Past Grants

Patient Mentorship Program in the Heart Transplant Clinic

Heart transplant (HT) and Ventricular Assist Device (VAD) implantation is a life-changing event for patients with acute heart failure (AHF). The process by which patients are assessed and selected for heart transplantation or VAD can be a difficult journey. Patients undergo intensive diagnostics and assessments by the multidisciplinary team. Patients within the Heart Transplant Program (HTP) at St. Paul’s Hospital (SPH) have expressed, through various modes of feedback, that they would value peer support to help manage these life-changing circumstances.

Currently, there is no formal peer-mentorship program at SPH for patients in the HTP, resulting in only informal connections being coordinated by clinic nurses. Clinicians working with this population at SPH echo the need for a structured and sustainable peer-mentorship program where both peer mentors and mentees are well supported in their respective roles.

The focus of this study is to determine what a peer-mentorship program for HT and VAD patients would look like when developed with patient involvement. The team will examine, with their patient partners, how such a program will look in terms of structure, content, and process. The overall aim of this study is to seek information regarding how best to develop a peer-mentorship program which will in turn improve patient’s health outcomes and quality of life. The hope is that if patients are the central voice in assembling a program, it will remove the paternalistic biases that clinicians may have when determining what would work best for the patient.

Principal investigator: Josie Mackey

Co-investigators: Erica Johansson, Kim Brownjohn, Kerry Ahn Uy, Wynne Chiu, Katrien Moore, and Rachel Milligan

Patient Partner: Naomi Lee, Marc Bains, Jillianne Code and Kristi Coldwell

The safety and efficacy of sotrovimab in kidney post transplant patients with COVID‐19: a single centre experience

Patients who receive a kidney transplant need to take lifelong medications to suppress their immune system. Even when fully vaccinated, this puts them at high risk of severe disease and death from COVID-19. New treatment options have become available in BC. One of the first treatments available was a monoclonal antibody treatment called sotrovimab. Sotrovimab was used to treat mild to moderate COVID-19 infection in high-risk patients, such as transplant recipients, to decrease the progression to severe disease. There is limited evidence on COVID-19 and treatment options in transplant patients. Anecdotally, the post-transplant kidney transplant program at St. Paul’s Hospital has seen better outcomes in patients who received sotrovimab.

Unfortunately, new strains of COVID-19 have shown resistance to sotrovimab. As a result, this treatment is no longer in use. Despite this, assessing the efficacy of sotrovimab in kidney transplant recipients will provide important data on the risk of COVID-19 in this population and highlight the need for an effective treatment. The team aims to conduct a retrospective chart review to compare the rates of hospitalization, ICU admission and death in kidney transplant patients followed by the St. Paul’s posttransplant clinic who got sotrovimab versus those that received no treatment.

Principal investigator: Erin Waters

Co-investigators: Bita Bateni, Odette Bodman, and Wayne Fritz

Patient Partner: Alexis Mackay‐Dunn

Frequency of Swallowing and Voice Dysfunction Following Double Lung Transplant

Being able to swallow and produce voice are actions that we complete constantly throughout the day. Swallowing and voice dysfunction following double lung transplant are quite common and carry risks of poor health outcomes, reduced quality of life, and increased hospital costs/length of stay. Limited literature exists regarding the incidences of voice and swallowing dysfunction post-transplant and there is notable methodological variability in the studies that have been done.

This project will employ rigorous standardized assessment of swallowing and voice in lung transplant patients at Vancouver General Hospital, to determine the frequency of impairment and observe related variables. The team will also gather information on how these changes impact patients’ quality of life by way of a brief interview. It is imperative to gain a better understanding of voice and swallowing changes in our lung transplant population.

This knowledge will enable the program to standardize the procedures in order to provide the best quality care for patients, while reducing hospital length of stay and acute hospital costs.

Principal investigator: Kimberly Noble

Co-investigators: Kevin Chen, Geeta Modha, and Dr. Stacey Skortez

Patient Partner: Larry Worfolk

Evaluation of the Live Donation Patient and Family Group

There are over 3000 people waiting for a kidney transplant in Canada and, unfortunately, close to 100 people die every year while waiting. The best treatment for most of these patients is a live donor kidney transplant (LDKT). With LDKT patients do not need to wait years for a deceased donor, spend less time on dialysis (a treatment which negatively impacts patient’s quality and quantity of life) and have better outcomes than deceased donor transplants.

