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News from the Emory Transplant Center: Integrating discovery, training, and patient-centered care
    October 2008  
         
 

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ETC Receives Key Medicare Approval

Your hard work has paid off. The Centers for Medicare and Medicaid Services (CMS) recently approved Emory's adult kidney, heart, liver, lung and pancreas programs under the new federal conditions of participation for transplant centers!

Over the last year, leadership and staff from each transplant program and from dietary and nutrition services, nursing, pharmacy, and social services rolled up their sleeves to prepare for the first CMS unannounced site visit of our transplant programs during the week of Feb. 18–23, 2008. All went well with only a few standard level deficiencies to correct. In July, the lung program joined the heart, kidney and pancreas programs in meeting requirements for approval. By last Wed., Sept. 24, after submission of additional current data on our new liver transplant services, we learned from CMS that the liver transplant program also would be approved. We are now waiting for the official stamp of approval in a forthcoming letter from the CMS.

So, heartfelt thanks to you, one and all. We also really appreciate the kind words and encouraging comments from the CMS. This experience and subsequent lessons we've learned from the process will be used to further enhance our clinical transplant programs into 2012 and beyond.

 
         
     
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ChrisLarsen
Dr. Christian Larsen

 

State of the Center 2008

The State of the Center meeting on Sept. 25 started off on a positive note. Participants were encouraged by the opening remarks of Dr. Wright Caughman, VP of clinical and academic integration for the WHSC, who confirmed that Emory has made a strong commitment to the ETC in FY 2008 and will continue to do so in 2009.

The university's commitment to our mission combined with the hard work and dedication of our staff and faculty have led to a phenomenal year. Dr. Chris Larsen continued the meeting by pointing out some of priorities we set going into FY 2008 and featuring some of the resulting successes of our programs. Last year, we made it a priority to enhance each patient’s experience, outcome, and care delivery through improved multidisciplinary care and services. Our other goals included differentiating the WHSC from local and regional competitors through innovation in translational science and novel quality programs. We were dedicated to solidifying our regional role and strengthening our national position as a top 10 national comprehensive transplant center. In addition, we wanted to continue fostering strong philanthropic relationships to fund future vision and opportunities. 

The good news is we've met our goals. Dr. Larsen highlighed some specific accomplishments from 2008:

  • Provided care for approximately 24,000 outpatient encounters.
  • Established an ETC patient family care council that developed a patient resource guide, a regular orientation program for new patients and families, and a plan to decrease waits and delays in the outpatient clinic.
  • Enhanced the outreach program by providing more than 400 remote patient visits and educating over 1,000 patients and staff in home communities or educational conferences. It also developed a formal system for communicating with referring physicians through patient review conference calls.
  • Surpassed all Press Ganey transplant patient satisfaction scores (see results below) and significantly improved patients' median days from the time of referral to the transplant list.
  • Recruited key faculty to enhance our mission.
  • Enhanced transplant research by growing extramural funding to nearly $16 million in FY 2008, which is a more than 95 percent increase over FY 2004.

Some of our new goals for 2009 are to:

  • Continue developing leadership who will create a plan to transition patient care services to 7G and establish a dedicated transplant ICU; explore strong quality initiatives that focus on prospective monitoring; empower the patient family care council to continue improving services and clinical care delivery; and implement a new global transplant Press Ganey patient survey.
  • Ensure appropriate infrastructure and resource support for growth in all services.
  • Continue clinical process improvements for program service delivery that will reduce wait times, decrease listing median days, and grow transplant volumes.
  • Restructure clinical research infrastructure and create an administrative core that will support growing clinical research trials and patient enrollment and will ensure compliance with regulatory requirements.
  • Develop a formalized telemedicine program in collaboration with existing Georgia programs that provide care to a growing post-transplant population.
  • Recruit or assist in the recruitment of faculty in key areas, including islet transplantation, immunology, pulmonary medicine, nephrology, critical care medicine, and anesthesiology.

Later in the meeting, Zadya Lundgren, guest services coordinator, highlighted some of the many employee engagement activities the ETC has sponsored this year, including Operation Backpack, the Family Feud game (see below), and the daily huddles, to name a few. 

The meeting concluded with a presentation by Dr. Allan Kirk, kidney/pancreas transplant surgeon, on ETC research activities. He reported that NIH funding continues to be significant and the number of peer reviewed research studies exceeds any other institution.

In summary, 2008 was a successful year. You can feel proud of the fact that the ETC will continue to broaden our mission and challenge of delivering compassionate and high quality patient- and family-centered care while achieving the best possible outcomes for our patients.

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At the State of the Center meeting

 
         
     
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SanFran
Cynthia Devroy and Dr. Paul Tso in Calif.

