Consult - Transplant - Spring 2011 by Mary Jones Smith

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Consult Spring 2011 | Transplant

Contents 3 Comprehensive Transplant Center 9 Heart Transplant 13 Kidney, Kidney-Pancreas and Pancreas Transplant 19 Liver Transplant 23 Diabetes Practice Tool 25 Updates on new services and facilities available for your patients at Ohio Stateâ&#x20AC;&#x2122;s Medical Center

Ohio State’s

Consult Spring 2011

The Ohio State University Medical Center

Comprehensive Transplant Center w Expertise in comprehensive transplant care—transplant surgery and the diseases that lead to transplant w More than 7,500 transplants in our program’s 40-year history w Central Ohio’s only adult transplant center w Transplant survival rates meet or exceed national benchmarks w Now under the leadership of Robert Higgins, MD

Ohio State’s Comprehensive Transplant Center In 2010, The Ohio State University Comprehensive Transplant Center (CTC) performed transplants

Higgins brings world-class experience to Ohio State’s Medical Center (OSUMC). He led the transplant and mechanical assist device program at Rush University Medical Center in Chicago for seven years, served as chair of Cardiothoracic Surgery at the Medical College of Virginia and founded the lung transplant program at Henry Ford Hospital in Detroit. Higgins is past president of the Society of Black Academic Surgeons and past president of the United Network of Organ Sharing (UNOS), the private, non-profit organization that manages the nation’s organ transplant system under contract with the federal government.

for more than 270 patients. For almost four decades, the CTC has been a nationally recognized leader in the field of transplantation. We enjoy national preeminence but also are proud to serve the hometown patient base with our unique position as central Ohio’s only adult transplant center. “We are making important developments to the program at Ohio State— in transplant patient care, research and education—to provide the best service for the Ohio Valley region as well as across the nation,” says Robert Higgins, MD, director, Comprehensive Transplant Center and director, DiviRobert Higgins, MD sion of Cardiac Surgery. “We have the leadership, vision and resources at Ohio State to change the future of transplantation. Advances on the horizon in transplant medicine may be able to extend the procedures we perform every day and improve patients’ quality of life even more in significant ways.”

Experts in Transplant and Diseases that Lead to Transplant Our approach to transplant medicine is better described as a comprehensive approach to the patient’s disease. The journey from disease or dysfunction to transplant is not necessarily a straight, predictable course. Rather, a patient’s disease may initially require treatment or management, and the roadmap specialists prepare is for a journey that may involve unanticipated side trips. For these reasons, a transplant center’s expertise in the disease itself is vitally important.

Program Leadership

A transplant center’s expertise in the disease itself is vitally important

“The development of modern day transplant successes in all organs as well as in islet cells reflects the extraordinary efforts of dozens of healthcare professionals at Ohio State’s Medical Center,” says Higgins. “Tireless nurses and physicians, technically gifted surgeons, compassionate social workers and mental health experts and effective administrative staff—all committed to providing outstanding transplant patient care at our Comprehensive Transplant Center,” he adds.

When a patient comes to us for consideration for a transplant, our evaluation includes assessing whether the patient’s function can be improved to avoid transplant. This requires an in-depth, complete understanding of diseases and causes of dysfunction, not simply an understanding of transplant surgery. This, in turn, requires an absolute team approach to patient care. Simply put, there can be no barriers between disease specialists and transplant surgeons. They must work hand in hand and shoulder to shoulder to best serve patients. When transplant is unavoidable, we develop a timeline and plan to keep the patient as healthy as possible to ensure their candidacy for a new organ.

Higgins assumed leadership of Ohio State’s Comprehensive Transplant Center in July 2010. He oversees our Solid Organ Transplant Program, which includes heart, kidney, liver, pancreas and combined kidney-pancreas transplantation. He also leads the Division of Cardiac Surgery. The liver, kidney and pancreas programs are directly supervised by Mitchell Henry, MD, Todd Pesavento, MD and Amer Rajab, MD.

We develop a timeline and plan to keep the patient as healthy as possible to ensure their candidacy for a new organ

4 Comprehensive Transplant center

Medical Specialists and Transplant Surgeons Working Hand in Hand

transplant infectious disease specialist interact regularly with the transplant physician and surgeon and the other team members. This ensures a specialty patient-focused practice with immediate access to expertise from all related fields.”

The Ohio State University Medical Center has equal expertise in transplantation and in treatment of diseases that lead to organ failure or dysfunction. Our transplant surgeons are experts in the organ surgeries they perform. Other specialists, including non-physicians in our Transplant Center, care only for transplant patients. This ensures a profound understanding of the issues transplant patients face every day.

Regardless of a patient’s disease or dysfunction, our worldclass program—continuously enhanced with additional dedicated specialists and surgeons—is equipped to evaluate, diagnose and treat every patient who seeks our care. As an academic medical center, we participate in clinical trials and research programs that allow our patients access to the latest treatments available. Our research efforts involve new compounds for immunosuppression, clinical trials of new medications and ongoing studies to monitor the immune response to transplanted organs.

Profound understanding of the issues transplant patients face every day “Traditionally, transplant medicine was a surgical field. Our team approach to patient care breaks down that barrier,” says Todd Pesavento, MD, transplant medicine physician, associate professor, Nephrology, and director, Transplant Medicine in the Solid Organ Transplant Program. “Today, at Ohio State, the physicians and surgeons involved with transplant patients work as a team under one roof and in proximity to each other. The transplant pharmacist and

Equipped to evaluate, diagnose and treat every patient who seeks our care Additionally, our physicians are involved in the issues that affect transplant programs. This includes accepting board positions in national transplant-related organizations, 5

Comprehensive Transplant center

Facts & Firsts

which helps to keep our team members’ fingers on the pulse of trends in transplantation and evolving regulatory circumstances.

Since 1967, OSUMC has performed more than 7,000 life-saving transplants, including kidney, living donor kidney, liver, pancreas, kidneypancreas, heart and lung transplants. Here are some significant moments in our history:

Pretransplant Patients considered for transplant at Ohio State’s Medical Center undergo extensive medical and psychological evaluations to ensure their readiness. After these evaluations and additional testing, patient cases are presented to our Transplant Selection Committee. This team determines whether patients are eligible to go on a transplant wait list. Throughout this process, patients are educated about all aspects of transplant to help them make the best decisions for their health. We offer a Transplant Support Group for individuals and their loved ones to learn more about others’ experiences and determine if transplant is right for them.

1967 A transplanted kidney is OSUMC’s first solid organ transplant

1982 OSUMC is one of five centers nationwide to study cyclosporine, an immunosuppressant that revolutionized transplantation.

Post-transplant

1984

Our transplant team and affiliated specialists focus on improving patients’ quality of life after transplant. This includes ongoing patient education and follow up to ensure patients have the best chance of success after transplant, as well as communication with their local community physicians.

OSUMC’s first liver transplant is also the first in Ohio.

Patients’ presurgical complications do not necessarily end with transplant. They require not only surgical expertise but also careful, diligent postoperative management. We excel at caring for these challenging conditions. Our transplant team keeps in contact with transplant patients for life.

1986

1985 First pancreas transplant

First heart transplant

1988 First combined kidney-pancreas transplant

1996 Immunosuppression

First laparoscopic kidney donor nephrectomy

The transplant program at The Ohio State University Medical Center uses steroid-free immunosuppression.

1998

“Steroids have long-term side effects for patients. There are enough other medications available today that we can select based on side effects we wish to avoid,” says Ron Pelletier, MD, transplant surgeon, associate professor, Surgery, and director, Immunohistopathology Research Lab in the Division of Transplantation. “The majority of U.S. transplant programs still use steroids for immunosuppression. Our involvement in clinical trials for immunosuppression drugs convinced us to incorporate this finding into our practice for the benefit of patients. Our patients do as well as or better than they did with steroidal medications.”

1999

First lung transplant

First double-lung transplant

2005 First heart-double-lung transplant

2005 First paired, non-related living kidney transplant

2006 OSUMC is one of only a few sites in North America approved to process pancreatic islet cells for transplants that may cure type 1 diabetes.

