Mayo Clinic is taking steps to bolster the medical marvel of transplantation while addressing the confounding problem of a critical shortage of donor organs. It created the Transforming Transplant Initiative with a bold goal of providing organ transplants for everyone who needs one. Another objective is to eliminate the waitlist that has grown to more than 100,000 people in the U.S.

"My vision is to not just help one patient, but help the thousands who have end-stage organ failure get lifesaving transplants," says C. Burcin Taner, M.D., a Mayo Clinic surgeon who leads the initiative. Dr. Taner is also the chair of the Department of Transplantation at Mayo Clinic in Florida.

Addressing shortcomings of organ transplants

The Transforming Transplant Initiative was created as a collaboration between the Department of Transplantation and Mayo Clinic's Center for Regenerative Biotherapeutics. The project seeks to overcome the shortcomings of transplantation, the greatest of which is the need for more organs. Researchers working to improve transplantation ask tough questions like, "Could we bioengineer organs to reduce or eliminate the wait list?"  To answer that question, Mayo Clinic has formed a collaboration with Carnegie Mellon University, pairing medical expertise with engineering know-how to make experimental organs.

"Bioengineering new organs is promising, but complex. We're looking at a research timeline of 10-15 years to potentially bring this new option to patients," says Dr. Taner.

This bioengineering research brings together 3D bioprinting, tissue engineering, biomaterials and cellular materials to grow humanlike organs.

The research is focusing on nine different bioengineering projects ranging from better ways of monitoring the health of transplanted organs to engineering complex organs such as hearts, lungs, livers and kidneys.

The Center for Regenerative Biotherapeutics is supporting the project with biomanufacturing, stem cell technology and other resources.

"Regenerative biotherapeutics seeks to repair or replace diseased organs. As such, we are very excited to be part of the Initiative for improving transplantation," says Wenchun Qu, M.D., Ph.D., the Jorge and Leslie Bacardi Associate Director, Center for Regenerative Biotherapeutics in Florida. "We hope to assist in the build out of this project by providing researchers, workspace, biomanufacturing capabilities and cell and gene technologies."

Making organ transplants more successful

Another challenge the Transforming Transplant Initiative is trying to address is graft failure or rejection of transplanted organs. Mayo Clinic's vision is to prevent the need for a second transplant. One research project is focusing on whether chimeric antigen receptor-T cell therapy (CAR-T cell therapy) could be used to control the body's immune response and prevent organ rejection. CAR-T therapy has mainly been used to treat blood cancers. Applying this technology to transplants would be a new, experimental use of CAR-T therapy.

"Some organ transplant patients have antibodies in their bloodstreams that increase their chances of (organ) rejection. Unfortunately, that makes it difficult to find a proper match," says Dr. Taner. "We hope research will show whether CAR-T cell therapy could harness the immune system to suppress antibodies that are causing rejection." Other Mayo Clinic goals include reducing the number of organs that are discarded and making more organs available through advanced preservation techniques. Another goal is to identify and treat disease early to prevent end-stage organ failure and the subsequent need for a transplant.

Working together to improve transplant options

Mayo Clinic leaders recognize that overcoming the complex barriers to organ transplantation will require powerful new collaborations. They are actively seeking new ways to work with experts in industry and academia that could bring new ideas, tools, specialized knowledge and energy to the field.

"Organ transplantation is one of the greatest accomplishments in modern medicine. There is also a lot of good expertise outside our organization," says Dr. Taner. "We welcome outside collaborators that could help us improve organ transplantation for patients."

It could take many years to realize the fruits of the Transforming Transplant Initiative. Nevertheless, Mayo Clinic researchers continue to work tirelessly to address the critical shortage of organs and bring the gift of organ donation to more people.

###

Related stories:
Four ways organ transplants are being transformed to save lives
Transplant program at Mayo Clinic in Florida celebrates its 25th anniversary with vision for future of transplant

The post Transforming Transplant Initiative aspires to save lives through bioengineering appeared first on Mayo Clinic News Network.

When Alice Alimurung was diagnosed with a rare and life-threatening tumor, she embarked on a hunt for a surgeon with enough expertise to remove the mass. The search led Alice from the Philippines to Minnesota and Mayo Clinic, where she found an experienced surgical team that saved her life.

