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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.

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
Daniel Babekuhl PhD student
Dr Andrew Jacques PhD student
Dr Soon Lau PhD student
Dr Mark Ly PhD student
Anita Niu Masters student
Charles Risbey PhD student
Victor Yu Masters student

Selected Grants

Amount awarded Grant and project details
$150,000 Royal Australasian College of Surgeons (RACS), 2022-2023
Development of an Automate system for Preservation of a Metabolically Active Liver For More Than 2 Weeks.
Investigator: Pulitano C
$150,000 Royal Australasian College of Surgeons (RACS), 2021-2022
Long term ex-vivo perfusion
Investigator: Pulitano C

Our Publications

2023

Alaimo L, Lima HA, Moazzam Z, Endo Y, Yang J, Ruzzenente A, Guglielmi 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. Development and Validation of a Machine-Learning Model to Predict Early Recurrence of Intrahepatic Cholangiocarcinoma. Ann Surg Oncol. 2023 Sep;30(9):5406-5415. doi: 10.1245/s10434-023-13636-8. Epub 2023 May 20.
Alaimo L, Moazzam Z, Brown ZJ, Endo Y, Ruzzenente A, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Soubrane O, Koerkamp BG, Endo I, Pawlik TM. Application of Hazard Function to Investigate Recurrence of Intrahepatic Cholangiocarcinoma After Curative-Intent Liver Resection: A Novel Approach to Characterize Recurrence. Ann Surg Oncol. 2023 Mar;30(3):1340-1349. doi: 10.1245/s10434-022-12463-7. Epub 2022 Aug 27.
Alaimo L, Moazzam Z, Endo Y, Lima HA, Butey SP, Ruzzenente A, Guglielmi 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, Kim A, Ejaz A, Beane J, Cloyd J, Pawlik TM. The Application of Artificial Intelligence to Investigate Long-Term Outcomes and Assess Optimal Margin Width in Hepatectomy for Intrahepatic Cholangiocarcinoma. Ann Surg Oncol. 2023 Jul;30(7):4292-4301. doi: 10.1245/s10434-023-13349-y. Epub 2023 Mar 23.
Alaimo L, Moazzam Z, Endo Y, Lima HA, Ruzzenente A, Guglielmi 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, Pawlik TM. Long- Term Recurrence-Free and Overall Survival Differ Based on Common, Proliferative, and Inflammatory Subtypes After Resection of Intrahepatic Cholangiocarcinoma. Ann Surg Oncol. 2023 Mar;30(3):1392-1403. doi: 10.1245/s10434-022-12795-4. Epub 2022 Nov 16.
Alaimo L, Moazzam Z, Lima HA, Endo Y, Ruzzenente A, Guglielmi A, Ratti F, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Popescu I, Poultsides GA, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Kitago M, Aucejo F, Sasaki K, Fields RC, Hugh T, Lam V, Pawlik TM. An attempt to establish and apply global benchmarks for liver resection of malignant hepatic tumors. Surgery. 2023 Dec;174(6):1384-1392. doi: 10.1016/j.surg.2023.08.024. Epub 2023 Sep 22.
Angelico R, Sensi B, Quaranta C, Orsi M, Parente A, Schlegel A, Tisone G, Manzia TM; Real-World Machine Perfusion Study Group. The impact of center volume on the utilization and outcomes of machine perfusion technology in liver transplantation: An international survey. Artif Organs. 2023 Nov;47(11):1773-1785. doi: 10.1111/aor.14635. Epub 2023 Aug 27.
Ealing IV, Lau NS, Cheung D, Peruch S, Agostinho N, Crawford M, Pulitano C. Safety of laparoscopic repair of incisional hernias in liver transplant recipients. Clin Transplant. 2023 Jun;37(6):e14969. doi: 10.1111/ctr.14969. Epub 2023 Mar 28.
Endo Y, Moazzam Z, Alaimo L, Lima HA, Munir MM, Shaikh CF, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Kitago M, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Pawlik TM. Predictive risk-score model to select patients with intrahepatic cholangiocarcinoma for adjuvant chemotherapy. HPB (Oxford). 2023 Feb;25(2):229-238. doi: 10.1016/j.hpb.2022.10.011. Epub 2022 Nov 3.
Endo Y, Moazzam Z, Lima HA, Alaimo L, Munir MM, Shaikh CF, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Kitago M, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Pawlik TM. The impact of tumor location on the value of lymphadenectomy for intrahepatic cholangiocarcinoma. HPB (Oxford). 2023 Jun;25(6):650-658. doi: 10.1016/j.hpb.2023.02.013. Epub 2023 Feb 22.
Endo Y, Moazzam Z, Woldesenbet S, Araujo Lima H, Alaimo L, Munir MM, Shaikh CF, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Kitago M, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Pawlik TM. Predictors and Prognostic Significance of Postoperative Complications for Patients with Intrahepatic Cholangiocarcinoma. World J Surg. 2023 Jul;47(7):1792-1800. doi: 10.1007/s00268-023-06974-x. Epub 2023 Apr 3.
