Past Grants

2021


Vancouver Coastal Health

Kimberly Noble

Frequency of Swallowing and Voice Dysfunction Following Double Lung Transplant

Being able to swallow and produce voice are actions that we complete constantly throughout the day. Swallowing and voice dysfunction following double lung transplant are quite common and carry risks of poor health outcomes, reduced quality of life, and increased hospital costs/length of stay. Limited literature exists regarding the incidences of voice and swallowing dysfunction post-transplant and there is notable methodological variability in the studies that have been done.

By completing rigorous standardized assessment of swallowing and voice in lung transplant patients at Vancouver General Hospital, we can determine the frequency of impairment and observe related variables. We will also have the opportunity to gather information on how these changes impact patients’ quality of life by way of a brief interview. It is imperative that we gain a better understanding of voice and swallowing changes in our lung transplant population.

With this knowledge we will be able to standardize our procedures in order to provide the best quality care for these individuals, while reducing hospital length of stay and acute hospital costs.

Principle Investigator: Kimberly Noble
Mentor: Dr. Stacey Skortez
Co-investigators: Kevin Chen, Geeta Modha and Larry Worfolk (patient partner)

Neringa Kubiliene

Psychosocial factors associated with resilience after lung transplantation: an interpretive descriptive study.

To address the lack of research on resilience in lung transplant recipients, this exploratory study is designed to understand how resilience is subjectively experienced by the patients. The proposed research aims to identify factors that contribute to recipient’s successful adjustment after transplant.

Participants will be patients who consent to talking about their experiences with resilience in the context of lung transplantation. To capture patient perspectives of their transplant journeys, the goal is to recruit up to 15 individuals to participate in focus groups and individual interviews. These conversations will be analyzed to better understand a wide diversity of patients’ perspectives and to capture rich descriptions of their stories. Furthermore, findings may help clinicians to gain insights into factors that contribute to everyday joys while adapting to a new life post-transplant to better support transplant recipients.

To produce transformative and patient-driven knowledge, a patient advisory group (PAG) will be created to act as a research partner through the research, including planning, recruitment, data analysis, and knowledge translation. It is hoped that including people with lived experiences as part of the PAG will increase the impact of the findings.

Principle Investigator: Neringa Kubiliene
Mentor: Dr. Roland Nador
Co-investigator(s): Alana Attema, Courtney Steen, Katrina Smith and Dr. Monica Orendain.

Providence Health Care

Christina Schellenberg

Evaluation of the Live Donation Patient and Family Group

Christina Schellenberg

Jody Max

There are over 3000 people waiting for a kidney transplant in Canada and, unfortunately, close to 100 people die every year while waiting (Canadian Blood Services, 2020). The best treatment for most of these patients is a live donor kidney transplant (LDKT) (Waterman et al., 2006). With LDKT patients do not need to wait years for a deceased donor, spend less time on dialysis (a treatment which negatively impacts patient’s quality and quantity of life) and have better outcomes than deceased donor transplants (Waterman et al., 2006).

Despite the clear benefits of having a live donor, the rates of LDKT continue to be low (Canadian Blood Services, 2020). One of the hardest things about LDTK is that the responsibility is on the patient to find a live donor. Most patients feel very uncomfortable asking someone to donate a kidney and often lack information about the safety of LDKT and how it all happens (Rodrigue et al., 2008). To this end, in September 2020 this project team created the “Live Donation Group” over Zoom to help participants become more comfortable with having conversations about LDKT by providing education, resources, tools and emotional support.

The Live Donation group interventions include discussions on ways to bring up live donation with family and friends, guest speakers with expertise and lived experience of LDTK, education about how to cope with uncertainty, anxiety and depression, and a chance to share feelings and experiences with others in a similar situation.

This research project seeks to evaluate the effectiveness of this group in helping patients and family members become more comfortable with having conversations about LDKT.

Principle Investigator: Christina Schellenberg
Mentor: Dr. Monica Beaulieu
Co-investigator: Jody Max

2020


Vancouver Coastal Health

Trana Hussaini
Impact of Tacrolimus or Cyclosporine Co-Administration on Apixaban’s Exposure, Pharmacodynamics, and Bleeding Risk in Liver and Lung Transplant Recipients.
 