For more than 15 years, Alice 'Peachie' Sacasas Alimurung knew she had a rare tumor next to her heart. Physicians told Alice, who lives in Manila, Philippines, that the tumor couldn't be surgically removed. Despite that, she was able to live a normal life as she raised her children. Then in March 2018, Alice woke up in the middle of the night and feared she was having a heart attack.

"It felt like there was a 200-pound gorilla on my chest," Alice says.

When Alice got out of bed and walked around, the feeling subsided. But the next day, she had an echocardiogram, followed by an MRI and CT scan. They revealed that Alice's tumor had grown substantially. It had spread into her vena cava, the major blood vessel that brings blood into the heart, and it was pressing against her heart. The scans also revealed the nature of the tumor, which Alice hadn't known before: mediastinal paraganglioma.

A rare tumor that generally grows within the vascular tissues near the heart, major blood vessels and esophagus, mediastinal paraganglioma has been reported only 150 times in medical literature. In some cases, the tumor can become cancerous. Treatment for mediastinal paraganglioma is surgical removal, when possible.

The discovery that Alice's tumor was invading vital cardiac structures set off an urgent, international search for a surgical team with expertise to treat her.

"I was really praying about it, asking for God to guide us. We were so desperate about this," Alice says. "We finally found Mayo Clinic in Rochester."

Since 1973, Mayo Clinic surgeons have operated on 14 patients with tumors like Alice's. Mayo Clinic also offered Alice the opportunity to be cared for by a multidisciplinary surgical team, including Hartzell Schaff, M.D., in Cardiovascular Surgery and Stephen Cassivi, M.D., in Thoracic Surgery.

"Dr. Schaff and Dr. Cassivi, they were both godsent to me," Alice says. "When we found them, it was no doubt an answered prayer."

From innocuous to dangerous

Alice's tumor was discovered in 2004 during an MRI to check for the source of back pain. At that time, the tumor was about 2 centimeters in diameter. Alice's physicians believed it was related to tuberculosis. She was prescribed antibiotics. In 2006, a scan revealed the mass had not grown. But in 2010, a CT scan showed that it had.

"I wasn't really dwelling on it because there were no symptoms," Alice says.

That changed in 2017 when Alice's heart began beating too fast. On the treadmill, her heart rate skyrocketed. Alice took beta blockers to control her heart rate, but her heart continued to beat rapidly. On a sightseeing trip in December 2017, she felt out of breath and exhausted.

"I realized there was something wrong, but I still didn't mind it until that dreadful evening in March."

Alice Alimurung

"I realized there was something wrong, but I still didn't mind it until that dreadful evening in March," Alice says.

Following her nighttime cardiac episode and the ensuing diagnosis, Alice's symptoms became constant and painful. With the help of her local medical team, Alice and her husband, Benjamin Alimurung — who is a cardiologist in the Philippines and understood his wife's precarious condition — contacted one medical facility after another. Their efforts to find a surgical team that could operate on Alice were met with rejection, which amplified Alice's physical distress.

"The way that it was going, no one wanted to give me health care," Alice says. "I remember telling my husband, 'Just let me die a natural death.' But my husband said, 'Oh no, as long as I'm alive, I will give you the best health care.'"

Alice's search eventually led her back to a hospital in Manila: St. Luke's Medical Center. While surgeons at St. Luke's were not equipped to remove the tumor, they connected Alice with a place that could: Mayo Clinic.

As a member of Mayo Clinic Care Network, St. Luke's physicians opened a line of communication between Alice and Mayo Clinic. Alice's case was brought before Dr. Schaff, who reviewed it with his team and recommended tumor removal.

Preparation and collaboration

Alice and Benjamin flew to Mayo Clinic's Rochester campus, and on July 1, 2018, Dr. Schaff began preparations to remove the tumor.

"It was complicated to remove because of its size, vascularity and its location," Dr. Schaff says. "It was situated above the left atrium and had compressed her superior vena cava."

By the time Alice reached Mayo Clinic, the mass was about the size of an orange.

"These are very vascular tumors. They have a lot of blood supply to and from the tumor," Dr. Cassivi says. "And hers was sitting amidst all of the vessels on the top of the heart, and you have not just the large blood vessels moving in and out of the heart, but the small blood vessels that feed the heart muscle itself."

