marry her fiancé, Melmiah Walker, in the chapel at Houston Methodist Hospital.

With nurses minding his equipment, Lewis walked his daughter down the 40-foot aisle and danced with her after the ceremony.

“Because of the severity of my illness, I didn’t think I would be able to participate in a day that was so meaningful to my little girl and our whole family,” Lewis said afterward.“I thank God for giving me the strength to walk her down the aisle.”

A donor heart became available soon after the wedding, and Lewis was transplanted on Jan. 4, 2014.

He’s now doing well and getting stronger by the day.

SURGICAL TREATMENT OF ADVANCED HEART FAILURE 100 80 60 40 20 0

92% Transplant

87% LVAD

PHOTO: ©Houston Chronicle/Brett Coomer. Used with permission.

“Thankfully, Mr. Lewis was successfully transplanted and has been free of rejection and free of infection. Here, we individualize therapy, taking into consideration the best long-term benefit versus risk.”

Jerry D. Estep, MD, FACC, medical director, heart transplant

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

LEADING CARDIOLOGY RESEARCH AND EDUCATION

22

J.C. Walter Jr. Transplant Center

•

In 2013, the advanced heart failure group, as a joint cardiology and CV thoracic surgery effort, made over 20 presentations at various annual meetings including the ISHLT (International Society of Heart and Lung Transplantation), HFSA (Heart Failure Society of America), ACC (American College of Cardiology) and AHA (American Heart Association).

•

The advanced heart failure group published several manuscripts in high impact journals on various topics including novel ambulatory percutaneous IABP support as a bridge to heart transplant, the use of ventricular assist devices in patients with cardiac tumors and the role of echocardiography in predicting RV failure after LVAD support.

•

The group participated in several multi-center studies and was at the top in recruitment in the ROADMAP trial (risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients), a study to evaluate the effectiveness of the Thoratec® HeartMate II® Left Ventricular Assist System (LVAS) versus Optimal Medical Management (OMM).

•

In 2013, the group enrolled patients in several multi-center studies with the aim of evaluating novel therapies in advanced heart failure patients like CELL-004 (CELLADON) to test whether an experimental gene transfer, performed in the cath lab using an agent called MYDICAR®, helps to improve the clinical outcome in subjects with heart failure by reducing the frequency of heart failure related hospitalizations.

•

The advanced heart failure group recruited several patients in a first-of-its-kind stem cell initiated trial (AASTROM) to show that stem cells can be safely given back to a person, through an injection catheter, with heart failure due to ischemic dilated cardiomyopathy (IDCM).

•

In 2013, the group was an active participant in an NIH-based trial to test the hypothesis that B-cell depletion using anti-CD20 (Rituximab) as induction therapy in unsensitized cardiac transplant recipients would attenuate the development of coronary allograft vasculopathy (CAV) and improve cardiac transplant function.

HEART TRANSPLANT: THREE-YEAR PATIENT SURVIVAL 100

HMH Actual HMH Expected National

95 90 85 80 75 70 65 60 Jan 10

Jul 10

Jan 11

Jul 11

Jan 12

Jul 12

Jan 13

Jul 13

Jan 14

Jul 14

Jan 15

HEART TRANSPLANT IN 2013

54 179 27 LVAD IMPLANTS IN 2013

NEW PATIENT EVALUATIONS IN 2013

HEART AND HEART-LUNG TRANSPLANTS IN 2013

Leading Medicine: An Overview

Pulmonary Transplant

Renal Transplant

GI Care & Liver Transplant

Heart Transplant

Bone Marrow & Stem Cell Transplant

PURSUING MEDICAL DISCOVERIES IN BONE MARROW & STEM CELL TRANSPLANT THE CENTER FOR CELL & GENE THERAPY REPROGRAMS PATIENTS’ CELLS The Center for Cell & Gene Therapy (CAGT), a partnership of Houston Methodist Hospital, Baylor College of Medicine and Texas Children’s Hospital, is one of the country’s leading centers for the development of cellular and genetic treatments for adults and children with cancer and diseases of the bone marrow.

