Posts Tagged ‘transplant outcomes’

Transplant for Type 1 Diabetes? Julie Allred’s Story

Julie Allred, Islet Transplant Patient

Julie Allred

When Julie Allred heard that Emory was exploring alternate treatment options for patients with “brittle” or unstable type 1 diabetes, she didn’t realize that she would be the first to receive her transplant via a minimally invasive transplant technique in the interventional radiology suite at Emory Hospital, instead of the operating room.

Julie was diagnosed with type 1 diabetes at age 10. She got her first insulin pump in 1992 and has used several different types of pumps over the years. Despite her efforts to carefully watch her diet and test regularly, she developed many problems over the past couple of years with unstable hypoglycemia (low blood sugar).

Living with hypoglycemia affected Julie’s ability to do many of things she enjoyed. She was constantly worried about how she could or would be affected by the unpredictable changes in her blood sugar, including being caught unaware at night while asleep. Julie was never free—day or night—from the worry of a condition called hypoglycemic unawareness, which unpredictably causes unconsciousness.

“I wanted to have the transplant because I’ve seen so many changes in the treatment of diabetic patients over the years, from the first glucometers to new medications,” Julie says. She was placed on Emory’s islet transplant wait list in early July and received the call eight days later while at her dentist’s office on July 19, which was “a record for the shortest wait,” she notes.

Julie lives several hours from Atlanta in the Charlotte, NC, suburb of Concord, where she has worked as a nurse for the past 20 years in obstetrics and pediatrics. Julie made the trip to Atlanta for her islet transplant at Emory, which was performed by Dr. Kevin Kim, director of interventional radiology and image guided medicine, and Dr. Nicole Turgeon, kidney, pancreas and islet transplant surgeon.

“Our protocol is designed to treat patients who have had type 1 diabetes for at least five years and have experienced severe hypoglycemic unawareness,” reports Dr. Turgeon. She is principal investigator of the study and collaborated with Dr. Kim for more than a year to develop Emory’s protocol.

“We’re able to perform this type of transplant because of Dr. Kim’s expertise in image guided treatment of liver tumors in the interventional radiology suite and Emory’s experience in islet transplantation and the development of new treatment regimens to protect transplant grafts from rejection,” she says.

According to Dr. Kim, “The interventional radiology procedure involves a small access. We thread guidewires and catheters and a central line through the patient’s right side into the portal vein, which leads into the liver. The entire system is through a less than a quarter inch skin access, and there are no stitches required—only a bandage on her skin. There is no general anesthesia required, and the entire procedure is performed under moderate sedation. In fact, we were talking to Julie during the entire procedure.” The fragile islets implanted in Julie’s liver serve to take over the job of making insulin.

Julie Allred with her daughter at Disneyland

Julie with her daughter at Disneyland.

The conventional islet transplant involves a two- or three-inch incision in the abdomen. This open surgical approach can be painful, whereas, Julie experienced no side effects and took only one pain pill following her less invasive transplant.

Julie has been able to gradually taper her insulin from about 50 units a day pre-transplant to 8 to 11 units a day four weeks post-transplant. She is now free from the unpredictable changes in her blood sugar and has had no hypoglycemia.

“My doctor told my mother when I was first diagnosed that I wouldn’t live to age 30 or be able to have children. But because of these advances, I’ve been able to prove him wrong twice,” Julie chuckles. Thanks to the procedure, Julie was able to happily celebrate her daughter Meredith’s 16th birthday at Disney World in January of this year, and turned 43 years old on July 23rd, two days after her transplant.

Transplant Patients Benefit from Telemedicine Follow-Up Care

Transplant TelemedicineTelemedicine, now that is a word that either sounds from the future, or a phone call you get right when you sit down for dinner. At Emory though, telemedicine and organ transplantation are two medical innovations that work symbiotically to improve access to health care, patient outcomes, and the overall well-being for our Emory transplant patients.

Beyond providing consistent care at Emory’s Transplant Center, it is imperative that transplant patients have adequate follow-up care for a successful post-transplant recovery.  Transplant patient, Ken Sutha, winner of multiple medals at the National Kidney Foundation’s U.S. Transplant Games, is living proof of the importance of follow-up care. Via telemedicine, Emory physicians stay in contact and provide guidance in keeping transplant patients like him healthy.

Patients at Emory come from all over our large state of Georgia, including many from rural areas with limited access to appropriate health care. Today, after transplant patients are discharged from the hospital following surgery, they have the option to get their laboratory test and clinic visits done virtually over a telehealth network. This allows us to serve our transplant patients, and especially those outside of Atlanta with convenient and effective follow-up care.

Emory started its transplant telehealth program in January 2009 in an effort to increase access to health care throughout the state and in the past three years, it has seen substantial growth. Kevin Clark, Emory’s transplant department business manager, said the program is on track to have nearly 100 encounters with patients this year.

“We looked at 41 patients over the past couple of years to get an idea of true benefit and what we found was that these patients actually saved about 9,400 miles of drive time,” Clark said. With 33 patient presentation sites around the state of Georgia, transplants patients from Florida are also making use of the telehealth network. Ocala, Florida, resident Frank Brickey traveled to Tifton, Georgia, regularly for evaluations with his Emory transplant physicians following a kidney transplant in October 2008. Rather than making the six-hour drive to Atlanta for each visit and staying overnight, he only had to drive three and half hours and could make it a day visit.

“There is no waiting time, you just went right in and they take your vitals and you sit down in front of the teleprompter on the screen and communicate with the doctor face-to-face,” Brickey said. “It is very beneficial in that they know about you and it’s neat to have that contact with them. It is very reassuring.”

