Community Profile: Dr. Tom Byldt-Hansen

Dr. Tom Blydt-Hansen is the Director of the Pediatric Multi-Organ Transplant Program at BC Children’s Hospital, Associate Professor in the UBC Department of Pediatrics, the Director of Pediatric Transplantation with BC Transplant and a clinician scientist at Child and Family Research Institute (CFRI).

What brought you into the field of pediatric transplantation?
Transplantation has always been my first love. I came to the decision back when I was doing my fellowship and I was looking for something that was interesting and cutting edge but also allowed me to get to know a patient and their family, to deal with them long term. Transplantation is one of the few miracles left in medicine. You take someone who is desperately ill and put a healthy, functioning organ into them, it’s a very special thing to be involved in.

What are some of the unique challenges of pediatric transplant patients?
The main challenge is the balance of preventing rejection and preventing the side effects that come with immunosuppression. We are always in this dichotomy of trying to control the immune system but not doing it so aggressively that we end up causing problems. At the end of the day we want our patients feeling better. If we prevent rejection but make them feel miserable with their medications we haven’t accomplished our primary goal, which is to make people better. Medically that is the biggest challenge.

What role does research play in addressing these challenges?
Research helps us to change the way we think about regulating the immune system as opposed to suppressing the immune system. There is a lot of research taking place that focuses on trying to make the immune system better. Most people will be surprised to learn that we don’t actually do any procedures that test the level of immunosuppression in patients. We can check the drug levels, which give us a bit of an idea, but everyone responds differently to these drugs and we can’t measure these differences. Therefore, one of the big areas of transplant research, including mine, is related to biomarkers. Biomarker tests are done with blood, urine or other body fluids and can help to diagnose and predict organ failure and rejection. Essentially, biomarker testing is a better way to get the information we need to make decisions with our patients. This type of testing is valuable, as it would potentially lessen the need for biopsies.

What research are you currently working on?
One of my areas of research focuses on biomarkers in urine for pediatric kidney transplants. A lot of people look at biomarkers in the blood circulation system, but for my research with kidneys I thought it made the most sense to focus on urine, as it’s the fluid that drains the kidneys. If we can find the right biomarkers that help us determine whether a patient may face organ rejection, or the level of inflammation in the immune system, then we can reduce our reliance on biopsies. Urine testing is non-invasive and much less scary than having to take blood. So, I would prefer to monitor my pediatric patients this way as it reduces stress and pain. The other big area of research for me is along the rehabilitation side of things. One of the biggest issues in all pediatric transplant, not just kidney, is the level of trauma that some of these kids have gone through up to and including the time of their transplant. If you think about it, every kid who has a transplant has nearly died. They all have end stage organ failure that but for the transplant they would have died. And, that’s not lost on most of our kids. If you ask them, and we have been doing some initial mental health screening, it’s a very common finding that kids answer the questionnaire saying they think a lot about death, which is not something that is typical of most kids. We need to help them and their families work on those things in a healthy way. I am working with Erika Penner, a psychologist here at BC Children’s, to develop a mental health and quality of life screening process. We need to address this at the front end. If we don’t, they grow into traumatized adults who continue to have problems. There is a lot of research that shows that kids with psychiatric or mental health issues have trouble adhering to their medication. And, so there are a lot of good reasons to address this over and above simply having someone feel more whole.

Where do you see the future of pediatric transplant research going?
I think the key thing is to understand we can’t treat everyone the same. If we can identify that a patient is at higher risk of rejection that will change the way I take care of them. Again, it’s the balance between immunosuppression and rejection. If we can see that patients are not having problems, we could lighten up the immunosuppression medication. These kinds of monitoring tools will better enable us to tailor medication and treatment in such a way that we get the best bang for our medications without so much immunosuppression.

Do you think it’s important to include and engage patients in transplant research?
I do. Researchers and clinicians have an idea of what we think our patients want and it’s a bit paternalistic but if we don’t have the patient voice we may lose focus. Both in research and in clinical programs it’s important to involve patients and families so our priorities and theirs match. If develop programs to treat support and monitor patients but don’t’ ask our families what they think then we will not have support from them. Here at Children’s we are hoping to develop a core mechanism to reach out to families. If they believe in our program they will advocate for it. This helps us and them.