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Transplant Surgery Research

The transplant unit at Royal Prince Alfred Hospital is the largest abdominal organ transplant centre in NSW and home to the Australian National Liver Transplant Unit. The  department has many active research projects, primarily in the fields of organ preservation and regeneration, transplant oncology and clinical outcomes.

Surgeon and scientists with the surgical Liver Transplant Research Program conduct basic science research and clinical research directed at improving care before, during and after liver transplant for patients with liver failure and certain malignancies.

The RPA Translational Centre for Organ Assessment, Repair, and Optimisation (COARO) was established in 2018. The COARO has assembled a research team that is uniquely suited to integrate modern knowledge of organ perfusion4-6, bioengineering, ischemia-reperfusion injury, metabolism, and liver transplantation. The COARO is the first and only centre that has preserved human livers for up to 13 days under normothermic conditions. Several clinical trials are currently underway in the fields of organ reconditioning and transplant oncology.

Our Research Team

Dr Michael Crawford Head of Department
Associate Professor Carlo Pulitano Director of RPA Translational Centre for Organ Assessment, Repair, and Optimisation and the liver transplant oncology program
Associate Professor Jerome Laurence Research lead in renal transplantation
Chuanmin Wang Senior Hospital Scientist
Sumon Chanda Perfusionist
Paul Yousif Perfusionist
Charles Risbey PhD student
Anita Nu PhD student
Shreya Metha PhD student
Mark Ly PhD student
Victor Yu Masters student
Daniel Babekuhl Masters student

Selected Grants

Amount awarded Grant and project details
$1,200,000 MRFF 2023 Clinician Researchers: Applied Research in Health, 2024-2027
Long-term preservation of Human Livers before Transplantation.
Investigators: Pulitano C, Lau N-S, Liu K, McCaughan G, Strasser S.