At CAGT, researchers genetically engineer patients’ own immune system t cells to selectively attack and kill lymphomas, leukemias, brain cancers and cancers of the bone marrow. The early phase trials are showing promise.

Helen Heslop, MD, director of the Adult Stem Cell Transplant Program, and her team are advancing this type of research by adding new growth factors to make modified cells more active and to reduce side effects for patients. With 11 ongoing trials and more than 50 patients participating in genetically-modified t-cell studies, Houston Methodist is one of the top three sites in the country for this type of research.

AT A GLANCE

189 24

J.C. Walter Jr. Transplant Center

BONE MARROW TRANSPLANTS IN 2013

45

patients received cell therapy treatments at HMH on 23 investigatorinitiated studies in 2013

NATIONAL MARROW DONOR PROGRAM TOTALS

161

EVALUATED AND SCREENED IN 2013

125 HARVESTED AND COLLECTED IN 2013

PATIENT SATISFACTION % INPATIENT AND OUTPATIENT

IP OP

90% 93%

GRANTS The Leukemia and Lymphoma Society awarded CAGT a $6.25 million grant as a Specialized Center of Research (SCOR).

The NCI renewed an $11 million grant to the CAGT for the study of pancreas, nasopharyngeal and sarcoma cancers.

THE CENTER HAS SEVERAL MAJOR PROGRAMMATIC GRANTS INCLUDING: • National Cancer Institute – T-Cell Therapy for Cancer Project • National Cancer Institute – Specialized Programs of Research Excellence (SPORE) in lymphoma • Cancer Research and Prevention Institute of Texas – Texas Assistance for Cancer Cell Therapy • Leukemia & Lymphoma Society – Specialized Center of Research Program (SCOR) • National Heart Lung and Blood Institute – Production Assistance for Cellular Therapies Center (PACT)

TRANSPLANT LEADERSHIP & TEAM MEMBERS DIRECTOR A. Osama Gaber, MD, FACS

CARDIOLOGY Guha Ashrith, MD Arvind Bhimaraj, MD Jerry D. Estep, MD, FACC Danelle McLain, NP Loren Semones, NP Guillermo Torre-Amione, MD, PhD, FACC Barry Trachtenberg, MD

HEART TRANSPLANT SURGERY Brian Bruckner, MD Matthias Loebe, MD, PhD, FACC, FCCP Dewei Ren, MD Scott Scheinin, MD, FACS Erik Suarez, MD

PULMONOLOGY Soma Jyothula, MD Thomas Kaleekal, MD Babith Mankidy, MD Neeraj Sinha, MD

LUNG TRANSPLANT SURGERY Brian Bruckner, MD Matthias Loebe, MD, PhD, FACC, FCCP Dewei Ren, MD Scott Scheinin, MD, FACS Erik Suarez, MD

NEPHROLOGY Abdul Abdellatif, MD Horacio J. AdroguĂŠ, Sr., MD Mario Assouad, MD Stephen Brennan, MD Joey Buquing, MD Joslyn Campbell, MD Lazaro Cherem, MD

26

J.C. Walter Jr. Transplant Center

Juan Gonzalez, MD Namrata Goel, MD Anna Kagan, MD, PhD, FASN A. Jabbar Khan, MD Mehreen Khan, MD Uday Khosla, MD Sreedhar Mandayam, MD Justin Merszei, MD George Nassar, MD, FASN Peter Tuan Nguyen, MD, FASN Rahman Noor, MD Juan Jose Olivero, MD, FACP, FASN Juan Jorge Olivero, MD, FASN Rupal Patel, MD Venkataraman Ramanathan, MD Edward Rhee, MD Anand Saranathan, MD Wadi N. Suki, MD, FACP

KIDNEY TRANSPLANT SURGERY Laura Lessard, NP Emad Asham, MD Brian James Dunkin, MD, FACS A. Osama Gaber, MD, FACS Alvin Goh, MD R. Mark Ghobrial, MD, PhD, FACS, FRCS(Ed) Sherilyn Gordon Burroughs, MD, FACS Richard Knight, MD, FACS Richard E. Link, MD, PhD Wesley A. Mayer, MD Hemangshu Podder, MD, PhD Ashish Saharia, MD

