2015-2016

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.

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.

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.

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.