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Published in CenterView on September 10, 2012
Abdominal transplant team members include, front row from left, Ashley Seawright, nurse practitioner, Dr. Truman Earl, Dr. Fauzia Butt, Dr. Christopher Anderson, Dr. Iasmina Craici, Dr. Kenneth Kokko and Dr. Mehul Dixit, and back row from left, Dr. Brian Borg and Dr. Steven Wagner. Not pictured: Dr. Louis Juncos and Dr. Shirley Shlessinger.
Abdominal transplant team members include, front row from left, Ashley Seawright, nurse practitioner, Dr. Truman Earl, Dr. Fauzia Butt, Dr. Christopher Anderson, Dr. Iasmina Craici, Dr. Kenneth Kokko and Dr. Mehul Dixit, and back row from left, Dr. Brian Borg and Dr. Steven Wagner. Not pictured: Dr. Louis Juncos and Dr. Shirley Shlessinger.

Division chief assembles powerhouse staff of liver, kidney transplant specialists

By Patrice Sawyer Guilfoyle

Dr. Chris Anderson joined UMMC last year with a vision in mind: to build a top-notch abdominal transplant program that meets or exceeds the standards of other programs in the country.

To accomplish this goal, Anderson, associate professor of surgery and division chief of transplant and hepatobiliary surgery, needed to assemble a team. He began the process of recruiting some of the best and brightest in the field of transplantation and nephrology.
He didn’t have to look far.

It takes less than six degrees of separation to find the connection between the three physicians who have joined the Medical Center in the last two months. They all trained at Washington University in St. Louis, the same place where Anderson trained and worked before coming to UMMC.

Dr. Brian Borg, associate professor of medicine, Dr. Mark Earl, assistant professor of surgery, and Dr. Steven Wagner, assistant professor of medicine, all were drawn to UMMC for similar reasons. They all revolve around providing services needed in the state.

Borg, the first and only transplant hepatologist in Mississippi, arrived less than a month ago. A transplant hepatologist receives the referrals for liver transplants and is the front line of the decision process to evaluate patients for transplant. Borg also manages care of patients with liver disease before and after transplant surgery.

Borg said UMMC is in the process of obtaining United Network for Organ Sharing (UNOS) approval to be listed as a liver transplant center.

“Having a hepatologist here and a hepatology program will make a big difference in the state in the management of liver disease,” he said. “This is a very specialized service, which requires years of training.”

After medical school in Tehran, Iran, Borg completed residency training in internal medicine at Prince George’s Hospital Center in Maryland. He was a hepatology fellow at the National Institute of Diabetes, Digestive and Kidney Disease at the National Institutes of Health in Maryland and earned the M.S. in clinical research at Duke University – National Institutes of Health in North Carolina. He also completed a gastroenterology fellowship at Washington University.

Before joining the Medical Center, Borg was transplant hepatologist at Ochsner Health System in New Orleans. He is a familiar name to referring physicians and patients with liver disease in the state.

Borg said about 30 percent of the patients he treated at Ochsner were from Mississippi.
“We will give people locally an opportunity for transplantation at home and save them the expense of traveling,” Borg said. “We will be able to keep organs in this state.”

An East Texas native, Earl, trained in liver, kidney and pancreas transplantation, wanted to return to the southeastern region, which made the opportunity at UMMC attractive. Before joining the Medical Center, Earl was an assistant professor of surgery at Oregon Health and Science University.

Working with Anderson, who he’s known for 10 years, was a plus.

“Dr. Anderson and I were trained in all the same places, so we do things dramatically similar,” Earl said. “We have the same preferences.”

The opportunity to build a program that would impact an entire state also drew him to Mississippi. Earl could have gone to a large, established transplant program, but he would have no chance to leave an imprint.

“Here, it’s a blank slate,” he said. “There is no status quo. You can set things up the way they should be done.”

Earl earned the M.D. at the University of Texas School of Medicine at San Antonio and the M.S. in clinical investigation at Vanderbilt University, where he completed residency training in general surgery. Also, he received fellowship training in abdominal organ transplantation and hepatobiliary surgery at Barnes Jewish Hospital in St. Louis.

Earl said it will be the liver transplant program’s goal to provide care that will rival any liver care in the country.

“This is something not just important to us; this is a service I feel very strongly this institution needs to provide to this state,” he said. “Mississippians don’t have to leave the state any more to get advanced liver care.

“It’s going to take time and infrastructure building, but I think we’re well on our way.”

Earl said UMMC has basic science and clinical research efforts in liver disease and liver transplantation that “will not only define the standard of care now, but what the standard of care will be tomorrow.”

In kidney transplants, Earl wants to build the living donor program. He would like to see paired donations take place.

In those cases, a living donor wants to give a kidney, but doesn’t match with the person he wants to receive the organ. The donor does match with a different patient on a kidney transplant list, however.

Altruistic donors – individuals who want to donate a kidney to someone in need – are rare, but a large “swap” among donors and recipients can be facilitated. Larger transplant centers in the country have had success with similar kidney exchange programs.

Wagner, a transplant nephrologist, and his wife, Dr. Iasmina Craici, also a nephrologist and an assistant professor of medicine, said they supported kidney transplant chains.

“We also feel pretty strongly that living donation is the best way to get a transplant, and it’s often underutilized,” Wagner said. “We’re excited that Chris is interested in that, too.”

Dr. Luis Juncos, professor and chair of nephrology, was the driving force behind Wagner and Craici joining UMMC. They had worked with him at the Mayo Clinic in Rochester, Minn., and they took him up on an invitation to visit the Medical Center last December.

Additionally, Wagner completed a one-year fellowship in transplant nephrology at Washington University, where he heard about Anderson. So when he had a chance to meet Anderson, Wagner was impressed by both Anderson and UMMC.

“Certainly meeting with him and seeing his vision for the transplant program was a reason why we came here,” Wagner said. “The nephrologists and surgeons work well together.”

Craici, whose research interests are preeclampsia and women’s health, said they viewed their decision as a choice between two paths.

“What it came down to was: Do we want to join a program that’s already established, or do we want to be a part of something new and growing?”

Living donations have dropped nationally, Wagner said, but patient education can help alleviate some of the problems. Patients can talk to friends and not just family about donating an organ. Also, kidney transplant recipients can talk to dialysis patients about the process and the impact on their lives.

“When a dialysis patient can see what transplant can do for them, they may be more inclined to advocate for themselves,” Wagner said.

The new faculty expressed enthusiasm for the program’s future, and Borg said the transplant team’s commitment to make a difference supports their efforts.

“At the end of the day, this is the place where you can make a difference,” Borg said.  (Click for Large Image)