Transplant Anesthesia Research Group
The Transplant Anesthesia Research Group (TARG), housed within the Department of Anesthesiology and Perioperative Care, is integrated with the Transplant Center at the University of California, San Francisco. UCSF ranks among the top programs in the nation for solid organ transplantation. Transplant anesthesiologists provide care during a crucial time in the journey of a transplant patient – the perioperative period during which the organ is transplanted, and the initial phases of recovery afterwards. The TARG strives to innovate in all areas of research impacting this process with a particular focus on liver and kidney transplantation and donor research. We are a highly multidisciplinary team with diverse expertise who collaborate with colleagues from surgery, hepatology, and nephrology as well as basic scientists, statisticians, and data scientists.
TARG is currently led by co-Principal Investigators Dr. Dieter Adelmann and Dr. Michael Bokoch, who founded the group in 2017 along with Dr. Rishi Kothari. TARG carries on the tradition of transplant anesthesia research established by its mentor: Dr. Claus Niemann. TARG is closely affiliated with the Peri-Operative and Critical Care Outcome research group (POCCO).
TARG is broadly interested in all aspects of transplantation, beginning temporally with the care of the organ donor, continuing through the transplant operation itself, encompassing the recovery of the recipient, and beyond. We bring together three broad domains of expertise to address our research questions:
- Clinical trials – TARG designs and conducts prospective research, including randomized controlled trials (RCTs) of interventions at both the donor and recipient level, with the aim of improving patient and graft outcomes.
- Data science – Using modern database technology (SQL) to unite multiple data streams, our Transplant Outcomes and Anesthesia Database (TOAD) allows streamlined analysis of high-quality data from thousands of transplants using modern statistical packages (R and Stata).
- Translational science – Transplantation offers a rich opportunity to investigate mechanisms of disease, organ injury, and ischemia-reperfusion through biospecimen collection and collaboration with basic scientists.
Human kidney glomerular microvascular endothelial cells. Nuclei are stained with DAPI (blue) and actin cytoskeleton with rhodamine-phalloidin (red). Photo courtesy of C. Zhuang.
TARG is the coordinating center for ongoing, prospective, randomized controlled trials (RCTs) in Liver Transplantation. A theme of our trials is protecting kidney function during the perioperative period before, during, and after surgery. We also have strong interests in optimizing blood pressure, fluid and transfusion management during transplant surgery.
Participation in TARG clinical trials is an outstanding opportunity for senior anesthesia residents to participate in cutting-edge clinical research while rotating on the transplant anesthesia service. Clinical liver anesthesia fellows have an opportunity to become more deeply involved and may conduct their own independent research.
- Mild Hypothermia & Acute Kidney Injury in Liver Transplantation (MHALT) – Acute kidney injury (AKI) is extremely common after liver transplantation and leads to serious consequences for patients. AKI impairs recovery and can lead to increased mortality, graft loss, cost, and ICU and hospital length of stay. The MHALT Trial (NCT03534141) aims to reduce AKI by testing the hypothesis that mild hypothermia (34-35 °C) may provide kidney protection during surgery. Mild hypothermia has been shown in animal models, and more recently in deceased kidney donors, to help preserve kidney function after ischemic injury or transplantation.
MHALT is a prospective, single-blind, randomized controlled trial that aims to determine the optimum patient core temperature to preserve post-operative kidney function. MHALT is conducted at three transplant centers around the United States (UCSF, University of Colorado, and Houston Methodist). The trial has surpassed 80% enrollment and has completed the planned interim analysis. Final results are expected in 2023.
MHALT is funded by a UCSF Department of Anesthesia SEED Award and a UCSF REAC Grant to Dr. Michael Bokoch.
- Angiotensin II in Liver Transplantation (AngLT-1) – Vasoplegia is a life-threatening syndrome that can arise during liver transplantation. It consists of low blood pressure due to low systemic vascular resistance (SVR) that is highly resistant to standard drugs such as catecholamines. The AngLT-1 trial (NCT04901169) aims to test the recently FDA-approved drug, angiotensin II, for safety and efficacy as a second-line vasopressor agent during liver transplantation. AngLT-1 is a single-center (UCSF), prospective, double-blind, randomized, placebo-controlled trial.
MHALT is funded by a Pilot & Feasibility Grant from the UCSF Liver Center, (NIH P30 DK026743) to Dr. Michael Bokoch, and supported by collaborators at La Jolla Pharmaceutical.
- TARG Trial in Kidney Transplantation – coming soon!
