Biography
Peter G. Stock, M.D., Ph.D. is Professor of Surgery at UCSF, Surgical Director of the Pediatric Renal Transplantation Program and Surgical Director of the Pancreas Transplant Program. He was trained at the University of Minnesota, completing a surgical residency before coming to UCSF for a transplant fellowship. He joined the UCSF faculty in 1992. Dr. Stock specializes in liver, kidney and pancreas transplantation.
For many years, Dr. Stock was Chair of the Department of Surgery Research Committee. Under his outstanding leadership. he has helped to establish UCSF Surgery as one of the top research programs for surgical residents in the U.S.
A clincial investigation on which Dr. Stock served as principal investigator led the passage of the Hope Act lifting the ban on research for transplanting organs between HIV-positive donors and recipients.
Dr. Stock is a frequent presenter on issues related to transplantation and immunosuppression, and holds membership in numerous professional and honorary societies.
TEACHING AND MENTORING ACTIVITY
Teaching Summary: My teaching responsibilities for the last three years continue to focus on my role as a transplant surgeon, and are directed toward medical students, residents, fellows and junior faculty – I view this as one of my most important roles at UCSF. Teaching is conducted during daily rounds, in the operating room during transplant surgeries, and in the outpatient liver and pancreas clinics. In the last 3 years, I have been recognized twice for receiving evaluations from the surgery residents for having outstanding evaluation scores significantly exceeding the mean scores of faculty in the formal MedHub system (Surgery 450/455 – evaluations/recognition submitted).
For the medical students, I taught the class on transplantation (Surgery 110) in person (six times per year) until 2020, when it became virtual. I continue to be the Course Director for Surgery 140.18, Advanced Studies in Solid Organ Transplantation. This subinternship is for 4th year medical students interested in pursuing a surgical residency and fosters important relationships with top candidates for surgical residency. For the UCSF medical and graduate students, I serve as a lecturer for the GEMS NS219: Introduction to Human Biology and Medicine. This course is designed to attract graduate students into specific areas of translational research. My lecture focuses on strategies for beta cell replacement (pancreas/islet/stem cell-derived islets) as a cure for diabetes mellitus, and includes patient interviews with recipients of pancreas and islet transplants (course evaluations submitted).
Mentoring Summary: At the departmental level, I continue to serve on the Resident Research Committee (Chair until 2020), and am responsible for the curriculum development for the surgery residents during their research years. Until 2020, I provided mentorship to all categorical surgery residents to help define a pathway consistent with their goals. Since stepping down as Chair in 2020, my principal focus is on developing a research pathway for residents pursuing research in transplant or transplant-related fields (2 residents per year). This involves meeting with interns, R2's and R3's as they develop research plans and strategies for funding (at least 5 hours per categorical resident per year during the first 3 years), as well as monitoring progress of all research residents. The research and training plans are focused on the strategy outlined in the NIH T32 training grant (T32A112522 – Filling a Void of Research Transplant Training for Transplant Surgeon). I am the PI of this training grant, which has been highly successful in the training of the first group of residents that have completed the program (08/2016-07/2021); we just received a renewal (08/24/2021-07/31/2026).
My mentorship in translational research (pancreatic islets and HIV immunology) has included medical students, residents and transplant fellows during the period since the last advancement (last 3 years). During the last 3 years, primary mentorship for committed research (2 years) has included: Dominic Amara (medical student/gap year), Simon Chu (medical student/now surgery resident), Casey Ward (surgery resident), Yvonne Kelly (surgery resident), Arya Zarinsefat (surgery resident), Hillary Braun (surgery resident), Audrey Brown (surgery resident), and Steve Wisel (surgery resident/transplant fellow). The success of these mentees is evidenced by the Awards that these students and residents have achieved: Hillary Brown and Casey Ward both won the top award for best research at the UCSF Resident Research Symposium. Dominic Amara was awarded the Presidential Award for medical students from the ASTS. Audrey Brown and Yvonne Kelly both were awarded research grants from the ASTS. Arya Zarinsefat also received an award for his research at Resident Research Day, as well as getting intramural funding for his work with the immune response following transplantation in the HIV positive recipient.
I continue to mentor all of my junior colleagues with regards to surgery/clinical transplantation. For the last 3 years, my focus has been on the three most junior colleagues: Garrett Roll (NIH clinical trials), Shareef Syed (surgical education), and James Gardner (translational research).