Our Publications

2024

Lau NS, Ly M, Dennis C, Toomath S, Huang JL, Huang J, Ly H, Chanda S, Marinelli T, Davis R, Liu K, McCaughan G, Crawford M, Pulitano C. Microbial Contamination During Long-term Ex Vivo Normothermic Machine Perfusion of Human Livers. Transplantation. 2024 Jan 1;108(1):198-203. doi: 10.1097/TP.0000000000004653. Epub 2023 Dec 13.
Wei T, Lu J, Xiao XL, Weiss M, Popescu I, Marques HP, Aldrighetti L, Maithel SK, Pulitano C, Bauer TW, Shen F, Poultsides GA, Soubrane O, Martel G, Koerkamp BG, Itaru E, Lv Y, Zhang XF, Pawlik TM; International Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma Study Groups; U.S. Extrahepatic Biliary Malignancy Consortium. Classification of Intrahepatic Cholangiocarcinoma into Perihilar Versus Peripheral Subtype. Ann Surg Oncol. 2024 Feb;31(2):1232-1242. doi: 10.1245/s10434-023-14502-3. Epub 2023 Nov 6.
De Goeij FHC, De Meijer V, Mergental H, Guarrera JV, Asthana S, Ghinolfi D, Boteon YL, Selzner N, Kalisvaart M, Pulitano C, Sonnenday C, Martins PN, Berlakovich G, Schlegel A. Challenges With the Implementation of Machine Perfusion in Clinical Liver Transplantation. Transplantation. 2024 Jun 1;108(6):1296-1307. doi: 10.1097/TP.0000000000004872. Epub 2023 Dec 7.
Lau NS, Ly M, Ewenson K, Toomath S, Ly H, Mestrovic N, Liu K, McCaughan G, Crawford M, Pulitano C. Indocyanine green: A novel marker for assessment of graft quality during ex situ normothermic machine perfusion of human livers. Artif Organs. 2024 May;48(5):472-483. doi: 10.1111/aor.14696. Epub 2023 Dec 22.
Alaimo L, Endo Y, Catalano G, Ruzzenente A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Kitago M, Pawlik TM. Benchmarks in Liver Resection for Intrahepatic Cholangiocarcinoma. Ann Surg Oncol. 2024 May;31(5):3043-3052. doi: 10.1245/s10434-023-14880-8. Epub 2024 Jan 12.
Nguyen CL, Dayaratna N, Graham S, Azimi F, Mak C, Pulitano C, Warrier S. Evolution of Indocyanine Green Fluorescence in Breast and Axilla Surgery: An Australasian Experience. Life (Basel). 2024 Jan 17;14(1):135. doi: 10.3390/life14010135.
Tsilimigras DI, Han X, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Chaucy F, Koerkamp BG, Endo I, Sasaki K, Aucejo F, Zhang XF, Zhu H, Pawlik TM. Early Onset Intrahepatic Cholangiocarcinoma: Clinical Characteristics, Oncological Outcomes, and Genomic/Transcriptomic Features. Ann Surg Oncol. 2024 May;31(5):3087-3097. doi: 10.1245/s10434-024-15013-5. Epub 2024 Feb 12.
Kawashima J, Sahara K, Shen F, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Maithel SK, Marques HP, Martel G, Pulitano C, Cauchy F, Koerkamp BG, Matsuyama R, Endo I, Pawlik TM. Predicting risk of recurrence after resection of stage I intrahepatic cholangiocarcinoma. J Gastrointest Surg. 2024 Jan;28(1):18-25. doi: 10.1016/j.gassur.2023.10.002.
Dalli J, Nguyen CL, Jindal A, Epperlein JP, Hardy NP, Pulitano C, Warrier S, Cahill RA. A feasibility study assessing quantitative indocyanine green angiographic predictors of reconstructive complications following nipple-sparing mastectomy. JPRAS Open. 2024 Jan 26;40:32-47. doi: 10.1016/j.jpra.2024.01.012.
Endo Y, Tsilimigras DI, Woldesenbet S, Marques HP, Cauchy F, Weiss M, Bauer TW, Poultsides GA, Maithel SK, Kitago M, Alexandrescu S, Martel G, Guglielmi A, Pulitano C, Gleisner A, Hugh T, Aldrighetti L, Shen F, Koerkamp BG, Endo I, Pawlik TM. The complication-overall survival (CompOS) risk tool predicts risk of a severe postoperative complications relative to long-term survival among patients with primary liver cancer. J Gastrointest Surg. 2024 Feb;28(2):132-140. doi: 10.1016/j.gassur.2023.12.010. Epub 2024 Feb 5.
Cabanes-Creus M, Liao SHY, Gale Navarro R, Knight M, Nazareth D, Lau NS, Ly M, Zhu E, Roca-Pinilla R, Bugallo Delgado R, Vicente AF, Baltazar G, Westhaus A, Merjane J, Crawford M, McCaughan GW, Unzu C, González-Aseguinolaza G, Alexander IE, Pulitano C, Lisowski L. Harnessing whole human liver ex situ normothermic perfusion for preclinical AAV vector evaluation. Nat Commun. 2024 Mar 14;15(1):1876. doi: 10.1038/s41467-024-46194-y.
