Transplant Digest

Spring/Summer 2015, Issue No. 18

In this issue ...40 Year Anniversary of a Living Donor Transplant

From the Editor’s Desk

Contact Information

Kidney Stones and Shock Wave Lithotripsy

An Introduction to the Immune System

Are you Thinking of Travelling? Have you heard of Chikungunya?

Dental Care After a Transplant

Transferring Care

Post Transplant Chat: Leg Swelling

An Insider’s Guide to your Pharmacy: How to get the most out of your visit

New and Improved Canadian Transplant Registry Launched

Blood Tests After Transplant

Dr. Norman Struthers, In Memoriam

TRANSPLANT DIGESTSPRING/SUMMER 2015, Issue No.18

The only anti-rejection drugs available in 1975 were Imuran and high doses of Prednisone. Tillie mused whether she needed the transplant drugs, but “did not want to tempt fate by stopping them!” Because of the high doses of the Prednisone she received, she had to have both her hips and shoulders replaced.

In spite of this Tillie was able to continue working in the shipping office at General Electric. Since she retired she focused on her passion for sewing and has enjoyed traveling with friends. In 1999 she moved to London to be closer to her family and receives her follow up care now at London Health Sciences Centre.

Ervin was 32 years old and recently married with two small children when he donated his kidney. There were seven siblings and they were all tested as donors for Tillie. Ervin and another sibling Olga were the closest matches and it was decided that Ervin would proceed as the donor. Five of those seven siblings are still alive and stay in close contact with one another. Ervin is now seventy two and enjoying retirement with his wife, Dianne. He told me “kidney donation was a no brainer and he was glad he was able to help his sister.”

Tillie and Erwin were part of a cohort of brave “pioneers” who forged the way for those who followed when the success rates for kidney transplants improved. The St. Michael’s Transplant Program extends a big thank you and congratulations to Tillie and Ervin for sharing this wonderful story.

40 Year Anniversary of a Living Donor Transplant Maureen Connelly, RN, BScN, Living Donor Transplant Coordinator

Transplant patient Tillie Hein has a few reasons to celebrate. She just celebrated with her family two wonderful milestones: her 82nd birthday and 40 years with a transplant from her brother Ervin Hein. I caught up with Tillie and Ervin to reminisce with them about their experience.

Tillie was 17 years old when she first started to experience difficulties with her kidneys. She had recurrent kidney stones complicated by infections that necessitated removal of one of her kidneys and then insertion of a special tube into her remaining kidney called a nephrostomy tube. She went to work and carried on with life with this tube in her kidney for a number of years. By the time she was 42; she had to start dialysis but only had dialysis treatment for eight months before receiving her brother’s kidney.

Ervin Hein & Tillie Hein

2

A lot has changed since 1975 in pre and post-transplant care and living kidney donation.

If Tillie received her pre-transplant and transplant care in 2015 versus 1975, she would:

• Receive lithotripsy to blast her kidney stones. See Dr. Honey’s profile about his lithotripsy work in the Lithotripsy Clinic on page 4.

• Receive pre-dialysis care from a multi-disciplinary health care team in a kidney care clinic.

• May have her living donor transplant before starting dialysis.

• Be in hospital for a week after her transplant versus six weeks in hospital in isolation.

• Receive a much lower dose of Prednisone that would be easier on her bones.

• Receive tailored dosing of immunosuppressive drugs that have passed rigorous clinical drug trials.

If Erwin donated his kidney in 2015 instead of 1975 he would:

• Be one of 6-8 living donors who donate their kidneys monthly versus one of three per year.

• Meet with a multidisciplinary team of health professionals to support and assist him with his donor evaluation.

• Have laparoscopic or “keyhole” surgery with much smaller incisions.

(In 2000, St. Michael’s Hospital was the first hospital in Ontario and the second in Canada to perform laparoscopic or “keyhole” surgery. Our expert team of surgeons performs this surgery. This allows for a faster recovery, shorter hospital stay and earlier return to work)

•Be in hospital for 3-4 days versus a week.

•Be able to return to work in 4-6 weeks versus 8-12 weeks.

