Tomoaki Kato

5 Questions With Dr. Tomoaki Kato

A pioneer in multiorgan transplantation who leads with innovation

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Resiliency and focus are the trademarks of Dr. Tomoaki Kato, a world-renowned multiorgan transplant surgeon who regularly takes on difficult surgeries that often require marathon hours in the operating room.

The Chief of the Division of Abdominal Organ Transplantation at NewYork-Presbyterian/Columbia is known for finding innovative ways to treat patients. He helped pioneer auxiliary partial orthotopic liver transplantation (APOLT), which treats a failing liver by attaching a partial donor liver onto it. He was also the first in the world to perform a six-organ ex vivo surgery, in which he removed six organs from a pediatric patient, removed a large tumor growing in her abdomen, and then re-implanted the organs over a 23-hour surgery.

When tackling cases other doctors might find daunting, Dr. Kato’s motto is: “Don’t say ‘no’ just because it’s never been done before,” he says. “I always try to see if there’s anything we can do outside the box to help a patient in need.”

Dr. Kato spoke with NYP Advances about how innovation and pushing boundaries in the name of patient care has shaped his career.  

How did you know that you wanted to pursue transplant surgery?

While I was finishing my surgical residency in Japan, I knew I wanted to do advanced training in the U.S. in a specialty that wasn’t as readily available in Japan. Although Japanese surgery is also advanced, there were two areas that were lacking back then: vascular surgery, because there was really no atherosclerotic disease then in Japan; and transplant surgery, because the diagnosis of brain death wasn’t accepted in Japan at the time, so organ donations weren’t prevalent.

I went to the vascular surgery professor first for a recommendation, but he was too busy preparing for a talk at an international conference, so he told me to come back in a month. Instead, I went to the transplant professor, and he wrote me the recommendation right away. If the vascular professor had been available at the time, it’s possible I could have become a vascular surgeon.

You’ve since become a leader in multiple-organ transplantation. What drives you to continue expanding the boundaries of transplantation?

It always comes down to the patient. A lot of the hard cases I’ve taken on are because they’ve gotten a “no” from someone else. I think it’s meaningful to at least try to find a solution because it’s likely that it exists, you just have to find it through outside-the-box thinking.

"I saw it as modifying the technology and the knowledge we already had to do whatever we could to help the patient."

For example, with the ex vivo surgery, even though it had never been done before, I knew I had the building blocks to do it. The technology already existed to take each organ out and to put it back in, and all the organ transplants I had done previously prepared me for this. We just needed to figure out a way to put all these procedures together so we could perform the surgery. I saw it as modifying the technology and the knowledge we already had to do whatever we could to help the patient.

As for the future, in the next 10 years, I’d like to do xenotransplantation research that helps make it possible to do a pig-to-human liver transplant. The liver is a very complex organ, so this isn’t anywhere within reach yet. It’s important that we do this research because patients with advanced liver cancer often can’t receive livers from human donors based on organ utility. I’ve seen a lot of heartbreaking stories where individuals discover they have liver cancer and are suddenly being told they’re terminal. Being able to do transplants with pig livers would be a big game changer because it would provide a more readily available resource of organs for these types of patients.

When you look back on your career so far, what’s the accomplishment you’re proudest of?

Something that I’m very proud of is helping to develop a pediatric liver transplant program in Latin America, which I’ve been involved with for almost 20 years now.

It started while I was a surgeon in Miami. I was contacted by a mother in Venezuela who needed a liver transplant for her child because pediatric liver transplants weren’t available where she lived. Since she couldn’t afford to come to America, I thought about going to Venezuela to perform the surgery, but I needed to find a hospital there. Coincidentally, around that time I happened to talk to a surgeon from Caracas who was looking for somebody with my experience to help him start a pediatric liver transplant program.

Unfortunately, that child didn’t make it before we got to do the surgery, but somebody else heard about what we were doing and showed up on our doorstep. We were able to do our first case in Caracas in 2005. Since then, we’ve expanded the program to the entire Latin American region. I’m proud that not only are we providing access to life-saving surgeries for kids in underprivileged areas, but we’re also training the local medical teams on cutting-edge surgical technology and transplant care.

Early in the pandemic, you were on the brink of multiorgan failure after contracting COVID-19 and ended up being treated by your colleagues at NewYork-Presbyterian. How did surviving that change your outlook on work and life?

When something like that happens, you feel the preciousness of life and realize you can’t just take it all for granted. The day I went into the hospital, I had no idea I was going to be intubated or have to go on ECMO. When I first woke up from the ventilator, I could barely move. I still remember the first time I tried to write, no one could read my handwriting.

To go from that state to performing transplants and participating in patient care again took about five months. By November of the following year, I was even able to run the New York City marathon, which I do every year. I experienced firsthand the power of medicine, rehabilitation, and physical therapy. I believe in advanced medicine and science, but to understand firsthand what patients go through was quite an experience for me. It was good to witness that something I believe in works. I’m living proof, and I can share that with my patients.

What is most rewarding about working at NewYork-Presbyterian and Columbia?

It’s really all about the patient-centered values and the enormous number of talented individuals I work with. People here really want to work toward what’s best for the patient. Having that many talented colleagues who are working toward the same purpose is a great environment to be in.

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Dr. Tomoaki Kato: A pioneer in multiorgan transplantation who leads with innovation

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