HEPATOLOGY Victor Ankoma-Sey, MD Chukwuma Egwim, MD Joseph S. Galati, MD, FACGT Robert McFadden, MD Howard P. Monsour, Jr., MD Ky-Dieu Tran, MD

David Victor, MD Deborah Calares, PA Veronica Carreon, NP Janine Hyden, NP Hung Nguyen, NP Rochelle Nguyen, NP

LIVER TRANSPLANT SURGERY A. Osama Gaber, MD, FACS R. Mark Ghobrial, MD, PhD, FACS, FRCS(Ed) Sherilyn Gordon Burroughs, MD, FACS Hemangshu Podder, MD, PhD Ashish Saharia, MD Janine Hyden, NP Nancy Yarbrough, NP

ANESTHESIOLOGY Mohamad Abdalla, MD Nidal Abdel-Rahman, MD Nicolas Athanassiou, MD Steve Boozalis, MD Jessica Brown, MD Ghazala Butt, MD James Carter, MD Jane Carter, MD Francis Falbey, MD Patrick Giam, MD Diane Gibson, MD Alfred Groen, MD Elizabeth Herrera, MD Christopher L. Hutson, MD Saras Karri, MD Scott Lindberg, MD Lingen Lu, MD Gary Monteiro, MD Joseph Naples, MD Alejandro Rosas, MD Hany Samir, MD Karanbir Singh, MD Luis Velez-Pestana, MD Zbigniew Wojciechowski, MD

BONE MARROW TRANSPLANT Malcolm Brenner, MD, PhD George Carrum, MD Helen Heslop, MD Rammurti Kamble, MD Robert Krance, MD Carlos Ramos, MD

ISLET TRANSPLANT A. Osama Gaber, MD, FACS Dan Fraga, MD Omaima Sabek, MD Wade Rosenberg, MD

CRITICAL CARE John Fetter, MD Sheikh Hai, MD Faisal Masud, MD, FCCP, FCCM Tariq Nabil, MD Robert Ochoa, MD Laurie Punch, MD Iqbal Ratnani, MD Kamlesh Thaker, MD Davina Tuazon, MD Faisal Uddin, MD Saleem Zaidi, MD Asma Zainab, MD

ENDOCRINOLOGY Dale J. Hamilton, MD, FACe, FACP Willa Hsueh, MD Abishek Kansara, MD Archana Sadhu, MD Saundra Hendricks, NP Eunice Ihaza, NP Dena Rose, NP Fang Ye, NP John Mucha, PA

INFECTIOUS DISEASE Dipti Agrawal, MD Ashley Drews, MD, FACP Victor Fainstein, MD, FACP

Kevin Grimes, MD, MPH Richard Harris, MD

DONOR ADVOCATE Elie Saber, MD

INTERVENTIONAL RADIOLOGY Jett R. Brady, MD Mark Brodie, MD Jerry Gibbs, MD Thomas D. Hedrick, MD John S. Labis, MD Chenwei Lee, MD David W. Light, MD Lucho Rossman, MD Steve L. Sax, MD Morris A. Weiner, MD Adrian Wong, MD Nam Yu, MD

PATHOLOGY & LABORATORY Roberto Barrios, MD Smaroula Dilioglou, PhD Todd Eagar, PhD Lillian Gaber, MD Geoffrey Land, PhD, HCLD Luan Truoung, MD

RESEARCH Wenhao Chen, PhD Daniel Fraga, BS Malgorzata Kloc, PhD, D.Sc. Xian C. Li, MD Linda W. Moore, RD, CCRP Tadashi Motomura, MD, PhD Omaima Sabek, PhD Roger Sciammas, PhD Neelam Tejpal, M.Sc. Xiang (Johnny) Xiao, PhD Junping You, MD, PhD Zhiqiang Zhang, PhD

SIMULATING THE TRANSPLANT EXPERIENCE HOUSTON METHODIST INSTITUTE FOR TECHNOLOGY, INNOVATION & EDUCATION (MITIE SM ) One of the largest and most comprehensive medical education and research facilities in the world, MITIE is utilized to train complete transplant teams on complex procedures using real-time operating room simulations.