Transplant recipients are at high risk of developing blood clots requiring treatment with blood thinners (anticoagulants), usually for 3 to 6 months and at times for life. For years, warfarin was the only blood thinner that was available in tablet form. Warfarin therapy is however complicated with variable dosages requiring frequent blood work monitoring and many drug-¬drug and drug-¬food interactions. Recently newer oral anticoagulants, such as Apixaban, have become available that are much simpler to use with fixed dosages, no requirement for blood work monitoring and improved effectiveness and less bleeding risk. However, these medications are avoided in transplant patients because there is a potential risk of drug interactions with antirejection medications (tacrolimus and cyclosporine), with antirejection medications increasing apixaban’s levels. There is some limited evidence that apixaban may be safe in transplant patients. In this study, we will initiate apixaban in 20 lung or liver transplant patients who need blood thinner therapy and are taking tacrolimus or cyclosporine. We will then measure apixaban’s blood levels and the degree of anticoagulation in these patients, in addition to closely monitoring them for any signs of bleeding. We hope to demonstrate that apixaban’s levels and its anticoagulant effects are not appreciably increased, and that apixaban can be safely used in transplant patients, leading to simplified anticoagulation therapy in these patients.

2019


Vancouver Coastal Health

Cindy Luo
Voriconazole associated adverse drug events in lung transplant recipients
 

Cindy’s team, L to R: Dr. Robert Levy, Dr. Cindy Luo, Dr. Nilu Partovi, Dr. Roland Nador.

Lung transplant recipients require potent life-long immunosuppressive medications to prevent the immune system from recognizing the transplant lungs as foreign; on the other hand, chronic suppression of the immune system also increases a patient’s risk for development of life-threatening infections including fungal infections such as Aspergillosis. Studies have demonstrated that appropriate fungal prophylaxis and treatment are essential components of lung transplantation, as colonization with Aspergillus increases the risk for chronic lung allograft dysfunction and patient death. Voriconazole is the drug of choice for prophylaxis and treatment of Aspergillus in lung transplant recipients; however, voriconazole has multiple adverse drug events associated with its use.

This study has the following aims:

  1. evaluate the incidence of adverse drugs events associated with voriconazole
  2. identify the most common toxicities experienced by lung transplant recipients on voriconazole
  3. evaluate the frequency of medication discontinuation due to voriconazole-related adverse drug events

Principal Investigator: Dr. Cindy Luo
Mentor: Dr. Nilu Partovi
Co-investigator(s): Dr. Robert Levy, Dr. Roland Nador and Dr. Matthew Kadatz

Providence Health Care

Clare Bannon
Wound Complications in Kidney Transplant: WONDER
 

Clare’s Team, L to R: Luba Veverytsa, Clare Bannon, Joanah Habacon, Jessica Donnan, Pamela Turnbull (insert)

The kidney transplant recipient of today is vastly different from the recipient of twenty years ago, when higher-risk patients with diabetes, obesity and other co-morbid conditions were excluded from receiving a transplant. As research and practice has progressed, it has been affirmed that despite the risks of transplanting more marginal recipients, there is still a derived benefit from a quality of life and systems cost perspective.

Wound healing in renal transplant recipients is impaired by the necessary use of immunosuppression and steroid therapy to prevent graft rejection. The common presence of co-morbid conditions further complicate wound management in this patient population. Currently, there is no evidence-based post-operative wound management protocols, and no clear data collection system in place to capture post-operative wound complications. We hope to identify risk factors that will allow us to intervene early or even in the pre-transplant phase, and to develop protocols for better post-operative wound management in kidney transplant recipients.

Principal Investigator: Clare Bannon
Mentor: Dr. Luba Veverytsa
Co-investigator(s): Pamela Turnbull, Jessica Donnan and Joanah Habacon

BC Children’s Hospital

Kat Broad
Increasing Preparedness: Examining the effect of transition themed workshops for pediatrics solid organ transplant recipients before transfer to adult care.
 

The transition from pediatric to adult care is challenging for adolescents with medical complexity, including recipients of a solid organ transplant (SOT). It is well known that young adult and adolescent recipients are at higher risk of medical complications before, during and after transition. The goal of this study is to design and pilot a patient-centered, evidence informed transition workshop to improve readiness for transfer to adult care. The feasibility, acceptability and design of the workshop will be evaluated in order to incorporate this feedback into future workshops.

