Returning to life after organ transplant rehab

After years of struggling with a deteriorating liver, Charles Cannarella was eager to embark upon a path of recovery and good health. The 42-year-old arrived at St. John’s Rehab Hospital in February 2009 after successfully undergoing liver transplant surgery. “I had just received the gift of life and could finally start feeling healthy again, but I needed a lot of help to get me there.”

Charles waited two years for a liver donor to become available before he underwent liver transplant surgery at Toronto General Hospital. He was then referred to the St. John’s Rehab organ transplant rehab program.

Launched in 2004, the program is the only dedicated specialized organ transplant rehabilitation program in Canada. Developed in partnership with the Multi-Organ Transplant team at the University Health Network’s Toronto General Hospital, the program provides intensive rehabilitation to adults who have undergone heart, lung, kidney, liver and other transplants. A continuum of care includes inpatient rehab and outpatient services.

Organ transplant operations are major surgeries that require time for physical and emotional recovery. Patients can be susceptible to numerous health complications due to their fragile immune systems. A recent research study by members of the St. John’s Rehab organ transplant team showed that many organ transplant patients continued to experience significant health problems within the first two months following transplant surgery. The problems include edema, poor balance, weakness, incontinence, poor wound healing and dependence on medication. Providing rehabilitation care helped patients overcome these health issues.

In Charles’ case, he was unable to walk or function independently. He struggled with pneumonia and felt severely weak and fatigued. But, with the support of an interdisciplinary team of rehab professionals including physiotherapists, occupational therapists, physicians, nurses, dieticians and social workers, Charles achieved his goal of walking and regaining strength and independence.

The St. John’s Rehab organ transplant program is customized to help patients maximize their independence, mobility and endurance. The interdisciplinary team focuses on each patient’s individual goals, and supports their physical, social, emotional and psychological needs. Janice Tsui, a physiotherapist working with Charles explains: “For every patient, we provide an intensive program of therapy, education and support. But since every patient is different, we tailor it to the individual’s needs.”

The organ transplant rehab team emphasizes self-care and independence. “This program provides patients with the supports they need to successfully return to their daily activities, families, and the community,” says Dr. Robert Riddle, Hospitalist Physician for the organ transplant rehab program.

According to the St. John’s Rehab organ transplant rehab study, the five-year-old program is showing impressive success rates. Patients showed up to a 91 per cent improvement in mobility, and at discharge, over 80 per cent of the patients demonstrated improvements in self-care, functional ability, locomotion, communication and cognition.

Dr. John Patcai, specialist in Physical Medicine and Rehabilitation explains, “In terms of improving function, the outcomes of our transplant patients are as good as those for our other rehab patient groups. The program also helps free up acute-care transplant beds, thereby improving patient flow through the system.”

Darlene Wright, a nurse and mother of three, has successfully returned home to her family following liver transplant surgery and rehabilitation at St. John’s Rehab Hospital. Although Darlene’s liver transplant surgery was successful, she faced numerous health problems following the surgery. She accumulated 50 pounds of excess fluid and was unable to walk due to weakened muscles. However, by the time she left the program, she was able to walk, and even run up stairs. “The improvement in my health and independence is astonishing. I am back at home with my children and will soon be returning to full-time work,” she says.

Recent reports by the Canadian Institute of Health Information (CIHI) showing the increasing numbers of organ transplant surgeries and survival rates, further underscore the crucial importance of rehabilitation following transplant surgery. According to CIHI, the total number of solid organ transplants in Canada increased from 1,620 to 2,087 in 2006. Liver transplants increased by 33 per cent in 2006, and the rate of lung transplants saw a particularly dramatic increase of 84 per cent from 1997 to 2006. Survival rates of organ transplants also continue to improve, with the rate for lung transplant recipients reaching 80 per cent in 2003.

Charles easily walks the length of the parallel bars the day before he is scheduled to return home. He looks forward to resuming his career as a cook. “My health has improved tremendously. I can walk, I feel more independent, and most importantly, I have a more positive outlook on life. St. John’s Rehab truly helped me get my life back.”