2011 6 Comprehensive Transplant center

First islet cell transplant

Hear from Dr. Higgins

Communication with You

on how our Comprehensive Transplant Center is refocusing its commitment on keeping you involved in the care of your patients while they’re at Ohio State.

We consider the physicians who refer their patients to us for specialized transplant care our valued partners. We want to work with you to ensure the continued health of your patients. This requires a commitment to communicate with you about the status of your patients’ care at Ohio State’s Medical Center. We pledge to keep you well informed about their progress every step of the way.

Snap this code with your smartphone’s camera or go to http://go.osu.edu/Higgins.

In addition to our proactive communication with referring physicians, we use TransChart software, developed at Ohio State specifically for transplant patients’ electronic medical records. Referring physicians can access this program online to check the status of their patients being treated at Ohio State’s Medical Center. The program is interactive and allows you to ask questions of our specialists.

To download the free ScanLife reader for your smartphone, go to: http://go.osu.edu/BrH.

Visit medicalcenter.osu.edu/go/transplant to access TransChart.

How to refer patients... Our physicians are happy to evaluate any patient for current or future transplant, without restrictions. Our transplant referral lines are staffed 24 hours a day. We have staff trained to help you and your patients navigate the social services, insurance and government funding issues involved with transplantation. We process transplant referrals as quickly as possible. The sooner patients are seen for consultation, the sooner appropriate patients can be put on organ transplant wait lists.

Urgent Referral Clearly, some patients cannot withstand even a minimal wait between your initial inquiry on their behalf and a consultation with us. Please notify us when a patient’s condition warrants immediacy, including an in-hospital consultation at our facilities. Abdominal Transplant (kidney, liver, pancreas) 614-293-6724 800-293-8965

Heart Transplant 614-293-3787 800-538-1886

After business hours, call 1-800-293-5123. 7 Comprehensive Transplant center

The Ohio State University Medical Center Comprehensive Transplant Center www.medicalcenter.osu.edu/go/transplant

ÂŠ 2011 The Ohio State University Medical Center â&#x20AC;&#x201C; 4 CORP20100483-08

Ohio State’s

Consult Spring 2011

Heart Transplant 1986: First heart transplant at OSUMC w The only adult heart transplant center in central Ohio w More than 350 heart transplants performed w Seven heart-failure cardiologists and three transplant surgeons w Renowned researchers work to improve treatment options

Program Leadership The Heart Transplant Program at The Ohio State University Medical Center (OSUMC) is led by Ayesha Hasan, MD, director of the cardiology component of heart transplant and Robert Higgins, MD, director of our Comprehensive Transplant Center, and director of heart transplant and of the Division of Cardiac Surgery. Higgins brings world-class experience to Ohio State’s Medical Center. He led the transplant and mechanical assist device program at Rush University Medical Center in Chicago for seven years, served as chair of Cardiothoracic Surgery at the Medical College of Virginia and founded the lung transplant program at Henry Ford Hospital in Detroit. He is past president of the Society of Black Academic Surgeons and past president of the United Network of Organ Sharing (UNOS), the private, non-profit organization that manages the nation’s organ transplant system under contract with the federal government.

About Our Program “When we founded our heart transplant program 25 years ago, it was the first of its kind in central Ohio. Today, it remains the only adult heart transplant program in central Ohio. Our success stems from our longstanding experience with all aspects of heart transplantation and deep understanding of the medical and surgical issues associated with it,” says Carl Leier, MD, professor of Cardiovascular Medicine and a founder of our Heart Transplant Program.

Our seven heart-failure cardiologists and three transplant surgeons at The Ohio State University Richard M. Ross Heart Hospital are dedicated to caring for patients with heart failure. Expertise in managing and treating end-stage heart disease is as important as expertise in transplant medicine.

Drug and device options have been exhausted before recommending transplant Our renowned researchers actively work to improve treatment options and the patient experience. This includes determining new methods to increase the length of time a heart remains viable for transplantation and developing new drugs and devices for heart failure.

eart transplant patients are cared for at the Ross Heart Hospital. This 150-bed, 290,000 square foot state-ofthe-art hospital is listed by U.S.News & World Report as one of America’s best hospitals for heart care and is one of the few dedicated academic heart hospitals nationwide. “Patients who see us present with a full spectrum of cardiac needs—from assistive devices and drug and surgical therapy to transplant,” says William Abraham, MD, director, Division of Cardiovascular Medicine and professor of Internal Medicine and of Physiology and Cell Biology. “Our comprehensive cardiac program provides the appropriate care for patients at every point in the spectrum. We strive to optimize every patient’s health, which means ensuring drug and device options have been exhausted before recommending transplant.”

Want to learn more about Ohio State’s Heart Transplant program?

Our Dual-Expertise Approach The Ohio State University Medical Center has equal expertise in transplantation and treatment of diseases that lead to heart failure or dysfunction. Our surgeons who perform heart transplants were trained in transplant surgery. Other specialists, including non-physicians, in our Transplant Center care only for transplant patients. This ensures a profound understanding of the issues heart transplant patients face.

Watch interviews with our physicians, team and a heart transplant patient at: Onlyohiostate.osu.edu

Profound understanding of the issues heart transplant patients face every day “We have flipped the paradigm that says transplant is strictly a surgical field,” says Chittor Sai-Sudhakar, MBBS, assistant professor of Surgery. “Here at Ohio State we provide true collaboration between the medical and surgical aspects of transplant management. This allows us to provide ‘whole’ care of the patient, drawing on expertise from all aspects of transplant care.” Regardless of a patient’s heart disease or dysfunction, our world-class program—continuously enhanced with additional dedicated specialists and surgeons— is equipped to evaluate, diagnose and treat every patient who seeks our care.

option. This critical window must not be closed. To ensure it remains open, our specialists should see patients as early as possible in the heart disease process. Even if a patient is not ready for transplant, specialists can help to determine when transplant might be a possibility, the likely timeline and the steps that are necessary to ensure the patient’s health for transplant.

Window of Opportunity For every patient for whom heart transplant is a possibility, there is a window of opportunity when transplant is a realistic

How to refer patients... Our physicians are happy to evaluate any patient for heart failure and current or future heart transplant. Our transplant referral lines are staffed 24 hours a day. Let us help you and your patients navigate the social services, insurance and government funding issues involved with transplantation. We process transplant referrals as quickly as possible. The sooner patients are seen for consultations, the sooner appropriate patients can be put on the transplant waiting list. We maintain an ongoing commitment to our referring physicians to keep you informed about your patient while they are in our care, and to return your patient to you for ongoing care.

Urgent Referral Clearly, some patients cannot withstand even a minimal wait between your initial inquiry on their behalf and a consultation with us. Please notify us when a patient’s condition warrants immediacy, including an in-hospital consultation at our facilities. Heart Transplant 614-293-3787 800-538-1886 After business hours, call 1-800-293-5123.

10 heart transplant

Our Team Transplant Medicine Specialists William Abraham, MD

Pallavi Solanki, MD

Division Director, Cardiovascular Medicine; Deputy Director, The Ohio State University Dorothy M. Davis Heart and Lung Research Institute

Assistant Professor-Clinical, Cardiovascular Medicine Clinical interests: cardiovascular diseases, congestive heart failure, heart transplant and ventricular assist device and echocardiography

Clinical interests: heart failure, cardiac transplantation, cardiac resynchronization therapy

Research interests: congestive heart failure, signaling pathways in heart failure, heart transplant and ventricular assist devices

Veronica Franco, MD Transplant Medicine Assistant Professor-Clinical, Cardiovascular Medicine Associate Director, Exercise Physiology/ Metabolic Exercise Testing Program

Heart Transplant Surgeons

Clinical interests: heart failure, transplantation, pulmonary hypertension, metabolic exercise testing, systemic arterial hypertension

Juan Crestanello, MD Transplant Surgery Associate Professor, Surgery Clinical interests: adult cardiac surgery, minimally invasive surgery, robotic surgery, valve repair, aortic and aneurysm surgery

Garrie Haas, MD Transplant Medicine Professor-Clinical, Cardiovascular Medicine Section Director, Heart Failure and Transplant, Cardiovascular Medicine