Principal Investigator: Kat Broad
Mentor: Dr. Tom Blydt-Hansen
Co-investigator(s): Sarah Fay and Jessie Ahuja

 

2018


Christine Adair
Prevalence Study of Vitamin D status of Renal Patients Post-Transplant
 

Christine’s team. L to R: Chelsea Bruce, Erin Waters, Christine Adair, Simran Dukhia, Clare Bannon and Vanessa Lewis (mentor). Not pictured: Katrina McAndrew, Patient Partner

Winning this year’s award is a team led by registered dietitian Christine Adair, “Prevalence Study of Vitamin D status of Renal Patients Post-Transplant.” This project will be assessing vitamin D status in post renal transplant patients at St. Paul’s Hospital (SPH), who are at risk of vitamin D deficiency. Currently, it is not known if patients are obtaining sufficient vitamin D through diet and supplementation, which further increases patients’ risk for bone loss and fracture. Christine says, “We hope that this project will fill a knowledge gap and allow us to re-evaluate clinical practice to improve and expand treatment options for kidney transplant patients. Our team is thrilled to have the opportunity to participate in a project that will build our research skills, while addressing a real issue that patients care about.”

Principal Investigator: Christina Adair
Mentor: Vanessa Lewis
Co-investigator(s): Erin Waters, Chelsea Bruce, Simran Dukhia and Clare Bannon
Patient Partner: Katrina McAndrew

2017


Providence Health Care

Ruth McCarrell
Assessing the knowledge, attitudes, and beliefs of Kidney Care Clinic staff about kidney transplantation before and after a multi-pronged education program.
 

Kidney transplant is the best renal replacement option for most individuals living with end stage renal disease and pre-emptive living kidney donation results in the best prognosis for patients. To increase rates of living kidney donation it is imperative that kidney transplant be discussed with patients early in their chronic kidney disease journey.

In British Columbia, regional Kidney Care Clinic staff are best situated to provide this education and ongoing patient support. A Kidney Care Clinic/BC Transplant pre-emptive transplant working group has been established to develop a variety of educational materials aimed at increasing kidney care staffs’ knowledge and comfort in discussing kidney transplantation with their patients. This study aims to assess the effectiveness of this multi-pronged education approach by testing health care providers’ knowledge, attitudes and beliefs at two time points during the implementation of this multi-pronged educational program.

 

Principal Investigator: Ruth McCarrell
Mentor: Wayne Fritz
Co-investigator(s): Erin Waters, David Grenkov, Jody Max, Clare Bannon

Sally Kwan
Assessment of HeALth Literacy on Medication AdheRence and graft outcomes in Kidney
transplant recipients (HALLMARK)
 

This project specifically looks at improving medication adherence and clinical outcomes of kidney transplant recipients by proactively measuring patient’s health literacy and addressing any gaps in treatment approach for the individual patient, as well as at the system level in the post-transplant clinic. Transplant related patient education materials will be amended and tools developed to tailor to transplant recipients with limited health literacy.

 

 

Principal Investigator: Sally Kwan
Mentor: Marianna Leung
Co-investigator(s): Clare Bannon, Anita Ziekiewicz, Nancy Szeto, Linnea Young

Wynne Chiu
How do highly sensitized patients describe their experience with being on the heart transplant waitlist
 

This project focuses on understanding the highly-sensitized patient experience on the transplant waiting list. Our aim is to understand the groups lived experience, which would provide an important perspective to the characteristics of this emerging group of transplant patients.

Principal Investigator: Wynne Chiu
Mentor: Annemarie Kaan
Co-investigator(s): Kim Brownjohn, Erica Johansson

Vancouver Coastal Health

Grace Adderly
A Survey of Post Lung Transplant Patients to Assess Correlation between Demographic and Transplant-related Factors with the Incidence of Depression/Low Mood
 

The goal of this study is to assess the potential correlation between the incidence of depression and the indicator variables described in the previous section (demographics, transplant recovery phases, social support, clinic/home follow-up). The study expects that the patient population at VGH will show similar characteristics to those described in the literature and will that the incidence of depression is well-correlated with all of these variables.

The specific objectives of this study are defined as follows:

  • To determine which literature-identified factors in the study population are associated with incidence of depression.
  • To determine if there is a relationship between patient compliance with home monitoring and depression.
  • To determine if there is a relationship between the frequency of clinical follow-up and depression.

Principal Investigator: Grace Adderly
Co-investigator(s): Rizza S. Angeles, Alexia L. Jones