Despite the clear benefits of having a live donor, the rates of LDKT continue to be low. One of the hardest things about LDTK is that the responsibility is on the patient to find a live donor. Most patients feel very uncomfortable asking someone to donate a kidney and often lack information about the safety of LDKT and how it all happens. To this end, in September 2020 this project team created the “Live Donation Group” over Zoom to help participants become more comfortable with having conversations about LDKT by providing education, resources, tools and emotional support.

This research project seeks to evaluate the effectiveness of this group in helping patients and family members become more comfortable with having conversations about LDKT.

Principal investigator: Christina Schellenberg

Co-investigators: Jody Max and Dr. Monica Beaulieu

Impact of Tacrolimus or Cyclosporine Co-Administration on Apixaban’s Exposure, Pharmacodynamics, and Bleeding Risk in Liver and Lung Transplant Recipients

Transplant recipients are at high risk of developing blood clots requiring treatment with blood thinners (anticoagulants), usually for 3 to 6 months and at times for life. For years, warfarin was the only blood thinner that was available in tablet form. Warfarin therapy is however complicated with variable dosages requiring frequent blood work monitoring and many drug and food interactions.

Recently newer oral anticoagulants, such as apixaban, have become available that are much simpler to use with fixed dosages, no requirement for blood work monitoring and improved effectiveness and less bleeding risk. However, these medications are avoided in transplant patients because there is a potential risk of drug interactions with anti-rejection medications, with anti-rejection medications increasing apixaban’s levels. There is some limited evidence that apixaban may be safe in transplant patients.

In this study, the team will initiate apixaban in 20 lung and liver transplant patients who need blood thinner therapy and are taking tacrolimus or cyclosporine. The levels of apixaban in patients’ blood will be measured and patients will be closely monitored for any signs of bleeding. It is hoped the study will demonstrate that apixaban’s levels and its anticoagulant effects are not appreciably increased, and that apixaban can be safely used in transplant patients, leading to simplified anticoagulation therapy in these patients.

Principal investigator: Trana Hussaini

Co-investigators: Dr. Vladimir Marquez, Dr. Leslie Zypchen, Dr. Tyler Smith, Dr. Roland Nador, Nilu Partovi, Robert Wright and Dr. Eric Yoshida

For an up-to-date list of publications by Trana Hussaini, please see ResearchGate

Voriconazole associated adverse drug events in lung transplant recipient

Lung transplant recipients require potent life-long immunosuppressive medications to prevent the immune system from recognizing the transplant lungs as foreign; on the other hand, chronic suppression of the immune system also increases a patient’s risk for development of life-threatening infections including fungal infections such as Aspergillosis. Studies have demonstrated that appropriate fungal prophylaxis and treatment are essential components of lung transplantation, as colonization with Aspergillus increases the risk for chronic lung allograft dysfunction and patient death. Voriconazole is the drug of choice for prophylaxis and treatment of Aspergillus in lung transplant recipients; however, voriconazole has multiple adverse drug events associated with its use.

This study has the following aims:

1. Evaluate the incidence of adverse drugs events associated with voriconazole

2. Identify the most common toxicities experienced by lung transplant recipients on voriconazole

3. Evaluate the frequency of medication discontinuation due to voriconazole-related adverse drug events

Principal investigator: Cindy Luo

Co-investigators: Dr. Robert Levy, Dr. Roland Nador, Dr. Nilu Partovi, and Dr. Matthew Kadatz

Patient Partner: Larry Worfolk

For an up-to-date list of publications by Cindy Luo, please see ResearchGate

Prevalence Study of Vitamin D status of Renal Patients Post-Transplant

Winning this year’s award is a team led by registered dietitian Christine Adair, “Prevalence Study of Vitamin D status of Renal Patients Post-Transplant.” This project will be assessing vitamin D status in post renal transplant patients at St. Paul’s Hospital (SPH), who are at risk of vitamin D deficiency. Currently, it is not known if patients are obtaining sufficient vitamin D through diet and supplementation, which further increases patients’ risk for bone loss and fracture. Christine says, “We hope that this project will fill a knowledge gap and allow us to re-evaluate clinical practice to improve and expand treatment options for kidney transplant patients. Our team is thrilled to have the opportunity to participate in a project that will build our research skills, while addressing a real issue that patients care about.”

Principal investigator: Christina Adair

Co-investigators: Erin Waters, Chelsea Bruce, Simran Dukhia, Vanessa Lewis, and Clare Bannon

Patient Partner: Katrina McAndrew