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Richard N. Pierson III

Richard N. Pierson III M.D.

Academic Title: Professor
Primary Appointment: Surgery
Location: Cardiac Surgery, 110 South Paca Street, 7N-134
Phone: (410) 328-5842
Fax: 410-328-2750

Personal History:

Dr. Pierson received his BA from Princeton University in English and American Studies in 1978, and his MD from Columbia University College of Physicians and Surgeons in 1983. His postgraduate clinical training included General Surgery at the University of Michigan, Ann Arbor, MI (1983-1990), Cardiac and Thoracic Surgery at the Massachusetts General Hospital, Boston, MA (1990-1992), and clinical and research fellowship in Cardiothoracic Transplantation at Papworth Hospital, Cambridge University, Cambridge, England (1993-1994).

He joined the faculty at Vanderbilt University as Director of Heart and Lung Transplantation in 1994, with staff appointments at Vanderbilt University Medical Center and the Nashville VAMC. He was promoted to Associate Professor with tenure in 1999.

In 2002 he was recruited as Clinical Director of Heart and Lung Transplantation at University of Maryland Baltimore, with staff appointments in Cardiac Surgery at UMMC and Baltimore VAMC. In 2006 he was promoted to Professor of Surgery at University of Maryland, and served as Director of the Surgical Service at the Baltimore VA Medical Center (VA Maryland Health Care System) from 2006 until 2012.

From 2012-2014 he served as Senior Associate Dean for Academic Affairs and Interim Director of Research Affairs for the University of Maryland School of Medicine. Since 2014 he has served as Senior Associate Vice Chair for Research in the Department of Surgery, UMSOM.

Research Training

Dr. Pierson received his initial research training in pulmonary pathophysiology at St. Luke’s/Roosevelt Hospital during summers through high school and college. During surgical training he spent two years working on xenotransplantation, first at Columbia with Keith Reemtsma and Eric Rose (1986-7), and then at Massachusetts General Hospital with Hugh Auchincloss, Henry Winn, and Paul Russell (1987-8). These projects described and characterized cross-species immune responses in concordant (monkey-to-baboon) and discordant (rabbit-, human, and monkey-to-mouse) species combinations. Following his thoracic fellowship at MGH he spent an additional 18 months continuing his xenotransplant studies at Cambridge University, working with David White and Sir Roy Calne to develop test systems for evaluating hearts and lungs from pigs that were genetically modified to prevent immediate immune injury (hyperacute rejection).

Research Interests:

Basic & Translational Research

Dr. Pierson's laboratory specializes in basic and translation research related to transplant immunology, with the following principle foci:

  • Investigating the mechanisms by which costimulation pathways modulate the immune response to an allograft, a xenograft, or an infectious antigenic challenge in primates (cynomolgus monkeys or baboons). The immediate goal of this work is to prevent immune injury to, and especially “chronic rejection” of, heart grafts during treatment with highly selective costimulation pathway “immune modulators”. The long term goal of this work is to promote induction of “tolerance”, permanent graft acceptance without the need for ongoing immunosuppressive medications.
  • Defining the pathogenesis of initial pig lung and liver xenograft injury, using pigs genetically modified to protect them from known injury mechanisms. The influence of each genetic modification is evaluated in an ex vivo model of pig lungs perfused with human blood to identify and prevent residual injury mechanisms. Translation toward clinical application for these organs is explored by orthotopic pig lung transplant and by paracorporeal pig liver perfusion in baboons.

Clinical Speciality:

Thoracic Surgery, Thoracic Transplantation, Mechanical Circulatory Support (Heart and Lung)

Extramural Grant Support:

Dr. Pierson’s research has been continuously supported from federal sources (NIH, VA) since 1997.  Current major awards and research topics are listed below:

NIH UO1 AI 066719  Pierson, RN III  7/10-6/15
“Immunomodulation for Heart Allograft Tolerance”
This study investigates the mechanisms by which costimulation pathway blockade modulates the immune response to an allograft or a surrogate viral immune challenge. The goal of this work is to define the role of the costimulation pathway with regard to induction of operational tolerance.

