Henry Ford Health System Transplant Institute

HEART
TRANSPLANT



John Payne 53

Hear t Transplan t Recipien t

D et r o i t, M i c h i ga n

The year was 1986. Ronald Reagan was serving a second term as president. Whitney Houston was climbing the Billboard 100 with
“Greatest Love of All.” And 39-year-old Detroiter John Payne was introduced to a new lifesaving surgery called the “heart transplant” at
Henry Ford Hospital.

Although young, Payne suffered from end-stage heart failure following a massive heart attack. His heart muscle continued to weaken
and he was in the hospital two to three days a week to have fluid removed from his lungs. The previous year, Henry Ford surgeons had
made history by performing the first heart transplant in metro Detroit. Doctors told Payne that a heart transplant was his only hope.

“I thought it was too experimental,” recalls Payne. “You’re scared when you hear they’re going to take your heart out and put someone
else’s heart into you.”

Then, Payne spent some time with several patients, including David Butts, the first person to receive a heart transplant at Henry Ford
Hospital.

“Seeing him (Butts) and other people who had a transplant was very encouraging - to see a better quality of life.”

Payne discussed the possibility with his wife and four children, and they decided as a family that he should become a candidate.

On July 16, 1986, Henry Ford transplant coordinator Conrad Drost, R.N., made a call to Payne’s home. Mr. Payne was at the store with
his wife, and in the era before cell phones, Drost had no choice but to leave a message: a donor heart was available. Payne went into
surgery later that day and became the 22nd heart transplant recipient at Henry Ford Hospital.

“When I woke up, one of the first things I told my wife is, ‘This is not experimental. This is for real,’” says Payne. “I could breathe. I didn’t
have the pain anymore. I felt better immediately.”

For Payne, the heart transplant was not only life-giving, but life-changing. “When I had my heart attack, I was burning the candle at
both ends, working overtime, working extra shifts,” he says. “You think working is the most important thing in your life, but you don’t
realize that while you’re getting ahead financially, you’re putting yourself behind.”

The heart transplant granted him time to become, in his words, a “kindler, gentler” man, focused on his family, which has grown to
include 11 grandchildren and three great grandchildren.

“Without a heart transplant, I wouldn’t be here today to see them.”

When Payne asked the transplant team how long his new heart would last, he says they estimated five to 10 years. Now 32 years later,
Payne ranks among the longest living-heart transplant recipients in the world.

HENRY FORD TRANSPLANT INSTITUTE

Liver HEART TRANSPLANT Ford Mechanical Circulatory Support Program implants around 50 devices a year, both as a
Intestinal & bridge to transplant or as destination therapy for those who are not transplant candidates.
Multivisceral INNOVATIVE APPROACHES TO HEART FAILURE AND TRANSPLANTATION Henry Ford survival rates exceed the national average, with lower stroke and infection
rates as well.
Kidney The multidisciplinary Advanced Heart Failure team at the Henry Ford Transplant
Pancreas Institute offers the full continuum of state-of-the-art, advanced heart failure Mechanical devices available to our patients include:
care — from the latest therapeutic regimens and mechanical assist devices, to
Lung transplant surgery and post-surgical management and rehabilitation. • ventricular assist device (VAD) therapy for right and/or left ventricular support. Currently,
Heart implanted devices include the HVAD, the HeartMate II and the new HeartMate 3 continuous
Bone COORDINATED TRANSPLANT CARE flow LVAD.
Marrow
Advanced Heart Failure & Mechanical Circulatory Support • extracorporeal membrane oxygenation.
Nationally renowned for its Advanced Heart Failure program, the Henry Ford Heart
and Vascular Institute at Henry Ford Hospital receives referrals for management of • temporary circulatory support: Centrimag, Impella and Tandem support of the right and/or
complex cardiac cases from throughout the Midwest. We are the only comprehensive left ventricle.
heart failure and transplantation program in metro Detroit and one of only three in
Michigan. Our cardiothoracic surgeons and heart failure specialists coordinate efforts • total artificial heart support. The FDA-approved SynCardia total artificial heart replaces
to ensure patients receive exemplary care for their condition before, during and after both failing heart ventricles and the four heart valves. In carefully selected individuals with
transplantation. failure of both ventricles or other unique cardiac conditions for which LVAD is not possible,
Henry Ford offers total artificial heart support as a bridge to transplantation.
Heart Transplant
Henry Ford Hospital’s participation in all major VAD clinical trials gives our patients
Since its first cardiac transplant in 1985, the Henry Ford Transplant Institute has access to the most innovative devices. We were among the first U.S. hospitals to
implant the HeartMate® and HeartMate II®, for which our success rate as a bridge
offered more than 500 patients with heart failure a second chance at survival by to transplantation surpassed the national average, and one of the first to use the
HeartWare HVAD, a small assist device inserted within the heart sac. As of 2018, Henry
means of cardiac transplant. The transplant program comprises a multidisciplinary Ford ranks #16 in the country for the highest clinical trial volumes of the HeartMate
3 VAD, which offers a prolonged battery life, lower major stroke risk and two-year
team of cardiology and surgical transplant specialists, along with transplant specialists survival (83%) on par with cardiac transplant. This experience has led to excellent
patient outcomes on HeartMate 3 support.
in infectious disease and immunology. Henry Ford also participates in multi-organ
Our VAD program has maintained the Joint Commission Gold Seal of Approval™ since 2008.
transplants, including heart-liver, heart- There’s five to ten This advanced certification recognizes our commitment to meeting the highest national
kidney and heart-lung transplant, for percent of the heart safety and quality standards.
carefully selected individuals. failure population
VAD Co-Management
Total Artificial Heart & VADs with biventricular Henry Ford is committed to maintaining the important relationship between a patient
and the referring physician. We encourage our VAD patients to maintain local cardiology
Many patients with severe heart failure failure or malignant follow-up, especially for ICD monitoring. For select interested referring providers who are
cannot wait for transplant and require arrhythmias, who trained or desire to be trained in VAD care, Henry Ford offers a shared VAD management
urgent intervention with mechanical are candidates opportunity. This allows patients to receive safe and appropriate follow-up in their
circulatory (“heart pump”) support. When it for either long- community with ongoing support from the Henry Ford Transplant Institute.
comes to mechanical circulatory support term support or
devices, Henry Ford Hospital is among transplant and could benefit from an FOR REFERRALS OR
the most experienced and successful PATIENT APPOINTMENTS:

institutions in the United States. During artificial heart. (313) 916-2895

multidisciplinary heart failure evaluation, — Dr. Themistokles Chamogeorgakis
the optimal device is selected to ensure Surgical Director, Mechanical

the best outcomes are achieved. The Henry Circulatory Support

54 HENRY FORD TRANSPLANT INSTITUTE

HEART TRANSPLANT OUTCOMES – AT A GLANCE 4/3/1985 HENRY FORD PATIENT SURVIVAL RATES FOR HEART TRANSPLANT*
16
FIRST TRANSPLANT 511 ONE-YEAR 88.80%
TRANSPLANTS PERFORMED IN 2017 47 ONE-YEAR EXPECTED^ 92.96%
TOTAL NUMBER OF PROGRAM TRANSPLANTS THROUGH 2017
NUMBER OF VADs IN 2017 8/2/1988 THREE-YEAR 80.65%
RECEIVED MEDICARE APPROVAL 10.5 months THREE-YEAR EXPECTED^ 88.981%5.09%
MEDIAN TIME TO TRANSPLANT< (COMPARED WITH 8.5 MONTHS NATIONALLY)
WAITLIST MORTALITY~ (EXPECTED .086, NATIONAL .109) .11 % 0 10 20 30 40 50 60 70 80 90 100
MECHANICAL DEVICES AT TIME OF TRANSPLANT IN 2017# 81.2%
HENRY FORD GRAFT SURVIVAL RATES FOR HEART TRANSPLANT+

ONE-YEAR 88.80%
ONE-YEAR EXPECTED^ 92.84%

MILESTONES IN HEART TRANSPLANTATION THREE-YEAR 80.65%
THREE-YEAR EXPECTED^ 88.9814%.25%
SEVERAL “FIRSTS” WERE PERFORMED AT HENRY FORD HOSPITAL:
% 0 10 20 30 40 50 60 70 80 90 100
FIRST IN Detroit to perform a heart transplant (1985)
AMONG THE FIRST in the United States to offer the HeartMate® and HeartMate II® < Patients on the waitlist between 01/01/2012 and 06/30/2017
~ Patients on the waitlist between 01/01/2016 and 12/31/2017
ventricular assist devices as a bridge to heart transplantation * Estimated probability of surviving at one month and one year, for patients receiving their first

