Oriented to Thoracic Transplant Recipients -- November 1997

The UPBEAT! Archive

ORGAN TRANSPLANTS AND REHAB

by Scott Huelskamp

On board, packed in dry ice, safely contained in an insulated container, and watched over closely by a helicopter crew flying almost I, 000 feet above the ground, is a vital piece of cargo. For one of the nearly 53,000 people in the United States who need an organ transplant, this could be their time to cheat death. It is another step in the intricate, complicated procedure of transferring an organ from one body to another- a process that must be planned and orchestrated right down to every last-minute detail.

Transplantation is one of the most complex medical endeavors, yet it has become a common lifesaving solution for patients experiencing end-stage organ failure. If a heart, lung, kidney or liver transplant is going to be successful, everyone must go according to plan. For the teams of surgeons and nurses on the giving and receiving ends at 281 transplant centers in the United States, the transfer must be smooth, without hesitation, without doubts

The urgency of the situation is clear. One-third of the people on the United Network for Organ Sharing (UNOS), the national waiting list, will die before they get their lifesaving transplant.

But if they're lucky enough to get an organ, they have a good shot at making it. In fact, the success rate for heart and liver transplants is between 85 percent to 90 percent. And for kidneys, the figure climbs to between 85;Percent and 95 percent.

As the number of transplants continues to grow, the role and need for rehabilitation professionals grows as well. "Rehab works the best when the patient is motivated to learn and get better. They have a new organ and they' re thinking, 'I'm lucky to be alive,' and they're willing to do whatever it takes to get healthy again," says Milena Matzinger, PT, critical care specialist of Stanford Health Services' heart and lung program in Stanford, Calif., site of the first successful heart transplant in the United States in 1968.

Although rehab doesn't have a bearing on whether a new organ will be accepted or rejected, postsurgical rehab can speed recovery time. In the post-transplant phase, rehab components include assessing progress over time, discovering appropriate levels of exertion, addressing nutritional concerns and overcoming misconceptions that exercise will damage the new organ.

Presurgical rehab can provide a healthy foundation. Pre-transplant rehab involves educating patients, identifying baseline problems, maintaining the body and establishing a structured program that can be continued as soon as possible post-transplant. It plays a"preparatory role in terms of maximizing the patient's functional capacity and minimizing risk," says Robert M. Kotloff, MD, director for advanced lung disease and transplants, University of 'Pennsylvania Medical Center, Philadelphia.

Missing a Golden Opportunity

With organ transplants increasing in frequency-from 12,788 in 1988 to 20,260 in 1996, according to UNOS stats - the population of potential pre- and post-transplant rehab candidates continues to grow. In many cases, though, therapists are being left out of the loop.

Rehab pros should become part of the transplant team, asserts Patricia Painter, Ph.D., by being more involved in the education phase, in post-transplant follow-up and long-term quality of life issues. "We' re not progressing in our need to increase rehabilitation," says Dr. Painter, director of the transplant rehabilitation program at the University- of California, San Francisco.

"Physical therapists are missing the opportunity."

Part of the problem may be a lack of contact with patients, in both the pre and post-transplant phases. With managed care reducing hospital stays to a minimum, rehabilitation is done primarily on an outpatient basis. Surgeons monitor a patient's progress for one or two months to ensure that the organ is accepted, but over the years, quality of life remains a mystery, Dr. Painter says.

"We need to really optimize physical functioning afterwards and physical therapy and exercise physiology have an important role with that. So if we can be proactive as a profession and make sure physicians know what our services could offer and why it's important for these patients, then there are going to be more opportunities for physical therapy to be involved," she says.

MaryJo Modica, RN, MS, BSN. at the Ohio State University Medical Center.. Columbus, Ohio, agrees that rehab professionals should be on the team from the beginning. "We need to develop postop protocols and assess physical therapy needs and risk factors," she says. Having an illness leading to transplantation almost always predisposes people to PT, OT or other forms of rehab, adds Modica, president of the International Transplant Nurses Society.