Research Overview
During the last 3 years, the major thrust of my research and creative activities have focused in three areas, which are listed below along with related NIH and extramural funding covering the research since the last advancement (2018):
- Improving the outcomes of solid organ transplantation in people with HIV and translational studies bridging the previously distinct worlds of HIV and transplantation. Related funding during last 3 years: A) NIH U01Al118594-05 – Impact of CCR5 Blockade in HIV+ Kidney Transplant Recipients (Stock PI)(active until 07/31/2021); B) NIH U01 Hope in Action Prospective Multi-Center Trial (Stock Site PI)(active until 07/31/3021); C) NIHU01 Al152153-01 – Maximizing the success of HIV+ to HIV+ Kidney Transplantation in South Africa (Stock Co-Investigator)(active until 03/31/2025); D) NIH U01 A1115714-03 Sofusbuvir and Ledipasvir in HIV/HCV Coinfected Pre and Post Liver Transplant (Stock PI)(funding ended 12/31/19); E) American Foundation for AIDS Research (amfAR) 109119-57-RGRL – Impact of Everolimus on HIV Persistence Post Kidney or Liver Transplant (Stock PI)(funding ended 01/31/2018).
- Beta Cell Replacement strategies for the treatment of diabetes mellitus with pancreas transplantation, islet transplantation, or stem cell-derived beta cell clusters. We were funded ($11-million dollar grant) from CIRM to develop the forearm as a site for islet cell transplantation. This novel approach uses co-transplantation of islets with parathyroid tissue to facilitate engraftment – and has the potential for the development of a safe and accessible site for stem cell-derived beta cells. Related funding during last 3 years: A) California Institute for Regenerative Medicine (CIRM) – Islet and PARAthyroid Co-Transplantation for Treatment of Diabetes in Intra-Muscular Site (PARADIGM) (Stock PI) (active until 06/30/2023); B) NIH/NIDDK P30 DK063720 Diabetes Endocrinology Research Center (Stock Director of the Islet Production Core, German PI) (funding end 03/31/2020, renewal pending).
- Public Policy/Organ Allocation: During the last 3 years, I continue to have an active role in the development of national allocation policy. Based on previous experience as the Chair of both the national pancreas and kidney committees of UNOS, I have been funded as a senior investigator of the Scientific Registry of Transplant Recipients (SRTR). The SRTR is contracted by the government (HRSA) to provide analysis based on the national data registry to guide policy development. Related funding during last 3 years: HSRA 75R60220C00011 (annual funding – contract to continue thru 2025).
In addition to the public policy development guided by the SRTR, I have served as the Chair of the Ethics Committee of The Transplantation Society, which guides international policies regarding the complex ethical issues involved in transplantation (see Professional Competence below).
Pancreatic Islet Transplantation
The translational research in the field of pancreatic islets revolves around clinical trials of the safety and efficacy of islet transplantation in patients with Type I diabetes. The clinical trials are funded by the National Institutes of Health (NIH) and the Juvenile Diabetes Research Foundation (JDRF). These clinical trials focus on novel immunosuppressive strategies that utilize co-stimulatory blockade to prevent the immune response against pancreatic islets with a regimen that is not toxic to kidneys or beta cells.
Related research involves improving the techniques required for isolating pancreatic islets from the pancreas, which is being conducted in a fully compliant GMP laboratory facility. The study of the alloimmune and autoimmune response following islet transplantation will be conducted to determine the efficacy of the immunosuppressive strategies. Further translational studies will include methods of expanding the source of beta cells, using direct proliferation, as well as manipulation of precursor cells localized in the adult pancreas. We are currently funded (PI) for a translational grant from California Institute of Regenerative Medicine (CIRM) to bring embryonic stem cell-derived beta cells to a clinical trial.
Solid Organ Transplantation in People with HIV
With the advent of highly active anti-retroviral therapy (HAART), HIV has been a chronic disease. People with HIV are no longer dying from progression of HIV to AIDS, but rather as a result of end stage live disease (viral hepatitis co-infection) and kidney disease (HIV nephropathy). Our laboratory heads up the large NIH-sponsored national multicenter trial which is studying the safety and efficacy of solid organ transplantation in people with HIV. Translational research is exploring the impact of HIV on organ function and the impact of immunosuppression on the immune response against HIV and associated copathogens.