Tsilimigras DI, Endo Y, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Popescu I, Poultsides GA, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Pawlik TM. Recurrent Intrahepatic Cholangiocarcinoma: A 10-Point Score to Predict Post-Recurrence Survival and Guide Treatment of Recurrence. Ann Surg Oncol. 2024 Jul;31(7):4427-4435. doi: 10.1245/s10434-024-15210-2. Epub 2024 Mar 23.
Huang J, Lau NS, Ly M, Babekuhl D, Yousif P, Liu K, McCaughan G, Crawford M, Pulitano C. Incorporating a hemodialysis filter into a commercial normothermic perfusion system to facilitate long-term preservation of human split-livers. Artif Organs. 2024 Sep;48(9):1008-1017. doi: 10.1111/aor.14749. Epub 2024 Mar 25.
Risbey CWG, Lau NS, Niu A, Zhang WB, Crawford M, Pulitano C. Return of the cold: How hypothermic oxygenated machine perfusion is changing liver transplantation. Transplant Rev (Orlando). 2024 Jul;38(3):100853. doi: 10.1016/j.trre.2024.100853. Epub 2024 Apr 3.
Tang LCY, Chetwood JD, Lai MSM, Yip TCF, Cao R, Powter E, Salimi S, Wu R, Coulshed A, Bowen DG, Strasser SI, Valliani T, Crawford M, Pulitano C, McKenzie C, Kench J, McCaughan GW, Liu K. Incidence, epidemiology, and outcomes of acute allograft rejection following liver transplantation in Australia. Liver Transpl. 2024 Oct 1;30(10):1039-1049. doi: 10.1097/LVT.0000000000000375. Epub 2024 Apr 23.
Ma ZJ, Xiang JX, Weiss M, Popescu I, Marques HP, Aldrighetti L, Maithel SK, Pulitano C, Bauer TW, Shen F, Poultsides GA, Soubrane O, Martel G, Koerkamp BG, Itaru E, Lyu Y, Zhang XF, Pawlik TM. Long-term survivors after curative-intent resection for intrahepatic cholangiocarcinoma. J Surg Oncol. 2024 Sep;130(3):443-452. doi: 10.1002/jso.27739. Epub 2024 Jun 18.
Risbey CWG, Lau NS, Pulitano C. The importance of developing viability criteria to assess liver grafts undergoing multi-week normothermic perfusion. J Hepatol. 2024 Dec;81(6):e290-e291. doi: 10.1016/j.jhep.2024.07.013. Epub 2024 Jul 20. 
Chatzipanagiotou OP, Tsilimigras DI, Catalano G, Ruzzenente A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Kitago M, Pawlik TM. Preoperative platelet count as an independent predictor of long-term outcomes among patients undergoing resection for intrahepatic cholangiocarcinoma. J Surg Oncol. 2024 Oct;130(5):1042-1050. doi: 10.1002/jso.27806. Epub 2024 Aug 13. 
Risbey CWG, Thomas C, Niu A, Liu K, Crawford M, Pulitano C. Hypothermic Oxygenated machine PErfusion for high-risk liver grafts for transplantation: A systematic review and meta-analysis. Artif Organs. 2024 Oct;48(10):1085-1099. doi: 10.1111/aor.14814. Epub 2024 Jun 22.
Catalano G, Alaimo L, Chatzipanagiotou OP, Ruzzenente A, Aucejo F, Marques HP, Lam V, Hugh T, Bhimani N, Maithel SK, Kitago M, Endo I, Martel G, Pulitano C, Shen F, Popescu I, Koerkamp BG, Bauer TW, Cauchy F, Poultsides GA, Weiss M, Gleisner A, Pawlik TM. Prognostic value of the advanced lung cancer inflammation index in intrahepatic cholangiocarcinoma. Eur J Surg Oncol. 2024 Dec;50(12):108773. doi: 10.1016/j.ejso.2024.108773. Epub 2024 Oct 18. PMID: 39447453.
Lau NS, McCaughan G, Ly M, Liu K, Crawford M, Pulitano C. Long-term machine perfusion of human split livers: a new model for regenerative and translational research. Nat Commun. 2024 Nov 12;15(1):9809. doi: 10.1038/s41467-024-54024-4. 
Marsh-Wakefield F, Santhakumar C, Ferguson AL, Ashhurst TM, Shin JS, Guan FHX, Shields NJ, Platt BJ, Putri GH, Gupta R, Crawford M, Pulitano C, Sandroussi C, Laurence JM, Liu K, McCaughan GW, Palendira U. Spatial mapping of the HCC landscape identifies unique intratumoral perivascular-immune neighborhoods. Hepatol Commun. 2024 Oct 17;8(11):e0540. doi: 10.1097/HC9.0000000000000540.