UChicago Medicine transplant teams look for ways to say ‘yes’ to patients

The University of Chicago Medicine has been at the forefront of organ transplantation since the beginning, building on a legacy including the world’s first successful living-donor liver transplant and the first heart-liver-kidney triple organ transplant. Today, the health system’s transplant programs are adding even more clinical experts, researching and implementing the latest technologies and techniques, and prioritizing patient-focused approaches to evaluation and care.

“We’ve achieved a record expansion of the program in the past year, which we're all pretty proud of,” said Rolf Barth, MD, co-director of the UChicago Medicine transplant institute and director of liver, kidney and pancreas transplantation.

Diverse efforts across the academic health system all unite under a single goal: saying “yes” to more transplant patients — including those who may have been turned down elsewhere — and improving access, safety and outcomes.

Next-generation organ preservation

Traditional organ preservation involves cooling and storing donor organs on ice, a practice that limits how long an organ stays viable and sometimes leads to tissue damage or difficulties restoring blood circulation upon rewarming. Cutting-edge perfusion technologies are among the ways UChicago Medicine transplant teams overcome these historic challenges and constraints, keeping donor organs healthier for much longer.

“These tools help us optimize organ outcomes for our patients and allow us to consider using organs that in the past would not have been deemed suitable for transplant — ultimately meaning more patients receive a transplant,” said transplant surgeon Arielle Cimeno, MD. “It also really helps with the logistics of multi-organ transplants — an area where UChicago stands out.”

Hypothermic machine perfusion pumps oxygenated preservation fluid through an organ at cold temperatures, reducing the risk of freezing or other damage. Normothermic machine perfusion goes even further, using oxygenated blood at body temperature to keep the organ functioning. This allows surgeons to assess viability and reduce the stress that comes from abruptly reintroducing blood flow at the time of transplant.

Barth pointed out that these new technologies play a role in all areas of the academic medical center’s tripartite mission: “We're using these tools in the clinic as part of standard care. We’re using them in research — both in the laboratory and in clinical trials in which patients can get involved. And then in education, we're training residents, research fellows and clinical fellows on how to use, manage and interpret these devices.”

Innovations in transplant techniques and approaches

Preservation improvements dovetail with new techniques and approaches that make transplantation safer and more efficient. For example, Pablo Sanchez, MD, PhD, surgical director of the lung transplant program, recently published new evidence confirming that transplant teams can use a specialized cooler to keep donor lungs at a safe, non-freezing temperature overnight, allowing the surgical team to perform transplants during the day instead of pushing through overnight shifts and working with less familiar anesthesiologists and nurses.

“As you can imagine, having well-rested surgical teams makes everything better not only for clinicians but also for patients,” Sanchez said.

Sanchez also helped pioneer a surgical technique called “bloodless lung transplantation,” which involves using anti-coagulants and extracorporeal membrane oxygenation (ECMO) technology to avoid the need for blood transfusions during or after lung transplant surgery. This can improve patient outcomes by shortening hospital stays and reducing the risk of graft dysfunction, kidney failure or other complications.

As more transplant-related technologies and clinical trials continue to roll out, UChicago Medicine is well-positioned to participate and will continue innovating to improve the standard of care.

Personalized care and case-by-case evaluation

All these technological and procedural advancements only matter if patients have the opportunity to benefit from them.

“Our programs and physicians look for reasons to say ‘yes’ to patients, rather than looking for reasons to say ‘no,’” said Beatrice Concepcion, MD, medical director of kidney and pancreas transplant. “A lot of our patients are those who have been turned down at other centers, so we want to be the place where someone takes a closer look to see how we can help them get ready and eligible for transplant.”

Cimeno agreed: “Instead of having hard, arbitrary cutoffs for different metrics such as BMI, we do a more holistic review and work with each patient as a team, giving them a chance when other centers turn them down.”

For example, patients in need of a transplant who might otherwise be disqualified due to their weight can be enrolled in UChicago Medicine's Access to Transplant through Novel Approaches to Weight Loss (ACTNOW) Clinic, which offers a personalized, medication-assisted program to support patients in losing weight so they can become eligible for transplant and improve post-surgery outcomes.

Similarly, patients who are “highly sensitized” — meaning their bodies have developed antibodies that make it extremely difficult to find a compatible donor organ — have a unique chance to find hope at UChicago Medicine. The kidney transplant program offers a desensitization treatment that creates a much-needed “window” for transplantation by preventing the usual rebound of antibodies that occurs after traditional methods.

“We pride ourselves on personalized assessment and care of transplant candidates and recipients. We take a close look at every case with the goal of getting that person a transplant, and we try not to be limited by rigid criteria or protocols when we come up with a plan,” said Concepcion. “Likewise, when we see that a patient has unique post-transplant care needs, we’re very quick to make sure they receive that individualized treatment.”

Expanding the reach of accessible transplant care

Eligibility is not the only barrier many transplant patients must overcome. Geographic distance, limited financial resources and systemic healthcare disparities can all make it challenging for patients to access the care they need. Meeting patients where they are — both literally and figuratively — is another critical part of making high-quality transplant services within reach for as many people as possible.

“Our teams work together to solve the logistics of finding and transplanting organs for patients no matter where they live,” Barth said. He recalled one out-of-state patient who was unable to get on a transplant wait list anywhere in his region: “We were able to get him a kidney within months and keep it viable using perfusion devices while he flew from the East Coast to Chicago for the surgery.”

For some patients, limited time, money and energy make travel especially burdensome. UChicago Medicine transplant teams use telemedicine appointments for evaluation, preparation and post-transplant follow-up care when possible. Within the greater Chicago area, clinics in Hinsdale, Glen Oaks, Bolingbrook, Flossmoore, Peoria, Evanston and Crown Point, Indiana can all provide pre-transplant consultation and care to help patients get on donor lists and prepare for and recover from surgery while staying closer to home.

“Our teams look at so much more than numbers; we try to provide the best experience possible, starting from the first time someone calls us,” Sanchez said. “It’s very important to us that patients and referring physicians all know that we care deeply, and we want to help.”