• Participate in Canadian Blood Services kidney paired donation program if he was not a match for his sister by blood type or immune system compatibility. (www.blood.ca/organsandtissues)

(Canadian Blood Services manages the Kidney Paired Donation Registry and works in partnership with Canada’s kidney transplant community-giving incompatible living donors another way to help an individual receive a kidney transplant. Since inception through 2013, the KPD Program has resulted in 218 transplants of candidates registered with the program, as well as 53 transplants of patients who were on local kidney waitlists for a total of 271 transplants)

•Receive financial assistance to offset his expenses for his travel to the hospital and time away from work.

Tillie Hein & Ervin Hein, December 1975

Tillie Hein & Ervin Hein, February 2013

3

St. Michael’s HospitalRenal Transplant Program(across the hospital)61 Queen Street 9th Floor Toronto, Ontario, M5C 2T2 Phone: (416) 867-3665

Please send your comments or sugges-tions of topics for future publication to:jayomam@smh.ca

Disclaimer Note:Views presented in this newsletter are those of the writers and do not necessarily reflect those of St. Michael’s Hospital or the University of Toronto. Subject matter should not be construed as specific medical advice and may not be relevant to individual patient circumstances. For all questions related to your own health please contact your health care provider.

Contact InformationDr. Ramesh Prasad – EditorMeriam Jayoma-Austria, RN, CNeph(C) – Newsletter Coordinator

Being busy is a part of life. There is so much for us to do, every single day. Even waking up in the morning and getting the body in good enough shape to leave the house takes a bigger effort than many of us realize. There may be as many as 100 different tasks! We think a lot about those parts of the body that we and others can see, and not so much about the others. The kidney is a bit of both. We can’t see our kidneys, but seeing urine every day reminds us of their presence, and after a transplant, each drop of urine that we see should remind us of that precious gift of life. The kidney needs to be taken care of too.

As usual, we have strived to create for you a variety of topics for this Spring/Summer 2015 issue of Transplant Digest. We discuss your relationship with your health care provider in terms you may have never thought about. There are articles about how to get the most out of your pharmacy visit, and post-transplant dental care. Our news section covers the “new and improved” Canadian Transplant Registry, while our ever-popular Post-Transplant Chat discusses leg swelling. There is a discussion about what the “immune system” is all about. We celebrate the long-term success of a living donor transplant, and provide tribute to one of our pioneering surgeons. Comments and suggestions, as well as submissions are always welcome.

Dr. Ramesh Prasad, Editor

From the Editor’s Desk

4

Kidney Stones and Shock Wave Lithotripsy

Prior to the 1980’s an open surgical procedure, through a long flank incision was required for the removal of any symptomatic kidney stone. In 1981, Dr. John Honey from the Division of Urology at St. Michael’s Hospital, performed the first percutaneous stone removal in Canada. In this procedure, called percutaneous nephrolithotomy (PCNL), the stone is fragmented with ultrasound and removed through a small 1 cm incision in the back. This minimally invasive procedure is still performed in centres around the world and is recommended for larger and complex stones. Dr. Honey along with Dr. Kenneth Pace have an accredited fellowship program at St. Michael’s Hospital where they teach this and other minimally invasive endoscopic procedures for the removal of stones.

For small stones, mainly in the ureter where they cause obstruction and pain, ureteroscopy and laser lithotripsy can be performed. In this procedure a tiny 2.5 mm diameter scope is passed up the ureter, via the bladder, and stones are fragmented using a Holmium laser. Dr. Honey also developed the first atraumatic flexible stone retrieval basket which allows urologists to remove stones from the ureter and the kidney with miniature flexible scopes. He has taught this technique to urologists from around the world at his Hands-on Courses at the

American Urological Association’s Annual Meetings.

A new era in stone treatment was also introduced in the early 1980’s with the development of Extracorporeal Shock Wave Lithotripsy (ESWL). This is a non-invasive treatment, using a focused shock

“Dr. John Honey is an icon in the history of urological surgery at St. Michael’s Hospital and the University of Toronto. He has always had a special interest in kidney transplantation and, as head of the

division of urology, made sure that St. Michael’s was at the forefront in surgical innovation for this life saving procedure. His warm and

friendly demeanor is well known and loved, and his aggressive advocacy for his patients is legendary. We are fortunate that he

chose St. Michael’s as his professional home. “

Dr. Bob HowardPresident & Chief Executive Officer

St. Michael’s HospitalToronto, Canada

Dr. John Honey

5

wave generated under water, for medium size and smaller stones in the kidney or ureter. This procedure is performed under intravenous sedation and fragments stones down to particles of 2 mm or less that can pass without pain.