 

ETC to Start Paired Kidney Donation Program

Emory’s kidney and pancreas transplant program staff and faculty traveled to San Francisco this summer to learn about the paired kidney donation program at California Pacific Medical Center (CPMC). Paired kidney donation is a new option that can help some of the estimated 7,000 patients waiting for kidney transplants nationally who have family members or friends willing to be donors, but the donors' blood or tissue types are incompatible with the recipients'. The ETC is currently working through the logistics of setting up its first paired kidney donation, and insight gleaned from this trip has proved invaluable.

PairedDonationWith a paired kidney transplant, one incompatible donor-pair is able to give a healthy kidney to a compatible recipient. In exchange, the second donor-recipient pair will give a compatible kidney to the first donor-recipient pair. This exchange makes two compatible living donor transplants possible and increases the potential number of available donor kidneys.

HRSA, an agency within the U.S. Department of Health and Human Services, awarded the ETC kidney and pancreas program an opportunity to visit CPMC to learn about the paired kidney donation program, says Cynthia Devroy, ETC financial manager. The HRSA award was a part of the support it provides to the National Transplant Growth and Management Collaborative's Peer Assist Program to encourage sharing of best practices in living donation. A number of institutions—most notably, Johns Hopkins’ transplant program—have pioneered the idea. However, only a relative few paired kidney donations have been performed nationally. According to UNOS, more than 400 living paired donor transplants—a small fraction of the total number of living donor transplants—have been performed to date.

For those facing kidney transplantation, a living donor transplant offers better long- and short-term outcomes than a deceased donor transplant. Unfortunately, about 40 to 50 percent of potential living donor candidates are incompatible with their recipients. Historically, if no other compatible living donors are identified, the recipient has to wait on the kidney transplant list for a deceased donor. With 75,000 patients nationally waiting for a kidney transplant, there simply are not enough donor organs available. The waiting time locally is about five years.

Medical literature suggests that about one in five individuals with an incompatible living donor(s) can find a compatible donor-recipient pair with paired kidney donation, making a potentially more successful living donor transplant a possibility. Consequently, patients can be removed from the national waiting list for a transplant if a compatible living donor is found. But paired kidney donation can shorten an individual's waiting time for a kidney transplant if a matching donor-recipient pair can be identified.

In addition to Devroy, the members of the kidney/pancreas program who went to CPMC included Dr. Paul Tso, kidney/pancreas surgeon, Dr. Ken Kokko, nephrologist, Ginny McGrath, clinical nurse manager for the kidney, pancreas, and liver programs, Erica Henderson, living donor coordinator, Cindy Moore, director of Emory Hospital's operating room, and Shannon Luetkemeyer, living donor coordinator at Children’s Healthcare of Atlanta.

Dr. William Bry, surgical director of CPMC's kidney/pancreas transplant program, hosted ETC team members, who spent three days at the facility with different staff discussing and witnessing many aspects of the program, including the opportunity to learn from several patients in the program. The group returned with many innovative ideas that will have a substantial impact on our programs in the future, says McGrath, and we will be presenting the peer assist visit experience at the next National HRSA Collaborative in Nashville in late October.


SanFranciscoTeam

The ETC team prepares for a paired donor kidney transplant at CPMC.

 
         
     
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JuanitaConner
Juanita Conner

Dana_Duan_image
Dana Duan

Erin_Fears_image
Erin Fears

Ana_Howells_Ferreira_image
Ana Howells-Ferreira

Jennifer_Hutchinson_image
Jennifer Hutchinson

Bing_Kampen_image
Bing Kampen

Jean_Kwun_image
Jean Kwun

Brett_Mendell_image
Brett Mendel

 

