Volume 23
Number 17
August 24, 2012
Hospital of the University of Pennsylvania
THE MATCHMAKERS OF HUP The success of an organ transplant depends on many factors, but results from the HLA lab can be critical in the final decision. Find out why this particular lab has such a major impact on transplant clinical outcomes.
Getting Down to the Basics Human leukocyte antigens (HLA) are proteins that serve as markers on most cells in a person’s body. The immune system uses these markers to recognize which cells belong in your body… and which don’t. Antigens also play a part in stimulating the development of antibodies, which seek out and destroy foreign matter. While this action acts as a defense against pathogens, it can also lead to rejections of organ transplants. “Let’s say a transplant patient has antibodies directed at antigen A1 and A2,” explained Jane Kearns, MT(ASCP), CHS, technical manager of the HLA Laboratory. “Transplanting an organ that’s positive for these antigens would lead to a more difficult posttransplant course…and the patient might ultimately lose the graft.” In other words, the closer the match between a patient’s HLA markers and those of the donor, the lower the potential for developing donor-specific antibodies and the greater the chance for a successful outcome. Determining which antibodies a transplant patient has — and doing a crossmatch to determine if they would have a detrimental effect on the donor organ — is the main responsibilities of the HLA lab. This typing is part of a transplant patient’s initial evaluation and continues through post-transplant followups. The lab’s 17 technologists perform these screenings for every one of HUP’s
INSIDE Blankets of Hope.......................3 Heartfelt Thanks........................3 Helping People All the Time.....3 Getting to the Root of the Problem..................4
`` Scott Hoeckele sets up HLA typing using molecular methods.
transplant patients with the exception of those waiting for a liver. “HLA supports all of the other transplant services, including kidney, pancreas, islet cell, heart, and lung, as well as autologous and allogeneic bone marrow transplants.” Malek Kamoun, MD, PhD, director of the Immunology Lab, said these regular screenings are critical because, while a person’s antigens never change, antibodies can. For example, he said, “women develop antibodies through pregnancy and people who undergo transfusions and transplants can also develop antibodies.” The results of these antibody screenings are saved in both the HLA database as well as that of the United Network for Organ Sharing (UNOS), which manages the country’s organ transplant system. HLA typing is also performed on all donor organs. Gift of Life (the region’s organ procurement agency that coordinates distribution of organ material) sends blood samples of every donor organ to the Hershey Medical Center for testing, the results of which are also uploaded on the UNOS data base. As a result, when a request for a crossmatch comes to the HLA lab from a transplant coordinator, “we already have a fairly good idea if the recipient-donor pair will be compatible or if there’s a possibility of incompatibility,” Kearns said. (Continued on page 2)
Join Penn Medicine at the Undy 5000!......................4
1
(Continued from cover)
`` Maria Tague does sample processing in preparation for the HLA testing.
THE MATCHMAKERS OF HUP Crossmatching to Confirm Compatibility Still, crossmatching is never taken lightly. It’s a slow process — each crossmatch takes up to six hours — and there are no shortcuts. “We’re very vigilant,” said Marilyn Eisenstadt, HLA technologist. “There are serious ramifications of making any mistake.” It’s a huge challenge, Kamoun agreed, “ with no tolerance for errors.” The call for a crossmatch can occur at any time — day or night. “Once a donor becomes available, we drop everything and proceed with the donor crossmatches,” Kearns said.
average, the HLA lab performs typing on On more than 2,700 samples and antibody screening on more than 5,600 patients each year.
Generally, the transplant coordinator sends the lab a list of potential recipients to be crossmatched with a single donor organ. For each crossmatch, the tech uses patient sera stored in one of several large freezers in the lab and harvested cells from donor blood specimens. In most cases, the crossmatch is done prior to the actual transplant. However, when there are time restrictions, such as with a heart and lung transplant, “we perform a virtual crossmatch before the transplant, which is based on the antibody screening information entered into the UNOS database,” Kearns said. The actual crossmatch is done post-transplant. In addition to running the crossmatch, the tech checks a patient’s historical data and antibody profiles. “How the patient developed antibodies is important,” Kamoun said. “It’s of more concern if it’s from a previous transplant than a blood transfusion.” Kamoun said that, for heart transplant candidates, when test results indicate an increased risk of rejection, the transplant team works closely with the HLA lab to make a final decision. “Generally speaking, if the patient has a high risk of rejection due to HLA incompatibility but is stable, the transplant won’t be done,” Kamoun said. However, if that same patient were in dire need of a transplant, “we’ll work with the transplant team to define compatibility criteria based on more aggressive treatment aimed at decreasing the antibody level.” Recently, the lab switched to a new data base (HistoTrac). Kearns and her team worked tirelessly for months to create a mechanism for moving data from the old database system to HistoTrac without corrupting it in any way. “We didn’t want the change in our database to impact our ability to support the transplant team.” The new system automatically transfers patient information directly from instruments into the lab’s database, thus eliminating errors from manual data entry. It also automatically uploads into UNOS and the National Bone Marrow Registry. On average, the HLA lab performs typing on more than 2,700 samples and antibody screening on more than 5,600 patients each year. “The work is hard,” Kearns said, “but there is much satisfaction when a high-risk patient gets a transplant and has a successful outcome.”