Featured publications:
Chen, Victoria J.1,2; Guan, Lucy S. MPH1,3; Bokoch, Michael P. MD, PhD1; Langnas, Erica MD, MPH1; Kothari, Rishi MD1; Croci, Rhiannon BSN, RN-BC4; Campbell, Liam J. MS1,5; Quan, David PharmD6; Freise, Chris MD6; Guan, Zhonghui MD1. Mismatched Postsurgical Opioid Prescription to Liver Transplant Patients: A Retrospective Cohort Study From a Single High-Volume Transplant Center. Transplantation ():10.1097/TP.0000000000004728, July 12, 2023. | DOI: 10.1097/TP.0000000000004728
Galli AM, Kothari R, Adelmann D, Holm Z, Bokoch MP, De Gasperi A, Niemann CU, Kolodzie K. Lactate concentration at the end of liver transplant: Early predictor of graft function or just one piece of the puzzle? Clin Transplant. 2023 Jun 23:e15057. doi: 10.1111/ctr.15057. Epub ahead of print. PMID: 37350743.
Mavrothalassitis O, Marcus SG, Roll GR, Tallarico RT, Bokoch MP. Pulmonary Injury Causing a Massive Air Leak During Liver Transplantation: A Case Report and Discussion of Decision-Making. A A Pract. 2023 Jun 19;17(6):e01694. doi: 10.1213/XAA.0000000000001694. PMID: 37335882.
Dixon W, Sheetz K, Adelmann D, Bokoch M, Reddy M, Kothari R, Roberts JP, Syed S, Feng S, Roll G. Real-world implementation of normothermic machine perfusion: A detailed analysis of intraoperative and early postoperative impact. Clin Transplant. 2023 Jun 17:e15049. doi: 10.1111/ctr.15049. Epub ahead of print. PMID: 37329290.
Organ donor management goals and delayed graft function in adult kidney transplant recipients. Clin Transplant. 2022 02; 36(2):e14528. Kothari R, Tolles J, Adelmann D, Lewis RJ, Malinoski DJ, Niemann CU. PMID: 34739731.
Machine Learning Prediction of Liver Allograft Utilization From Deceased Organ Donors Using the National Donor Management Goals Registry. Transplant Direct. 2021 Oct; 7(10):e771. Bishara AM, Lituiev DS, Adelmann D, Kothari RP, Malinoski DJ, Nudel JD, Sally MB, Hirose R, Hadley DD, Niemann CU. PMID: 34604507; PMCID: PMC8478404.
The Association Between Vena Cava Implantation Technique and Acute Kidney Injury After Liver Transplantation. Transplantation. 2020 11; 104(11):e308-e316. Hannon V, Kothari RP, Zhang L, Bokoch MP, Hill R, Roll GR, Mello A, Feiner JR, Liu KD, Niemann CU, Adelmann D. PMID: 32467477.
The Impact of Deceased Donor Liver Extraction Time on Early Allograft Function in Adult Liver Transplant Recipients. Transplantation. 2018 Nov; 102(11):e466-e471. Adelmann D, Roll GR, Kothari R, Syed S, Burdine LJ, Tavakol M, Niemann CU. PMID: 30048397.
Claus Niemann, MD
Founder, Mentor
Michael Bokoch, MD PhD
Founder, co-Principal Investigator
Dr. Bokoch is an anesthesiologist specializing in the care of patients undergoing solid-organ transplantation (liver and kidney) and vascular surgery, as well as clinical and translational research. His current research interests include interventions to reduce acute kidney injury (AKI) after high-risk surgery, biomarkers of organ injury, and the role of the vascular endothelium in liver ischemia-reperfusion injury and end-stage liver disease. He is the principal investigator of the MHALT and AngLT-1 trials.
Dr. Bokoch was born near Pittsburgh, Pennsylvania USA. He received his undergraduate degrees in Biology and Chemistry at Case Western Reserve University in 2003. He then completed his MD PhD training at Stanford University in 2011. He obtained his PhD in Biophysics under the mentorship of Dr. Brian Kobilka, the 2012 Nobel laureate in Chemistry. His thesis work involved the structural biology and pharmacology of adrenergic G-protein-coupled receptors (GPCRs). Dr. Bokoch then moved to UCSF where he completed residency training in anesthesiology followed by a liver transplant anesthesia fellowship in 2017. During that time, he also performed postdoctoral research on thrombin GPCRs with Dr. Shaun Coughlin at the UCSF Cardiovascular Research Institute. Subsequently, he joined the anesthesia faculty at UCSF and has since been active in clinical work, education, and research. He recently received an IARS Mentored Research Award for work on endothelial biology in liver transplantation mentored by Dr. Judith Hellman .