Brickey and other patients have said the staffs at telehealth sites are professional, easy to work with,and relatable, making this post surgery option an easy and steadfast choice. Being able to stay in contact with the physicians who actually performed their transplant procedure proved to be a huge benefit when complications arose, or just for the
peace of mind of communicating with the doctor who knows the patient best.

“I would definitely encourage anyone that has had a transplant at Emory or anywhere else that they stay close to the team that worked on them, with their physician and with their coordinators,” Brickey said.

Since Emory started its telehealth initiative, the program has seen substantial growth, a true tribute to not only the system, but the doctors, nurses, technicians, and patients, all who collaborate together to make telehealth not only successful, but revolutionary, for the post-transplant care.

To learn more about the Emory Transplant Center, visit: http://www.emoryhealthcare.org/transplant-center/index.html target=”_blank”

Top Transplant Doctors in Atlanta are at Emory

Each year, Atlanta magazine recognizes the top doctors in the metro Atlanta area as ranked by a thorough physician-led research process. The 2011 Atlanta Magazine Top Docs list included 318 doctors from across the Atlanta area and across specialties, highlighting the cream of the crop in specialties ranging from pediatric to geriatric services and everything in between. We’re very pleased to announce that not only can you find over 100 of the doctors recognized this year here at Emory, seven of them are our very own transplant team members!

Our Emory Transplant Center and its physician team are unique in that they are part of a multidisciplinary team providing care in seven core transplant specialty areas: kidney transplant, pancreas transplant, heart transplant, hand transplant, islet transplant, liver transplant & lung transplant. All of our doctors here at Emory Healthcare play a role in changing and saving lives, but often times our transplant team and the treatments they provide touch the lives of our patients and their families on a deeper level. And more often than not, receiving treatment from our transplant specialists is their last, if not only option. Thankfully, based on our program’s rankings, both from a statistical post-transplant quality outcome perspective, and the perspective of the physician research team, researchers at Castle Connolly Medical LTD, and Atlanta Magazine, the Emory Transplant Center is a great option to have.

We again congratulate each of our transplant surgeons for their dedication to providing outstanding patient centered care for our patients and families faced with less than idea circumstances that can warrant organ transplantation. It is because of our multidisciplinary team of transplant specialists and their compassion, that recognition such as the Atlanta Top Doctors rankings is given. If you’d like to shout out a particular transplant doctor who has impacted your life, please do so in the comments below. You can also find the listing of transplant surgeons recognized in this year’s rankings below. If you’re interested, check out the full list of Emory Healthcare doctors recognized as the best doctors in Atlanta.

Pancreas & Kidney Transplant Doctors:

  • Chris Larsen, MD, DPhil – Transplant Surgeon
  • Kenneth Newell, MD – Transplant Surgeon

Liver Transplant Doctors:

  • Stuart Knecthle, MD – Transplant Surgeon

Lung Transplant Doctors:

  • Seth Force, MD – Transplant Surgeon

Heart Transplant Doctors:

  • Andrew Smith, MD – Transplant Surgeon
  • Javed Butler, MD – Cardiologist

Hand Transplant Doctors:

  • Linda Cendales, MD – Transplant Surgeon

 

 

 

Emory Transplant Center Achieves and Sustains Outstanding Quality Outcomes

Transplant Center OutcomesThe idea of replacing an organ via transplant can be a scary topic for people faced with a condition that may require one. At Emory, we’re consistently taking steps to improve transplant survival rates and hopefully, remove some of this fear for our patients. We’ve just received results from the January 2011 transplant center-specific report on outcomes from the Scientific Registry of Transplant Recipients (SRTR). We’re very pleased to announce that the Emory kidney transplant program, liver transplant program, and lung transplant program have all demonstrated consistently strong and in some cases better-than-expected patient outcomes.

Kidney Transplant

  • Emory’s overall one-year graft survival rate of 95.85% for the most recent cohort studied (July 2007 – December 2009) is statistically higher (p = .026) than the expected rate of 92.81%.
  • Emory’s living-donor graft survival rate of 100% is statistically higher (p =.033) than the expected rate of 96.36%.
  • Emory’s deceased donor graft survival rate is also numerically higher than expected (93.69% observed vs. 90.95% expected).

We’re pleased to also note that in 2010, the Emory transplant team performed 207 kidney transplants, and 22 pancreas transplant procedures – the largest number of transplants in the history of the kidney and pancreas transplant program. Of the 207 kidney transplants, 31% (64) involved living donors.

Lung Transplant

  • Emory’s one-year patient survival rate for the latest cohort (July 2007 – December 2009) is 90.14%, compared to a risk-adjusted expected rate of 82.74%.
  • Emory’s graft survival rate is 85.29%, compared to a risk-adjusted expected rate of 81.10%.

This past year, the Emory Transplant Center and team of transplant doctors performed its 300th lung transplant. The lung program has come a long way to reach this milestone, performing 35 transplants in 2010, a 300% increase over the annual total just 10 years ago.

Liver Transplant

Emory’s liver transplant program continues to achieve and sustain outstanding outcomes, with patient survival rates >91% following transplantation.

Since July 2008, our surgical transplant team has performed 241 liver transplantations (216 liver only, 25 liver/kidney combination transplants). Between January 1, 1988 – November 30, 2010, Emory has performed 67.9% (1,496 of 2,203) of all liver transplants in the state of Georgia.

Our transplant center continues to excel with statistically significant patient organ transplantation outcomes, demonstrating a commitment to high quality and patient success. If you have questions about our transplant program or outcomes, please leave them in the comments section below.