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). Research 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). Trials 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.