Houston Methodist and the local organ procurement organization conduct joint training simulations on organ procurement, donation after cardiac death (DCD) and managing the complex operating room environment.

MITIE offers multidisciplinary, hands-on training using advanced imaging and robotics. Surgeons, nurses, fellows, coordinators and practicing physicians continually refine and acquire new skills to perform at optimal levels throughout their careers. Using procedural laboratories and sophisticated simulation tools, researchers at MITIE focus on the development and assessment of emerging technologies and skills that improve patient care through less invasive therapies. At MITIE, the finest researchers and clinicians are building on our legacy of ingenuity and accelerating the discovery and delivery of better care and better cures.

HOUSTON METHODIST INSTITUTE FOR TECHNOLOGY, INNOVATION & EDUCATION 2013 AT A GLANCE

MORE THAN

6,300 LEARNERS IN 2013

40,000 SQUARE FEET OF EDUCATION AND RESEARCH SPACE

26 MORE THAN

SURGICAL SPECIALTIES FROM ACROSS THE WORLD

20,000

LEARNERS SINCE INCEPTION For more information, visit mitietexas.com

HOUSTON METHODIST HOSPITAL LEADING MEDICINE YESTERDAY, TODAY AND TOMORROW At Houston Methodist, we’ve built a legacy of ingenuity that spans multiple decades and disciplines. In the last 95 years, we’ve transformed from a humble 19-bed community hospital to a global leader in health care, treating patients from 90 countries in more than 8,150 visits last year. In 2004, Houston Methodist established a long-term affiliation with Weill Cornell Medical College and New York-Presbyterian Hospital in New York City.

Through this affiliation, three internationally renowned institutions collaborate to bring tomorrow’s advances to our patients today. Together, we provide cutting-edge clinical and biomedical research, and education and training for future physicians and scientists. One of the nation’s top research medical schools, Weill Cornell Medical College ranked No. 15 in the 2015 U.S. News & World Report Best Medical Schools list.

For Houston Methodist clinicians and researchers, “leading medicine” is a holistic call for excellence in every aspect of patient care. We consistently rank among the best hospitals in the country. In 2013, U.S. News & World Report named Houston Methodist the “Best Hospital in Texas” for the second consecutive year, with 12 specialties recognized in the Best Hospitals list.

Houston Methodist is consistently recertified to Magnet status for exceptional nursing. Because of our reputation, the finest researchers and clinicians from around the world are joining us to build on our legacy of ingenuity and accelerate the discovery and delivery of better care and better cures. That’s the difference between practicing medicine and leading it.

FAST FACTS 73 Operating Rooms

1,119

Licensed Beds (824 operating beds)

1,862

Affiliated Physicians

6,101 Employees

8,150

International Patient Encounters (from 90 foreign countries)

36,310 Inpatients in 2013

61,043

Emergency Room Visits in 2013

301,478

Outpatient Visits in 2013

FORTUNE is a registered trademark of Time Inc. and is used under license.

From FORTUNE Magazine, February 3, 2014 ©2014 Time Inc. FORTUNE and Time Inc. are not affiliated with, and do not endorse products or services of, Licensee.

LEADERS IN RESEARCH Accelerating discovery and delivery to patients

At Houston Methodist, we are dedicated to defining the future of medicine. We engineer discoveries in the lab to become clinically useful products, channel the best innovations through early stage clinical trials and actively transition those innovations to our industry partners. Our commitment to the full cycle of discovery and delivery sets us apart as leaders who provide patients from around the world access to the latest health care advances.

More than 840 active clinical protocols $55m TOTAL RESEARCH FUNDING IN 2013 See all the ways we’re leading medicine at hmleadingmedicine.com

Photo courtesy of WHR Architects, Inc. Š Aker/Zvonkovic Photography, Houston, Texas

Houston Methodist Hospital 6565 Fannin Street Houston Texas 77030

LEADING MEDICINE YESTERDAY, TODAY AND TOMORROW. At Houston Methodist we have a proud tradition of revolutionizing medicine. Our past achievements have built a legacy that spans multiple decades and disciplines, and that same culture of excellence inspires us to be the pioneers of tomorrow.

houstonmethodist.org/transplant