Research interests: ischemic preconditioning, cellular cardiomyoplasty, outcomes of coronary artery bypass surgery

Clinical interests: heart failure, heart transplant

Robert Higgins, MD, MSHA

Ayesha Hasan, MD Transplant Medicine Assistant Professor-Clinical, Cardiovascular Medicine Director, cardiology component of transplantation Director, Heart Failure Fellowship Program, Department of Internal Medicine Clinical interests: heart failure, transplant, device implantation/therapy for heart failure Research interests: optimization of cardiac resynchronization devices

Transplant Surgery Professor, Surgery Director, Division of Cardiac Surgery Director, Comprehensive Transplant Center Director, Heart Transplant Clinical interests: heart transplantation, adult cardiac surgery, coronary artery bypass surgery, mechanical circulatory support Research interests: healthcare outcomes, disparities in transplantation and healthcare, ischemia reperfusion injury

Carl Leier, MD

Chittor Sai-Sudhakar, MBBS

Transplant Medicine Professor, Cardiovascular Medicine

Transplant Surgery Assistant Professor, Surgery

Clinical interests: congestive heart failure, cardiac transplantation, clinical pharmacology Research interests: congestive heart failure, cardiomyopathy, cardiac transplantation

Clinical interests: heart transplantation, cardiac mechanical assist devices, aortic surgery Research interests: signal transduction pathways in endothelial cells

Rami Kahwash, MD Assistant Professor-Clinical, Cardiovascular Medicine Clinical interests: heart failure, heart transplantation, ventricular assist device for treatment of heart failure, device based therapy and cardiac resynchronization for treatment of heart failure 11 heart transplant

The Ohio State University Medical Center Heart Transplant medicalcenter.osu.edu/go/transplant

ÂŠ 2011 The Ohio State University Medical Center â&#x20AC;&#x201C; 4 CORP20100483-06

Ohio State’s

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Kidney, Kidney-Pancreas and Pancreas Transplant Program Leadership The Kidney, Kidney-Pancreas and Pancreas Transplant programs at The Ohio State University Medical Center (OSUMC) are under the leadership of Robert Higgins, MD, director of our Comprehensive Transplant Center. Directing the Kidney, Kidney-Pancreas and Pancreas Transplant programs are Todd Pesavento, MD, transplant medicine physician and Amer Rajab, MD, PhD, transplant surgeon. They are part of a team that includes six transplant medicine specialists and seven transplant surgeons.

specialty for the benefit of the patient is what distinguishes Ohio State’s transplant programs.” Regardless of a patient’s kidney or pancreas disease or dysfunction, our world-class program—continuously enhanced with additional dedicated specialists and surgeons—is equipped to evaluate, diagnose and treat every patient who seeks our care.

About Our Kidney Transplant Program 1967: Kidney – First solid organ transplant at Ohio State’s Medical Center 1996: First living-donor kidney transplant

Our Dual-Expertise Approach Our transplant medicine specialists and transplant surgeons provide comprehensive expertise in the full spectrum of disease and treatment—from evaluation, diagnosis and treatment of diseases that lead to organ failure or dysfunction to planning for and performing transplantation. Kidney and pancreas patients at Ohio State’s Medical Center benefit from care by physicians and other team members who focus solely on transplant patients. This ensures intense concentration on and comprehension of the concerns that kidney, pancreas and kidney-pancreas transplant patients face.

Intense concentration on and comprehension of the concerns kidney, pancreas and kidneypancreas transplant patients face “Our expertise in transplant medicine isn’t limited to surgery,” says Pesavento. “Rather, we favor an approach that involves side-by-side collaboration of transplant medical specialists and transplant surgeons, along with transplant pharmacists and transplant pulmonologists, as well as other transplant-specific specialists. We have created a program focused on communication, collaboration and easy access to expert colleagues. This focus on the broad

2005: First paired, non-related living kidney transplant w More than 250 kidney transplants per year w Nationally recognized kidney transplant program is among top 5 percent in patient volumes in the United States w Recognized by U.S.News & World Report as a top hospital for kidney disease care w Expertise with transplant in patients who have comorbidities that put them at higher risk, including age, diabetes and obesity w More than half of kidney transplant patients receive organs from living donors w Almost 2,000 laparoscopic kidney donor surgeries performed w Recognized as Best Practices Center by Centers for Medicare and Medicaid Services for living kidney donor follow up

13 kidney, kidney-pancreas & pancreas transplant

“Our physicians and other team members have

Want to learn more about Ohio State’s Kidney Transplant program? Watch interviews with our physicians, team and a kidney transplant patient at:

seen every nuance possible in kidney disease, dysfunction and surgery,” says Mitchell Henry, MD, transplant surgeon, deputy director, Comprehensive Transplant Center and current president-elect of the American Society of Transplant Surgeons. “The breadth of our team and our depth of experience translates into the ability to avoid certain situations and knowing instinctively how to manage or treat them when they are inevitable.”

Have seen every nuance possible in kidney disease, dysfunction and surgery

Onlyohiostate.osu.edu

Kidney transplantation is a relatively mature field. For kidney recipients, the basic operation has not changed significantly. What does vary from facility to facility is the ability to care for high-risk patients. Ohio State’s Medical Center has particular expertise with transplant in patients who have comorbidities that put them at higher risk, including age, diabetes and obesity. Many of these patients have been turned down for transplant at other facilities. We strive to help get these patients off dialysis and improve their quality of life with a new kidney. Our experience and expertise allow us to offer transplant as a good option to more patients to help them live longer, healthier lives.

Expertise with transplant in patients who have comorbidities that put them at higher risk “A large, multidisciplinary team is dedicated to caring for transplant patients, and includes endocrinologists, infectious disease specialists, transplant surgeons and medical nephrologists,” says Pesavento. “This team, increased in strength in recent years, cares only for transplant patients and therefore is immersed in the unique issues facing transplant patients every day.” More than half of our kidney transplant patients receive organs from living donors. We have performed almost 2,000 laparoscopic kidney donor surgeries. Our program has been recognized as a Best Practices Center by the Centers for Medicare and Medicaid Services for living kidney donor follow up—an area of particular interest to the CMS.

Performed almost 2,000 laparoscopic kidney donor surgeries Pesavento was involved in a National Institutes of Health study focused on long-term monitoring of living kidney donors—we were one of only seven institutions involved in this research. OSUMC’s volume of living donor transplants and subsequent expertise makes our program better able to accept donors who have been turned down for donation elsewhere. Our large, dedicated transplant team evaluates potential donors, discusses 14 kidney, kidney-pancreas & pancreas transplant

risks with them and helps them decide on a course of action according to their best interests.

provide these patients with a normal glucose environment that eliminates the need for a strict diabetes-care regimen.”

Better able to accept donors who have been turned down for donation elsewhere

Ohio State’s 92 percent one-year survival rate for kidney/pancreas transplants is within the range of the national average expectation (95 percent) of the Scientific Registry of Transplant Recipients.

Our kidney transplant program is involved in two national donor exchange programs, which can speed the wait time for patients and reduce their dependency on a deceased donor organ transplant.

Ohio State’s 96 percent one-year survival rate for kidney transplants is within the range of the national average expectation (97 percent) of the Scientific Registry of Transplant Recipients.

Abo ut Our Pancreas Islet Transplantation Program 2006: Ohio State’s Medical Center is one of only a few sites in North America approved to process pancreatic islet cells for transplants that may cure type 1 diabetes 2011: Ohio State performs its first islet cell transplantation

About Our Kidney-Pancreas Transplant Program

Some patients with type 1 diabetes may be candidates for pancreatic islet cell transplantation. Typically, these patients do not have kidney dysfunction or it has been treated with a kidney transplant. OSUMC is one of just a few centers performing islet cell transplantation in the research phase. In early 2011, Rajab led a team that performed Ohio State’s first islet cell transplantation.

1988: First combined kidney-pancreas transplant • Transplanted pancreas or combined kidney-pancreas in more than 1,000 patients • In top 3 percent in volume in the United States • The only kidney-pancreas transplant center in central Ohio • Surgeons among most experienced in world

Why would a patient opt for islet cell transplantation?