Endo Y, Sasaki K, Moazzam Z, Lima HA, Alaimo L, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Kitago M, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Pawlik TM. Higher Tumor Burden Status Dictates the Impact of Surgical Margin Status on Overall Survival in Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma. Ann Surg Oncol. 2023 Apr;30(4):2023-2032. doi: 10.1245/s10434-022-12803-7. Epub 2022 Nov 17.
Jackson S, Combes A, Latif E, Tran M, Lam S, Gore N, Utsiwegota M, Mawson J, Smith L, Palma C, Laurence J, Crawford M, Pulitano C, Wyburn K, Chadban S, Leslie S, Vasilaras A. Laparoscopic donor nephrectomy-Technique and peri- operative outcomes in an Australian transplant center. Clin Transplant. 2023 May;37(5):e14945. doi: 10.1111/ctr.14945. Epub 2023 Feb 27.
Lau NS, Ly M, Dennis C, Ewenson K, Ly H, Huang JL, Cabanes-Creus M, Chanda S, Wang C, Lisowski L, Liu K, Kench J, McCaughan G, Crawford M, Pulitano C. Liver splitting during normothermic machine perfusion: a novel method to combine the advantages of both in-situ and ex-vivo techniques. HPB (Oxford). 2023 May;25(5):543-555. doi: 10.1016/j.hpb.2023.02.003. Epub 2023 Feb 8.
Lau NS, Ly M, Dennis C, Jacques A, Cabanes-Creus M, Toomath S, Huang J, Mestrovic N, Yousif P, Chanda S, Wang C, Lisowski L, Liu K, Kench JG, McCaughan G, Crawford M, Pulitano C. Long-term ex situ normothermic perfusion of human split livers for more than 1 week. Nat Commun. 2023 Aug 8;14(1):4755. doi: 10.1038/s41467-023-40154-8.
Ly M, Lau NS, McKenzie C, Kench JG, McCaughan G, Crawford M, Pulitano C. Does an Additional Bile Duct Flush With Low-viscosity Preservation Solution Reduce Bile Duct Injury? A Single-blinded Randomized Clinical Trial. Transplant Direct. 2023 Feb 8;9(3):e1443. doi: 10.1097/TXD.0000000000001443.
Ly M, Lau NS, McKenzie C, Kench JG, Seyfi D, Majumdar A, Liu K, McCaughan G, Crawford M, Pulitano C. Histological Assessment of the Bile Duct before Liver Transplantation: Does the Bile Duct Injury Score Predict Biliary Strictures? J Clin Med. 2023 Oct 27;12(21):6793. doi: 10.3390/jcm12216793.
Moazzam Z, Alaimo L, Endo Y, Lima HA, Ruzzenente A, Guglielmi 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, Cloyd J, Ejaz A, Pawlik TM. Combined Tumor Burden Score and Carbohydrate Antigen 19-9 Grading System to Predict Outcomes Among Patients with Intrahepatic Cholangiocarcinoma. J Am Coll Surg. 2023 Apr 1;236(4):804-813. doi: 10.1097/XCS.0000000000000557. Epub 2023 Jan 12.
Munir MM, Endo Y, Lima HA, Alaimo L, Moazzam Z, Shaikh C, Poultsides GA, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Kitago M, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Pawlik TM. Albumin-Bilirubin Grade and Tumor Burden Score Predict Outcomes Among Patients with Intrahepatic Cholangiocarcinoma After Hepatic Resection: a Multi- Institutional Analysis. J Gastrointest Surg. 2023 Mar;27(3):544-554. doi: 10.1007/s11605-023-05578-z. Epub 2023 Jan 18.
Nguyen CL, Comerford AP, Dayaratna N, Lata T, Paredes SR, Easwaralingam N, Seah JL, Azimi F, Mak C, Pulitano C, Warrier SK. Trends in outcomes with adoption of indocyanine green angiography in postmastectomy reconstruction. ANZ J Surg. 2023 Jan;93(1-2):270-275. doi: 10.1111/ans.18241. Epub 2022 Dec 28.
Nguyen CL, Zhou M, Easwaralingam N, Seah JL, Azimi F, Mak C, Pulitano C, Warrier S. Novel Dual Tracer Indocyanine Green and Radioisotope Versus Gold Standard Sentinel Lymph Node Biopsy in Breast Cancer: The GREENORBLUE Trial. Ann Surg Oncol. 2023 Oct;30(11):6520-6527. doi: 10.1245/s10434-023-13824-6. Epub 2023 Jul 4.
Nguyen CL, Zhou M, Easwaralingam N, Seah JL, Azimi F, Mak C, Pulitano C, Warrier SK. ASO Author Reflections: Indocyanine Green Fluorescence Sentinel Lymph Node Biopsy in Breast Cancer-An Alternative to Blue Dye? Ann Surg Oncol. 2023 Oct;30(11):6528-6529. doi: 10.1245/s10434-023-13951-0. Epub 2023 Jul 20.
Risbey CWG, Pulitano C. Normothermic Ex Vivo Machine Perfusion for Liver Transplantation: A Systematic Review of Progress in Humans. J Clin Med. 2023 May 28;12(11):3718. doi: 10.3390/jcm12113718.
Xin H, Romanazzo S, Tomaskovic-Crook E, Mitchell TC, Hung JC, Wise SG, Cheng K, Al Maruf DSA, Stokan MJ, Manzie TGH, Parthasarathi K, Cheung VKY, Gupta R, Ly M, Pulitano C, Wise IK, Crook JM, Clark JR. Ex Vivo Preservation of Ovine Periosteum Using a Perfusion Bioreactor System. Cells. 2023 Jun 27;12(13):1724. doi: 10.3390/cells12131724.
Zhang XF, Xue F, Weiss M, Popescu I, Marques HP, Aldrighetti L, Maithel SK, Pulitano C, Bauer TW, Shen F, Poultsides GA, Cauchy F, Martel G, Koerkamp BG, Itaru E, Lv Y, Pawlik TM. Lymph Node Examination and Patterns of Nodal Metastasis Among Patients with Left- Versus Right-Sided Intrahepatic Cholangiocarcinoma After Major Curative-Intent Resection. Ann Surg Oncol. 2023 Mar;30(3):1424-1433. doi: 10.1245/s10434-022-12797-2. Epub 2022 Nov 18.