In 1987 Dr. Honey was involved with opening the first Lithotripsy Unit in Ontario. This was initially located at the Wellesley Central Hospital prior to its merger with St. Michael’s. In 2001, Dr. Honey, Director of Lithotripsy and The St. Michael’s Hospital Kidney Stone Centre, was instrumental in transferring the Lithotripsy Unit over to St. Michael’s. This is now one of the highest volume lithotripsy units in the world, treating over 2,800 patients per year. Research studies done through this unit have changed the way shock wave lithotripsy is practiced worldwide. In 2005, Dr. Honey and his team published the results of a study that demonstrated improved stone fragmentation at a slower shock wave rate (“Shock wave lithotripsy at 60 or 120 Shocks per minute: A randomized, double-blind trial”). This practice has since been adopted by the majority of lithotripsy centres around the world.

TransplantationDr. Honey’s interest in Kidney Transplantation goes back to 1966 when he was a medical student at Cambridge University in England. A school friend had developed kidney failure and had one of the earlier kidney transplants performed by a pioneer in the field, Sir Ray Calne. Dr. Honey was fortunate enough to visit Professor Calne and watch a transplant that same year. He was then involved with kidney transplantation as a resident in training and returned to work with Professor Calne 15 years later, during his fellowship. On this occasion it was to learn the technique of kidney-pancreas transplantation for patients with kidney failure and diabetes. Dr. Honey has now been performing and teaching kidney transplantation to residents and fellows for almost 35 years.

In 2000 when Dr. Honey was Head of the Division of Urology, laparoscopic donor nephrectomy was introduced to replace the previous open surgical procedure which was performed through a large flank incision. This minimally invasive procedure has significantly reduced the morbidity of the surgery and has allowed patients to go home 3 to 4 days after surgery and return to work 2 to 4 weeks later. St. Michael’s Hospital now performs up to 40 live donor transplants out of a total of about 150 kidney transplants each year.

Dr.Honey in the Kidney Stone Centre demonstrating the Holmium Laser

6

You will hear the term “immune system” many times during your transplant journey. This is a medical term that can be both vague and ambiguous. The first time you will hear about it is during your pre-transplant assessment. You may remember being told about how anti-rejection drugs “suppress the immune system” and how this can lead to some types of complications after the transplant. At the time of the transplant, you will find that “anti-rejection drugs” and “immunosuppressive drugs” are terms used interchangeably. So you quickly realize that the success of the transplant depends on, most of all, how your immune system is acting. If it is overactive, you can reject the transplant, and if it is underactive, you experience infections, cancers, and the like.

So what exactly is the immune system? With your permission, let’s go “medical” for a while. The immune system refers to a group of specific organs including the bone marrow, thymus, spleen, and lymph nodes, along with a circulation system that consists of the lymphatic system and blood system. It also contains many types of white blood cells (called immune cells), their molecules such as cytokines, and complement proteins. The immune system is a biological term used by immunologists and clinicians to denote the physical entities that perform the functions involved in immunity, such as the immune reaction and immune response. Wow! So basically, the immune “system” is all these body parts that are responsible for the immune reaction and immune response. So now, we need to know what these two are.

The immune reaction is the biochemical interaction between an immune receptor and its ligand. This means any interaction between a receptor on any cell that is part of the immune system and what this receptor binds to, in order to carry out its function. The immune reaction is a normal phenomenon that is always occurring and is essential to health. We are all alive today because we have an immune system that is always immune reacting.

The immune response is the result of activation of an immune cell typically leading to increased cell numbers and types. Depending on the type of cell involved, the end result of the immune response may be either destruction of the target, or inhibition of that destruction. Therefore, an immune response is preceded by an immune reaction, but not every immune reaction leads to an immune response. Put simply, the immune response is what happens when the immune reaction is turned up in response to something that excites it. Without an immune response, we wouldn’t be able to survive in an external environment, and our own body environment would not be organized enough for us to stay alive.

There is one last introductory point about the immune system. There are two kinds of immunity: “innate” and “adaptive”. Innate immunity is what you are born with, as a product of evolution. It is needed to repair your damaged tissues, as well as protect against invaders. Its memory is short, and so the response tends to be the same each time. Once the body has been exposed to an unwanted cell, it learns to deal with it more effectively, the next time it is encountered. Special cells are produced in greater numbers, so the next time the immune response becomes much more effective. This is adaptive immunity.