When a patient with type 1 diabetes has compromised kidney function and significant chronic complications from the disease, the optimal solution may be combined kidney-pancreas transplantation.

Islet cell transplantation is much less invasive than organ transplant but requires the same follow up, including immunosuppressant therapy to avoid rejection of the new cells. Only the cells that secrete insulin are transplanted to the patient from a donor pancreas via injection.

Determining when it is optimal to explore transplantation

“Patients who have diabetes that negatively affects their quality of life but are not in kidney failure may opt to try islet cell transplantation to avoid a major surgery,” says Rajab, who has a PhD in pancreatic islet cell transplantation. “Patients who have islet cell transplantation can have a pancreas transplant down the road if it becomes necessary.”

“When a patient with type 1 diabetes has complications that begin to affect the eyes or kidneys or result in hypoglycemia or very high blood sugar, it is appropriate to refer the patient to us for consultation,” says Rajab. “A patient does not need to reach kidney failure before transplantation is a good option. Rather than continue to adjust the patient’s insulin dosage when routine treatment does not address chronic complications, it is optimal to explore options that may prevent permanent negative effects of diabetes.”

Window of Opportunity For every patient for whom kidney or pancreas transplant is a possibility, there is a window of opportunity when transplant is a realistic option. This critical window must not be closed. To ensure it remains open, our specialists should see patients as early as possible in the disease process. Even if a patient is not ready for transplant, specialists can help determine when transplant might be a possibility, the likely timeline and the steps necessary to ensure the patient’s health for transplant.

When a patient has reached the point of renal failure, receiving both a transplanted kidney and pancreas can improve quality of life over a kidney transplant alone. “The new pancreas and improved function it provides can help to protect the newly transplanted kidney,” says Elizabeth Essig, MD, transplant medicine physician and assistant professor, Endocrinology, Diabetes & Metabolism. “Dialysis is debilitating. The expertise exists today at Ohio State to 15

kidney, kidney-pancreas & pancreas transplant

Our Team Transplant Medicine Specialists Elizabeth Essig, MD

Jon Von Visger, MD

Transplant Medicine Assistant Professor-Clinical, Endocrinology, Diabetes & Metabolism

Transplant Medicine Assistant Professor-Clinical, Nephrology Clinical interests: transplant nephrology Research interests: acute renal failure

Clinical interests: diabetes, general endocrinology

Transplant Surgeons

Uday Nori, MBBS Transplant Medicine Assistant Professor-Clinical, Nephrology

Kenneth Andreoni, MD Transplant Surgery Associate Professor, Surgery Director, Liver Transplantation, Comprehensive Transplant Center

Clinical interests: transplant nephrology Research interests: immunology and transplant outcomes

Clinical interests: liver, pancreas and kidney transplantation

Kwame Osei, MD

Research interests: new anti-rejection drugs, antibody-mediated injury to liver and kidney grafts

Transplant Medicine Professor and Director, Endocrinology, Diabetes & Metabolism Professor, Internal Medicine

Ginny Bumgardner, MD, PhD Transplant Surgery Professor, Surgery Associate Dean for Research Education and Graduate Studies, College of Medicine

Clinical interests: diabetes and nutrition Research interests: type 2 diabetes mellitus, endocrine and metabolism, ethnicity

Clinical interests: transplantation, pregnancy and fertility after transplant, recurrent disease after transplant, immunosuppression

Todd Pesavento, MD Transplant Medicine Associate Professor-Clinical, Nephrology Director of Transplant Medicine, Solid Organ Transplant Program Deputy Director, Comprehensive Transplant Center Medical Director of Clinical Services, Comprehensive Transplant Center

Research interests: hepatocellular and islet transplantation, transplant immunology

Elizabeth Davies, MD Transplant Surgery Clinical Assistant Professor, Surgery

Clinical interests: transplant nephrology, preservation of renal function in the liver transplant recipient, hypertension in transplant patients, chronic allograft dysfunction

Clinical interests: deceased donor management Research interests: clinical and humanistic outcome measurement, xenotransplantation

Research interests: Risk stratification for high-risk candidates for transplantation, hypertension in transplant patients, maximization of dysfunctional renal allografts

Elmahdi Elkhammas, MD Transplant Surgery Professor-Clinical, Surgery

Neeraj Singh, MBBS

Clinical interests: liver, kidney and pancreas transplantation, complications in transplantation

Transplant Medicine Assistant Professor-Clinical, Nephrology Clinical interests: Kidney and pancreas transplantation

Research interests: liver transplantation, complications in transplantation

Research interests: Immunosuppression, highly sensitized transplant candidates continued on next page... 16 kidney, kidney-pancreas & pancreas transplant

Mitchell Henry, MD Transplant Surgery Professor, Surgery Director, Clinical Transplantation Deputy Director, Comprehensive Transplant Center Director, Division of Transplantation President-elect, American Society of Transplant Surgeons Clinical interests: transplantation and immunosuppression Research interests: organ preservation, xenotransplantation, clinical immunosuppressive drug trials

Ronald Pelletier, MD Transplant Surgery Associate Professor, Surgery Director, Immunohistopathology Research Lab, Department of Surgery, Division of Transplantation Clinical interests: kidney; pancreas and liver transplantation, laparoscopic living donor nephrectomy Research interests: immune tolerance, chronic rejection, post-transplant donor alloimmunity

Amer Rajab, MD, PhD Transplant Surgery Associate Professor, Surgery Clinical interests: laparoscopic living donor nephrectomy, pancreatic islet cell transplantation, organ preservation Research interests: pancreatic islet cell transplantation, organ preservation

How to refer patients... Our physicians are happy to evaluate any patient for current or future kidney, pancreas or kidney-pancreas transplant, without restrictions. Our transplant referral lines are staffed 24 hours a day. Let us help you and your patients navigate the social services, insurance and government funding issues involved with transplantation. We process transplant referrals as quickly as possible. The sooner patients are seen for consultations, the sooner appropriate patients can be put on organ transplant wait lists. We maintain an ongoing commitment to our referring physicians to keep you informed about your patient while they are in our care, and to return your patient to you for ongoing care.

Urgent Referral Clearly, some patients cannot withstand even a minimal wait between your initial inquiry on their behalf and a consultation with us. Please notify us when a patientâ&#x20AC;&#x2122;s condition warrants immediacy, including an in-hospital consultation at our facilities. Abdominal Transplant (kidney, liver, pancreas) 614-293-6724 800-293-8965 After business hours, call 1-800-293-5123.

kidney, kidney-pancreas & pancreas transplant

The Ohio State University Medical Center Comprehensive Transplant Center www.medicalcenter.osu.edu/go/transplant

ÂŠ 2011 The Ohio State University Medical Center â&#x20AC;&#x201C; 4 CORP20100483-09

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Consult Spring 2011

Liver Transplant 1984: Ohio State’s first liver transplant—the first in Ohio w One-year survival rate exceeds the national average w Expertise in treating hepatocellular carcinoma and preparing patients for transplant

Program Leadership The Liver Transplant Program at The Ohio State University Medical Center (OSUMC) is led by Robert Higgins, MD, director of our Comprehensive Transplant Center. Directing the Liver Transplant Program are Kenneth Andreoni, MD, transplant surgeon, and James Hanje, MD, transplant hepatologist. “Our Liver Transplant Program provides a comprehensive approach to treatment of liver disease, including novel treatments available through our affiliation with The Ohio State University Comprehensive Cancer Center- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James),” says Andreoni. “This allows patients unbelievable access to clinical trials and treatment options not available elsewhere. Ohio State has made significant investments in this program in recent years. Our seven transplant surgeons and seven transplant medicine specialists provide the finest available care for liver disease for patients at every stage of illness.”

Identifying patients with liver disease serious enough to warrant transplant consideration

Specialists in liver disease at Ohio State’s Medical Center want every patient who has liver dysfunction or liver disease to have an opportunity to be considered for liver transplant. “Any patient who has liver dysfunction should be referred for consultation by a liver specialist,” says Andreoni. “In some cases, we can improve the patient’s liver function and avoid transplant. When the patient does need a transplant, we can develop a plan to optimize health until transplant is unavoidable.” “Liver disease is too often overlooked for too long,” notes Andreoni. “Every day, patients tell us, ‘I wish I’d been sent here a year ago.’”

