Quality of life and mental health needs of children after solid organ transplantation in BC
Severe kidney, hear or liver failure that is life threatening can be rescued by organ transplantation. Children and families who have survived these critical illnesses often carry mental scars related to their experiences with organ failure. They have endured testing and treatment in times of intense vulnerability, as well as dependence on life-support technologies, operations, and critical illness that may require extended hospitalization. As a result, children and their parents experience intense and chronic stress, isolation, family disruption and restriction in their ability to participate in “normal” childhood activities. The long-term impact of these experiences is not well understood in children and needs further study.
We expect that children with this lived experience may suffer symptoms related to anxiety, post-traumatic stress, depression and impaired tolerance of medical procedures. It may affect their social and emotional development, interfere with their peer relationships and prevent them from attaining a quality of life equivalent to their peers. Quality of life is perhaps the most important outcome for solid organ transplant recipients, given that the goal of transplantation is rehabilitation with restoration of organ function.
We have previously initiated mental health and quality of life screening in the transplant clinic at BC Children’s Hospital. The gaol was to understand the needs and improve access of children and families to mental health services. We learned quickly that the need is great. This research proposal will review the results from screening to learn what types of mental health symptoms are most common, their severity and to understand how they impact quality of life. We will also review the medical history of children before transplantation to see if there are early warning signs that might help us to identify children and families who are at risk of mental health distress much earlier, and before transplantation. With this information, we will be able to better get mental health services to children and families earlier and support them better through this difficult time. We will also use this information to raise awareness and obtain better access and funding for mental health resources to support this vulnerable population. Ultimately, we hope to develop better interventions that holistically enhance rehabilitation of children after transplantation and improve their long-term quality of life.
Dr. Kevin Harris
Early detection of artery thickening in pediatric heart transplant recipients
Children who have had a heart transplant are at risk for developing a disease called cardiac allograft vasculopathy (CAV) where their coronary artery walls thicken over time. Sadly, CAV is responsible for 1 in 4 patient deaths. The current way to look for CAV is to use a technique called angiography where dye is injected directly into the coronary arteries and imaged. However, the limitation of angiography is that it can only detect late stage disease and therefore treatment is less likely to work. For this project, Dr. Harris will use a new imaging technique called optical coherence tomograph (OCT) to detect problems developing in children’s heart transplant grafts early enough to treat the problem. OCT is an imaging technique designed for use in adults that is beginning to be used in children. Dr. Harris has already performed a preliminary OCT study and found that OCT detects artery thickening earlier than angiography in children heart transplant recipients. He will now use OCT to follow these children over time in order to establish this technique for reliable, routine use.
Dr. Amee Manges
Treating multi-drug resistant infections in Transplant recipients with fecal microbiota transplants
Organ transplant patients are at increased risk of developing highly antibiotic resistant infections as a result of their transplant surgery, lengthy hospitalization and repeated use of antibiotics during their medical care. The source of these multidrug-resistant bacteria is the patient’s own gut. In this study, Dr. Manges will test whether fecal microbiota transplantation (FMT) can remove highly drug-resistant bacteria from the gut of kidney transplant patients. FMT is a therapy that involves the infusion by enema of well screened, healthy donor stool into a patient’s gut. FMT can replace the gut microbial community containing these drug-resistant bacteria, with a microbial community characterized by more beneficial organisms with lower levels of antibiotic resistance, thereby lowering a kidney transplant patients risk of hard to treat, post-transplant infections. The goals of this study are to confirm that FMT can eliminate drug resistant bacteria from the gut of Transplant recipients, and to determine how long the patient remains free of these drug resistant organisms.
Dr. Sam Wiseman
Transplantation of thyroids enclosed in protective pouches
The thyroid gland makes hormones which control how quickly the body uses energy, makes protein and controls the body’s sensitivity to other hormone. The thyroid is often removed because of cancer or benign disease (several hundred thousand per year in N America), and loss of thyroid function leads to severe illness and disease so these people take thyroid hormone (thyroxine) replacement therapy. But people receiving thyroxine still experience side effects (weight gain, depression, headaches, cardiovascular disease) because taking thyroxine is not the same as having a functional thyroid gland that can monitor the body’s metabolism and produce hormones in real time as it is needed. Transplantation of thyroid gland back into these people would give better metabolic control. Dr. Wiseman will test whether thyroid glands obtained from deceased donors can be placed inside a special pouch and implanted into a recipient. The pouch will protect the thyroid gland from attack by the immune system so the recipient can live a normal life with a functioning thyroid gland without having to take anti-rejection drugs.