A Stage of Preparation

Pretransplant rehabilitation means taking a proactive approach, says Ginny Bumgardner, MD, Ph.D., assistant professor of surgery at Ohio State University Medical Center. A pretransplant exercise program serves two purposes: It gives the patient a structured program, which is necessary because patients often don't feel well and find motivation difficult. And it establishes a familiar routine they can continue after surgery when they're physically able. "[Patients] ...need help early on," says Dr Bumgardner. "We're trying to give them the tools to do things themselves. We have to give them motivation."

When a patient's name goes on the lung waiting list at the University of Pennsylvania Medical Center, pretransplant outpatient rehab is mandatory. If a patient, in spite of his best exercise efforts, still becomes bedbound, he is no longer considered viable for transplant. Harsh perhaps, but a patient must be able to withstand the physical toll an impending surgery will take.

Throughout the pretransplant stage. patients continue to mark time. Everyone accepted onto a transplant center's waiting list are registered with UNOS, which maintains a central computer network linking all organ procurement organizations and transplant centers. when a donor organ becomes available, the transplant center or organ procurement organization accesses the UNOS computer, which generates a list of patients ranked according to UNOS policies. Each organ has its own allocation criteria.

Candidates could spend one month or one year in a state of limbo. As such, depression is common, which triggers noncompliance, says Dr. Kotloff. For heart, lung and liver candidates, who can become more debilitated, patients may use their weakness as an excuse not to exercise, and in turn, may make family members back off from pushing therapy. 'There is a tendency to pamper a patient with far advanced disease," Dr. Kotloff admits.

Yet, therapists must strike a balance between making patients do too much or making them do too little. 'You do want to caution against pushing them too quickly and doing too much too fast, "which can breed frustration if positive results aren't accomplished, adds Dr. Kotloff'.

Despite the cautions, building an aerobic component is critical. Even though an organ is failing, exercise strengthens the surrounding muscular, vascular and pulmonary systems which puts the patient in better position to resume rehab more quickly after transplant. "Even though they have a sick heart, they have a healthy vascular system, and we try to make it a better system," says Matzinger.

Matzinger makes a parallel between two former heart patients at Stanford. One patient, bedridden six Weeks prior to transplant, took four weeks postsurgery just to get out of bed and walk to the bathroom. Another man, who regularly walked and played golf, was fully ambulatory within seven days of receiving his new heart.

Aside from producing known physiological effects, exercise also decreases the stress patients experience, particularly at a time when much of their life is out of their control, says Dr. Painter, who started the kidney rehab program at UCSF in 1989. The program has since expanded to include all transplant patients.

For instance, patients may be plagued with anxiety-provoking questions: How quickly is my organ failing? Will I get an organ? What's going to happen? Am I going to die? Exercising is the one variable a patient can control. "Exercise reduces stress," Dr. Painter says. "When you have a chronic illness, so much is going on around you and so much is happening that you feel out of control."

To give patients control and to address the nurturing side of rehab, the program at the University of Pennsylvania mixes pre- and post transplant patients. The pretransplant patients, who go through a treadmill workout set at 1 m.p.h. and wear an oxygen mask, get to see the tremendous strides made by the post-transplant group, who are cruising on the treadmill at 3 m.p.h. without a mask.

Post-Transplant Rehab

If the initial transplant procedure goes smoothly, patients can be ambulatory as soon as two days post transplant. Within two to three weeks, most patients can be in a structured, outpatient exercise program of stretching, strengthening and conditioning three times a week. Liver, heart and lung recipients tend to be more debilitated from the progressive effects of longer illness prior to transplant, and consequently require longer recovery periods.

"The task now is getting the rest of the body to catch up with this new organ. The body must still recover from months, or even years, of debilitating illness," Dr. Kotloff says.

Post-transplant rehab ambulatory techniques begin as soon as the patient's feet hit the floor. In some situations, ambulation begins with sitting up in bed and moving to a chair. When the patient becomes stronger, he can walk short distances, take longer walks or go up a ramp. The theory is that as soon as people can walk, they should be doing some form of rehab, even if it means standing with chest tubes still in or walking around wheeling multiple IVs. Even slow-to-recover, bedridden patients should be doing minor muscle strengthening with range of motion activities.