Liver disease is too often overlooked for too long OSUMC offers particular expertise in treating hepatocellular carcinoma and preparing these patients for transplant. Treatment for this disease is managed through our clinical research programs in collaboration with the OSUCCCJames. A team of surgical oncologists, interventional radiologists, transplant surgeons, transplant hepatologists and medical oncologists provides unparalleled care for this malignancy and prepares patients for transplant.

Specialists in hepatology spend their entire careers studying this matter, a level of specialty that is critical in predicting who will be an appropriate candidate for transplantation, given the myriad factors involved in making this decision.

19 liver transplant

Our Dual-Expertise Approach

“We have a team approach to caring for liver patients,” says Hanje. “We collaborate between transplant surgery and transplant medicine at every stage of the patient’s interaction with us. Our Liver Transplant Program team members work under one roof, with a transplant pharmacist, pulmonologist, liver specialist and surgeon interacting daily. The benefits include patient centricity and immediate access to experts in every discipline of liver care.”

The Ohio State University Medical Center has equal expertise in liver transplantation and treatment of the diseases that lead to liver failure or dysfunction. Whether they are surgeons, medical specialists, nurses or other providers, team members in our Transplant Center care only for transplant patients. This specialization and experience with transplant patients’ unique needs helps to ensure we have insights and instincts about the myriad issues liver transplant patients face every day.

Regardless of a patient’s liver disease or dysfunction, our world-class program—continuously enhanced with additional dedicated specialists and surgeons—is equipped to evaluate, diagnose and treat every patient who seeks our care.

Insights and instincts about the issues liver transplant patients face every day

Window of Opportunity For every patient for whom liver transplant is a possibility, there is a window of opportunity when transplant is a realistic option. This critical window must not be closed. To ensure it remains open, our specialists should see patients as early as possible in the liver disease process. Even if a patient is not ready for transplant, specialists can help to determine when transplant might be a possibility, the likely timeline and the steps necessary to ensure the patient’s health for transplant.

Ohio State’s 90 percent one-year survival rate for liver transplants exceeds the national average of 88 percent reported by the Scientific Registry of Transplant Recipients.

How to refer patients... Our physicians are happy to evaluate any patient for current or future liver transplant, without restrictions. Patient transfers can be arranged 24 hours a day through our transfer center. We can help you and your patients navigate the social services, insurance and government funding issues involved with transplantation. We process transplant referrals as quickly as possible. The sooner patients are seen for consultations, the sooner appropriate patients can be put on transplant wait lists. We maintain an ongoing commitment to our referring physicians to keep you informed about your patient while they are in our care, and to return your patient to you for ongoing care. Urgent Referral Clearly, some patients cannot withstand even a minimal wait between your initial inquiry on their behalf and a consultation with us. Please notify us when a patient’s condition warrants immediacy, including an in-hospital consultation at our facilities. Abdominal Transplant (kidney, liver, pancreas) 614-293-6724 800-293-8965 After business hours, call 1-800-293-5123.

20 liver transplant

Our Team Transplant Medicine Specialists Maher Azzouz, MD

Todd Pesavento, MD

Transplant Hepatology Associate Professor-Clinical, Gastroenterology, Hepatology and Nutrition Director of Endoscopy, Gastroenterology, Hepatology and Nutrition

Transplant Medicine Associate Professor-Clinical, Nephrology Director of Transplant Medicine, Solid Organ Transplant Program Deputy Director, Comprehensive Transplant Center Medical Director of Clinical Services, Comprehensive Transplant Center

Clinical interests: hepatology, therapeutic biliary endoscopy

Clinical interests: transplant nephrology, preservation of renal function in the liver transplant recipient, hypertension in transplant patients, chronic allograft dysfunction

Elizabeth Essig, MD Transplant Medicine Assistant Professor-Clinical, Endocrinology, Diabetes & Metabolism

Research interests: Risk stratification for high-risk candidates for transplantation, hypertension in transplant patients, maximization of dysfunctional renal allografts

Clinical interests: diabetes, general endocrinology

James Hanje, MD

Transplant Surgeons

Transplant Hepatology Assistant Professor-Clinical, Gastroenterology, Hepatology and Nutrition Director, Hepatology Assistant Program Director, Division of Gastroenterology, Hepatology and Nutrition

Kenneth Andreoni, MD Transplant Surgery Associate Professor, Surgery Director, Liver Transplantation, Comprehensive Transplant Center

Clinical interests: drug-induced liver injury, hepatocellular carcinoma, evolving treatment strategies for hepatitis C

Clinical interests: liver, pancreas and kidney transplantation Research interests: new anti-rejection drugs, antibody-mediated injury to liver and kidney grafts

Robert Kirkpatrick, MD Transplant Hepatology Associate Professor-Clinical, Gastroenterology, Hepatology and Nutrition Medical Coordinator, Liver Transplant Program

Elmahdi Elkhammas, MD Transplant Surgery Professor-Clinical, Surgery Clinical interests: liver, kidney and pancreas transplantation, complications in transplantation

Clinical interests: liver and biliary tract diseases, liver transplant evaluation Research interests: bile acid metabolism, drug metabolism, hepatitis

Research interests: liver transplantation, complications in transplantation

Mitchell Henry, MD

Douglas Levin, MD

Transplant Surgery Professor, Surgery Director, Clinical Transplantation Deputy Director, Comprehensive Transplant Center Director, Division of Transplantation

Transplant Hepatology Assistant Professor-Clinical, Gastroenterology, Hepatology and Nutrition Clinical interests: fatty liver disease

Clinical interests: transplantation and immunosuppression

Anthony Michaels, MD

Research interests: organ preservation, xenotransplantation, clinical immunosuppressive drug trials

Transplant Hepatology Assistant Professor-Clinical, Gastroenterology, Hepatology and Nutrition

continued on next page... 21 Liver transplant

Ginny Bumgardner, MD, PhD

Ronald Pelletier, MD

Transplant Surgery Professor, Surgery Associate Dean for Research Education and Graduate Studies, College of Medicine

Transplant Surgery Associate Professor, Surgery Director, Immunohistopathology Research Lab, Department of Surgery, Division of Transplantation

Clinical interests: transplantation, pregnancy and fertility after transplant, recurrent disease after transplant, immunosuppression

Clinical interests: kidney; pancreas and liver transplantation, laparoscopic living donor nephrectomy

Research interests: hepatocellular and islet transplantation, transplant immunology

Elizabeth Davies, MD Transplant Surgery Clinical Assistant Professor, Surgery Clinical interests: deceased donor management Research interests: clinical and humanistic outcome measurement, xenotransplantation

Research interests: immune tolerance, chronic rejection, post-transplant donor alloimmunity

The Ohio State University Medical Center Liver Transplant medicalcenter.osu.edu/go/transplant

ÂŠ 2011 The Ohio State University Medical Center â&#x20AC;&#x201C; 4 CORP20100483-07

Ohio State’s

Consult Spring 2011

How to identify impaired hypoglycemic unawareness

Practice Tool

How to identify which patients might benefit from pancreas transplant

Individuals who have diabetes must be able to identify the signs of hypoglycemia to take the steps necessary to prevent it from worsening. However, patients on insulin therapy for type 1 diabetes may have a reduced ability to notice these signs. This reduced awareness of hypoglycemia is a strong risk factor for severe hypoglycemia, a condition that can lead to significant consequences including seizure, coma and death. A useful tool to specify which patients are affected by impaired hypoglycemic awareness is the Clarke Score. Patients answer a series of questions about their symptoms, and the provider determines a score. Four or more answers indicating a reduced ability to notice symptoms is a signal to the provider to examine a patient’s need for changes in treatment. Patients who rate 4 or higher on the Clarke Score may be candidates for pancreas or pancreatic islet cell transplantation. This is one of the criteria The Ohio State University Medical Center Pancreas Transplant Program uses to screen patients.