In future issues, we’ll discuss some of the types of cells in your body that are part of the immune system, and how and why we use some of the common anti-rejection drugs in kidney transplantation.

Reference: Pradeu T, The Limits of the Self. Oxford University Press, 2012.

An Introduction to the Immune SystemDr. Ramesh Prasad

7

Chikungunya is a virus that is transmitted to humans by mosquito bites. It usually causes fever and joint pains. There is no vaccine or medicine to prevent it. Chikungunya occurs in over 60 countries across Africa, Asia, the Caribbean and the Indian subcontinent. Symptoms usually appear 4 to 8 days after a mosquito bite, but may take longer. It usually starts with fever and joint pain. Other symptoms may include rash, muscle pain, headache, nausea, and fatigue. The joint pain can be very debilitating, and may last days or weeks. Complications are uncommon, but can happen in infants, older people, or those with weakened immune symptoms like kidney transplant recipients.

If you think you may have chikungunya, see a health care provider. There is no cure for chikungunya. Treatment involves relieving the symptoms with medications to treat the pain, and fluids. Remember that it is not a good idea for kidney transplant patients to take anti-inflammatory

medicines (sometimes called NSAIDs) because they can damage your transplanted kidney. Tell your healthcare provider about all the medicines you are taking.

The mosquitoes that carry chikungunya usually bite during the daytime. Be sure to wear mosquito repellent at all times. You can also cover up with light-coloured long sleeved pants and shirts. Make sure there are screens on your windows when you are sleeping, or sleep under a mosquito net.

We recommend you visit a Travel Health Clinic at least 6 weeks before your trip, to find out more information about your destination. You can also visit the Government of Canada’s website:

http://travel.gc.ca/travelling

or the World Health Organization:

http://www.who.int/mediacentre/factsheets/fs327/en/

Are you thinking of travelling? Have you heard of Chikungunya?Sarah Mattok, RN

8

Dental Care after a Transplant

One of the most common questions we get from patients after their transplant is what should be done at the time of their visit to the dentist. Common procedures include routine cleaning, dental extractions or root canal procedures, and more complicated surgeries. The biggest concern is obviously the spread of infection through the rest of the body, since the oral cavity is full of germs and these could spread when there is cutting and scraping going on. This spread could be more rapid when anti-rejection drugs are being used to suppress the immune system. In rare instances,

the heart valves could become infected and lead to serious complications, particularly if you have had trouble with your heart valves before.

A common approach is to prevent these infections with antibiotics. The decision about using antibiotics will always be with your dentist. If your dentist’s office calls us, we can send them a list of your current medications. But generally speaking, the indications for antibiotics in transplant patients are no different from those for anybody else. If the dentist was not planning on prescribing a antibiotic, this does

not usually change because you have a transplant. Keep in mind, however, that if an antibiotic is prescribed, the dose may need to be adjusted based on your level of kidney function. Also, certain antibiotics (such as clarithromycin and erythromycin) have serious interactions with anti-rejection drugs. If you have been prescribed an antibiotic, please check with your pharmacist or the Transplant clinic. It may be preferable to avoid elective dental procedures for the first few months after a transplant when your anti-rejection drug doses are highest, but you should never defer urgent care.

9

Transferring CareDr. Ramesh Prasad

Sometimes patients wish to transfer their care, either because they are moving to another city, just find the commute downtown to be too difficult, or have fallen out with the Transplant Team. Since this can be a very delicate and difficult topic to discuss, we’ll just tackle it “head on”.

It’s important to realize that among kidney health care providers, some specialize in transplantation and others in dialysis. Many patients have come to St. Michael’s for a transplant from another hospital where they received dialysis. Most patients stay at St. Michael’s after their transplant. However, many of the issues that you dealt with before starting dialysis are the same as after the transplant, and can be handled by both dialysis and transplant nephrologists. It is therefore possible for you to maintain an ongoing relationship with your dialysis nephrologist if you wish, and if your nephrologist wishes to help with your care, while still coming to the Transplant Clinic for transplant-specific issues at the same time. In most cases, ongoing communication between your nephrologist and the Transplant Clinic is possible. However, it is advisable not to “split” your care among too many providers, since taking care of your needs in an urgent or emergency situation will be more difficult if your medical chart is incomplete at every place you go. Some patients have all their care at their original hospital, and are sent here only for emergencies. If you wish to enter this type of model for your care, speak with the Transplant Team at your next clinic visit.