NIH U19 AI090959  Cooper, DKC (Pierson, RN III, Project 2 PI)  9/10-8/15
“Genetically-engineered pig organ transplantation into nonhuman primates”
Project 2 (“Coagulation Control to Protect GaITKO Lung and Liver Xenografts”) will define the role of complement activation and coagulation pathway dysregulation in rejection of GalT KO and GalTKO/hTFPI transgenic lung and liver xenografts.


Dr. Pierson was awarded a Presidential Early Career Award for Science and Engineering in 1999.  He received an Individual National Research Service Award from the PHS (NIH NRSA; 1987), the Vice-Chancellor's Award from Vanderbilt University (1996), the F.H. Martin Faculty Research Fellowship from the American College of Surgeons (1996), the John Alexander Research Scholarship from the American Association for Thoracic Surgery (1996), and the ASTS Wyeth Mid-Level Faculty Research Fellowship (2004),  He has been listed among America’s Top Doctors and Best Doctors in America since 2002.


Selected Publications

Pierson RN III, Winn HJ, Russell PS, Auchincloss H Jr: Xenogeneic skin graft rejection is especially dependent on CD4+ T cells. Journal of Experimental Medicine 1989; 170: 991-6.

Moses RD, Pierson RN III, Winn HJ, Auchincloss H Jr: Xenogeneic proliferation and lymphokine production are dependent on CD4+ helper T cells and self antigen-presenting cells in the mouse. Journal of Experimental Medicine 1990; 172(2): 567-75.

Pierson RN III, Rosengard BR: The uses of molecular biology in transplantation. JAMA 1994; 272(21): 1706-7.

Pierson RN III, Tew DF, Konig WK, Dunning JJ, White DJG, Wallwork J: Pig lungs are susceptible to hyperacute rejection by human blood in a working ex-vivo heart-lung model. Transplant Proc 1994; 26(3): 1318.

Robson SC, Young VK, Cook NS, Metternich R, Kasper-Konig W, Lesnikoski BA, Pierson RN III, Hancock WW, White DJG, Bach FH: Thrombin inhibition in an ex vivo model of porcine heart xenograft hyperacute rejection. Transplantation 1996; 61(6): 862-8.

Pierson RN III, Pino-Chavez G, Young VK, Kasper-Konig W, White DJG, Wallwork J: Expression of human decay accelerating factor may protect pig lung from hyperacute rejection by human blood. J Heart and Lung Transplantation 1997; 16(2): 231-239.

Pierson RN III, Kasper-Konig W, Tew DN, Young VK, Dunning JJ, Horsley J, Carey NRB, Wallwork J, White DJG: Hyperacute lung rejection in a pig-to-human transplant model. 1) The role of anti-species antibody and complement. Transplantation 1997; 63(4): 594-603.

Miller GG, Davis SF, Aune TJ, Zhao SM, Pierson RN. Fibroblast growth factors and their receptors in allograft vascular disease. Graft 1998; 1(3): 96-100.

Skepper JN, Pierson RN, Tew DN, Boa Y-P, Williamson G, Wallwork J, White D, Davies MJ, Jones JG, Menon DK. Cytochemical demonstration of sites of hydrogen peroxide generation and increased vascular permeability in isolated pig hearts after ischemia and reperfusion. Microscopy Research and Techniques 1998; 42(5): 369-385.

Chang AC, Blum MG, Blair KSA, Zhang J, Scott MA, Brock JE, Thomas DW, Burkly LC, Miller GG, Pierson RN III. Modulation of interleukin-12 gene expression in primate cardiac allografts during anti-CD40 Ligand monoclonal antibody treatment, Surgical Forum 1998; Vol. XLIX: 363-364.

Miller GG, Davis SF, Atkinson JB, Chomsky DB, Pedroso P, Reddy VS, Drinkwater DC, Zhao XM, Pierson RN. Longitudinal analysis of fibroblast growth factor (aFGF) expression following transplantation and association with severity of cardiac allograft vasculopathy. Circulation, 1999; 100: 2396-99.

