UW Health Transplant Teams Share Expertise at International Conference

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Lung Transplant Team: "Increased Risk of Colon Carcinoma in Lung Transplant Recipients with Cystic Fibrosis"


Increasing patient long-term survival rates is a consistent goal of the UW Health Transplant program. Last April, the UW Health lung transplant team was selected to present its research findings at the International Society of Heart and Lung Transplantation's (ISHLT) 29th Annual Meeting and Scientific Sessions in Paris. Mary Francois, RN, MS, CCTC, manager of the cardiopulmonary transplant program, presented her article at the Friday poster session.


Participating in the international learning session was an honor in and of itself. But for Francois, it was especially poignant given that very few non-physician providers are invited to present at this prestigious event.


The abstract explores the occurrence of increased colon cancer in lung transplant patients with cystic fibrosis (CF). Among the 65 CF lung transplant (LTX) patients at the University of Wisconsin Hospitals and Clinics, three developed colon cancer. The team set out to determine why.


"We also wanted to find out what other centers had experienced, and what they were doing to address or combat this issue," says Francois.


Colon cancer is particularly difficult to manage in transplant patients because they are immunosuppressed. If physicians could detect colon cancer early, they could work to improve outcomes for these patients.


"We found a lack of available data," she adds, "so we conducted a retrospective chart review of UW Hospital and Clinics lung transplant patients with CF to determine if they had been screened for colon cancer either pre- or post-transplantation. And, would that screening have helped?"


Through their research, the team found there was no specific protocol to screen patients pre- and post-transplant with colonoscopy. Furthermore, they determined that initiating this protocol would be useful in early detection and treatment. According to the abstract, they determined that the "overall incidence of malignant disease in patients with CF is within the expected range; patients with CF have an increased risk of developing GI malignancies. The odds for CF patients age 20-29 years for all GI malignancies has been reported as 20 to 1. This risk may be increased for LTX recipients with CF due to impaired tumor surveillance."


The conclusion of the article states that "carcinoma of colonic origin can be a devastating complication following successful bilateral LTX for end stage lung disease (ESLD) in patients with CF. Lung transplant programs should consider early and perhaps sequential screening colonoscopy for these patients following LTX to detect and remove pre-malignant lesions."


Presenting her team's findings at the international conference was valuable on several levels.


"Having the opportunity to meet with other professionals and see what is being done on a more global level was exceptional," says Francois. "Since the lung transplant field is small, it is especially important to determine what centers in other countries are doing in their practices to see if there is something more we could be doing."


Right now the five-year survival rate for lung transplants remains at 60 percent. That statistic has not changed over the years. Programs like UW Hospital and Clinics' are always working to determine what research they can conduct to increase life expectancy.


"No one center is going to do it alone," says Francois. "Having the input of other centers globally is invaluable. Uncovering new approaches," she adds, "can help us make these outcomes even better."

Cardiothoracic Transplant Team: "Physical or Verbal Barriers are Not Contraindication for Mechanical Assistance"


Margaret Murray, RN, MSN, Clinical Nurse Specialist at the University of Wisconsin Hospital and Clinics, was selected to present her abstract at the ISHLT poster session in Paris. The team's research examines the use of mechanical ventricular assist devices (VAD) to support the heart in patients or families who experience a particular challenge. Given these types of personal or family challenges, other centers may opt not to put in these devices in their patients.


In reviewing the literature, the team was unable to find any studies on these types of patients. They then examined modified strategies used in caring for these patients and families who were illiterate, handicapped or unable to communicate normally. They worked to create unique methods of communication or education depending on the particular needs of the individuals.


The team conducted a retrospective review of all discharged VAD patients from August 2003-August 2008. Six of the patients presented special challenges: illiteracy, no verbal communication, primary family member illiteracy and primary family member handicapped.


The study adjusted the preparation as needed, developing new educational materials using pictures, creating communication cues for problems and compiling community resources for patients and their families. According to the abstract, "All 53 patients completed the program and had 100 percent 30-day survival. There was no difference between readmissions or unplanned clinic visits and emergency room visits post discharge."


The team concluded that providing individualized care to VAD patients presented with challenges for education and management allows them to be discharged, and achieves outcomes similar to general VAD population.


"As a nurse," adds Murray, "one of our goals with VAD patients is to best prepare them to succeed at home. By individualizing care for patients or families with specific challenges, we have most certainly met those goals."


Murray said presenting this to a global audience was exceptional and worthwhile.


"People come to these sessions with similar patient experiences," she says. "Several people have sought advice for similar patients as a result of our research."


While in Europe, Murray was also invited by a nursing school colleague to do a Grand Rounds presentation on "Best Practice for Heart and Lung Transplantation" at the Mediterranean Institute for Transplantation and Advanced Specialized Therapies in Palermo, Sicily. Several disciplines attended the presentation, including nurses, cardiothoracic surgeons, cardiologists, pulmonologists, and anesthesia and rehab therapy specialists.


"It is just one more way to continue the process of learning from each other across the globe," she adds. "The goal is to take home something new, provide insight on something that is working well and possibly initiate new protocols back home, all with the ultimate goal of making patient outcomes better."


You can find both articles, "Increased Risk of Colon Carcinoma in Lung Transplant Recipients with Cystic Fibrosis" and "Physical or Verbal Barriers are Not Contraindication for Mechanical Assistance" in the Journal of Heart and Lung Transplantation, February 2009, online at http://www.jhltonline.org.