Another situation that can lead to a clinic change is when your transplant is failing. In that case, where you will be followed after you return to dialysis becomes important. It is much easier to be seen in a pre-dialysis clinic in the hospital where you will be starting dialysis, and then transfer to dialysis there, rather than start dialysis at the Transplant Centre

and then apply for a transfer. You may get stuck with a long and difficult commute for a while. Even after you transfer, you can still come to the Transplant Clinic for transplant-related advice. Being seen in a pre-dialysis clinic doesn’t mean we are giving up on the kidney.

Finally, some patients may wish to transfer their entire care to another Transplant Centre. This can be easily facilitated if you are moving to a major city with a Transplant Centre, but if you are moving to a small town, it may be more difficult. Our social worker may be able to offer some useful advice in this situation. Conversely, when a transplant patient moves to Toronto, we are quite happy to accept them into the next available clinic. We also are able to collaborate with other Transplant Centres if they are involved in a research protocol at the other centre, and many of our research patients can be followed at other centres.

What about when patients are on vacation? While we can try to respond to inquiries and communicate with you while you are away, the Transplant Clinic cannot be responsible for your medical care while you are there. You must be seen and treated by a local health care provider until you come back. Sometimes medical records can be transferred and phone calls made, but this process can be unreliable and so you should not depend on it. If you choose to have bloodwork or other tests elsewhere, it is your responsibility to ensure that we receive these reports.

In all cases, we strongly encourage everyone to stay at our Transplant Centre for at least the first year after the transplant. We are of course absolutely delighted if you continue to receive your care through us, for as long as you have the transplant.

10

Post Transplant Chat - Leg SwellingFernanda Shamy, RN, Jenny Huckle, RN, Sarah Mattok, RN, Michelle Gabriel, RN, Kevin Bradley, RN

1. I’ve just had my transplant. Now my legs look swollen. Is this common?

Yes, it is common to have swollen legs after a transplant. This is called “edema”. Most patients receive an extra 3-4 litres of fluid during and after the operation, which is generally good for the kidney. Some patients get more because the blood pressure was low, they also have heart trouble, or the new kidney didn’t work well right away and so the fluid accumulates. Your new kidney will slowly get rid of the extra fluid. If you still need dialysis, which happens sometimes, you are likely to have swollen legs. Sometimes the scrotum is swollen, and in the most severe cases, there is water in the lungs as well.

2. When I have swelling, my weight is usually checked. How are leg swelling and body weight related?

Extra water in your body will make you weigh more. If you have extra water, your weight may go up by about 5 kg before you actually see swelling in your legs. Since 1 litre of water weighs 1kg, it is simple to calculate how much extra fluid you have based on your weight. So you should always remember what your ‘dry weight” was before the transplant, keeping in mind this may actually be lower after the transplant because you would have lost some tissue weight as well. As you begin to lose the extra fluid, measuring your weight will help assess how much you are losing and at what rate, since we can’t measure the amount of fluid in your body directly.

3. Why is my blood pressure important to know when I have leg or ankle swelling?

Leg swelling is usually a sign you have extra water, and more importantly, extra salt in your body. Extra salt can make your blood pressure go higher. Over time, high blood pressure can harm your kidney and other organs. It is also possible to have extra water in your body without extra salt, or a bad infection concurrently, in which case your blood pressure might actually be low.

4. Why is my urine checked if I have leg swelling?

Swelling in your legs may be a sign that your kidney is spilling extra protein, particularly if it has been some time since your transplant. This could indicate kidney damage. Checking your urine will show if this is the case, since a biopsy may then be required. Sometimes the salts in the urine are measured to see if you have too much or too little salt in your body.

5. Do I need to change my diet?

As part of a healthy diet, you should always avoid too much salt in your diet, since this can cause leg swelling and high blood pressure. Your doctor and dietician will give advice on the proper diet for you. Don’t be surprised if these recommendations change from one visit to the next since many factors like your blood test results are also taken into account when giving specific advice.