Post-transplant rehab typically focuses on the lower extremities, due to the tenuous condition of the upper extremity chest cavity. As such, patients must be careful not to tear sutures and are restricted from pushing, pulling or lifting more than 5 pounds for at least six weeks.

Fear of damaging their new addition makes many patients shy of activity, anyway, experts say. Family members also reinforce that notion with the"take it easy, I'll take care of everything" mentality, says Dr. Painter.
Stanford's Margaret Dougherty, MS, OTR, changes that mentality by instilling confidence and putting fears to rest. "We spend time talking about the advantages of getting up and around to increase strength, and try to convince them that they should walk to the sink to brush their teeth instead of having the nurse do it for them," says Dougherty. "It' s very important that they take responsibility for the situation they are in right now."

It is a fear that was reinforced prior to surgery, she adds." They are used to being out of energy. They've been sick for so long that they couldn't do anything, and if they did do something, they'd be tired the rest of the day."

Therapists typically don't have this problem with children, who are active anyway. Plus, kids usually don't have pre-existing health risks, such as cardiovascular problems, high cholesterol or obesity often seen in older patients.

Along with exercise, drug therapy is another component of post-transplant rehab. Heavy doses of cyclosporine, administered to reduce the risk of rejection, and the steroid prednisone do produce side effects, but they do not impede the ability to do rigorous exercise, says Dr. Kotloff.

Cyclosporine may cause blood pressure increase, shaky hands, hyperactivity and nausea. Prednisone causes increased appetite. weight gain, and even compression fractures because the drug weakens bone and muscle. Also. kidney recipients may develop hyperglycemia and require insulin for a short time. Temporary dialysis may be necessary if the body is slow to accept the new kidney.

Weight gain is a primary concern because it can easily turn into a life-long problem. Severe diet restrictions during the long pretransplant stage skew the patient's perceptions of adequate intake levels for protein, calories and fluids. An exercise program helps balance the caloric increase.

Some patients gain up to 100 pounds during the first year post transplantation. says Dr. Bumgardner. And if the patient were obese prior to transplant, this weight gain exacerbates obesity-related problems, including deficiencies in wound healing.

Fitness professional Vanessa Underwood. AFAA, ACE, believes every transplant program should have a wellness component to address specific exercise, fitness and dietary needs. Underwood, who's received two kidney transplants since 1979-one from her sister and the other from her mother-speaks to health care professionals about incorporating exercise into their rehab units with her program: "Moving into wellness: A fitness approach to renal and transplant health."

"Exercise is metabolic," says Underwood, a fitness editor for the Transplant Chronicles newsletter and the author of a monthly fitness column. "It's a way to fight back. It's a panacea that we have at our fingertips that we don't use. If you believe it works, you will be able to fight the side effects of the meds."

Underwood is living proof of the potential longevity of organ recipients through a healthy lifestyle. One-year survival rates for all organ recipients range from 91.3 percent for living kidney donors to 73 percent for lungs. In between are cadaver donor kidneys (93.4), heart (82.8) and liver (80) , according to UNOS statistics. People with a kidney from a live donor have a 92.4 percent chance of living four years. according to UNOS figures. Other four-year survival rates are 84.4 percent for a cadaver kidney. 71 5 for heart transplants, 71.3 for the liver and 48.9 for lung transplants.

"We' re looking at good out comes for organ recipients, so physical therapy is really becoming more and more important," says Matzinger.

advance for Directors in Rehabilitation. Sept 97 pp. 24-7

Contributed by T. Michael Smith. M.S. Ed. Certified Athletic Trainer: Official Personal Trainer to UpBeat's Staff. Phase III cardiac Rehabilitation, Riverside Walter Reed Hospital, Gloucester, VA

IMPORTANT NOTICE TO ALL UPBEAT READERS:

With this issue, UpBeat has completed 10 years of publication. It started as a very simple local document put together by a very recent Tx recipient still quite "high" prednisone. In fact the first couple of issues were made by pasting news clips on paper and then Xeroxing same. It was less than pretty and in fact it was pretty awful.