Pierson RN III, Chang AC, Blum MG, Blair KSA, Scott MA, Atkinson JB, Collins BJ, Zhang J-P, Thomas DW, Burkly LC, Miller GG. Prolongation of primate cardiac allograft survival by treatment with anti-CD 40L (CD154) antibody. Transplantation, 1999; 68(11): 1800-5.

Pierson RN III, Miller GG. Late graft failure: Lessons from clinical and experimental thoracic organ transplantation. Graft 2000; 3 (2): 88-93.

Shin H-G, Barnett JV, Chang P, Reddy S, Drinkwater DC, Pierson RN, Wiley RG, Murray KT. Molecular heterogeneity of protein kinase C expression in human ventricle. Cardiovasc Res 2000; 48: 285-299.

Pierson RN III, Crowe JE Jr., Pfeiffer S, Atkinson J, Azimzadeh A, Miller GG. CD40-Ligand in Primate Cardiac Allograft and Viral Immunity. Immunologic Research 2001; 23(2-3): 253-62.

Pierson III RN, Schraeder C, Wu GS, Kawka DW, Peterson L, Springer MS, Siciliano SJ, Lyons K, Mills, S, Illiff S, Miller GG, Azimzadeh AM, Singer II, DeMartino, JA. Synergism between CCR5 blockade and CSA in primate cardiac allotransplantation. Transplantation 2002 Suppl. 74; 4: 299.

Crowe JE Jr, Sannella EC, Pfeiffer S, Zorn GL III, Azimzadeh A, Newman R, Miller GG, Pierson RN III. CD154 regulates primate humoral immunity to influenza. Am J Transplantation 2003; 3: 680-88.

Schraeder C, Azimzadeh AM, Wu G, Price JO, Atkinson JB, Pierson RN III. Anti-CD20 treatment depletes B-cells in blood and lymphatic tissue of cynomolgus monkeys. Transplant Immunology 2003; 12(1): 19-28.

Pierson RN III, Barr ML, McCullough KP, Egan T, Garrity E, Jessup M, Murray S. SRTR Report on the State of Transplantation: Thoracic Organ Transplantation. Am J Transplant 2004; 4 (Suppl 9): 93-105.

Azimzadeh AM, Pfeiffer S, Wu GS, Schroeder C, Zorn GL III, Kehry M, Miller GG, Rose ML, Pierson RN III. Humoral immunity to vimentin is associated with cardiac allograft injury in nonhuman primates. Am J Transplantation, 2005; 5(10): 2349-59.

Pfeiffer S, Zorn G III, Blair K, Farley S, Wu G, Schuurmann HK, Azimzadeh A, Pierson RN III. Hyperacute lung rejection in the pig-to-human model. 4) Evidence for complement- and antibody independent mechanisms. Transplantation 2005; 79(6): 662-71.

Wu G, Pfeiffer S, Schroeder C, Zhang T, Nguyen BN, Kelishadi S, Atkinson JB, Schuurman H-J, White DJG, Azimzadeh AM, Pierson RN III. Co-stimulation blockade targeting CD154 and CD28/B7 modulates the induced antibody response after a pig-to-baboon cardiac xenograft. Xenotransplantation 2005; 12(3): 197-208.

Azimzadeh A, Pfeiffer S, Wu G, Schroeder C, Zorn G III, Ozkaynak E, Kehry M, Atkinson J, Miller G, Pierson RN III. Alloimmunity in primate heart recipients with CD154 blockade: evidence for alternative costimulation mechanisms. Transplantation 2006; 81(2): 255-64.

Barrows BR, Azimzadeh AM, Zhou H, Vives-Rodriguez G, McCulle SL, Stark WN, Ambulos N, Yin J, Pierson, RN III, Johnson FL, Balke CW, Gottlieb SS, and Bond M. Robust gene expression analysis using amplified RNA from biopsy-sized human heart tissue. J Mol Cell Cardiol 2007; 42: 260-264.