Eliminating barriers to organ donation registration
Dr. John Gill
Integrating registration for organ donation into routine health care encounters
Canadians have made it overwhelmingly clear they support organ donation, yet this does not translate into eventual donation. Our deceased organ donor rate is around 15 per million people. This ranks us 23rd in the world behind countries such as Croatia, Puerto Rico and Latvia. Dr. John Gill is a renowned researcher in the field of kidney transplantation and a respected nephrologist. He is also an advocate for increasing organ donation. Dr. Gill and his team propose eliminating one potential barrier by getting health care providers to discuss organ donation with patients during routine health encounters. His project will establish protocols and quantify their effect on the rate of organ donation. By “normalizing” the conversation around organ donation, much as the medical system in BC has done with routine HIV testing, Dr. Gill believes we can greatly enhance organ donation rates.
A new source for kidneys?
Dr. Chris Nguan
Development of Multi Allograft Kidney Organ (MAKO) units from nephrectomy specimens for meeting kidney transplant donor supply
With kidney transplant waitlists in BC up to ten years long, one of the province’s leading urologic surgeons is hoping to find a potential new source of kidneys. Dr. Chris Nguan’s primary clinical focus is renal transplantation but he has a keen interest in advanced technologies research. He believes a potential new source of kidneys could be those that are removed for reasons such as kidney stones, obstruction and small tumors. Even though only part of the kidney is damaged, the entire organ is usually discarded. Initial research has shown some of these discarded kidneys can be successfully repaired and transplanted. Dr. Nguan and his team want to go one step further by taking smaller portions of disease-free discarded kidneys and devise surgical techniques to reassemble them into a whole functioning organ. These reassembled kidneys can then be used for transplantation.
Dr. Caigon Du
A novel flush/preservation solution for cold preservation of donor organs for transplantation
Cold preservation of donor organs is a crucial aspect of organ transplantation, not only to keep the organ viable but also to prevent as much cellular damage as possible during the time the organ is out of the body. Several organ-preservation solutions are available, but they are not satisfactory and as a result organ damage still occurs. Thus, a new cold storage solution that can prevent cellular edema and tissue destruction is needed for the safe preservation of donor organs before they are transplanted into recipients. We have developed a novel cold storage solution that has the potential to minimize cold ischemia-related injuries in donor organs. Preliminary studies have demonstrated our novel polymer-based solution significantly increased cell survival of cultured human endothelial cells at 4oC, and reduced tissue damage of murine hearts during cold storage. However, more preclinical studies are needed to prove our hypothesis and test the efficacy in animal models. In this proposal, we would like to further evaluate the beneficial effect of this polymer-based solution on cold organ preservation using transplantation models.
Dr. Jan Dutz
Use of Topical Immunosuppressive Drugs for the Induction of Tolerance to Allogeneic Skin Transplantation
Solid organ transplantation may be a life-saving treatment in individuals with illnesses that have caused organ failure. However, a challenge remains in preventing graft rejection and eventual graft loss. Organ rejection is caused by the patient’s white blood cells recognizing the donor organ as foreign (hence dangerous) and mounts an immune response to attack the organ. Current strategies to minimize organ rejection include matching recipients with donors according to their genes and by controlling the patient’s immune system with immunosuppressive drugs. Although current immunosuppressive drug therapy has dramatically improved early transplant outcomes, the long-term rate of organ rejection has not decreased substantially and the use of immunosuppressive drugs can induce serious side effects. Therefore, we need a better method of educating the immune system to tolerate a foreign organ. We think that expanding the number of regulatory T cells in transplant patients will help them accept the foreign organ, minimizing the need for life-long immunosuppressive drug therapy. Corticosteroids and Vitamin D are two immunosuppressive drugs that can direct our bodies to make regulatory T cells. Our laboratory has shown that topical application (rubbing onto the skin) of Vitamin D and corticosteroids generates regulatory T cells, and it is less toxic than the traditional oral method of delivering the drugs. We would like to optimize the method of drug delivery through the skin to make regulatory T cells and evaluate its efficacy to prevent organ rejection in laboratory animals. This delivery method is less toxic than administering the same kind of drug orally. In addition, it should prevent long- term side effects in patients: the cream is applied only for a short period before and after transplant, whereas the oral drug must be taken for the rest of a patient’s life.