New Faculty/Staff

  • Juanita Conner, who came on board at the ETC last month, is a new pre-transplant coordinator in the renal transplant program. She has more than 21 years of nursing experience, 17 of which in case management, discharge planning, Medicaid compliance, and utilization and review. She has a 4-year-old daughter, Celine, and enjoys cooking, gardening and cycling.
  • Dana Duan is a new lead research specialist working with Dr. Mark Rigby, assistant professor of pediatrics. She comes to us from Indiana University.
  • Erin Fears, a recent graduate of Agnes Scott College, is a research specialist now working in a research lab/clinical interface position at the ETC.
  • Ana Howells-Ferreira is a new research specialist working in the GRA biorepository. She is an avid volleyball player who was on the team at Georgia State University for five years.
  • Jennifer Hutchinson has joined the ETC as a clinical research nurse. She also works with Dr. Rigby.
  • Bing Kampen is a new laboratory assistant in the ETC lab. She is expecting a baby boy in November.
  • Instructor Jean Kwun is new to the ETC research laboratories. He came to Emory from the University of Wisconsin-Madison with Dr. Stuart Knechtle, director, liver transplant program.
  • Brett Mendel is now working as a Howard Hughes Research Institute research fellow at the ETC in the lab of Dr. Neal Iwakoshi, a research scientist in immunology and virology.
  • Wenxin Pang joined the cell and tissue processing lab as part of the islet isolation team. He completed medical training in Beijing, a hematology fellowship in France, and medical technology training at George Washington University. He has 10 years of research experience and three years in the clinical laboratory. Pang has two children.
  • Dr. Mingqing Song joined the ETC research team as a lead research specialist. She is an expert in histology and immunohistochemistry.
  • Sarah Swygert, another recent graduate of Agnes Scott, is a research specialist specializing in molecular biological techniques.
  • Shirley Symes, RN, is a new project coordinator in the ETC.
    She has three children and enjoys cooking and gardening.
  • Cindi Tillery joined the ETC in Sept. as a post-transplant coordinator for the renal transplant program. She has two children, Ella and Luke, and a dog, Bogie. She loves to snow ski, ride horses and work in her garden.
  • Emily Williamson is a new pre-transplant coordinator for the Andrew McKelvey Lung Transplant Center. Williamson came to us in Sept. after spending two years as an infusion nurse/account executive with PrimeCare Home Infusion. She has a BSN from Emory. She also has a little girl named Macie.


    WenxinPang_imageMingqing_Song_imageSarah_Swygert_image
    Wenxin Pang, Mingqing Song and Sarah Swygert

    Shirley_Symes_imageCindi_Tillery_imageEmily_Williamson_image
    Shirley Symes, Cindi Tillery and Emily Williamson


     
         
     
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Andres_Pelaez_image
Dr. Andres Pelaez

 

New Approach to Improve Lung Transplantation

Since lung transplantation has become an accepted therapeutic intervention for end-stage lung disease, the number of patients on lung transplant waiting lists has grown exponentially. According to UNOS, more than 2,100 patients currently are waiting for lung transplants nationally. The number of patients waiting markedly outweighs the number of available donor lungs, says Dr. Andres Pelaez, a pulmonary medicine specialist at McKelvey Lung Transplant Center. This has led to significant mortality rates for those on the waiting lists.

Dr. Pelaez is organizing a new approach to donor management in conjunction with the education programs already in place at LifeLink of Georgia®, the non-profit, federally designated organ procurement organization. Dr. Pelaez' goal is to improve donor organ function and increase the pool of potential donors. He is building on some of the same maneuvers used to improve donor organ quality for lung transplantation as the protocol previously reported by Dr. Luis Angel, et al, from the University of Texas Health Science Center at San Antonio in the American Journal Respiratory and Critical Care Medicine (impact of lung transplantation donor-management protocol on lung donation and recipient outcomes 2006;174:710–716). Some of the techniques reported there as well as here at Emory included bronchoscopic airway clearing of secretions, mechanical ventilator strategies, and diuresis. An analysis of the impact at Emory of these maneuvers showed a significant increase—almost 20 percent—in the rate of organs offered to transplant centers when compared to previous years.

This analysis is important because it illustrates a significant increase from a relatively simple management protocol with an educational component from LifeLink coupled with basic interventions previously reported for the management of critically ill patients.

With Dr. Pelaez’s assistance, LifeLink has trained its coordinators on donor management and lung recruitment strategies and to evaluate every donor for lung donation potential, remarks Shri Bharadwaj, LifeLink's manager of recovery services. Further, LifeLink collaborates with Dr. Pelaez and his team on a real time basis to ensure that every transplantable lung gets matched with a potential recipient.

Through this collaboration, the ETC's lung transplant program has achieved a greater than 18 percent increase in donor lungs transplanted since January 2007. This offers new hope for the 15 patients currently waiting at Emory for donor lungs, reports Dr. Pelaez.

 
         
     
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MarkRigby
Dr. Mark Rigby

 

The Future Looks BRiTE

Emory began enrolling participants on Sept. 15 for an exciting new Emory-based, single-center, placebo-controlled trial to rescue adolescents and young adults from newly diagnosed type 1 diabetes mellitus (T1DM). Lead investigators are Drs. Mark Rigby and Eric Felner from the department of pediatrics, Dr. Sol Jacobs from medicine, and Dr. Chris Larsen from transplant surgery. Jennifer Hutchinson, is the research coordinator.

The two-year BRiTE trial—short for &beta cell rescue in type 1 diabetes with efalizumab trial—is supported by a $2.23 million grant from the Juvenile Diabetes Research Foundation. In addition, Genentech, Inc. is donating the study drug, efalizumab (Raptiva). This study is based at the ETC, and participants will be seen at Emory's General Clinical Research Center.

