CANADA’S FIRST UPPER LIMB TRANSPLANT PERFORMED AT UHN

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Getting to the last few steps of the procedure, surgeons (including Dr. Steven McCabe, second from the left) attach the muscles and plan how to suture the skin. (Photo: UHN)​

Dr. Steven McCabe was part of the surgical team that performed the world’s first hand transplant in 1999 in Louisville, Kentucky.

Fast forward 17 years and Dr. McCabe has made the possibility of hand transplants in Canada a reality, leading a multi-disciplinary team of experts to complete the country’s first transplant of the upper limb.

The team at Toronto Western Hospital (TWH) successfully attached the hand and forearm from a donor to a patient who had lost her arm below the elbow in an accident several years ago.

“We are very proud to have successfully performed this forearm and hand transplant procedure,” said Dr. McCabe, Director of TWH’s Hand and Upper Extremity Transplant Program.

“This is a tremendous accomplishment involving many people across several programs, and we are excited to make this treatment possible and available for patients who would benefit from it.”

The procedure lasted approximately 14 hours and involved 18 surgeons of a variety of different surgical disciplines from a number of hospitals.

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To protect the privacy and confidentiality of the patient, the donor and their families, the hospital will not be releasing the date of the surgery or any possible identifying details.

“It’s another milestone for our program,” says Dr. Atul Humar, Director of UHN’s Multi-Organ Transplant Program. “With this Canadian first, we are entering another era in transplantation.

“This kind of effort requires not only the expertise of a diverse surgical, medical, and rehabilitation team at UHN, but also a life-changing gift by a tissue and organ donor and his or her family.”

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High School Outreach Initiative (HSOI)

Dear Colleagues:

Happy New Year!  Hope everyone had some quality time with loved ones during the holiday break.  As we embark on a new year, I thought it would be opportune to provide a brief update about an important outreach initiative on behalf of the Toronto Transplant Institute, the High School Outreach Initiative (HSOI).

Many of you may already know that the High School Outreach Initiative (HSOI) started 5 years ago as a unique partnership with Trillium-Gift-of-Life Network (TGLN) and  Health Care Professionals (HCP’s) from the Toronto Transplant Institute (Sick Kids, UHN, St. Mike’s) towards an overall objective of  providing education and awareness of transplantation and organ donation to youth in Toronto high schools. The overarching goal is to increase donor registration in the Greater Toronto Area.  Since the initiative began, 265 presentations have been provided to more than 17,000 GTA high school students.

I am writing now to ensure that you all knew that the HSOI is still going strong – and to let you know how you can support this initiative!

First off –  this year we welcome a new coordinator from the Toronto Transplant Institute – Anna Cocco – who will be working with us to quarterback all invitations and speaking opportunities at High Schools in the GTA.  We know that with Anna’s energy and proximity to us all within the Transplant programs, the opportunities to capitalize on all your expertise will be enhanced.

1) How you can support this initiative – Volunteer to be a HSOI Speaker in 2016!

HCP’s participate as Guest Speakers in classroom presentations and assemblies at secondary schools in the Toronto District School Board (TDSB) or Toronto Catholic District School Board (TCDSB). In previous years TGLN attended the presentations, starting this year they will not be attending presentations, the HCP presenters will now provide information on donation in a newly designed presentation. An organ recipient or donor family will also attend to take part in the presentation, sharing their story, which is an integral aspect of the presentation.

Anyone interested in participating as an HCP presenter will receive training on the 25 minute presentation. Your commitment may be 1-2 presentations over a year, which may require ½ day of your time.

If you are interested in participating, please advise Anna Cocco for tracking – anna.cocco@uhn.ca

2) Promote the Initiative to Teachers you know:

We continue to target all Toronto public and Catholic high schools and in doing so we hope to utilize as many Health Care Professional (HCP) volunteers as possible.   Everyone’s help is appreciated in trying to bring the program to new schools in the GTA.  Please find attached a healthcare professional letter that we encourage you to share with any teacher and school contacts you have.

Please contact me if you have any questions related to this important initiative.

Thank you,

Vicky Ng

Chair, HSOI Steering Committee

 

Triple transplant teen doing well after rare surgery

​​​​​​ Image of Reid lifting weights Triple transplant recipient Reid Wylie makes regular visits to Toronto General Hospital to go through a post-operative workout routine. (Photo: UHN)

​A unique triple transplant has transformed the life of a 19-year-old Cystic Fibrosis patient who can now walk without an oxygen tank, exercise, eat full meals, and plan for the future.

Just two weeks after his life-saving three-organ transplant, Reid Wylie was walking around the transplant unit at Toronto General Hospital (TGH), inhaling and exhaling without coughing, and diligently keeping up his breathing exercises to expand his lungs.

“For the first time, when I walk, my legs are more tired than my lungs,” says a smiling and shy Reid, who was diagnosed with Cystic Fibrosis at age two.

Being sick made Cystic Fibrosis patient Reid Wylie feel like there was no light in his future. His triple transplant has changed that. (Video: UHNToronto YouTube)

​​​Reid received a world-first transplant combining double lungs, liver, and a pancreas in the summer of 2015. The procedure took 17 hours, with 15 staff which included: surgeons, surgical fellows, anesthesiologists, operating room nurses and healthcare specialists in the use of the heart-lung machine during surgery.