Quite frankly in recent years I have debated whether it is of any real service to continue, in that news of transplantation is so much more widely disseminated now than it used to be. In fact a year ago I inserted a question on the survey as to whether UpBeat should be continued. Rather surprisingly to me, the response was something on the order of a resounding 99%, "yes".

Well, the services of the editor are free and they always have been. However, the rest of the program costs about $450 per month/issue. All of this money comes from donations. Some readers have given small amounts very, very regularly - they regard it as a subscription, which is fine. Others have given larger amounts from time to time, and they are much appreciated also. And every now and then a doctor, or transplant program, or pharmaceutical house will come through with a surprise donation that is enough to help upgrade the computer printer, or even assist a bit in upgrading the computer itself.

Unfortunately, not everyone remembers to keep up their donations, and at present UpBeat is in a very tight cash position. Whenever the separate Upbeat checking account gets below $1,000, or about 2 months expenses, I start to worry. Just recently it dropped below $500 and I have started thinking seriously of cessation.

In previous years I have notified everyone who appears to be behind in payment i.e. we haven' t received anything in more than a year - by means of a personal letter. This year in order to conserve funds remaining, I'm not going to do that.


I'm asking everyone to take a look at their address label and see when their last donation was received by UpBeat. In most cases it shown as a date after your name. That date is the last time you contributed to UpBeat. If it's more than 12 months ago, i.e. 11/96 or prior, please do what you can to make a renewed donation now. If nothing is received from you prior to February, 1998, you risk removal from the mailing list.

If there is no date after your name, you have never contributed to UpBeat and you will be discontinued in February, 1998.


If there is an "*" after your name it means one of several things: a. Your last contribution was large enough to "carry" you for several years. b. You have indicated you just can't afford to donate, which is absolutely acceptable. Anyone in that situation merely has to drop us a postcard and say so. c. You are being "comped" for your contributions to the field of transplantation, or the editor's life.

STAMP TO PROMOTE ORGAN DONATIONS

Washington (AP 11/6/97) -- Greeting cards, letters and bill payments can do double-duty next year when the U.S. Postal Service issues a stamp promoting organ and tissue donation.

The stamp design shows two intertwined figures with hands reaching inside and touching each other's heart. It carries the slogan "Share your life."

It was unveiled Thursday at a Capitol Hill ceremony with members of Congress who have pushed for two years for a stamp. Among them were Sen. Bill Frist, R-Tenn., a transplant surgeon; Rep. Joe Moakley, D-Mass., a liver transplant recipient; and Sen. Mike DeWine, R-Ohio, who became an advocate for organ donation after his 22-year-old daughter, Becky, was killed in an auto accident.

The DeWines donated Becky's eyes, which provided transplants for two recipients in different states. "This is no ordinary stamp," said Postmaster General Marvin Runyon. "It is not meant to be an attractive ornament for a letter or a keepsake that will be stashed away in a stamp album... It is meant to be part of a crusade."

"We hope that this stamp will cause families to talk about this," added DeWine. "I'm convinced the issuing of this stamp will in fact save lives."

More than 55,000 Americans are awaiting organ transplants, according to the United Network for Organ Sharing. Last year there were fewer than 9,000 U.S. donors. The stamp will be issued next summer; the date has not been set.