Wu G, Pfeiffer S, Schroder C, Zhang T, Nguyen BN, Kelishadi S, Atkinson JB, Schuurman HJ, White DJ, Azimzadeh AM, Pierson RN III. Coagulation cascade activation triggers early failure of pig hearts expressing human complement regulatory genes. Xenotransplantation 2007; 14:34-47.

Nguyen BN, Azimzadeh AM, Zhang T, Wu G, Shuurman H-J, Sachs DH, Ayares D, Allan JS, Pierson RN III. Life-Supporting Function of Genetically Modified Swine Lungs in Baboons. J Thorac CV Surg 2007; 133(5): 1354-63.

Schroeder C*, Pierson RN III*, Nguyen BN, Kawka DW, Peterson LB, Wu G, Zhang T, Springer MS, Siciliano SJ, Iliff S, Ayala JM, Lu M, Mudgett JS, Lyons K, Mills S, Miller GG, Singer II, Azimzadeh AM, DeMartino JA. CCR5 blockade modulates inflammation and alloimmunity in primates. J Immunol. 2007; 179(4): 2289-99.

Cooper DKC, Dorling A, Rees M, Seebach J, Yazer M, Ohdan H, Awwad M, Ayares D, Pierson RN III. aGalactosyltransferase gene-knockout pigs: where do we go from here? Transplantation 2007; 84(1): 1-7.

Nguyen BN, Azimzadeh AM, Zhang T, Wu G, Shuurman H-J, Sachs DH, Ayares D, Allan JS, Pierson RN III.  Life-Supporting Function of Genetically Modified Swine Lungs in Baboons.  J Thorac CV Surg 2007; 133(5): 1354-63.

Rogers JG, Butler J, Lansman SL, Gass A, Portner PM, Pasque MK, Pierson RN III.  Chronic Mechanical Circulatory Support for Inotrope-Dependent Heart Failure Patients Who Are Not Transplant Candidates: Results of the INTrEPID Trial. J. Am. Coll. Cardiol. 2007; 50 (8): 741-7.

Silverman RP, Banks ND, DeTolla LJ, Shipley ST, Panda A, Sanchez RA, Azimzadeh AM, Pierson RN III, Wang D, Rodriguez ED, Holton LH III, Bartlett ST.  A Heterotopic Primate Model for Facial Composite Tissue Transplantation.  Ann Plast Surg 2008; 60(2): 209-216.

Pierson RN III.  Current Status of Xenotransplantation.  JAMA 2009; 301 (9): 967-9.

Ezzelarab M, Garcia B, Azimzadeh A, Sun F, Hara H, Kelishadi S, Zhang T, Lin JY, Tai H-C, Long C, Wagner R, Thacker J, Murase N, McCurry K, Barth RN, Ayares D, Pierson RN III*, Cooper DKC*.  The Innate Immune Response and Activation of Coagulation in α1,3-Galactosyltransferase Gene-Knockout Xenograft Recipients.  Transplantation 2009; 87(6): 805-12. 

Pierson RN 3rd.  Antibody-mediated xenograft injury: Mechanisms and protective strategies.  Transpl Immunol 2009; 21(2): 65-9. PMID: 19376229

Pierson RN 3rd, Dorling A, Ayares D, Rees MA, Seebach JD, Fishman JA, Hering BJ, Cooper DK.  Current status of xenotransplantation and prospects for clinical application.  Xenotransplantation. 2009; 16(5): 263-80.

Cozzi E, Tallacchini M, Flanagan EB, Pierson RN 3rd, Sykes M, Vanderpool HY.  The International Xenotransplantation Association consensus statement on conditions for undertaking clinical trials of porcine islet products in type 1 diabetes--chapter 1: Key ethical requirements and progress toward the definition of an international regulatory framework.  Xenotransplantation. 2009 Jul;16(4):203-14. PMID: 19799760

Hering BJ, Cooper DK, Cozzi E, Schuurman HJ, Korbutt GS, Denner J, O'Connell PJ, Vanderpool HY, Pierson RN 3rd.  The International Xenotransplantation Association consensus statement on conditions for undertaking clinical trials of porcine islet products in type 1 diabetes-- executive summary.  Xenotransplantation. 2009; 16(4): 196-202.