FIRST IN Michigan to perform an adult heart-liver transplant (2015) transplant between 01/01/2015 and 06/30/2017; and at three years, for patients receiving their first
FIRST IN Detroit to implant a total artificial heart (2017) transplant between 07/01/2012 and 12/31/2014
FIRST IN Michigan to perform a heart-liver-kidney transplant (2018) ^ Adjusted for patient and donor characteristics
+ Estimated probability of surviving with a functioning graft at one month and one year, for patients
There’s never a simple solution. Our team looks at all receiving their first transplant between 01/01/2015 and 06/30/2017; and at three years, for patients
pieces of the puzzle — from supporting the left side or receiving their first transplant between 07/01/2012 and 12/31/2014
the right side of the heart, along with all aspects of # Devices include ventricular assist devices (VAD), extracorporeal membrane oxygenation (ECMO),
a patient’s illness — to arrive at the best mechanical intraaortic balloon pump (IABP), and total artificial heart (TAH).
support to achieve the best outcome. Source: Scientific Registry of Transplant Recipients, Center and OPO-specific Reports, based on data
available July 31, 2018, released October 9, 2018
— Dr. Jennifer Cowger
Medical Director, Mechanical Circulatory Support 12-MONTH LVAD SURVIVAL>

HENRY FORD 85.10%
NATIONAL 81.60%

% 0 10 20 30 40 50 60 70 80 90 100

> For patients receiving LVADs at this institution between January 1, 2015 and June 30 2018.
Source: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Quality
Assurance 2018 Q2 Report

HENRY FORD TRANSPLANT INSTITUTE 55

Liver
Intestinal &
Multivisceral

Kidney
Pancreas

Lung
Heart
Bone
Marrow

56 HENRY FORD TRANSPLANT INSTITUTE

BONE MARROW STEM CELL
TRANSPLANT



Br i a n W i lli a m s

Bo n e Ma r r o w Stem Cell Re cip i e n t

So u t h fi eld, M i c h i ga n

Ten days before Christmas, Brian Williams learned he had leukemia.

After months of visits to doctors and urgent care centers for lingering ailments — allergies, sinus infections, a sore neck and extreme
fatigue — Brian Williams had blood work with results that raised a red flag. He was referred to an oncologist the following day.

“The oncologist said even though it still needed to be confirmed with a bone marrow biopsy, I most likely had leukemia,” says Williams.
“Everyone’s reaction was shock. There’s no history of cancer in the family. My first emotion with a diagnosis like that is my kids.”

Williams had holiday plans with his wife and daughters, ages 9 and 11, including seeing the new Star Wars movie. Those advanced
tickets would go unused, as Williams checked into the hospital. His daughters decorated his room and his wife delivered home-cooked
holiday meals, as Williams underwent the first of several rounds of chemotherapy to prepare for a stem cell transplant.

Unfortunately, Williams’ brother was not a match, and his sister was pregnant and unable to donate, so the search began for an
unrelated donor. Williams was familiar with the National Bone Marrow Registry, having registered as a potential donor for a friend’s
family member.

Within three weeks, Williams received an email with the subject “Congratulations, you’re a match!” His heart jumped, but then he read
more closely and realized the Registry had unknowingly matched him with himself. The ultimate perfect match.

“The whole time, my doctors were extremely optimistic,” recalls Williams. “I never asked the question, ‘how much time do I have?’ They
said a stem cell transplant was a curative procedure. It was helpful for me to stay positive.”

By March, a donor was located. Williams is grateful for his donor, a young man from Houston with whom he corresponds and hopes to
meet some day. Now an advocate for stem cell donation, Williams attends events with a table for Be the Match to educate and recruit
potential donors.

“It just takes a cheek swab to register. It’s something everybody can do,” says Williams. “My donor gave me my life back. He gave my
kids their father back and gave my wife her husband back. I am here today because of his generosity.”

HENRY FORD TRANSPLANT INSTITUTE 59

Liver BONE MARROW STEM CELL TRANSPLANT Compatibility Testing and Immunology
Intestinal & Our on-site Transplant Immunology Laboratory features the latest technology and state-
Multivisceral For more than 30 years, the Henry Ford Bone Marrow Stem Cell Transplant of-the-art equipment to improve a patient’s likelihood of a successful transplant. The tests
Program has offered this lifesaving treatment for cancer and blood disorders. we perform for bone marrow stem cell transplants include:
Kidney
Henry Ford Hospital has a long and successful track record performing complex • high- and low-resolution HLA typing
hematopoietic (blood-forming) transplants, utilizing the most advanced
techniques and expert care management. • antibody screening