Well golly, if only Ed Heyn could read this article/And wasn't it here in UpBeat several months ago where the editor said it seemed in order to make progress on the donor stamp we needed to get political. Of course, "getting political" is also making them think it was their idea, or at least making it look like it was their idea. Well after about 8 years we finally got the stamp, that's the important thing. DM

PVCS

UpBeat apologizes for the apparent "copy crunching monster" appearing last month and creating a mixture of two Texan's comments. Here's what they really had to say:

Tx Ralph Thornton reveals what may be the coming protocol in "annuals". "My transplant team (UT Southwestern Health Sciences Center/ St. Paul Medical Center, Dallas) really surprised me at my annual. I am 8 1/2 years post-transplant. They said that out of all the left-right caths that had been done on those more than a year out. the procedure only revealed four problems. and they already suspected two. So this time I just had the right cath/biopsy (what I call a "quickie"). Also, they cut back on the periodic testing schedule. This is especially important for those of us who, are employed. The multiple visits to the Docs. even for labs, leave one's coworkers with an impression of illness that is hard to overcome.

And a Texas Tx writes: "l continue to be amazed and amused at the transplant world. how little the medical establishment seems to consider asking questions of a large number of transplants when it comes to survival, procedures. etc. I am amused that every time I go to a hospital -- which is often, not necessarily for my heart (best organ in my body) but associated ills -- how the nurse or the technician always asks, with a bright smile. "How are you today?" As if I would be there if I knew how I was. But that's not a gripe, just a comment. Beats what one MD specialist said to me a couple of years ago when it was discovered I had brain cancer, "You aren't ever going to get better." I was sorry to have to fool this esteemed Fellow. etc., but I got better and 3 MRIs have shown no sign of the cancer. You learn a few things as a transplant, and one of those is: Don't ever quit and don't ever look back.

A personal note: Many of us as transplant recipients develop some unpleasant side effects. some much worse than others. One of the only real solaces in such situation is the quasi-comfort of knowing that others have been, or are. in the same condition. With that in mind, is there anyone who has, or has heard of, a transplant recipient developing polyps on the vocal cords most probably due to long-term immunosuppression? I have had slime recently and the resulting surgery has pretty much resulted in the loss of an acceptable voice. I would be very interested to know whether this problem has cropped up in other recipients as the medical literature is quite silent on the matter.

And again, for about the 10th year. sincere best wishes for all the Holidays. and be sure and stay well in the New Year. Buy and use the donor stamp in '98 and remember the late Tx Ed Heyn of Baroda, MI got it all started a long time ago.

DM

STUDY CASTS DOUBT ON PIGS FOR ORGAN TRANSPLANTS

By Patricia Reaney

London, (Reuters 10/15/97) - Scientists cast doubt on Wednesday about the feasibility of using pig organs for human transplants after finding two types of viruses that could infect human cells.

In a letter in the scientific journal Nature, Jonathan Stoye and colleagues at the National Institute for Medical Research in London said the finding has reinforced fears about the potential risks of viral infections associated with xenotransplantation -- using organs from one species in another.

"Further support for these fears comes from the discovery of two different classes of porcine endogenous proviruses (PERVs), capable of infecting human cells," they said.

Endogenous viruses are passed on in the germ line as proviruses and are very difficult to remove when producing animals for organ transplants.

Doctors do not know if the virus would cause an infection in humans, or, if it did, what that infection could lead to. Doctors and patients would have to decide if the risk outweighs the benefit.

"Even if it proves impossible to breed pigs that are free of these viruses, it doesn't necessarily mean they would do anything in a transplant setting," Stoye said in an interview.

But he added that whenever the first human trials occur, which some scientists think could be within a year, there will inevitably be question marks.

Stoye and his colleagues cloned the region of the proviruses with the infected cells. In all the pig tissues they tested, from the heart, spleen and kidney, they found both classes of the provirus that could infect human cells.

Stoye also tried to find a breed of pig without PERVs but discovered that both classes of it are inherited in a range of pig breeds and are likely to be present in pigs genetically modified to be used as sources for organ transplants.

"Although we do not yet know which proviruses are capable of yielding infectious virus, the number of proviruses present suggest that the breeding of virus-free pigs, if at all feasible, will represent a complex task," he said.

Many scientists believe that xenotransplantation may be the only solution to the increasing shortage of human transplant organs. More than 50,000 people are currently waiting for a transplant in Europe, but there are not enough available organs.

Demand is growing at 15 percent per year, far outweighing supply.