Other criteria to determine which patients are appropriate to refer to Ohio State’s Medical Center for evaluation for pancreas or pancreas islet cell transplantation include: w Patients with type 1 diabetes and a stable kidney transplant w Patients with type 1 diabetes and kidney failure requiring either hemodialysis or peritoneal dialysis (appropriate for only pancreas-kidney transplant, not islet cell transplantation) w Patients with type 1 diabetes without significant kidney disease who have at least one of the following metabolic conditions: – Reduced hypoglycemic awareness – ≥2 severe hypoglycemic events or ≥2 hospitalizations for diabetes ketoacidosis in the last year Dr. Essig emphasizes that pancreas transplant is an important consideration for younger patients, in particular. “Current data suggest that pancreas transplant increases quality of life for patients who have unmanageable diabetes,” she says.

“A 4 or higher Clarke Score is a red flag, and interested patients can be referred for a consultation to our Pancreas Transplant Program,” says Elizabeth Essig, MD, transplant medicine physician and assistant professor of Endocrinology, Diabetes & Metabolism.

“Patients who can gain control of their glycemic problems with a pancreas transplant can have significant quality-of-life gains.” — Elizabeth Essig, MD

Clarke Score 1. Do you have symptoms when your blood sugar is low? q Always (A)

q Sometimes (R)

q No longer (R)

2. Have you lost the ability to recognize symptoms that used to occur when your blood sugar was low? q Yes (R) q No (A) 3. In the last 6 months, how often have you had moderate hypoglycemic episodes? (Symptoms of confusion, disorientation or lethargy and were unable to treat yourself) q Never (A) q Once or twice (R) q Every other month (R) q Once a month (R) q More than once a month (R) 4. In the last year, how many times have you had severe hypoglycemic episodes? (Episodes of unconsciousness or seizure and needed glucagon or intravenous glucose)

q Never (A) q 6 (R)

q 1 (R) q 7 (R)

q 2 (R) q 8 (R)

q 3 (R) q 9 (R)

q 4 (R) q 10 (R)

q 5 (R) q 11 or more (R)

5. How often in the last month have you had readings <70 mg/dL with symptoms? q Never

q 1-3 times

q 1 time/week

q 2-3 times/week

q 4-5 times/week

q Almost daily

6. How often in the last month have you had readings <70 mg/dL without any symptoms? q Never q 1-3 times q 1 time/week q 2-3 times/week Count as (R) if the number is GREATER for question #6

q 4-5 times/week

q Almost daily

7. How low does your blood sugar have to be before you experience symptoms? q 60-69 mg/dL (A)

q 50-59 mg/dl (A)

q 40-49 mg/dL (R)

q <40 mg/dL (R)

8. To what extent can you tell by your symptoms that your blood sugar is low? q Never (R)

Total Number of â&#x20AC;&#x153;Râ&#x20AC;? Responses

q Rarely (R)

q Sometimes (R)

Reduced awareness: >4 Rs Aware: < 2 Rs

q Often (A)

q Always (A)

Adapted from Diabetes Care 18:517, 1995

How to refer patients... Pancreas medicine specialists and transplant surgeons at The Ohio State University Medical Center are happy to evaluate patients for current or future pancreas or kidney-pancreas transplant. Our transplant referral lines are staffed 24 hours a day. Let us help you and your patients navigate the social services, insurance and government funding matters involved with transplantation. Abdominal Transplant (kidney, liver, pancreas) 614-293-6724 800-293-8965 After hours, call 1-800-293-5123.

24 Diabetes practice tool

CORP20100483-10

Ohio State’s

Consult | Spring 2011 |

MAKOplasty Robotic Arm Revolutionizing Knee Resurfacing MAKOplasty Partial Knee Resurfacing is an innovative robotic treatment option now available from Ohio State’s Department of Orthopaedics for adults living with early to mid-stage osteoarthritis that has not yet spread to all three compartments of the knee. Powered by robotic arm technology, the benefits of this minimally invasive procedure include more rapid recovery, shorter hospital stay and a more natural feeling knee. The procedure involves the use of a 3-dimensional CT scan to precisely plan the resurfacing, removal of affected bone and placement of the implant. During the procedure, the diseased portion of the knee is resurfaced, sparing the patient’s healthy bone and surrounding tissue. An implant is then secured in the joint to allow the knee to move smoothly again. The robotic arm provides the surgeon with real-time visual, tactile and auditory feedback to facilitate optimal joint resurfacing and implant positioning which results in a more natural knee motion following surgery. Candidate Overview: w Patient with early to mid-stage osteoarthritis in medial, patellofemoral or lateral knee compartment w Young (40-50) active adults or older (65+) adults experiencing knee pain

Benefits at a Glance: • New robotic partial knee resurfacing available only at Ohio State • Precision technology preserves the patient’s healthy bone and tissue • Faster recovery times, less pain, less trauma for the patient

Get Started: Surgeons accepting patients for the MAKOplasty procedure include: • Andrew Glassman, MD • Matthew Beal, MD • Christopher Kaeding, MD

• Thomas Ellis, MD • David Flanigan, MD • JeffreyGranger, MD 25

To learn more or to refer a patient, please call 614-293-BONE (2663).

Research Provides Better Treatment Options for Blood and Marrow Transplant Patients The BMT program at The James performs all types of transplants. Autologous transplantations, when a patient’s own stem cells are being used, are used mainly for patients with multiple myeloma, non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma. Allogeneic (when stem cells from a donor are used) are used mainly to treat patients with acute and chronic leukemia and increasingly for NHL. The program offers all types of allogeneic (donor) transplants including those from mismatched family members, unrelated volunteer donors, and even umbilical cord blood from cord blood banks.

At a Glance: • Largest BMT program in the state, top 15 in the nation • Performing all forms of BMT transplants • Advanced research trials improving treatment options and survival rates The number of transplants performed at the Blood and Marrow Transplant (BMT) Program at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute has grown from 100 transplants per year to 230 transplants performed in 2010, a total of more than 2,600 transplants since the program started.

In the last ten years, survival rates have steadily increased. This has made BMT a viable option for patients who may have previously been hesitant to consider transplant for treatment – and their physicians who were hesitant to make the recommendation.

Steven Devine, MD, director of the Blood and Marrow Transplant Program attributes the program’s success not only to an increase in the number of patients being treated, but also to the number of patients actively enrolling in clinical trials. Unlike other transplant centers across the country that might offer clinical trials for blood cancers in general, The James is focused on enrolling patients in clinical trials that focus on specific types of blood cancer, such as lymphoma, acute leukemia or multiple myeloma.

“There is a common misconception that age is a significant risk factor for this treatment,” Devine says. “Autologous transplantations are performed up to age 80 and allogeneic up to age 75. Even the senior population often benefits from BMT.” Physicians in the BMT Program work closely with referring physicians to keep them updated throughout their patient’s care. “Ultimately, our goal is to help a patient become well again so they can go back to their referring physician for ongoing care,” says Devine.

Interesting FACT...

The BMT treatment team is made up of physicians, nurses, a PharmD, social worker, nutritionist, physical therapist and psychologist.

w 60 percent of donor stem cells come from an unrelated volunteer w 40 percent of donor stem cells come from a family member

To learn more about clinical trials for leukemia, lymphoma and multiple myeloma, please visit cancer.osu.edu >Patients and Visitors>Clinical Trials.

“We have a robust list of Ohio State investigator-initiated trials as well as NIH-sponsored BMT Clinical Trials Network (BMT CTN) trials, and NCI Cancer and Leukemia Group B (CALGB) cooperative trials,” Devine says. Learning more about the way these rare blood cancers respond to treatment provides hope for future patients – and a unique advantage not available at many other centers.

Get Started: To learn more about blood and marrow transplant, or to refer a patient, call 614-293-3153 or toll-free 866-880-4698, or visit us online at cancer.osu.edu/go/BMT. The James partners with the National Marrow Donor Program (NMDP) to find stem cell matches for patients eligible for blood and marrow transplant.

