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The National Institutes of Health has announced the Miami Transplant Study, a joint program with the University of Miami Miller School of Medicine and UHealth/Jackson, to lead a national study examining the process of access, referral, selection, and care for early liver transplants. I selected the location (MTI). For alcohol-related liver disease.
The Miller School team forms one of two consortia selected, along with UT Southwestern, Columbia University and the University of Michigan. Each facility will be paid $2.7 million over seven years of research.
The primary objective of this study is to characterize and develop a risk prediction model for transplant-free survival in people with limited access to liver transplantation. According to the co-principal investigators, this model will help target referrals and listings of patients most in need of early liver transplantation (defined as less than six months of abstinence). Dr. David Goldbergassociate professor of medicine in the Miller School’s Division of Digestive Health and Liver Diseases.
Other research aims to assess barriers and facilitators to early liver transplant referral in alcohol-related liver disease, according to Dr. Goldberg. He will evaluate biopsychosocial factors and develop risk models to predict outcomes at critical points in early liver transplantation for this type of liver disease. To define stakeholder perceptions and preferences for early liver transplant selection and outcomes for alcohol-related liver disease. and evaluate how the integrated treatment process impacts the outcome of liver transplantation early in the disease.
He said the Miller School and MTI are ideally positioned for this research.
“The University of Miami/MTI has one of the most diverse patient populations of all transplant centers. “We will be able to evaluate the issue of early liver transplantation for alcohol-related liver disease in patients with alcohol-related liver disease,” Dr. Goldberg said. “Also, the complications of alcohol-related liver disease can vary by population, so we will be able to address it within the population.”
Evaluation of patients undergoing liver transplantation
MTI is the largest liver transplant program in the country and performs many early liver transplants for alcohol-related liver disease.
Dr. Goldberg said the process for evaluating patients for early liver transplantation varies by transplant center, and there is no established right or wrong way.
“We evaluate each patient individually. We don’t have the same rigorous endpoints as other centers. This grant will allow us to compare and evaluate our processes and outcomes in our population with other populations. “We’re going to be able to do that,” Dr. Goldberg said.
Importantly, this study provides a better understanding of which patients are the best candidates for early liver transplantation.
“Furthermore, because the definition of transplant ‘success’ varies by stakeholder, we are working with patients, providers, and transplant staff to define what metrics should be used to define transplant success in alcohol-related patients.” , we plan to conduct a qualitative study among donor families with “liver disease,” he said.
Collaborative multidisciplinary team
The funding team is interdisciplinary and includes a range of junior and senior researchers, including three junior researchers.
“This will allow us to provide research guidance to junior faculty while ensuring continuity of research with this seven-year grant,” Dr. Goldberg said.
One of the young researchers and co-principal investigator of the grant Natasha Schaefer Sol, Ph.D., RNA research assistant professor in the Miller School, he is also a member of the consortium steering committee and the project’s qualitative principal investigator.
“Our Miami location will serve as the lead for the qualitative and mixed methods core, working collaboratively with members across the INTEGRATE collaboration to ensure successful completion of qualitative data implementation and analysis.” Solle said the doctor. “In collaboration with behavioral and community-based research shared resources, our Miami team is responsible for developing culturally and linguistically competent research materials specifically for Hispanic and Caribbean patients. .”
The study will involve transplant patients, patients admitted to Jackson Hospital, and referring area gastroenterologists.
Debate over allocation of rare organs
Junior researchers and grant researchers Dr. Eric MartinHe, who is part of MTI’s liver transplant team, said the study helps shed light on a difficult topic.
The question of whether to allocate rare organs to patients with alcohol-related liver disease remains a matter of debate, but the growing number of publications on the benefits of early liver transplantation in severe alcohol-related hepatitis has generated renewed interest. (The incidence of liver transplantation has more than doubled during COVID-19). Dr. Martin, who is also the medical director of the Miller School’s living donor liver transplant program, said -19 is a global pandemic.
“Despite the fact that alcohol-related liver disease is currently the most common indication for liver transplantation in the United States, referral rates across the United States are largely due to the negative stigma inherent in alcohol-related liver disease. There remains great variation in practice,” Dr. Martin said. “This collaboration will help destigmatize alcohol-related liver disease and standardize referral and selection practices using objective methods, rather than scrutinizing subjective patient profiles on a case-by-case basis. It offers a great opportunity.”
Dr. Martin hopes this collaboration will help overcome the arbitrary “six-month rule” that many healthcare providers still use as a benchmark to achieve before considering liver transplantation. He said he is doing so.
Other researchers at the Miller School and MTI include: Dr. Daniel Mars; Olvin Carrasquillo, MD, MPH; and Dr. Paul Martin
tag: Dr. David Goldberg, Liver Disease, Liver Transplantation, Miami Transplant Institute, NIH Funding, USNWR Gastro