The first attempts at xenotransplantation, in the United States and Europe, used baboon livers, hearts and kidneys. People survived with the animal organs for up to 70 days.

But scientists believe the greatest potential is with pig organs, which are approximately the same size as their human equivalents. Pigs also breed quickly and with big litters, so large quantities of potential organs can be produced.


Contributed by Dr. Maud A. Marshall, Norton, MA

CROSS-SPECIES TRANSPLANTS TRUMPETED

By Geir Moulson - Associated Press Writer

Geneva (AP 10/30/97) -- Transplanting animal organs into humans offers such promise that nations should work together to overcome scientific and ethical problems, experts said Thursday at a U.N.-sponsored meeting.
Scientists have suggested in recent years that animals not only could ease the shortage of kidneys, hearts and livers for transplantation, but also supply brain tissue to treat diseases like Parkinson's and pancreatic tissue to treat diabetes.

Attention has focused on the pig, which has internal organs the right size for transplant to humans and breeds rapidly, meaning a large potential organ supply.

There is concern, however, at the risk of infections crossing species barriers. Experiments so far have focused on limited transplantation of animal tissue rather than whole organs. The World Health Organization sponsored a two-day meeting ending Thursday to examine the possibilities and implications of "xenotransplantation."

British bioethics expert Dr. Rachel Bartlett said the starting point is the situation faced by people in need of transplants but unable to find donor organs.

Professor Jeffrey L. Platt of Duke University said as little as 5 percent to 15 percent of the donor organs required may be available.

About 2,000 heart transplants are carried out every year in the United States. while an estimated 40,000 hearts are needed. The problem is magnified in developing countries, where the resources are in far shorter supply.

Platt said every conceivable way to increase the amount of organs available for transplant in the United States has been tried. but all have fallen well short of meeting requirements.

The use of nonhuman organs could solve the dilemma of how available organs are distributed, he also denied that the need for organs could be met by using dialysis and other mechanical procedures. The experts said they also discussed the implications of transplants from pigs with scholars of Islam and Judaism, both of which forbid eating the animal as unclean. and had received a generally favorable response.

"The Koran and the Old Testament -Leviticus particularly -- talk about the pig only in dietary terms," said Professor Abdallah S. Daar of Oman University. "Neither restrict the introduction of porcine material through other orifices or through surgical incisions," Daar said.

Some concerns have been raised over the development of "transgenic" animals. containing a human gene, to reduce the risks of patients rejecting organs. Such animals could be viewed as hybrids, but Bartlett said the human gene was "one gene of many" which would bring about only a "small anti specific change."


Discussion between countries is necessary, she said, "to make sure xenotransplantation goes ahead as safely as possible." especially as "viruses and bacteria do not carry passports."

TRANSPLANT PATIENT CLIMBS MOUNTAIN

By Brendan Riley - Associated Press Writer
Mount Whitney, Calif. (AP 9/26/97) -Two years after her old heart gave out. Kelly Perkins put her new one to an amazing test: She scaled the nation's highest peak outside Alaska.

No other heart transplant patient is known to have climbed 14,495-foot Mount Whitney, a daunting trek even for those with no health problems.

Perkins, a 36-year-old real estate appraiser, made the rugged, 22-mile hike over three days, tearfully hugging her companions atop Whitney on Tuesday, and blowing bubbles to celebrate.

"You basically live in fear for so long that you' re afraid to try to push your limits at all," she said. "And so it's very freeing to be able to push those limits and to succeed and know that you're back."

Perkins -- 5-foot-3 and 95 pounds -had a go-ahead from her doctor because she was an experienced climber and had worked hard to rebuild her strength after her 1995 transplant.

But she also knew that of the thousands of people who try to climb the Sierra Nevada peak every year, many are forced to turn back. Sprains and other injuries are always a concern, along with altitude sickness, hypothermia, dehydration and violent changes in weather.

But the weather was perfect for Perkins. And her only problems were a slight knee bruise from a fall as she got out of her tent, and a mild headache.