BMT physicians at OSUCCC-James are involved in setting national standards of care for patients with blood cancers. Devine was recently named as the new chair of the NCI Cancer and Leukemia Group B (CALGB) transplant modality committee. He is now leading one of 12 CALGB modality committees that provide expert advice to the six CALGB disease committees concerning the application of treatments. 26

Hematology Expansion to Serve Patients in Eastern Ohio At a Glance: • State-of-the-art cancer care for patients

News from... Maternal Fetal Medicine

• Outpatient care for a benign and malignant hematology The Division of Hematology at Ohio State’s Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute is now offering expanded clinics at University Hospital East. The expansion supports University Hospital East’s and the Hematology Division’s commitment to providing those who reside and work in the eastern part of Columbus and Ohio with stateof-the-art cancer care closer to home. The Hematology expansion marks the first time a specific cancer disease-site team has been represented at UH East to treat patients. The Hematology clinics offer outpatient care to those with benign and malignant hematologic conditions. Services include: • Acute myelocytic/myelogenous leukemia • Acute lymphoblastic leukemia • Cytopenias of any kind (anemia, thrombocytopenia, neutropenia)

Annual Maternal Fetal Medicine Conference Now Registering The fourth annual Ohio Fetal Diagnosis and Therapy Collaborative Meeting will be held on The Ohio State University Medical Center campus on Oct. 21, 2011. This one-day program is for physicians, nurses, social workers, sonographers and genetic counselors involved in prenatal diagnosis and therapy in Ohio. Goals are to increase awareness of available resources in Ohio and to promote statewide collaborative projects and communication. CME credits will be available. For more information, please contact: Karen Rossi, RN, BSN Fetal Treatment Nursing Program Manager 614-293-8083 or rossi.34@osu.edu

New Physician Joins Maternal Fetal Medicine

• Myelodsyplasic syndrome (MDS) • Chronic lymphocytic leukemia (CLL) • Chronic myelogenous leukemia • Hypercoagulable disease • Lymphadenopathy (patients with abnormal lymph nodes) • Lymphoma • Hodgkin’s disease • HIV malignancies Get Started: The hematology clinics are held on Mondays and Thursdays from 8:30 a.m. – 12:30 p.m. on the seventh floor of the Tower. To schedule a patient, call The James Line at 614-293-5066 or toll-free at 1-800-293-5066.

Britton D. Rink, MD, MS, has joined OSU Maternal Fetal Medicine as an assistant professor of Obstetrics and Gynecology. A Columbus native, Rink graduated from Indiana University School of Medicine, where she also earned a master’s degree Britton Rink, MD in clinical genetics. She completed a residency program in Obstetrics and Gynecology and subsequent training in Genetics and Maternal Fetal Medicine at The Ohio State University Medical Center. Rink is board certified in Genetics and Obstetrics and Gynecology. Her interests include prenatal diagnosis, fetal therapy, obstetric imaging and genetics. Her practice includes the evaluation of pediatric patients at Nationwide Children’s Hospital as well as providing obstetric services for high-risk pregnancies at Ohio State. To make a referral to Dr. Rink, please contact: OSU Maternal Fetal Medicine 2050 Kenny Road 614-293-2222

Two New Physicians Join Our Neurovascular Stroke Center We are pleased to welcome Eric Sauvageau, MD, as associate professor of neurosurgery and surgical director of the Neurovascular Stroke Center, along with Diana Greene-Chandos, MD, assistant professor and director of the Neuroscience Critical Care program. Sauvageau specializes in endovascular, cerebrovascular and skull base neurosurgery. With his unique training – including both endovascular and skull base/cerebrovascular clinical fellowships – Sauvageau offers a comprehensive and impartial approach to the treatment of cerebrovascular pathologies, providing either conventional surgery or a less invasive catheter-based endovascular treatment. Greene-Chandos’ areas of expertise include the care and management of critically ill neurological and neurosurgical patients, intracerebral hemorrhage, subarachnoid hemorrhage, ischemic stroke, central nervous system vasculitis and traumatic brain injury. Her clinical interests also include diagnosis, evaluation and treatment of illness or injury to the neurologic system in a critical care setting. For questions or patient appointments, call: 614-293-0689 to schedule with Dr. Sauvageau 614-366-5681 to schedule with Dr. Greene-Chandos

Eric Sauvageau, MD

Diana Greene-Chandos, MD

Heart Failure Treatment Reduces Fluid Overload

New Cardiology Clinic for Cancer Patients and Survivors

At a Glance:

• Dialysis-like treatment option for patients with fluid overload

• Specialized cardiology care designed for patients living with or survivors of cancer

• Speeds up treatment of heart failure patients

• Treating heart-related side effects of cancer therapy

• Improves patient outcomes The Ross Heart Hospital’s OSU Cardiology Clinic for Cancer Patients and Cancer Survivors Cardio-Oncology Program is now open and accepting patients. This program, led by co-directors Ragavendra Baliga, MD and Garrie Haas, MD, and Cindy Boyd, RN, cares for individuals who:

For heart failure patients suffering from fluid overload, time is of the essence. Excess fluid builds up in various locations in a patient’s body and can lead to a reduction in the amount of oxygen entering the blood, causing shortness of breath and discomfort. Ohio State’s Medical Center is now offering aquapheresis therapy using the Aquadex FlexFlow to advance treatment of patients with fluid overload.

• are having heart-related side effects as a result of cancer therapy • have been diagnosed with heart disease in the past and are currently receiving therapy for cancer

“With the implementation of this new treatment protocol, we are able to reduce the time it takes to treat heart failure patients,” says Garrie Haas, MD, medical director of heart failure. “The faster we’re able to get the patients breathing easier, the better their outcomes.”

• are current cancer patients and cancer survivors and require advice on the best possible heart health solutions • require customized cancer therapy plans in order to reduce the risk of heart-related side effects

Get Started: Physicians can contact the Heart Failure Clinic at 614-293-6081 to refer a patient or for more information.

Get Started: Contact the Ross Heart Hospital 614-293-ROSS (7677) 888-293-ROSS (7677) 28

CarePoint Expansions to Serve More Patients

CarePoint Lewis Center Now Open

CarePoint East Slated to Open in July

Many of Ohio State’s talented experts have moved to CarePoint Lewis Center in order to offer patients access to care in a convenient, neighborhood setting. CarePoint Lewis Center is easily accessed by patients in Northern Franklin County, Delaware, Marion and adjacent counties.

CarePoint East is currently being constructed in the former veteran’s administration building at the Leonard Avenue exit of I-670. This 136,000 square-foot facility will be home to the following services:

CarePoint Lewis Center is located at 6515 Pullman Drive, at the corner of State Route 23 and Lewis Center Road, next to the Kroger Marketplace. Free parking is available to visitors. Services Offered: Cardiovascular Medicine | 614-688-7150 ENT | 614-366-ENTS Family Medicine | 614-688-7150 Internal Medicine | 614-688-7150 Imaging | 614-688-7130 Orthopaedics | 614-688-7160 Physical Therapy | 614-293-1008 Podiatry | 614-293-FOOT Sports Medicine | 614-688-7160 Wound Care | 614-293-9981

Connect With Resources from Ohio State’s Medical Center

• • • • • • •

Family Medicine Internal Medicine Occupational Medicine Orthopaedics Physical Therapy Radiology/Imaging Spine Center

Look for more information on CarePoint East coming this summer.

