Of Courage and Patient Advocacy
By Pascal J. Goldschmidt, M.D.
Dean, Miller School of Medicine
University of Miami

.....Transplant surgeon Andreas Tzakis, M.D., Ph.D., left, has pioneered innovative techniques that have dramatically improved patient outcomes and garnered international acclaim.
Far away in Greece, young Andy Tzakis was at the top of his game. The Hellenic world appeared to be his when he was driving toward Athens in his Triumph coupe, the sports car he received for his admission to medical school. Andy didn’t care so much for Europe, but loved the United States. With two fingers on the keys of an old typewriter, he wrote a residency application to every top U.S. academic center he had heard of. He matched at Mount Sinai in New York.

America was home instantly. He planned to become a plastic surgeon, and fell in love with Patty the very first time he met his future wife at the city hospital at Elmhurst. Patty was raised in Queens and told Andy everything he needed to know about the Big Apple. After a year of chief residency at Montefiore, Patty moved to Boston to the Joslin Clinic for a diabetes fellowship. Andy went to the University of Pittsburgh. Later, Patty went to the NIH for two and a half years to work with Jesse Roth, followed by a faculty position at Pitt. Their daughter Mariela was born in 1993.

This was also 10 years after another critical encounter in the career of Andy Tzakis—his meeting with Thomas Starzl, a master of liver surgery. Andy had gone to Peoria to recover a liver for a transplant; in the summer of 1983, liver transplantation was no longer experimental but an established treatment for end-stage liver failure. He was at the right place at the right time and he was feeling great, the way he did back in the days when he was driving his Triumph. Starzl was the only one at the time doing liver transplants, but the floodgates suddenly opened and the phenomenal contribution liver transplants made to the success of the University of Pittsburgh Medical Center is now history.

Andy’s first liver transplant, with the liver he recovered from Peoria, was on Michael, a physicist who had Wilson’s disease and had already rejected two liver grafts, destroying them. Michael’s brain functions were extraordinarily improved after his transplant. That success led Michael’s wife Meg to medical school, and the couple became friends with Patty and Andy. Now it’s almost automatic that Andy becomes good friends with his patients.

While he was chief of pediatric transplantation at the University of Pittsburgh Medical Center, Andy met with another University of Miami hero, Camillo Ricordi, in 1990. Andy felt that, instead of transplanting whole pancreases, which often complicated multi-organ transplants, transplanting beta islets of Langerhans would be simpler and more effective. That is how Camillo Ricordi, who had a successful career in St. Louis and then returned to Milan, came back to the United States to join the Starzl team in Pittsburgh. The first-ever islet transplant was performed in 1990 and its success led to an article in The Lancet. Andy was also instrumental in developing the drug Prograf, which was initially indicated for patients who failed cyclosporine. The use of Prograf was instrumental in the success of multivisceral transplants, another first for Andy who had become an extraordinary surgeon.

Andreas Tzakis, M.D., Ph.D., left, shares a rare relaxed moment with Dean Pascal J. Goldschmidt, M.D.
Andy was fascinated by the immune system, in particular with those individuals whose immune system perfectly tolerated the grafted organ, such as a two-year-old girl who, after being taken off all immunosuppression, thrived and is now a medical student at Florida International University. Camillo Ricordi left Pittsburgh for Miami where Dr. Gene Schiff was the world-renowned liver expert. Andy and Patty decided to relocate to Miami.

In 2006 the Miami Transplant Institute was created with Andy Tzakis as founding director. Andy’s reputation went on to grow internationally for his extraordinary accomplishments, saving patients who had been turned down by other centers. “He would die to save his patients” is Andy’s reputation, and once he almost did. While doing surgery (and after swallowing a bottle of Mylanta because of indigestion and chest pressure), Andy had a mild heart attack, which he took care of only after the operation was over.

From time to time, Andy returns to Greece to plunge back into the culture of his childhood. The man he’s become has saved hundreds of lives, has contributed much to the science that makes transplantation procedures a success, and has mentored so many outstanding surgeons. Andy is not done yet. He will always be the greatest advocate any patient can have. He will always look for ways to improve transplant tolerance and make the body recognize a new organ as its own. He will always try creating new organs with stem cells and transplanting the newly created organs to patients whose lives depend on it.

As the dean of the University of Miami Miller School of Medicine, I think about these individuals, Omaida Velazquez and Andreas Tzakis, and I realize how lucky I am. They are examples of the outstanding quality of individuals who are part of the Miller School family: from a young girl who was walking to school with a big bag full of books and determined to be the best to the young man driving his Triumph coupe somewhere in Athens, not knowing that one day he would be resolving issues of immune rejection, the Achilles heel of transplantation. These are the fearless people of our medical school; they are the pillars who have been here for a while, or have joined us recently to be the patients’ advocate. They have the courage it takes to make the world a better place.