A novel combination

Since 1990, the Multi–Organ Transplant Program at TGH has performed nine lung-liver transplants, but has never combined those with another organ – until Reid’s triple transplant.

Cystic Fibrosis (CF), a chronic, genetic disease, affects many organs, including the lungs, the digestive system, liver and the pancreas. This results in improper digestion of food, as well as a breakdown of pancreatic tissue, leading to diabetes.

When medical management alone can no longer maintain the health of a person living with CF, transplantation, although not a cure, can improve a person’s quality of life.

Since his diagnosis, Reid has had to take three to five enzyme pills with meals and snacks to digest his food, and insulin to control his diabetes.  Draining about three cups of sticky mucus from his lungs, by clapping his chest and coughing, had to be done daily. His condition worsened this summer, and Reid was hospitalized with severe lung infection.

Respirologist Dr. Cecilia Chaparro, who treats CF patients at TGH and St. Michael’s Hospital after they become transplant patients, has been treating Reid for about two-and- a-half years, with TGH transplant liver specialist Dr. Nazia Selzner.

Both agreed that a unique three-organ transplant offered Reid the best possibility of leading a more normal life.

“CF patients like Reid are a remarkable group of people, who live and enjoy their lives despite the limitations of their disease,” says Dr. Chaparro. “They live fully because they don’t know how long they have.

“The disease is unpredictable.”

Dr. Cecilia Chaparro comments on the unique opportunities Toronto General Hospital’s Multi-Organ Transplant Program can offer patients. (Video: UHNToronto)

“We all felt that Reid was ready for a transplant,” adds Dr. Selzner, “He was very ill, able to walk only with oxygen, and both his lungs and liver were failing quickly.

“Despite that, he was motivated, courageous and never complained.”

Dr. Shaf Keshavjee, Director of the Toronto Lung Transplant Program – the largest lung transplant program in the world – notes that the risk for performing lung transplants on CF patients has improved significantly since 1988, when the first one in the world was done at TGH.

“The question for our team was, ‘Can we help CF patients even more by curing their diabetes and liver disease?'” says Dr. Keshavjee, who is also the University Health Network (UHN) Surgeon-in-Chief.

“Each transplant has risks, but to do all three at the same time takes dedicated, skilful teams in the Operating Room and in the care of the patient afterwards.

“It’s a medical tour de force, a huge accomplishment.”

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Reid performs post-operative breathing exercises in his room prior to discharge from TGH. (Photo: UHN)

“Cystic Fibrosis Canada is proud to have supported innovations in transplantation processes at TGH,” says Norma Beauchamp, President and CEO of Cystic Fibrosis Canada. ”

“The world-class results have contributed to improving surgical rates for Canadians with CF, and are giving Reid a second chance at life.”

A ‘technically challenging’ surgery

The double-lung transplant was performed first by a team led by Dr. Tom Waddell, Head of Thoracic Surgery at UHN, as this was the most urgent procedure. Lung transplants are always emergency surgeries, never elective. It took about 10 hours, longer than most.

Dr. Waddell describes it as “technically challenging” due to the inflammation of the lungs and the extra time it took to control the bleeding. He especially praises anesthesiologist Dr. Karen McCrae and the anesthesia team for their skill in keeping the patient stable by managing his blood pressure, breathing and circulation “minute by minute” while the surgeons worked.

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Less than two months after his triple-transplant, Reid was back home and able to go for a walk around his neighbourhood, something impossible before the surgery.
(Photo: UHN)

Dr. Mark Cattral, Director of Pancreas Transplantation Program at UHN, led the team that transplanted the liver and pancreas as a whole unit. He received the nod from the anesthesia team to proceed after a careful assessment of Reid’s vital signs – blood pressure, heart rate, oxygen levels – as stable enough to undergo another seven-hour transplant.

One of the crucial moments in that transplant was when the surgeons unclamped the blood vessels to the transplanted liver to restore blood flow throughout the body. That sudden rush can cause instability in the heart.

“This is the part that gives us grey hair,” says Dr. Cattral. “That’s when things can go wrong. Your eyes are on the monitors, watching the blood pressure, activity of the heart. In the first few moments, you sense how things are going to go. Patients can have a heart attack at this stage.

“In this case, Reid sailed right through it. The organs ‘pinked up’ nicely, very quickly. In a surgeon’s world, that’s what we are looking for. I was quite happy with how it all worked out. ”

‘The benefit exceeded the risk’

Although performing both the liver and pancreas transplant at the same time was a challenge, Dr. Cattral points out that the transplant program performs 45 pancreas or pancreas/kidney transplants a year, making it the second largest in North America. The liver transplant program performs about 150 transplants from deceased and living donors a year, making it one of the largest in North America.

“We were taking on added risks by combining the two transplants, but the benefit of doing both exceeded that risk,” says Dr. Cattral, adding that the transplant has changed Reid’s life completely.

“He really needed a break, and he got one with the help of a generous donor and our excellent lung, liver and pancreas teams.”