The study is a randomized controlled trial of efalizumab (anti-LFA-1) given at home via weekly subcutaneous injections for six months. Patients will receive regular clinical, metabolic, and immunologic assessments through their 24 months in the study. The investigators will try to coordinate study visits with the participants' regular endocrine visits.

Efficacy endpoints for the study will include endogenous c-peptide production, insulin use, and HgbA1C as well as a number of (auto)immune parameters. The study will enroll a total of 45 participants, ages 12 to 35 years, with the caveat that enrollment will start with those 15 years old and older for the first few participants. Notably, inclusion criteria include participants with T1DM diagnosis for less than 6 weeks and who are positive for one of four diabetes auto antibodies (anti-GAD, anti-insulin, anti-islet cell, and anti-IA2). In addtion, participants should not have severe systemic illness. The investigators anticipate that study will be open for enrollment for three to four years. 

The way T1DM results from an absolute insulin deficiency following autoimmune destruction of pancreatic &beta cells is very similar to the transplant rejection process. Since the autoimmune basis of this disease has been established, immune suppressive and modulatory approaches have been heralded as the most promising means to prevent T1DM. At the time of clinical diagnosis, the study's investigators presume that a substantial number of &beta cells exist but are inflamed. Their primary hope is the drug will be able to quiet the inflamed pancreas and rescue these residual &beta cells so that they will make insulin when the body needs it, thereby decreasing or eliminating the participants' need for exogenous insulin. The BRiTE trial parallels the islet transplant research program in the use of efalizumab for immunomodulation and intercalates well with ETC's mission to improve care for patients with immune-mediated organ failure.

For more information, call 404-785-T1DM (8136) or email brite@emory.edu. Other study details also are available at www.clinicaltrials.gov.

 
         
     
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Press Ganey Patient Satisfaction Scores

FY08 Targets
Targets Actuals
Variance
Helpfulness of phone staff 89.2 90.5 1.3
Informed about delays 77.2 79.5 2.7
Overall rating of care 89.9 91.6 1.7
Likelihood of recommending 91.3 92.7 1.3
 
         
     
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Staff Awards and/or Certifications

Sandra Lourenco, financial coordinator, won the monthly prize for the I saw you doing something special Gallup Question #4 initiative in Sept. She selected a QT gas card as her prize, a $25.00 value.

 
     
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TamarioLenior_image
Tamario Lenior
 

It's All in the Family

Can you name the favorite five restaurants at which staff order lunch? What are the first five things staff do when they arrive at work? What are the top five things you leave in the break room fridge?*

Certain members of the kidney and pancreas transplant team—or was it the liver transplant team?—know the answers to these and many other pressing ETC questions. Amid many guffaws and much good-natured ribbing, the two programs tested their trivia knowledge at the first-ever ETC Family Feud game on Aug. 29. Tamario Lenior, ETC financial manager, served as the debonair host of the event.

The kidney and pancreas and liver programs' employee engagement team #7 organized the event and provided boxed lunches. They also held a lottery to randomly chose two teams—one from kidney and the other from liver—to compete in the game among the staff attending the event. The winning team received $20 gas cards, and the audience was thrown candy if they could guess the remaining answers. Needless to say, the Family Feud was a smashing success.

*Answers: 1. Top Spice, 2. Fortune Cookie, 3. Doc Cheys, 4. Paradise Grill, 5. Roly Poly; 1. clock-in, 2. drink coffee, 3. check e-mail, 4. check vmail, 5. check faxes; 1. science projects, 2. yogurt, 3. hotdogs, 4. salads, 5. party left-overs

 
         
     
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Upcoming Community Events

Date
Event
Location
Time
Contact
10/11/08
American Liver Foundation Walk

Stone Mountain Park

7:30 am (registration)

8:30 am (walk)

Jennie Daniel
jdaniel@liverfoundation.org
404-633-9169

Register a team: www.liverfoundation.org/walk Donate: http://click.goliver.org

10/25/08

National Kidney Foundation Kidney Walk

Lullwater Park, Emory

8 am (registration)

9 am (walk)

Cara Mckinney cmckinney@kidngeyga.org
770-452-1539, ext. 11

11/7 & 11/8/08
GTF Wellness Conference
Georgia International Convention Center
8 am - 4 pm
11/1/08
2008 Metro Atlanta Heart Walk

Turner Field Downtown Atlanta

8 am (registration)

9 (walk)

Lauren Brummett lauren.brummett@emoryhealthcare.org 404-712-0241

If you are interested in forming an ETC team for any of the walks, please contact Jo-Ann House, JoAnn.House@emoryhealthcare.org.

 
         
     
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