Centre of Excellence provides PROOF that research benefits heart transplant recipients

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In 2008, when Jane Miller began experiencing flu-like symptoms, she couldn’t have predicted what was to follow. Within days the mother of two slipped into a coma and awakened a month later in the Cardiac Intensive Care Unit at St. Paul’s Hospital in Vancouver. She had suffered acute heart failure caused by myocarditis – a virus that attacks the heart.

Jane was put on a ventricular assist device (VAD) to help her heart pump the blood through her body while she waited for a heart transplant. VADs are used in critically ill heart failure patients to keep them alive until they can receive a heart transplant and allows them to live at home and even return to work while they wait for a new heart. The BC Acute Heart Failure Program, part of the provincial Heart Centre at St. Paul’s Hospital, is a national leader in VAD implants, and the biggest and busiest of its kind in Canada.

“If it wasn’t for the VAD and the doctors at St. Paul’s Hospital, I wouldn’t be alive right now,” says Jane.

While waiting for a new heart, Jane attended a support group of other VAD patients and staff from the Heart Centre at St. Paul’s. Living with a VAD takes time to get used to and requires some lifestyle adjustments. Each month the group would come together to discuss new issues such as traveling, nutrition and managing moods.

Jane also became involved with Biomarkers in Transplantation (BiT), a program led by University of British Columbia Professors Paul Keown, Bruce McManus, Rob McMaster, and Raymond Ng in collaboration with the Centre of Excellence for the Prevention of Organ Failure (PROOF Centre). By participating in BIT, Jane is helping to advance research into new blood tests to help doctors better determine the most appropriate therapy for individual heart failure patients.

Now, nearly two years later Jane has received a new heart and is ecstatic with her new lease on life. However, she still has regular medical follow-ups to ensure that her body doesn’t reject the new organ. Following transplant, a patient must undergo numerous painful biopsies in the year after surgery to inform the doctor if a patient’s body is rejecting their new organ. If this is the case, the patient is treated with large doses of toxic immunosuppressant drugs and must endure more biopsies.

Just a few months after transplant Jane has already undergone several biopsies.

“I wasn’t scared about the transplant,” she recalls, “I was too excited. But I was quite nervous about the biopsy; I didn’t know what to expect.”

Biopsies are painful, invasive and costly procedures – anywhere between five to ten thousand dollars for each procedure in Canada – that an average heart transplant recipient will need to undergo between 14 and 16 times in the first year alone.

Thanks to the research that Jane participates in, a simple blood test may soon be used to diagnose organ rejection – sparing patients the pain and discomfort of biopsies and the health system millions of dollars. The team is running an international study of transplant patients to allow scientists and clinicians to test the biomarker panels (sets of genes and proteins) to identify those that could be used for future blood tests to predict or better diagnose heart disease or organ rejection and reduce the number of biopsies required.

BiT scientists have identified sets of genes and proteins in the blood that can identify acute rejection within the first few weeks after transplantation and chronic rejection after the first year post-transplant. The PROOF Centre hopes to receive regulatory approval in 2011 to start using this blood test in clinics. The Centre is also trying to finalize sets of biomarkers for pre-transplant patients to help determine if a patient would experience organ rejection, allowing doctors to adjust drug therapies as needed.

Jane is one of over 800 patients participating in the BiT project and hopes that the research results will help make the journey for future organ failure patients easier. She sees her involvement in research as a way to give back.

“I am so happy and truly grateful for the transplant, and I realize that it would never have been possible if there was not research done for many years on many different levels,” she says.

For other patients going through a similar experience she encourages them to be really involved in their own health care and to try not to dwell on problems that might arise, instead focusing on the good things that will come.

For Jane, that good thing did come and now she’s ready to take on life with a whole new zeal.

“I’m just so thankful,” she says. “The staff and doctors at St. Paul’s are unbelievable. They saved my life. And after this transplant, I feel so free!”

For more information on the Biomarkers in Transplantation project visit www.proofcentre.ca.