Pancreas The primary diagnosis for bone marrow stem cell transplantation includes: • crossmatch evaluations
Lung
Heart • non-Hodgkin’s lymphoma • ongoing cell chimerism studies and post-transplant monitoring
Bone • Hodgkin’s disease
• multiple myeloma Henry Ford Hospital’s Transplant Immunology Laboratory is accredited by the American
Marrow • acute and chronic myelocytic leukemia Society for Histocompatibility and Immunogenetics and the College of American
• chronic lymphocytic leukemia Pathologists, and it meets the standards of the National Marrow Donor Program and UNOS.
60 • renal cancer
• testicular cancer CAR T-cell Therapy
• myelodysplastic syndrome As a major research and clinical trials center, Henry Ford Hospital offers lifesaving options
• severe aplastic anemia for hematologic cancers. We continue to diversify our arsenal of available therapies,
recognizing that stem cell transplant is just one weapon.
The Henry Ford Bone Marrow Stem Cell Transplant Program performs:
Most recently, CAR T-cell therapy is a new, promising treatment employed by our Bone
• autologous transplant with a patient’s own stem cells Marrow Stem Cell Transplant team for select patients with advanced non-Hodgkin’s
• allogeneic transplant with stem cells from a related or unrelated donor, or from umbilical lymphoma. It works by genetically engineering a patient’s own T cells to attack cancer.
First, patients undergo apheresis to extract the necessary T cells from the blood.
cord blood Scientists then genetically modify the T cells to identify a protein on the surface of
• syngeneic transplant with stem cells from an identical twin or triplet cancerous cells, multiply them by the hundreds of millions, and infuse them back into the
• haploidentical transplant with stem cells from a family member who only partially matches patient to attack the cancer.

the patient is under study Integrated Cancer Care
The Henry Ford Cancer Institute is the largest adult cancer enterprise in Michigan and one
As a source of hematopoietic stem cells, our program is highly experienced using: of the country’s largest, and most integrated and respected clinical centers for oncology.
Blood: We were the first in Michigan to perform peripheral blood stem cell Our Bone Marrow Stem Cell Transplant team works closely with our cancer care colleagues
transplantation, in which stem cells are obtained from peripheral blood rather than to develop a personalized treatment plan.
surgically removed from the bone marrow. Today, this less-invasive approach is the
preferred harvest method. Our Bone Marrow Stem Cell Transplant Unit offers private, spacious rooms designed
Umbilical cord: While umbilical cord blood is a viable source, the volume is with the patient in mind. Rooms provide the latest technology and specially filtered air
considerably lower than collected through peripheral blood or harvested bone to prevent infection, along with the comforts of home such as flat-screen TVs during
marrow. A double-cord blood transplant is a novel advancement, designed to patients’ extended stay. To help patients through the transplant process, we connect them
increase cell dose and reduce the risk of graft failure. with a transplant coordinator and host monthly cancer support groups.
Bone marrow: Although the oldest and least frequently used approach, bone
marrow harvesting is still performed in rare cases when it provides the best option. Track Record of Success
The Henry Ford Transplant Institute has a long history of success with stem cell
HENRY FORD TRANSPLANT INSTITUTE transplants. Our 100-day and one-year transplant survival rates often exceed expected
results. The program has been recognized by the Foundation for the Accreditation of
Cellular Therapy (FACT) for demonstrating an exceptional level of patient care and medical
and laboratory practices.

BONE MARROW STEM CELL TRANSPLANT OUTCOMES – AT A GLANCE OUTCOMES*

FIRST TRANSPLANT 1988 HENRY FORD SURVIVAL RATES FOR 100.00%
TRANSPLANTS PERFORMED IN 2017 93 BONE MARROW STEM CELL TRANSPLANT 100.00%
TOTAL NUMBER OF PROGRAM TRANSPLANTS THROUGH 2017 100.00%
FACT ACCREDITATION 1,308 2006 100.00%
Since 3/20/2006 2007 94.00%
2008 89.00%
MILESTONES IN BONE MARROW STEM CELL TRANSPLANTATION 100-DAY 2009 96.00%
2010 100.00%
SEVERAL “FIRSTS” WERE PERFORMED AT HENRY FORD HOSPITAL: 20 1 1 98.00%
2012 100.00%
FIRST IN Michigan to perform peripheral blood stem cell transplantation (1991) 2013 98.00%
FIRST IN Michigan to perform a double-cord blood transplant (2014) 2014 100.00%
2015
FOR REFERRALS OR 2016 70 80 90 100
PATIENT APPOINTMENTS: 2017

