LOS ANGELES (August 27, 1999) -- Christopher R. Shackleton, M.D., an organ transplant specialist known for his high rates of success, his involvement in the establishment of transplantation programs and policies in Canada, and his previous work in Southern California, has returned to Cedars-Sinai Medical Center to assist in a major expansion of transplantation services.
Among his top priorities are the implementation of a kidney/pancreas transplant program, and to guide the development of programs in partial liver transplantation for both adults and children said Achilles A. Demetriou, M.D., Ph.D., chairman of the medical center's surgery department.
"Dr. Shackleton is an accomplished transplant surgeon. In fact, he brings tremendous technical expertise and experience in a number of areas," said Dr. Demetriou. "He has proven credentials, impeccable skills, and he is adding a new dimension to a very strong program."
A native Canadian, Dr. Shackleton served on the faculty of the Department of Surgery at the University of British Columbia from 1988 to 1993. He established a provincial organ retrieval team, directed British Columbia's organ procurement network, and co-founded the liver transplant program in Vancouver. The programs maintained the highest rates of organ retrieval and graft success in Canada, and Dr. Shackleton received national recognition for his contributions to the Canadian transplant community.
In 1993, Dr. Shackleton came to Southern California to help breathe new life into the whole-organ pancreas transplant program at the University of California Los Angeles. He also played a major role in UCLA's pediatric liver transplant program, introducing microsurgical techniques of arterial reconstruction that resulted in better function and improved success rates.
Dr. Shackleton served from 1995 to 1997 as program director for Cedars-Sinai's Center for Liver Diseases and Transplantation. He is returning to Cedars-Sinai to expand the spectrum of transplant services and to assist in the integration of several aspects of the abdominal organ transplant programs.
"We want to be among the top tier of transplant centers nationally and internationally in terms of the complement of services we offer, and in terms of our responsiveness to the needs of our patients and to the realities of the managed healthcare environment. But above all, we will put the needs of our patients first," said Dr. Shackleton. "I hope to complement the already outstanding transplant faculty at Cedars, and to act as a program integrating resource."
Pancreas transplants are not performed as often as those of the liver or kidney. There are a number of reasons for this, including the complexity of the operation in relation to the perceived benefits. "To date, a functioning whole-organ pancreas transplant is the only therapy available that can reliably remove the need for insulin injections in a Type I diabetic," said Dr. Shackleton, noting that pancreas transplantation still is usually reserved for diabetic patients who develop kidney problems.
"Our philosophy is that if a Type I diabetic is going to receive a kidney transplant and is thus going to undergo a major operation and be placed on immunosuppressive therapy, then there is no reason not to do a concomitant pancreas transplant and make them insulin independent at the same time. The ultimate consideration is whether the additional procedure can be done with a high expectation of success and at minimal additional risk to the patient."
Because the need for livers and kidneys is rising much more quickly than the number of organs becoming available, Dr. Shackleton and his colleagues will continue to employ the latest procedures to make the best use of cadaver organs and those provided by living donors.
"If we look at the growth in the number of candidates for liver transplantation in this country on an annual basis-- the number of new registrants-- that number continues to grow exponentially at 30 percent per year. Contrast that to cadaver donor numbers that are increasing at only one or two percent per year," said Dr. Shackleton. "There's no way that the need for liver transplantation is going to be met from the cadaver donor source alone without a dramatic and sustained rise in organ donation rates. And it seems unlikely that this will happen any time soon."
As part of the solution, a living-donor adult liver transplant program is being developed at Cedars-Sinai. This allows surgeons to take part of a liver from a living donor and transplant it into a family member who has a matching tissue type. Even as this adult program is launched, the pediatric transplant program is expected to increase dramatically, providing new hope for families with young children and infants afflicted with liver disease.
"There is no comparison between adult liver transplantation and pediatric liver transplantation," Dr. Shackleton said. "Pediatric transplantation presents a whole different set of challenges. Infants and children who become candidates for liver transplantation are usually very young, often one or two years of age. They're oftentimes very malnourished and small in terms of their achievement of weight and height milestones for their age. And they can't tell you what's wrong. There's very little margin for error, and you need to have the support network of pediatric intensivists, pediatric hepatologists and infectious disease specialists."
Dr. Shackleton said the success of today's transplant programs depends on the ever-increasing use of various "partial liver grafting techniques." For example, one cadaver liver is "split" to save two lives, a segment of a living donor's liver is transplanted to a related or unrelated individual, or in a "reduced-size" transplant, a cadaver liver is cut down to fit a smaller recipient.
"Reduced-size transplants have been around for a long time, and there are circumstances in which they are appropriate and necessary, but they don't expand the donor pool. What we want to do is employ those techniques that will expand the donor pool and offer more options for recipient candidates so they can be transplanted in a timely fashion."
Dr. Shackleton said Cedars-Sinai is pursuing the development of another new procedure-- called laparoscopic living-donor nephrectomy-- that is likely to increase the number of living donor kidney transplants by allowing a family member to donate a kidney to a relative without the long incisions and long-term recovery required after major surgery.
"This is a video-assisted, minimally invasive procedure that can be performed through a couple of puncture wounds and mini-incisions," he said. "It offers much shorter hospitalization time, much reduced need for pain medication, a significant reduction in the need for blood products in the perioperative period, much faster return to work and, most importantly, a greater willingness on the part of individuals to consider living donation. It is another incremental advance that should help to close the gap between recipient need and donor-organ supply in kidney transplantation."
Dr. Shackleton has authored more than 160 scientific papers and abstracts. He received his medical degree from the University of British Columbia, completed his residency and fellowship at the University of Toronto, the University of British Columbia and Harvard Medical School. He earned certification in internal medicine and nephrology before embarking on his surgical career. Following his general surgical residency, he completed training in transplantation surgery and biology as well as vascular surgery.
An outdoors enthusiast who enjoys hiking and camping, Dr. Shackleton and his wife, Paula, have a daughter and two sons: Emaleah, 16; Benjamin, 14, and Daniel, 12.
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