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University of Minnesota Health Transplant Services: Optimizing Patient Outcomes

January 2015 - Transplant Services

University of Minnesota Health Transplant Services, which includes University of Minnesota Medical Center and University of Minnesota Masonic Children’s Hospital, is one of the most successful transplant programs in the world, having performed more than 12,000 transplants in the past 52 years. We are committed to optimizing patient outcomes through leading-edge research and top-of-the-line care. Two recent highlights in our program are access to novel “breathing lung” transplants and innovations in pediatric total pancreatectomy with islet autotransplant.

“Breathing lung” transplantation

Approximately 6,000 to 7,000 patients on the lung transplant list die annually. 1 Donor lungs are in short supply, and only about 20% of donor lungs are found to be acceptable for transplantation.2 Most donor lungs are rendered unsuitable by inflammatory lung damage, attempted donor resuscitation or ventilator damage to the lungs, or cold ischemia during transport of the lungs on ice from donor to recipient.3

Breathing-lung-Screen-Shot-2015-01-07-443x281
— A donor lung rests in the portable perfusion, ventilation, and monitoring system prior to transplant. University of Minnesota Health Transplant Services performed the first such "breathing lung" transplant in the Midwest

At University of Minnesota Health Transplant Services, we are improving donor lung utilization with the Organ Care System Lung (TransMedics, Andover, MA), a portable perfusion, ventilation, and monitoring system that maintains donor lungs in a near physiologic state.4 With the Organ Care System Lung, normothermic blood and oxygen are pumped through donor lungs to keep them “breathing” during transport. The device also contains sophisticated monitoring equipment, providing detailed information about the status of the donor lungs.

As part of a “breathing lung” clinical trial, our Transplant Services team has performed 27 transplants since November 2013, 15 of them on the Organ Care System Lung. All of these transplants have been successful, and 4 transplants made use of lungs that would not have initially met standard transplant criteria without conditioning and monitoring in the Organ Care System Lung.

Total pancreatectomy and islet autotransplant

Chronic pancreatitis (CP) is a rare, progressive disease that commonly results from genetic mutations.5 Children with CP endure recurrent hospitalizations, increasing pain and narcotic dependence, loss of school days, and impaired quality of life.6, 7

Patients for whom medical and endoscopic interventions are not effective may be candidates for surgical intervention. Total pancreatectomy removes the source of the pain but results in brittle diabetes. In 1977, a novel approach for treatment of CP in adults, called total pancreatectomy and islet autotransplant (TP-IAT), was developed at University of Minnesota Medical Center. In the procedure, the pancreas is resected, and the islet cells are isolated and reinfused into the portal vein of the liver.

More recently, TP-IAT is being performed in the pediatric population. At University of Minnesota Masonic Children’s Hospital, our Transplant Services team has extensive experience in performing TP-IATs. Since 1977, our surgeons have performed more than 550 TP-IATs—more than three times the number completed at any other medical center. Roughly 1 in 4 of these procedures has been performed on children ages 3 to 18, with 95% of patients reporting significant pain reduction in their daily lives after the procedure. We are the only program in the nation performing TP-IAT on children under 10 years of age. 

References

1. U.S. Department of Health and Human Services. Organ Procurement and Transplantation Network. Lung Transplant National Data: Removal Reasons by Year. http://optn.transplant.hrsa.gov/converge/latestData/rptData.asp

2. Punch JD, et al. Organ donation and utilization in the United States, 1996–2005. Am J Transpl. 2007;7:1327–1338.

3. Munshi L, Keshavjee S, Cypel M. Donor management and lung preservation for lung transplantation. Lancet Respir Med. 2013;1:318-328.

4. Warnecke G, et al. Normothermic perfusion of donor lungs for preservation and assessment with the Organ Care System Lung before bilateral transplantation: a pilot study of 12 patients. Lancet. 2012;380:1851-1858.

5. Schmitt F, et al. Hereditary pancreatitis in children: surgical implications with special regard to genetic background. J Pediatr Surg. 2009;44:2078-82.

6. Howes N, Lerch MM, Greenhalf W, et al. Clinical and genetic characteristics of hereditary pancreatitis in Europe. Clin Gastroenterol Hepatol. 2004; 2:252-61.

7. Bellin MD, et al. Quality of life improves for pediatric patients after total pancreatectomy and islet autotransplant for chronic pancreatitis. Clin Gastroenterol Hepatol. 2011;9:793-9.

When to Refer

We at Transplant Services take pride in our ability to evaluate patients as quickly as the referring physician deems appropriate. For urgent situations, patients may be scheduled for an inpatient evaluation same day or in clinic within one week. For nonurgent referrals, we strive to schedule patients according to their availability and as clinically indicated.

A referral may be initiated by simply having your office staff call the following numbers and provide the pertinent demographic, diagnosis, and insurance information about the patient:

Adult and pediatric referrals:

612-625-5115 or 800-328-5465

After-hours and urgent-case referrals:

612-273-3000

Collaborative Care

We are committed to working with you to achieve the best possible outcome for your patient. Referring physicians are always welcome to call the referral numbers listed above to request consultation information or, in more urgent cases, to page the attending transplant physician on-call 24 hours a day at 612-273-3000.

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