As a precaution, her climbing team -including her husband, Craig, also 36, and four others -- shared her load, carrying her blood pressure monitor and oxygen canisters. As it turned out, she didn't use the oxygen at all, and her blood pressure was found to be OK during the periodic checks.

Perkins also drove from her sea-level home in Laguna Niguel, Calif., to the start of the trail a few days ahead of time to adjust to the high altitude, and started hiking slowly -- a necessity because it takes a few minutes to get her heart rate up.

(The heart is normally stimulated by nerves and adrenaline. But a transplanted heart no longer has nerves linking it to the brain. Perkins had to rely on adrenaline alone.)

"It was really hard there at the end, and I really didn't know if I was going to make it or not," she said.

Perkins had climbed Whitney once before, when she was 25 and there was no hint of the obstacles ahead.

But in 1992 she was diagnosed with viral cardiomyopathy, which made her heart race wildly. By 1995, her heart was failing and she was taking up to 30 pills a day. Her husband had to carry her up and down the stairs of their home.

Perkins got her new heart on Nov. 20, 1995, from a 40-year-old woman killed when thrown from a horse. By the following August, she had climbed 8,842-foot Half Dome in Yosemite National Park.

Mount Whitney became her next goal, but her husband had his doubts because of the altitude, which made him sick and kept him from reaching the summit when the couple first climbed Whitney II years ago.

During the climb up the rocky. zigzagging trails this time, he worked to assure his wife "that it wasn't her illness; it was our illness, something we had to deal with together as a couple."

Perkins' doctor, Jon Kobashigawa. is the medical director of the transplant program at UCLA Medical Center, the largest transplant center in the world. He said he knows of no other transplant patients who have attempted a high-altitude climb like Perkins' Whitney ascent. "She is physically quite active, she works out, and she has trained her new heart to achieve a high level of capacity," he said. "She's an inspiration to many other transplant patients, to show that they can get back to a good quality of life."


Perkins is now looking for a new goal. "But it won't be Mount Everest," which is twice as high as Mount Whitney, she said. "That's all I know for sure. I'm not that crazy."

TRANSPLANT IN ISRAEL SAVES ARAB KID

By Laura King - Associated Press Writer

JERUSALEM (AP 10/13/97)-- At the bedside of an Arab toddler who received the heart of a Jewish child killed by a car, two mothers wept in each other's arms.

"Do you know what heart she received? She received an angel's heart -- you don't know what a heart this boy had," said Braha Kaveh, whose 8-year-old son Yuval was killed while riding his bike last Thursday.

Aani Aljaroushi -- whose 3-year-old daughter Rim was listed in good condition on Monday, three days after the transplant -- embraced the other woman. "I know that it's very hard, but I thank you," she said through her own tears.

The story struck a powerful chord in a country where Arabs and Jews are most often depicted in bitter strife.
It was a medical milestone as well. If Rim recovers -- and her doctor says the prognosis is excellent- it will be Israel's first successful pediatric heart transplant, the hospital says.

Footage of Sunday night's emotional hospital meeting aired on Israeli television and was front-page news in Monday morning papers. "Heart of Gold" said a banner headline in the Maariv newspaper.

When the Kavehs were told their son' s heart was beating in the chest of an Arab child, "they were really happy," said cardiac surgeon Dr. Yakov Lavie, who headed the transplant team. "They thought it might bring the two peoples closer together."

Yuval, only days away from his ninth birthday, was riding his bicycle with his brother in his hometown of Herzliya. north of Tel Aviv, when he was hit by a car and thrown from the bike. He suffered multiple injuries.

As it became clear he would not survive, doctors gently asked his Jewish parents about the possibility of donating his organs.

Little Rim, whose family is from the town of Ramle near Tel Aviv, had been in danger ever since she was born with an enlarged heart. For two of her three years. as her condition steadily worsened. she had been waiting for a donor heart.

The surgery at Sheba Medical Center near Tel Aviv took only two hours. Lavie said the toddler is making an extremely rapid recovery; the day after the operation. she was able to sit up and sip juice.