Toni Emerson, Reid’s mom, smiles every time she talks about the progress her son has made. His blood oxygen levels are now usually 99 per cent when he exercises – well within the normal range – and he has gained five kilograms, or 11 pounds, in seven weeks.


Toni Emerson, Reid’s mother, reflects on the decision to go through with transplant despite the risks. (Video: UHNToronto YouTube)

​​”As a family we will always be grateful to that wonderful person and his or her family who made the decision to donate three organs to our son,” she says. “They gave Reid his life back.”

The Multi-Organ Transplant Program at TGH is the largest in Canada and within the top five in North America, performing more than 500 solid organ transplans a year – more than half of all transplants in Ontario – and providing lifelong follow-up care to almost 5,000 patients.

For more information about CF, please visit www.cysticfibrosis.ca

 

Written by: UHN News

Redefining Education for Transplant Research Students

The Toronto Transplant Institute (TTI) hosted its first annual Student Research Day.  This also saw the inception of the Summer Student Program (also known as the TTI-SSP).TTI Pic 2

 Photo : The Toronto Transplant Institute, Summer Student Program Annual Research Day

The program was conceived out of a desire to instill a greater and more diverse comprehension of the field of transplantation and regenerative medicine among student researchers. Specifically, it is intended to expose students to topics that they would otherwise not encounter in their day-to-day research. Once a week, in addition to their various investigative responsibilities, students attended an educational activity highlighting some aspect within the field of transplantation. These ranged from statistics and the use of statistical analysis software to advanced concepts in scientific writing as well as bioethics and translational medicine. Students also had the chance to explore different occupations in medicine and healthcare during a career seminar where they could speak to experts from government, industry and academia in a small group setting. Many students described this as a highlight of the program.

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Keeping Canada Alive

Dr. Heather Ross, Director of the Cardiac Transplant Program, Peter Munk Cardiac Centre, UHN, was featured on the second episode of CBC’s series Keeping Canada Alive series. Dr. Ross discusses the average life expectancy of patients diagnosed with heart failure, how it’s increased from 2 years to 10 to 15 years for some patients, and how heart transplants affect the lives of those with heart failure.

The video features a conversation between a recent heart transplant patient in recovery and Dr. Ross.

Dr. Ross also sees another patient who has heart failure and is currently using a mechanical pump and who wants to delay a possible heart transplant. Dr. Ross also discusses what this means for his quality of life moving forward. See Episode 2 of CBC’s Keeping Canada Alive.

Dr. Ross appears at 31:10 with first patient, and at 35:25 with her second patient.

Talking transplant to kidney patients across Ontario

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A team of 20 members from Ontario transplant hospitals and dialysis centres at the general Explore Transplant Ontario meeting, fall 2015

Many people know what diabetes and high blood pressure are.  However, less know that patients who have diabetes or high blood pressure can also lose the functioning of their kidneys, a disease called End-Stage Kidney Disease.  When a person’s kidney is functioning at less than 10%, patients must start dialysis, or be tested for a kidney transplant. During dialysis treatment, a machine filters their blood of waste and unwanted water from the blood. For those who are able to get a kidney transplant, research has shown that patients live longer than patients who remain on dialysis.

In Ontario, there are more than 17,000 patients with End-Stage Kidney Disease. (Statistics from Canadian Organ Replacement Register Annual Report Treatment of End Stage Organ Failure in Canada, 2004 -2013.) Many of these patients have not learned what a transplant requires and whether they would be interested in a deceased or living donor transplant.  They have lots of questions about the surgery and recovery and how their life would change with a transplant.  People who might want to donate a kidney also have to learn about the risks and benefits of living donation.

A first for UHN and kidney organizations across Ontario

Dr. Istvan Mucsi, a nephrologist in the Multi-Organ Transplant Program at the University Health Network (UHN) and Dr. Amy Waterman, Associate Professor at University of California- Los Angeles’ Division of Nephrology have teamed up with 20 members from Ontario, dialysis centre’s and hospitals to adapt a transplant education program called, Explore Transplant Ontario.  Explore Transplant Ontario will provide video and print education about kidney transplant and living donation for kidney transplant patients, their caregivers, potential living donors, and the public.

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Order of Canada investiture ceremony honours UHN Surgeon-in-Chief

Dr. Shaf Keshavjee and his Excellency the Right Honourable David Johnston, Governor General of Canada, at the Order of Canada investiture ceremony on Sept. 23.

Congratulations to Dr. Shaf Keshavjee, Surgeon-in-Chief, Sprott Department of Surgery and director of the Toronto Lung Transplant Program at UHN, for being made an Officer of the Order of Canada. Dr. Keshavjee was presented with the honour on Sept. 23.

The Order of Canada, one of Canada’s highest civilian honours, was established in 1967, during Canada’s centennial year, to recognize outstanding achievement, dedication to the community and service to the nation.

Dr. Keshavjee is a pioneer in developing the Toronto Ex Vivo Lung Perfusion System. The system allows donor lungs to be kept alive outside of the body in order to be assessed, treated and repaired before being transplanted into a patient.