A Novel Tolerance Induction Strategy for Allotransplantation
Within the immune system, there is a subgroup of immune cells, called T-regulatory cells. The function of these cells is to control and regulate other immune cells and prevent destruction of transplanted organs. One very promising solution to the problem of rejection is to generate tolerance. This can be done by increasing the number of this special T regulatory immune cells in transplant recipients’ bodies. In our BC Venture Grant, we proposed to find a novel and effective way to protect transplanted organ without putting the patients’ health in danger by avoiding the use immune suppressing medications.
Use naturally immune privileged cells in islet transplantation
Parts of hair follicles exhibit “immune privilege” due to the secretion of immuno-regulatory factors and a lack of expression of the human leukocyte antigen (HLA proteins) on their cell surface. It is the HLA antigens that are recognized by the immune system and lead to organ transplant rejection. Because these unusual hair follicle cells do not have HLA antigens on their surface, they are not “seen” by the immune system. Unlike most cells and organs, the hair follicle cells are not rejected when transplanted from one person to another. These hair follicle cells also actively secrete factors that suppress local immune system activity. We propose to use these cells, with their natural non- or low-immunity, to locally protect transplanted islets. We will “coat” islets with the hair follicle cells to provide a protective shield for the islets against rejection by the transplant recipient’s immune system. After transplantation, the hair follicle cells will hide the islet cells from the immune system but allow them to function and control blood sugar levels. If this approach is successful, it will provide a simple way to transplant islets to people who have type I diabetes. It should be a permanent treatment that will avoid the need for using immunosuppressive drugs and will mean that diabetic patients no longer need use insulin injections to control their blood sugar levels.
Dr. Bruce McManus
McManus Clinical Implementation of Diagnostic Biomarker Assays in Heart and Kidney Transplantation (BiT3)
Dr. Olwyn Johnston
Quality of Life After Living Kidney Donation: No-directed Versus Directed Donor
There has been an expansion of living kidney donation in Canada with the National Living Donor Kidney Exchange Program. However the quality of life after non-directed living kidney donation (paired exchange or anonymous kidney donation) is not well established. We hypothesize that quality of life after non-directed is equivalent to that after directed living kidney donation. We anticipate that there will be no quality of life differences between directed and non-directed giving additional evidence to support further expansion of non-directed living kidney donation which in turn would potentially reduce the prolonged waiting time for deceased donor kidney transplantation in British Columbia.
Dr. David Granville
Granzymes in allograft vacsulopathy
We have detected an increase in enzymes in patients experiencing chronic rejection following heart transplantation. We propose to investigate the consequences of these increased enzymes in the context of inflammation and wound repair. We hypothesize that increased enzymes lead to impaired wound healing.
Dr. Megan Levings
Tailoring Tregs: A Novel Approach to Generate Alloantigen Specific T Cells
We are studying how a type of white blood cell, known as a T regulatory cell, or Treg, can be used as a new way to control how the patient’s immune system responds to a foreign organ. We think that by increasing the numbers of Tregs in transplanted patients will be a new way to prevent organ rejection that will not come with the side effects of the immunosuppressive drugs that are currently used. In this proposal we aim to develop a new way to make Tregs that will specifically control immunity to transplanted organs without impacting any other aspects of the patient’s immune system. If successful, this approach would represent a major step towards implementing the use of Tregs as a novel cell-based therapy to improve the long-term success of organ transplantation.
Dr. David Granville
Granzymes in allograft vasculopathy
Dr. Jonathan Choy
Role of Bim in heart transplant rejection
Dr. Julian Christians
Identification of novel targets for intervention in Aspergillus infections
Organ donation saves lives. Thanks to organ donation and transplant research, patients are given the gift of time. Time to spend with loved ones, time to make memories and time to realize their dreams. Through research we can continue to help transplant recipients experience more Christmases because #everychristmascounts. Watch transplant recipients share how many Christmases they have had #becauseofanorgandonor and #transplant #research ...
Today may be Giving Tuesday but at TRF we are gearing up for our Christmas Campaign "Every Christmas Counts". It will launch December 1! Meet Addison - she was part of our Christmas Campaign last year. Addison received the gift of a new heart when she was only weeks old. Because of organ donation and transplant research Addison has lived every day of the last 6 years to the fullest and looks forward to many more years ahead! #everychristmascounts ...
Meet Addison, a 5-year old heart transplant recipient in Vancouver, and hear her talk about the medication she takes twice a day. Please share this story of hope & strength with your friends! What's your transplant story __________? #TransplantLife
Why do we need transplant research? Find out in our newest blog: www.trfbc.org/why-we-need-transplant-research-and-welcome-to-our-blog/