Dieter Adelmann, MD PhD
Founder, co-Principal Investigator
Rishi Kothari, MD
Founder, Research Associate
Dr. Kothari, a founding member of TARG, is currently Associate Professor of Anesthesia at Thomas Jefferson University in Philadelphia, Pennsylvania USA.
Affiliated Faculty
Kerstin Kolodzie, MD PhD MAS
Dr. Kolodzie is Professor of Anesthesia & Perioperative Care and of Biostatistics. She is a collaborator and statistical mentor to the TARG.
Nicholas Mendez, MD
Dr. Mendez is a Transplant Anesthesiologist and Assistant Professor of Anesthesia & Perioperative Care. His work with the TARG focuses on sarcopenia and recovery after kidney transplantation.
Matthieu Legrand, MD PhD
Dr. Legrand is Professor and Director of Clinical Research for the Department of Anesthesia and Perioperative Care. He is also the head of the Peri-Operative and Critical Care Outcome research group (POCCO) . He is a collaborator and mentor to the TARG in clinical research design.
Andrew Bishara, MD
Dr. Bishara is Assistant Professor of Anesthesia and Perioperative Care. He collaborates with the TARG and has expertise in machine learning and artificial intelligence.
Elizabeth Whitlock, MD
Dr. Whitlock is Assistant Professor of Anesthesia and Perioperative Care. She collaborates with the TARG on advanced statistical modeling.
Fellows and Residents
Edoardo Antonucci, MD
Dr. Antonucci is a Visiting Scholar at UCSF and a Resident Physician specializing in Anesthesia and Intensive Care at Milan University, Italy. He is dedicated to researching organ injury mechanisms following solid organ transplantation and is clinical interest is in critical care patients’ management.
Alessandro Galli, MD
Dr. Galli completed residency in critical care medicine and anesthesiology, and then worked as an anesthesiologist in the operating theatres in Bergamo, Italy. His interest is in liver transplantation, and his work with the TARG investigates the role of arterial lactate concentration as a predictor of early allograft dysfunction. He is a 2022-23 Liver Transplant Anesthesia Fellow at UCSF.
Conrad Lacom, MD
Dr. Lacom received his MD from the Medical University of Vienna in Austria, where he also completed his residency in anesthesiology. He has worked and studied in France, Spain and Germany. His research focuses on perioperative hemostasis. His most recent work on platelet function testing in thrombocytopenia was published in 2022. His personal interests include travel and foreign languages. He is a 2022-23 Liver Transplant Anesthesia Fellow at UCSF.
Sivan Marcus, MD
Dr. Marcus received his B.S. in Bioengineering from UC Berkeley and his MD from UCSF. He is currently an Anesthesia Resident in the Critical Care Scholars Track at UCSF. His research with the TARG focuses on advanced hemodynamic monitoring in the AngLT-1 trial.
Clinical Research Coordinators
Meghana Reddy
Meghana graduated from Santa Clara University with a B.S. in Neuroscience with a Computer Science emphasis. Currently, she works as a Medical Scribe at a local Emergency Department, volunteers at a women's health non-profit, and spends time teaching high school students about biology! She is an Assistant Clinical Research Coordinator with the TARG during 2022-23.
Amy Tran
Amy graduated from UC Berkeley with a B.S. in Microbial Biology and a B.A. in Public Health. Currently, she is a Medical Assistant at an Oculofacial Plastic, Reconstructive and Orbital surgery clinic and volunteers at community health clinics. She is an Assistant Clinical Research Coordinator with the TARG during 2022-23.
Elizabeth Sun
Elizabeth graduated from UCSD with a B.S. in Molecular and Cell Biology. She is an Assistant Clinical Research Coordinator with the TARG during 2022-23. Her research focuses on the MHALT trial and hemodynamic monitoring.
Students
Roberta Texeira Tallarico
Roberta T. Tallarico is an NIH T32 Postdoc Research Fellow from the Department of Anesthesia and Perioperative Care at UCSF. She is trained in surgery and critical care medicine in Brazil, having a postgraduation in Tropical Medicine and Clinical Nutrition. In 2023, she was inducted as a Fellow of Critical Care Medicine by the American College of Critical Care Medicine. Her interest is in clinical research, focusing on perioperative outcomes of patients living with chronic diseases (e.g. diabetes, obesity).