11

6. Does it make a difference if one leg or both legs are swollen?

Yes, it does! There are many possible reasons why one leg may be swollen, including poor circulation or blood clots. It is important that you

contact a health care provider if one or both of your legs are newly swollen. If you’ve had a vein from one leg removed in the past for heart bypass surgery, you may have more swelling on that side. Many patients also note more swelling on the side of their transplant.

7. I’ve been told some medications can cause leg swelling. Is this true? Do water pills (diuretics) help leg swelling?

It is true that some medications can cause leg swelling. A good example is a class of blood pressure medication called calcium channel blockers. Talk to your health care team to find out if any of your medicines can be changed to help reduce the swelling. Water pills may help with swelling, depending on what is causing it. Water pills are not always the solution though. Remember, many water pills are actually salt-removing pills. Water pills might be harmful

if your blood pressure is low or your kidney doesn’t get enough fluid supply as a result.

8. Is it normal for the legs to hurt when they are swollen? If they suddenly start hurting, what should I do?

There may be mild discomfort with leg swelling. However, if you develop sudden, severe pain, go to your nearest emergency department. Leg swelling can be associated

with complications like blood clots and infection, or swelling can co-exist with conditions like gout.

9. Do I need an ultrasound or X-ray if my legs are swollen?

It may be necessary to do a Doppler ultrasound or x-ray of your legs to help find the cause of the swelling. This decision will be made by your family doctor, in the Transplant Clinic or in

an Emergency Room.

10. When should I go to the Emergency Room?

You should go to the Emergency Room if you have sudden pain in your leg, or your leg is red or warm to touch. If you are not passing any urine, it is important that you be seen as soon as possible. Some causes of leg swelling can also lead to serious lung and heart complications. If you develop sudden shortness of breath, coughing, or chest pain, call 911.

Post Transplant Chat - Leg SwellingFernanda Shamy, RN, Jenny Huckle, RN, Sarah Mattok, RN, Michelle Gabriel, RN, Kevin Bradley, RN

12

Taking medications is one of the most essential aspects of taking care of your health after kidney transplant. This means you are probably quite familiar with visiting your local pharmacy regularly. Here are some insider tips (from a pharmacist!) on how to get the most from your visits.

Choose your pharmacy wisely.Pharmacies are not simply stores where you buy medicines. As health care professionals, pharmacists have an obligation to always put your health needs first and foremost. They stand as the last line of defense against you taking a medication that is unsuitable for you. Ask yourself:

• Does the pharmacist take the time to explain medications and answer my questions?• Does the pharmacist contact the doctor to review if there is a concern about a

prescription? • Does the pharmacy go the extra mile to make sure I can get my medicine if it is not

immediately available?• Do you feel you can trust the pharmacist with your health care concerns?If so, you have found yourself a great pharmacy! However, if the pharmacy is more concerned with the business instead of your health, it may be time to consider taking your prescriptions elsewhere.

If understanding English is challenging for you, you may consider going to a pharmacy where the staff speak your own language. The pharmacist can explain medications to you and even label your pill bottles in the language you understand.

Talk to your pharmacist.Most pharmacies provide a medication printout with your prescription. Sometimes, you may decide to just read this printout at home to understand your medication. However, not all the information on the printout applies to all patients. It may be confusing – or even frightening – to try to make sense of what information you actually need to know. The pharmacist can explain how the medication works in a way that is tailored just to you. He or she will tell you how the medication will help you, what the most common side effects are, what to do if side effects happen and how to combine it with the rest of your medications. Even if the doctor or nurse has gone through the medication already at your clinic visit, it can be helpful to review it again to make sure you completely understand all the instructions.

Schedule a yearly medication review session with your pharmacist. In Ontario, all pharmacies provide a program called MedsCheck where you can have a 30 minute appointment to review all your medicines one-on-one with a pharmacist. It is free with your OHIP card. You will need to bring all your medicines (including nonprescription ones like vitamins or supplements) to show the pharmacist. At the end of the appointment, the pharmacist will let you know if you are taking your medicines correctly and give you a printout of a medication schedule. This medication schedule can also serve as a medication list for you to bring to all doctors’ appointments.

Fill all your prescriptions at the same pharmacy.Anti-rejection medicines, especially, are very likely to interact with other medications in dangerous ways. Examples include certain gout medicines, common antibiotics, anti-seizure medicines, certain painkillers, and some over-the-counter supplements. Due to privacy laws, pharmacies do not share records with each other, even if they are from the same chain. It is important to bring all prescriptions only to one pharmacy where they have records on your medications, medical history and allergies. This way, dangerous interactions can be caught before you actually take them.