2
HLA Lab Rises to the Occasion When it comes to compatibility between donor and recipient, bone marrow transplants have much more stringent requirements than solid organs. As a result, matches are often difficult to find, even in the National Bone Marrow Registry which keeps a list of over 18 million donors throughout the world. Once a potential match is found, the confirmatory HLA (human leukocyte antigen) testing can take up to 10 days; the transplant occurs within a few weeks of confirmation. As Joanne Hinkle, RN, BSN, OCN, CHTC, Unrelated Bone Marrow Donor Coordinator, noted, “A bone marrow transplant is not normally an emergent situation.” But that was not the case earlier this year for a leukemia patient at HUP in dire need of a bone marrow transplant. Hinkle found only one potential donor on the Registry but there was a big problem: he was in another country and in a place where having his blood drawn would be extremely difficult. “The situation was absolutely critical. We couldn’t put it off because who knew when another matching donor might become available.” Working with the donor center in the originating country, Hinkle was able to have the donor brought to a donor center in this country within a couple days, but he could only stay for a week. His blood sample was Fed Exed overnight to HUP and Jane Kearns, MT(ASCP), CHS, technical manager of the HLA lab, and her team went into overdrive to do the necessary typing. “They worked around the clock and got results back within two days,” Hinkle said. “Their flexibility was amazing.” Their efforts were not for naught. The donor was a match. Within a week, the bone marrow donation was hand carried to HUP and the transplant went ahead. “The patient got through his transplant and continues to recover,” Hinkle said. “And we could not have done it without the efforts of the HLA lab.”
Heartfelt Thanks Letter to Stephen Hahn, MD, chair of Radiation Oncology:
`` Members of the River Sisters– along with nursing staff in the Abramson Cancer Center – display some of the Blankets of Hope donated to patients undergoing chemotherapy infusion. (Standing, l. to r.) Karen Prete, Carolyn Rosin, Peggy DiMarino, Jerrylee Milavsky, Denise Lannon, Marge Aitken, and Cynthia Howarth, and (seated) Clarice Maggio (l.) and Lisa Figueroa.
‘BLANKETS OF HOPE’ A COMFORT FOR CANCER PATIENTS The River Sisters dragon boat team gets together once a week – May through October – to practice for races. The team members come from many walks of life but they have a common bond: they are all female cancer survivors. “When we’re on the river, our focus is on paddling, staying in sync with one another, ” said Jerrylee Milavsky. “It’s a wonderful way for a survivor to get back to normalcy.” The group so enjoys the comradery that they decided to reach out in another direction: making ‘blankets of hope’ for cancer patients undergoing chemotherapy. Using a kit – that they frequently buy with out-of-pocket money – they’ve made and donated 55 blankets to patients undergoing chemotherapy infusion treatments at the Perelman Center for Advanced Medicine. As Dawna Gillespie, an associate director of the Abramson Cancer Center, explained, “Patients can feel cold during infusions, but the blanket represents more than warmth. It’s comfort as well.” And the women do more than donate the blankets. As certified volunteers, they present the blankets to the patients themselves. “When we enter a room and the patients are made aware that we are cancer survivors, there is an immediate bond,” said Marge Aitken, ‘Blankets of Hope’ coordinator. “We understand the difficult journey the patients are on and they know we get it.” One recipient wrote on the River Sisters’ Facebook page: “I am in the middle of chemo at the Perelman Center and today received one of your amazing blankets to warm me up! I will take it with me to all treatments! Just can’t get over what a wonderful gesture this was — it meant so much to me! Thank you!!!” “It’s hard the first time many of us enter an infusion room and see the patient getting treatment. The memories all come rushing back,” Aitken said. “But we want to do this, as a way to give back to the cancer community and provide hope and encouragement to the patients. And each time, we come away receiving much more than we give.” To learn more about the River Sisters, go to http://river-sisters.org.
On behalf of my wife and myself, I would like to express our most sincere appreciation for the tremendous care she received at your medical facility. We were told that it was the world’s best and we can confirm every aspect of that reputation…. Everyone we encountered at the Roberts Proton Therapy Center was knowledgeable, professional and extremely caring. We want to express our heartfelt thanks to all the staff but especially your reception group, the nurses at the clinic (notably Ken Morgan), your assistant Erin Davis, and the outstanding radiation therapists (Kristin Burnett, Danielle Echols, Erica Fulforth, and Danielle Leonetti)…. I will never be able to thank you enough for your outstanding care and lifesaving treatment to save my dear wife.