To prepare for the surgery, Alice's team had the Mayo Clinic 3D Printing Lab make two models of the tumor, heart and surrounding blood vessels. The first model could be broken down to demonstrate how the varying structures fit together. The second model was transparent and showed how the blood flowed through Alice's vessels. Even with this preparation, Alice's surgical team couldn't completely predict the extreme vascularity of the tumor.

"When we started to remove it during the initial operation, the bleeding got to the point where we felt like if we did resect anymore, we wouldn't be able to control the bleeding," Dr. Schaff says. "So we stopped the operation with the idea of asking our colleagues in Interventional Radiology to occlude the feeding vessels to the tumor."

While it's unusual to stop an operation midway through a procedure, in Alice's case, removing any more of her tumor would have put her life at risk, Dr. Schaff says.

"I woke up in between surgeries knowing something was up. It was a surprise, indeed, a lifesaving change in plan."

Alice Alimurung

Under the direction of Christopher Reisenauer, M.D., a Mayo Clinic interventional radiologist, several of the fine arteries feeding Alice's tumor were blocked. Next, a team of interventional cardiologists, including Rajiv Gulati, M.D., Ph.D., Donald Hagler, M.D. and Patricia Best, M.D., stepped in. The team used tiny coils to selectively embolize, or block, some of the branches of the heart's coronary arteries that fed the tumor. The coronary arteries that supplied blood to her heart were preserved.

After these procedures, Alice was taken to the Cardiac Intensive Care Unit, where she was awakened from sedation.

"I woke up in between surgeries knowing something was up," Alice says. "It was a surprise, indeed, a lifesaving change in plan."

When her team considered Alice strong enough for the final stage of the operation, she was put back to sleep.

"We took the tumor out, and bleeding was less of a problem because of what the teams in Radiology and Cardiology did," Dr. Schaff says. After removing the tumor, Dr. Schaff reconstructed Alice's vena cava.

When Alice began regaining consciousness following that surgery, the news was good.

"When I saw Dr. Schaff, he was happy to see how well I was recovering," Alice says. "He said, 'You really are one for the books.'"

Smooth recovery, ideal outcome

While recovering in the hospital, Alice says she was comforted by the constant support of her care team.

"The ICU nurses are the best ever," Alice says. "They were extremely caring and gentle."

Alice remained in the hospital for nearly three weeks before she was discharged to nearby housing, where she stayed for another week. Four weeks after her operation, Alice received the go-ahead from Drs. Schaff and Cassivi to fly back to Manila. Once home, Alice began cardiac rehabilitation. In November 2018, Alice returned to the gym, where she walks on the treadmill and lifts light weights.

Alice will continue to be followed by her cardiology team at St. Luke's, and she'll have checkups with her Mayo Clinic team, as needed, using telecommunications equipment.

"We can participate through video conference and virtual visits, and then can provide meaningful, long-term follow up for her without her necessarily having to make the trip," Dr. Cassivi says.

"When I saw Dr. Schaff, he was happy to see how well I was recovering. He said, 'You really are one for the books.'"

Alice Alimurung

Although there is a possibility Alice's tumor could return, her team is optimistic that it's not going to come back. "We hope the operation is curative," Dr. Schaff says.

The ability of the many members of Alice's care team to work in harmony with the goal of saving Alice's life was key to her successful results, according to Dr. Cassivi.

"It really was a coming together of so many different specialists to provide their expertise," he says, "which brings us to a really unbelievable outcome that I don't think could happen in many other places."

HELPFUL LINKS

• Learn more about paraganglioma tumors.
• Check out Cardiovascular Surgery and Thoracic Surgery at Mayo Clinic.
• Talk with others about heart and blood health on Mayo Clinic Connect.
• Explore Mayo Clinic.
• Request an appointment.

The post Sharing Mayo Clinic: A rare tumor next to her heart appeared first on Mayo Clinic News Network.

"It’s important to have breakfast before you begin your day but also have the right type of breakfast, as well," says Dr. Tina Ardon, Mayo Clinic family medicine physician.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:57) is in the downloads. Read the script.

Dr. Ardon says a healthy breakfast helps improve a student’s mood and his or her level of concentration.

"Studies actually indicate, too, that people who consistently eat breakfast throughout their lives tend to be at a healthier weight, as well," she adds.