Some special medicines, like cyclosporine, Aranesp® and Eprex®, can only be obtained from the St. Michael’s hospital pharmacy. In this case, you should inform your local pharmacy that you are also taking these medicines.

Get a flu vaccine every year.As a patient with weakened immunity, it is very important to get a flu shot every year in the fall. We know that family doctors’ offices can get especially busy around this time of year. So if you cannot get the flu shot from your family doctor, you can walk in to any pharmacy and the pharmacist will provide the flu shot after going through a brief health questionnaire.

An insider’s guide to your pharmacy: How to get the most out of your visitLucy Chen, PharmD

13

New and Improved Canadian Transplant Registry (CTR 2.0) LaunchedLiving Donor Paired Exchange name change implementedGalo Meliton, RN, CNeph (C), Senior News Correspondent

In keeping with providing consistent and excellent patient and customer service, the Canadian Blood Services (CBS) has launched a new and improved Canadian Tranplant Registry. Part of the launch is also a name change of the Living Donor Paired Exchange (LDPE) registry to Kidney Paired Donation (KDP). “The new name provides a more concise reflection of the registry”, says Dr. Zaltzman, Medical Director of the Renal Transplant Program at St. Michaels’ Hospital. The LDPE was created for potential kidney recipient and donor pairs who are either blood group incompatible or the recipient has identified pre-formed antibodies against their intended donor. This new registry has amalgamated the KPD with the Highly Sensitized Patient National Organ Waitlist (HSPNOW), and as the name implies, this registry would be for those potential kidney recipients on local wait lists who have antibody counts that are so high (95% or higher), it would be difficult to find them a kidney from their local region, hence the national registry. CBS’s plan is to have the HSP fully operational by Phase 3 of this project delivery. Phase 1 being the launch of the new KPD registry, and Phase 2 will focus on its enhancements by late 2015.

Prior to the launch of this new registry, a 4- hour training session was provided by experts from CBS to the Transplant Coordinators, Laboratory Staff, Clerical Assistants and their Managers over several days across

the country. Experts from CBS were at the training session by phone to answer any questions the trainees had in real time; John Harkins, Program Manager at the CBS, was at the session I attended. “I was very impressed with what I saw”, said Jonathan Fetros, Clinical Leader and Manager of the Renal Transplant Clinic at St. Michael’s Hospital.

A needs assessment was done by the CBS several months ago across the country amongst transplant centers across the country in order to ensure that the new registry reflects what the frontline users would want to see to tackle the ever growing patient population in the registry. The new registry features some exciting new features including a dashboard, task management, system generated notifications and much more. It is very user friendly.

Part of the training session was providing the trainees the program’s successes, milestones and achievements in the former LDPE program as of February 15, 2015. They include: 719 pairs registered, 181 pairs participating in the last match cycle prior to the training session, 21 match cycles have been performed, there have been 13 pediatric recipients, 100 chains, and 115 blood group O recipients (note

that the universal donor is blood group O and recipient O is therefore harder to match). An

impressive total of 328 transplants have been completed since the program launch in 2009.

14

After your transplant, you will need to do blood tests to monitor your kidney health. In the first month, you must have these done twice a week at St. Michael’s Hospital. We get these results the same day, so if there are any problems we can address them quickly.

After the first month, you can usually do your blood tests at a lab closer to your home. If you are no longer on dialysis, it is best to go to a lab outside a hospital. Some labs have an online appointment booking system, to help decrease your waiting time. Please ask us for some options.

Blood tests after transplant

Dr. Norman Struthers

Dr. Norman Struthers, In MemoriamKenneth Pace, MD, MSc, FRCSC, Head, Division of Urology

Dr. Struthers was a pioneering urologist at St Michael’s Hospital. After a long and full life Dr. Norman Struthers passed away on March 21, at the age of 87. He will be fondly remembered by all who worked with him as a kind, caring and always cheerful urologist who also served as head of the Division of Urology. He left a lasting impression with his patients, here at the hospital and with the many students and residents who trained under him. He will be sorely missed.

15

NOTES

Funding for this publication provided by Hoffmann-La Roche Limited