Krishna Govindaraju
Krishna studied microbiology, immunology, and molecular genetics at UCLA and helped to understand the effect of mistranslation on genetic competence and sporulation in prokaryotes. He pursued a master's degree in biomedical engineering and worked closely with the Department of Chemistry at SJSU and the Stanford Linear Accelerator Center to develop a novel synthetic method for modifying the surface of nanoscale diamond for use in optically detected magnetic resonance and boron neutron capture.
Liam St. Hilaire
Liam St. Hilaire is currently a medical student at UCSF. His work with the TARG is focused on Renin levels in all clinical trials.
Cindy Zhuang
Cindy graduated from USC with a BS in Neuroscience and a BA in Psychology. She is currently a medical student at SUNY Upstate. She is doing a summer research fellowship at UCSF through the FAER MSARF program, where she works on the effect of ischemic reperfusion injury on glomerular endothelial cells.
Brooke Clemmensen
Brooke Clemmensen is a medical student at the University of Nevada, Reno School of Medicine and is planning to apply to Emergency Medicine for residency. She assisted the TARG with data analysis and visualization using R for the MHALT trial.
Anthony Phero
Anthony is currently a medical student at UCSF. He completed a summer research fellowship at Michigan under the FAER MSARF program doing research informatics work with the MPOG/STS databases. His work with the TARG is focused on esophageal warming in the MHALT Trial.
Alumni
Vivienne Hannon, MBBS
Elizabeth Wilson, MD
Dr. Elizabeth Wilson is a transplant anesthesiologist and Assistant Professor of Anesthesiology at Emory University School of Medicine and practices at Emory University Hospital in Atlanta, GA, USA. She completed her anesthesiology residency at The Johns Hopkins Hospital in 2019 and liver transplant anesthesiology fellowship at University of California San Fransico in 2020. Her research interests include transplant immunology and ischemia reperfusion injury.
Zach Holm
Zach currently works as a general practice physician at Havnestadens Lægehus, Copenhagen, Denmark. He was a research fellow with the TARG in 2019-20 through the DARE (Danish-American Research Exchange) Fellowship Program sponsored by the Lundbeck Foundation. He conducted a retrospective cohort study on perioperative mortality in liver transplantation before and after the “Share 35” organ allocation policy.
Rachel Hill
Rachel was an Assistant Clinical Research Coordinator with the TARG in 2019-20. She is currently a medical student at the Weill Cornell Medical College in New York, NY USA.
Nikitha Reddy
Nikitha is currently a medical student at the Keck School of Medicine of USC. She earned a B.A. in Molecular and Cell Biology and a B.A. in Psychology from the University of California, Berkeley. She is currently conducting research in critical care and cardiology. Nikitha was an Assistant Clinical Research Coordinator with the TARG in 2020-21.
Jillene Sturgess-DaPrato
Jillene was an Assistant Clinical Research Coordinator with the TARG and POCCO in 2021-22. She is currently the Senior Clinical Research Coordinator for the Dept. of Anesthesia & Perioperative Care at UCSF and the POCCO.
Emily Bi
Emily is currently a first-year medical student at NYU Grossman School of Medicine with an interest in psychiatry. She graduated from UC Berkeley with degrees in Art and Molecular & Cell Biology in 2021. Emily was an Assistant Clinical Research Coordinator with the TARG and POCCO in 2021-22.
Our research seeks to improve outcomes and recovery for patients undergoing liver and kidney transplantation.
If you would like to help support this important work with a Donation, please click the link below. You may choose between “This contribution is in honor…” and “In honor of Michael Bokoch.”
Your contribution will support the entirety of the TARG’s research: Make A Gift
Dr. Michael Bokoch: [email protected]
Dr. Dieter Adelmann: [email protected]
Mailing Address:
UCSF Dept. of Anesthesia
521 Parnassus Ave
4th floor
San Francisco, CA 94143
Opportunities:
TARG welcomes inquiries from University of California, Berkeley undergraduates enrolled in the UCSF/Kaiser Permanente Undergraduate Research Internship (URI).
TARG typically has opportunities 1-2 times per year for Assistant Clinical Research Coordinator positions. If you are interested in applying for one of these positions, please send us an e-mail that includes your CV and a cover letter. We also welcome inquiries from Medical Students or Undergraduates seeking volunteer research experience as part of a summer or year-long project. Unfortunately, the TARG is unable to sponsor work visas at this time.