Dr. Ardon says before-school meals should include a combination of good protein, fiber and carbohydrates.

"The right combination of those ingredients is better for our kids because they release sugar over a slow period of time and help them stay fuller longer," Dr. Ardon explains.

Dr. Ardon suggests breakfasts like a vegetable breakfast burrito or a whole-grain waffle topped with peanut butter, or a parfait made with plain yogurt and real fruit. As for cereals, ...

"... I would look at the sugar content and look for cereals that have whole grains in them," says Dr. Ardon.

The post Mayo Clinic Minute: Fueling for school appeared first on Mayo Clinic News Network.

Walking pneumonia is one of the illnesses that increases in fall when kids are together in classrooms. That's because walking pneumonia is contagious and spread when a student comes in contact with a classmate who is already infected.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads. Read the script.

Walking pneumonia is caused by a bacteria that can have you down but not out.

"Usually people with this infection are well enough to kind of be up and about – even though they have an infection going on at the time," says Dr. Nipunie Rajapakse, a pediatric infectious diseases specialist.

Dr. Rajapakse says walking pneumonia is a lung tissue infection spread, in part, through the droplets of coughs and sneezes. Symptoms include a fever, cough and sore throat – sometimes combined with difficulty breathing caused by shortness of breath and chest pain.

"So if you think you might have walking pneumonia or any type of pneumonia, it’s a good idea to see your physician or your primary care provider," explains Dr. Rajapakse.

If a physical exam is inconclusive, Dr. Rajapakse says your health care provider may order a chest X-ray.

"Sometimes, it’s difficult just from looking at a patient and listening to their chest to know for sure," she says. "So, in those situations, it’s helpful to get a picture of the lungs to see whether there is any area of infection that’s visible."

Dr. Rajapakse says most people can recover from walking pneumonia without medication. However, if the symptoms are very severe, your doctor may prescribe an antibiotic to treat it.

The post Mayo Clinic Minute: Does your child have walking pneumonia? appeared first on Mayo Clinic News Network.

In this Mayo Clinic Minute, dietitian Kate Zeratsky explains what you get and what to watch out for when adding nutrient-dense foods to your meals. Jeff Olsen reports.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:57) is in the downloads. Read the script.

The post Mayo Clinic Minute: Why nutrient-dense food is so good for you appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I’m a 56-year-old man without any health problems. Recently, I’ve noticed I don’t have the energy for physical activities that I used to. Working in the yard, riding my bike and even just doing jobs around the house all wear me out much faster now than even five years ago. My sex drive is lower, too. I see ads all the time for testosterone therapy and what a difference it can make for men my age. Should I give it a try? Is it safe?

ANSWER: Recent research shows that testosterone therapy can be useful in some cases, but it’s not right for all men. To see if it could be helpful for you, start by making an appointment with your doctor to have your testosterone level checked.

Testosterone is a hormone produced primarily in the testicles. Testosterone helps maintain men’s bone density, fat distribution, muscle strength and mass, red blood cell production, sex drive and sperm production. For most men, testosterone peaks during adolescence and early adulthood. Then, as men get older, testosterone levels gradually fall.

If testosterone drops below a certain level, it can cause symptoms. Fatigue and low sexual interest are common. Some men also see changes in beard and body hair growth. Muscle wasting and a decrease in muscle strength can be a result of low testosterone, too.

Your doctor can use a blood test to check your testosterone level. Even if your testosterone level is found to be low, though, testosterone therapy is not automatically the answer. It’s also important to determine any potential causes or associated conditions of low testosterone before moving forward with treatment.

In some cases, medical conditions can contribute to low testosterone, including thyroid problems, obesity, obstructive sleep apnea, depression and excessive alcohol use. Some medications may cause testosterone levels to drop, as well.

As part of your evaluation, your doctor should review your current medications and check for underlying medical problems that could be contributing to your symptoms. If your testosterone is low and a medical condition is identified, treatment for that disorder may be all you need to bring your testosterone level back into the normal range. A change in medications also could make a difference.

If low testosterone isn’t due to medication or a medical problem, then taking prescription testosterone replacement may be beneficial. Numerous studies have found that testosterone may be helpful for men experiencing symptoms as a result of low testosterone. In many cases, however, the effects are modest. In men with normal levels of testosterone, taking prescription testosterone generally has no effect for most symptoms.