Poirier N, Azimzadeh AM, Zhang T, Dilek N, Mary C, Nguyen B, Tillou X, Wu G, Reneaudin K, Hervouet J, Martinet B, Coulon F, Allain-Launay E, Karam G, Soulillou J-P, Pierson RN III*, Blancho G*, Vanhove B*.  Inducing CTLA-4–Dependent Immune Regulation by Selective CD28 Blockade Promotes Regulatory T Cells in Organ Transplantation. Science Translational Medicine 2010; 2 (17): 17ra10 (page assignment pending).

Kelishadi SK, Azimzadeh AM, Zhang T, Stoddard T, Welty E, Avon C, Higuchi M, Laaris A, Cheng X-F , McMahon C, Pierson RN III. Preemptive CD20+ B cell depletion attenuates cardiac allograft vasculopathy in cyclosporine-treated monkeys.  J Clin Invest 2010; 120(4): 1275-84.  

Nguyen BN, Azimzadeh AM, Schroeder C, Buddensick T, Zhang T, Laaris A, Cochrane M, Schuurman H-J, Sachs DH, Allan JS, Pierson RN III.  Absence Of Gal Epitope Prolongs Survival Of Swine Lungs In An Ex Vivo Model Of Hyperacute Rejection.  Xenotransplantation 2011; 18(2): 94-107.

Mohiuddin MM, Corcoran PC, Singh AK, Azimzadeh A, Hoyt RF Jr, Thomas ML, Eckhaus MA, Seavey C, Ayares D, Pierson RN 3rd,* Horvath KA.*  B-Cell Depletion Extends the Survival of GTKO.hCD46TgPig Heart Xenografts in Baboons for up to 8 Months.  Am J Transplant. 2012; 12(3): 763-71.

Sorensen EN, Pierson RN 3rd, Feller ED, Griffith BP.  University of Maryland surgical experience with the Jarvik 2000 axial flow ventricular assist device.  Ann Thorac Surg. 2012; 93(1): 133-40.

Sanchez PG, Bittle GJ, Burdorf L, Pierson RN 3rd, Griffith BP. State of Art: Clinical ex vivo lung perfusion: Rationale, current status, and future directions.  J Heart Lung Transplant. 2012; 31(4): 339-48.

Thompson P, Badell IR, Lowe M, Turner A, Cano J, Avila J, Azimzadeh A, Cheng X, Pierson RN 3rd, Johnson B, Robertson J, Song M, Leopardi F, Strobert E, Korbutt G, Rayat G, Rajotte R, Larsen CP, Kirk AD.  Alternative immunomodulatory strategies for xenotransplantation: CD40/154 pathway-sparing regimens promote xenograft survival.  Am J Transplant. 2012; 12(7): 1765-75.

Burdorf L, Azimzadeh AM, Pierson RN 3rd.  Xenogeneic lung transplantation models.  Methods Mol Biol. 2012; 885: 169-89.

Cooper DK, Ekser B, Burlak C, Ezzelarab M, Hara H, Paris L, Tector AJ, Phelps C, Azimzadeh AM, Ayares D, Robson SC, Pierson RN 3rd. Clinical lung xenotransplantation--what donor genetic modifications may be necessary?  Xenotransplantation. 2012; 19(3): 144-58.

Bittle GJ, Sanchez PG, Kon ZN, Claire Watkins A, Rajagopal K, Pierson RN 3rd, Gammie JS, Griffith BP.  The use of lung donors older than 55 years: a review of the United Network of Organ Sharing database.  J Heart Lung Transplant. 2013; 32(8): 760-8.

LaMattina JC, Burdorf L, Zhang T, Rybak E, Cheng X, Munivenkatappa R, Salles II, Broos K, Sievert E, Brian McCormick B, Decarlo M, Ayares D, Deckmyn H, Azimzadeh AM, Pierson RN, Barth RN. Pig-to-baboon liver xenoperfusion utilizing GalTKO.hCD46 pigs and glycoprotein Ib blockade.  Xenotransplantation. 2014; DOI:10.1111/xen.12093