Helping People ALL THE TIME Congratulations to the October 2011 winners of the Helping People All the Time raffle. Sosamma Abraham. . . . . . . . . . . . . . . Rhoads 6 Genes Bitera. . . . . . . . . . . . . . . . . . . . . . Dulles 6 Kara Buchy. . . . . . . . . . . . . . . . . . . . Founders 9 Cynthia Byrd. . . . . . . . . . . . . . . . . Physical Plant Cheryl Carroll . . . . . . . . . . . . . . . . . . Radiology Lisa DiCicco. . . . . . . . . . . . . . . . . . . . . Rhoads 6 Antoinette Edwards. . . . . . . . . . . . . . Radiology Patricia Fink. . . . . . . . . . . . . . . . . . . . . . Dulles 6 William Fletcher . . . . . . . . . . Patient Transport Reginald Gary. . . . . . . . . . . . . . . . . . . Radiology Carla Grasso. . . . . . . . . . . . . . . . . . . . . . . . . . ED Holly Greenberg. . . . . . . . . . . . . . . . . Radiology Stephanie Hook. . . . . . . . . . . . . . Silverstein 10 Corey Howard. . . . . . . . . . . . . . . . . . . Rhoads 6 Laura Kain. . . . . . . . . . . . . . . . . . . . . . . . Dulles 6 Jeremy Kaut. . . . . . . . . . . . . . . . . . . . Radiology Melisa Leighton. . . . . . . . . . . . . . . . . . Rhoads 6 Caren Levine. . . . . . . . . . . . . . . . . . . . Radiology Wendy Mackins. . . . . . . . . . . . . . . . . Radiology Stephanie Marchesani. . . . . . . . . . . Radiology Jessica Moore. . . . . . . . . . . . . . . Silverstein 10 Rose Pupo. . . . . . . . . . . . . . . . . . . . . . Radiology Michelle Scott. . . . . . . . . . . . . . . . . . . Rhoads 3 Lisa Stewart. . . . . . . . . . . . . . . . . . . . . Rhoads 6 Jennetta Stubanas. . . . . . . . . . . . . . . Rhoads 2
3
GETTING TO THE ROOT OF S THE PROBLEM MAKE IT COUNT Penn Medicine CAREs Foundation grant helps bring dental care to those in need. Dental pain can be brutal but not everyone can afford to go to a dentist. “It’s hard for someone who is unemployed to get dental care,” said Sue Canning, formerly COO of Emergency Medicine but now part of Hospital Operations. “Working in the ED, I saw many people come in with a tooth abscess. We could help with the pain but could not repair the damage.” A grant from the Penn Medicine CAREs Foundation will allow her to help many get to the ‘root’ of the problem. Canning has been associated with the Ministry of Caring – a community-based nonprofit organization that provides a wide range of services to the homeless and unemployed —for over 25 years. “It’s an extraordinary charity,” she said. One of the services the organization provides is emergency dental care at the Pierre Toussaint Dental Office in Wilmington, Delaware.
`` Sue Canning (r.) with Bernetta Dacus, dental assistant at Pierre Toussaint Dental Office, which will receive a Penn Medicine CAREs Foundation Grant to help up to 20 people receive emergency dental care.
There’s still time to apply for the next round of grants from the Penn Medicine CAREs Foundation Grant Program to help fund your outreach projects. The deadline for applications is September 1. For more information or to apply, go to pennmedicine.org/community.
Thanks to the Foundation grant, up to 20 people will receive the emergency dental care they need at the Toussaint Dental Office, preventing them from getting an infection and thus eliminating the need to come to the Emergency Room. “I think it’s wonderful that Penn is reaching out and offering grants to deserving charities in our area,” she said. “To serve people in my community is a wonderful thing.” To learn more about the Ministry of Caring, go to www.ministryofcaring.org.
VIDEO SERVICES is now responding to service requests submitted via email at tvservice@uphs.upenn.edu in addition to the telephone service line at 215.662.3900.
JOIN PENN MEDICINE AT THE UNDY 5000! On Saturday, September 8, help raise awareness about colon cancer by joining Penn Medicine at this year’s Undy 5000! The Undy 5000 is a family-friendly 5K run/walk that was created by the Colon Cancer Alliance. Team members include Penn Medicine faculty and staff, patients, caregivers, friends and family. Half of this year’s proceeds will go to Penn Medicine and the Abramson Cancer Center’s West Philadelphia Gastrointestinal Health Outreach and Access Program, a patient navigation program which helps West Philadelphia patients complete their screening colonoscopies — a powerful way to prevent colon cancer! To register as a member of team Penn Medicine, or to make a donation, please visit http://bit.ly/NMPU1J. If you have any questions, please contact Alicia Lamanna at Alicia.Lamanna@uphs.upenn.edu or 215.439.8281.
4
HUPdate EDITORIAL STAFF Sally Sapega Editor and Photographer Trissy Harding Designer
ADMINISTRATION
Susan E. Phillips Senior Vice President, Public Affairs CONTACT HUPDATE AT: 3535 Market Street, Mezzanine Philadelphia, PA 19104 phone: 215.662.4488 fax: 215.349.8312 email: sally.sapega@uphs.upenn.edu HUPdate is published biweekly for HUP employees. Access HUPdate online at http://news.pennmedicine.org/inside/hupdate.