In addition to easing symptoms of low testosterone, prescription testosterone may have other benefits, including reducing fat mass, improving lean muscle mass, strengthening bones and improving insulin sensitivity.

Taking prescription testosterone does have risks. It may cause production of more red blood cells (a condition known as polycythemia); increase prostate-specific antigen, or PSA, in the blood; enlarge breasts; or reduce sperm production. Testosterone therapy does not cause cancer, including prostate cancer. If your doctor recommends that you take testosterone, you need regular blood tests to make sure the prescribed dose is correct, as too much testosterone potentially can lead to other medical problems.

Although most studies suggest that testosterone therapy does not increase the risk of heart attacks or stroke, and that it may even be protective in some cases, there is not enough information to prove its safety conclusively among elderly men with cardiovascular risk factors.

To see if testosterone therapy may be right for you, make an appointment to see your doctor and assess your symptoms. He or she can do a thorough evaluation and help you decide what, if any, treatment you may need. — Landon Trost, M.D., Urology, Mayo Clinic, Rochester, Minnesota 

The post Mayo Clinic Q and A: Testosterone therapy? Maybe appeared first on Mayo Clinic News Network.

Many people who suffer with chronic pain find relief from opioid pain medication. Mayo Clinic experts say opioids may benefit a certain percentage of people with chronic pain, such as advanced cancer patients, but they are usually not the best long-term option for most.

In this Mayo Clinic Minute, reporter Vivien Williams discusses the pros and cons of opioid use for chronic pain with pain medicine specialist Dr. Mike Hooten.

View complete series:

• Mayo Clinic Minute: Prescription drugs ─ the changing face of addiction
• Mayo Clinic Minute: Facts on fentanyl
• Mayo Clinic Minute: Avoid opioids for chronic pain
• Mayo Clinic Minute: 2 reasons not to share pain pills
• Mayo Clinic Minute: When are opioids OK to take?
• Mayo Clinic Minute: What opioids do to your guts
• Mayo Clinic Minute: How to stop popping painkillers

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads. Read the script.

The post Mayo Clinic Minute: Avoid opioids for chronic pain appeared first on Mayo Clinic News Network.

Maybe you've heard the following myths about pregnancy: exercise and sex are bad because they can hurt the unborn baby. Mayo Clinic experts say for healthy women who are having healthy pregnancies, sex and exercise are not only okay, they also may be beneficial. Reporter Vivien Williams has more.

Watch the Mayo Clinic Minute

Journalists: Broadcast quality video is available in the downloads. (TRT :55) Download the script.

The post Mayo Clinic Minute: Sex, Exercise and Pregnancy appeared first on Mayo Clinic News Network.

Stem cell transplantation, also known as bone marrow transplantation, is a procedure that infuses healthy cells, called stem cells, into your body to replace damaged ones. These transplants have become standard treatment for a number of cancers and blood-related diseases like leukemia and lymphoma.

It’s possible for a patient’s own stem cells to be used in the procedure, but sometimes donor cells are necessary. Although a family member is the first choice, often a complete stranger can be the best match. That’s why the National Marrow Donor Program, now called Be The Match, is so important.

“The bigger the donor pool, the better your chances of finding a good match,” explained Dr. Shakila Khan, Mayo Clinic pediatric oncologist. Dr. Khan says this is especially true for patients from an ethnic minority group perspective. “If you are a Caucasian, you have an 80 percent chance of finding a donor.  But if you are an ethnic minority, your chances are lower,” she explained. “That is why Be The Match is focusing on ethnic minorities and increasing the donor pool there.”

Listen to Dr. Khan’s Mayo Clinic Radio discussion.

Dr. Khan noted a special effort is also being made to reach younger donors in general. According to Be The Match, doctors request donors in the 18- to 44-year-old age group 90 percent of the time. “Studies have shown with younger donors, the survival is better,” she said. “That’s why they are doing drives on college campuses."

Learn about joining the donor registry and find out what happens if you are a match when you tune in to Mayo Clinic Radio during the weekend of October 24-25.

The post Ethnic Minorities, College Students Play Key Role in Donor Program appeared first on Mayo Clinic News Network.