"She was very small for her age. and her motor activities were underdeveloped." he said. "But now she can have a normal life." Sizan Aljaroushi, Rim's father. said he hoped the Kavehs would be part of his daughter's life. "I want the Kaveh family to visit Rim, and I want her to visit them because they gave part of their son-- a very, very precious part, the heart," he said.

Organ transplantation is a complicated subject in Israel. Both Orthodox Jews and traditionalist Muslims believe that bodies should be preserved intact after death, and transplants are thus taboo for many.

It wasn't an easy decision, Yuval's father told Maariv, but the family decided to donate his organs. His liver and one kidney were transplanted into a 14-year-old boy, and a 19-year-old man received his other kidney.


Said his mother: "Yuval' s death was not for nothing ... and others are living thanks to him."

Allergy Passed on in Transplant

Boston (AP 9/17/97) -- A man who received a new liver and kidney in an organ transplant also got something he didn't want -- an allergy to peanuts.

French doctors described the unusual case, which occurred eight years ago, in Thursday's issue of the New England Journal of medicine.

A 22-year-old man who knew he was allergic to peanuts ate them by mistake when he had Chinese food with satay sauce, which contains peanuts. He fell into a coma and died.

Doctors gave his liver and right kidney to a 35 -year-old man and his pancreas and left kidney to a 27-year-old woman. Neither was told of the cause of the organ donor's death.

Three months later, the man suffered a skin rash and difficulty breathing after eating peanuts. After concluding he had a newly developed allergy, the doctors fed peanuts to the woman under close medical supervision, but she showed no ill effects.

Doctors are unsure why one patient got the allergy and the other did not. However, they speculated that blood cells primed to recognize peanuts as foreign were passed along in the transplanted liver.

The man was told to avoid peanuts, and he is still healthy. The case was reported by Dr. Christopher Legendre and others from Necker Hospital in Pads.


NEW DRUG REDUCES REJECTION IN KIDNEY TRANSPLANTS

London, (Reuters 10/24/97) - A new drug designed to reduce rejection in kidney transplant patients has shown promising results, doctors said on Friday.

In a report in the Lancet medical journal, doctors who tested the drug basiliximab, which is made by Swiss life sciences group Novartis AG, said it"reduced the incidence of acute rejection episodes significantly."

Dr. Bjorn Nashan and colleagues in Germany, Britain, Switzerland and France studied 380 adults who were first-time kidney transplant patients. Nearly 200 were given basiliximab on the day of the surgery and four days later and 187 patients received a placebo.

Six months later, 44 percent of the placebo group had acute rejection problems but' only 29.8 percent of the patients who had taken baxiliximab.

Acute rejection occurs when the recipient's blood begins to flow through the new organ and white blood cells recognize foreign antigens on the graft cells.

Basiliximab interferes with a protein dial causes the proliferation of the white blood cells that form part of the body's immune response to the new organ.

If a transplanted kidney is rejected. the patient can go back to dialysis and may receive another kidney but demand far outweighs supply.


"This study indicates that basiliximab ix an immunosuppressant with a simple short-term administrative regimen that has a significant impact on the incidence of acute-rejection episodes, without giving rise to clinically relevant safety or tolerability concerns," Nashan said.

Disclaimer: The material in this document has been collected by Don Marshall and friends. If any of the views and opinions expressed here are taken the wrong way, we can be nothing m ore than sorry. New ideas and materials are welcome all the time. As a policy, UpBeat is sent upon request to heart and heart/lung transplant recipients and other interested parties. Donations of $15 per year, or more, from Tx recipients, if not a burden, are vital. From all others t he donation is specifically requested. The date shown after the name on the address label indicates the last time a donation was received. Please make checks payable to Don Marshall, as we cannot afford to become nonprofit. Send materials, letters, or checks to:

Don Marshall
P.O. Box 482
Mathews, VA 23109-0482
804-725-3686
Compuserve 74016,1725
FAX 804-725-3686
Internet: donmarsh@inna.net