Our Regional Outreach team is here to assist you in accessing the resources, education and patient referral information you need most from OSU Medical Center. Call on your Regional Outreach Coordinator at any time for information such as: • Help with the referral process • Requests for visits/calls with OSU physicians • Requests for patient materials • Access to CME and clinical research opportunities

Franklin County: Noreen Palmer | 614-366-6680 East/Southeast Ohio: Karen Mitchell | 614-293-4352 North/West Ohio: Bill Cox | 614-293-2824

Ohio State’s Heart and Vascular Center Participating in Aortic Valve Replacement Trial

JamesCare Comprehensive Breast Center Open House Our new JamesCare Comprehensive Breast Center is the first of its kind in the Midwest to offer the full continuum of breast cancer care – from prevention and screening through detection, diagnosis, treatment and survivorship – in one convenient, world-class facility. Please join us for an open house on April 16 from 10 a.m. to 1 p.m. The open house will feature a ribbon cutting, guided tours, entertainment and refreshments. Remarks will be given by the following distinguished leaders:

w The Ohio State University President E. Gordon Gee w Michael A. Caligiuri, MD, Director, Ohio State’s Comprehensive Cancer Center, CEO, James Cancer Hospital and Solove Research Institute w Steven G. Gabbe, MD, Senior Vice President for Health Sciences, The Ohio State University, CEO of The Ohio State University Medical Center

1145 Olentangy River Rd. Columbus, OH 43212 614-293-5066

The Heart and Vascular Center at The Ohio State University Medical Center is participating in a study that will explore a new nonsurgical approach to severe aortic valve stenosis. This multicenter trial, sponsored by Medtronic, Inc., is called the CoreValve U.S. Pivotal Trial and will evaluate the safety and efficacy of percutaneous aortic valve replacement for the treatment of patients with aortic valve stenosis. Aortic stenosis is common among elderly patients and leads to significant deterioration of functional status and, ultimately, limits survival. Surgical aortic valve replacement currently is the only effective treatment for this condition. However, some patients with aortic stenosis are poor candidates for open heart surgery because they are either too old or frail, or have some other complicating medical condition. Percutaneous transcatheter aortic valve replacement may be an option for those patients with symptomatic aortic stenosis who are considered “high risk” for conventional surgical therapy.

Get Started: If you have questions or would like to discuss a patient with aortic stenosis with one of our CoreValve Trial investigators, please call Dr. Thomas Ryan at 614-204-6170 or Dr. Juan Crestanello at 614-832-4864.

Save the Date! Ohio State’s Heart and Vascular Center’s Third Annual Contemporary Multi-Disciplinary Cardiovascular Medicine Conference October 7 – 9 Marriott Orlando World Center Resort 8701 World Center Drive Orlando, Florida 32821 Join us this year at a new location with more event space, expanded parking plus additional dining options and an 18-hole golf course. We will continue to offer a comprehensive learning experience highlighting the latest advances in cardiovascular care as well as case studies and lectures to help improve your practice. Bookmark this site http://bit.ly/orlando2011 for future updates on invited speakers, agenda and accommodations. 30

Ohio State Physicians

In The News

has been named Surgeon of the Year by the publication Surgical Products. Melvin’s main area of interest is gastrointestinal surgery, with special emphasis on laparoscopy and use of computer-enhanced surgical systems. He has authored over 90 articles and book chapters and has made hundreds of presentations worldwide pertaining to gastrointestinal and minimally invasive surgery.

Martha Gulati, MD, a nationally recognized expert in the study of women and heart disease, has been named director for preventive cardiology and women’s cardiovascular health at The Ohio State University Medical Center. Gulati also holds the Sarah Ross Soter Chair in Women’s Cardiovascular Health. Gulati previously served as the associate director of the Center for Women’s Cardiovascular Health at the Bluhm Cardiovascular Institute of Northwestern University, where she was the Lawrence E. and Nancy S. Glick Family Distinguished Physician in Women’s Cardiovascular Health. Gulati completed medical school at the University of Toronto, Canada. She went on to complete her internship, residency and cardiology fellowship at the University of Chicago. She received a Master of Science at the University of Chicago and is a fellow of the American College of Cardiology. She is board certified in cardiovascular disease. She is the author of the recently released book, “Saving Women’s Hearts.”

The Best Doctors in America, 2011-2012 database has recently been released, and all of the doctors listed in the Surgery category for central Ohio are faculty in the OSU Department of Surgery. Listed as the best are Kenneth Andreoni, MD, Ginny Bumgardner, MD, PhD, Elmahdi Elkhammas, MBBS, E. Christopher Ellison, MD, Mitchell Henry, MD, W. Scott Melvin, MD, Peter Muscarella, MD, Bradley Needleman, MD, Ronald Pelletier, MD, Amer Rajab, MD, PhD, and Steven Steinberg, MD.

John Campo, MD, will serve as interim chair of Ohio State’s Department of Psychiatry. Campo is currently director of Child and Adolescent Psychiatry, medical director of Pediatric Behavioral Health and professor of Clinical Psychiatry and Pediatrics at Ohio State and Nationwide Children’s Hospital.

Also listed by surgical specialty are Mark Arnold, MD, colon and rectal surgery; Mark Galantowicz, MD, and Alistair Philips, MD, pediatric cardiac surgery; Gail Besner, MD, Denis King, MD, and Steven Teich, pediatric surgery; William Carson, William Farrar, MD, and William Kraybill, MD, surgical oncology; and Patrick Ross, MD, PhD, thoracic surgery.

W. Scott Melvin, MD, professor of surgery, chief of General and Gastrointestinal Surgery and director of the Center of Excellence for Minimally Invasive Surgery,

The Best Doctors in America database is compiled by Best Doctors, Inc., and includes over 40,000 doctors in more than 40 medical specialties.

Tools You Can Use: Mobile Physician Referral Guide We’re making it easier than ever before to get the information you need to refer patients to Ohio State’s Medical Center. We have recently created our Physician Referral Guide in a mobile format for your smart phone. Now you can find listings of our medical services and patient referral information right on your phone. You’ll also be able to search our physician database. Access it by visiting www.medicalcenter.osu.edu from your smart phone and it will automatically display.

Your Resources DocLink healthsystem.osu.edu Web-based program allowing referring physicians access to their patients’ OSU Medical Center visit-specific treatment results

Physician-to-Physician Consultation Line 800-293-5123, option 1 Consult with an OSU Medical Center physician, discuss specific patient-related cases, appointment referral, transfer a patient

Referring Physicians medicalcenter.osu.edu/referringphysicians Referring physician information, links, downloads and forms, patient education materials, maps and directions

Physician Relations 800-293-4326 or mdrelations@osumc.edu Physician Relations supports the needs of community physicians and their staff as they interact with OSU Medical Center

The Ohio State University Comprehensive Cancer Center– Arthur G. James Cancer Hospital and Richard J. Solove Research Institute The James Line: 614-293-5066 cancer.osu.edu Patient referral center, clinical trials and research information, patient education materials

OSU Regional Outreach Program Franklin County, Noreen Palmer....................614-366-6680 East/Southeast Ohio, Karen Mitchell..........614-293-4352 North/West Ohio, Bill Cox..............................614-293-2824 Outreach provides access to OSU Medical Center services, specialty physicians, continuing medical education and other Medical Center programs Physician Directories To request a copy of our physician directory or to request updated sections for your existing directory, please call your Regional Outreach Coordinator (above).

Continuing Medical Education ccme.osu.edu Continuing Medical Education programs, including Category I CME offerings online through OSU MedNet21, traditional lecture series and Grand Rounds

Physician Referral Guide To request a copy of the Physician Referral Guide, call your Regional Outreach Coordinator or visit medicalcenter.osu. edu/referringphysicians to access an online version.

Physician Resources

Contact

DocLink healthsystem.osu.edu

Web-based program allowing referring physicians access to their patientsâ&#x20AC;&#x2122; OSU Medical Center visit-specific treatment results

OSU Medical Center medicalcenter.osu.edu

Referring physician information, patient education materials, maps and directions

The Arthur G. James Cancer Hospital and www.cancer.osu.edu Richard J. Solove Research Institute

Patient referral center, clinical trials and information, patient education materials

OSU Medical Center http://ccme.osu.edu Center for Continuing Medical Education

Web site featuring Continuing Medical Education programs including: Category I CME offerings online through OSU MedNet21, traditional lecture series and Grand Rounds

1-800-293-5123; option 1 Physician-to-Physician Consultation Line

Consult with an OSU Medical Center physician, discuss specific patient-related cases, appointment referral, transfer a patient

Physician Relations 1-800-293-4326 mdrelations@osumc.edu

Physician Relations supports the needs of community physicians and their staff as they interact with OSU Medical Center

Franklin County: 614-366-6680 OSU Regional Outreach Program East/Southeast Ohio: 614-293-4352 North/West Ohio: 614-293-2824

Outreach provides referring physicians with access to OSU Medical Center services, specialty physicians, continuing medical education and other medical center programs