(313) 916-5003 % 0 10 20 30 40 50 60

*Autologous transplants

100-DAY HENRY FORD SURVIVAL RATES FOR HENRY FORD SURVIVAL RATES FOR 96.00%
COMBINED AUTOLOGOUS AND ALLOGENEIC OUTCOMES BONE MARROW STEM CELL TRANSPLANT 91.00%
ONE-YEAR
2015 91.00% 2006 100.00%
ONE-YEAR 2016 93.00% 2007 95.00%
2017 96.00% 2008 84.00%
2009 85.00%
% 0 10 20 30 40 50 60 70 80 90 100 2010 89.00%
20 1 1
HENRY FORD SURVIVAL RATES FOR 2012 98.00%
COMBINED AUTOLOGOUS AND ALLOGENEIC OUTCOMES 2013 86.00%
2014
2015 78.00% 2015 91.00%
2016 83.00% 2016 95.00%
2017 88.00% 2017 93.00%

% 0 10 20 30 40 50 60 70 80 90 100 % 0 10 20 30 40 50 60 70 80 90 100

Source: Henry Ford Hospital *Autologous transplants

HENRY FORD TRANSPLANT INSTITUTE 61

HENRY FORD TRANSPLANT INSTITUTE STAFF

ABDOMINAL TRANSPLANT SURGEONS

Marwan S.Abouljoud,M.D. Atsushi Yoshida, M.D. Dean Y. Kim, M.D. Shunji Nagai, M.D.

Benson Ford Endowed Chair Surgical Director, Liver Transplant Surgical Director, Kidney and Surgical Director, Intestine Transplant
Director, Henry Ford Transplant Director, Transplant Robotic Pancreas Transplant and Rehabilitation
Institute and Hepatobiliary Surgery Chief of Transplant, Children’s Director, Transplant Surgery Research
Surgery Associate Director, Hospital of Michigan
Division of Transplant and Michael D. Rizzari, M.D.
Kelly M. Collins, M.D. Hepatobiliary Surgery Lauren E. Malinzak, M.D.
Director, Organ Care Support Systems
Surgical Director, Pediatric Liver Jason E. Denny, M.D. Medical Director, Transplant
Transplant Program, Children’s Inpatient Unit
Hospital of Michigan Surgical Director, Henry Director, Transplant and
Ford Center for Living Hepatobiliary Surgery
Donation Fellowship

TRANSPLANT HEPATOLOGY Dilip K. Moonka, M.D. Stuart C. Gordon, M.D. Yakir Muszkat, M.D. Syed-Mohammed R.
Jafri, M.D.
Kimberly A. Brown, M.D. Medical Director, Section Chief, Hepatology Medical Director, Intestine
Liver Transplant Director of Hepatology Transplant and Rehabilitation Sr. Staff Transplant
Associate Director, Henry Ford Research
Transplant Institute Deepak Venkat, M.D. Humberto C.Gonzalez,M.D. Hepatologist
Chief, Division of Ashina D. Singh, M.D.
Gastroenterology and Sr. Staff Transplant Sr. Staff Transplant
Hepatology Hepatologist Sr. Staff Transplant Hepatologist
Hepatologist
Reena J. Salgia, M.D.

Medical Director,
Liver Cancer Clinic

TRANSPLANT NEPHROLOGY Nadeen Khoury, M.D. Anita K. Patel, M.D. Rohini Prashar, M.D. Bhavin Patel, M.D.
Milagros D. Samaniego-
Picota, M.D. Sr. Staff Transplant Sr. Staff Transplant Medical Director, Center Sr. Staff Transplant
for Living Donation
Medical Director, Kidney and Nephrologist Nephrologist Nephrologist
Pancreas Transplant Sr. Staff Transplant
Nephrologist
62 HENRY FORD TRANSPLANT INSTITUTE

CARDIOTHORACIC TRANSPLANT SURGEONS Themistokles Chamogeorgakis, M.D. TRANSPLANT PULMONOLOGY Lisa D. Stagner, D.O.

Hassan W. Nemeh, M.D. Surgical Director, Lisa L. Allenspach, M.D. Medical Director Pulmonary
Rehabilitation
Section Head, Mechanical Circulatory Support Medical Director, Lung
Cardiovascular Surgery Transplant Kaitlin M. Hanlon, D.O.
Surgical Director,
Heart and Lung Transplant Julio C.Pinto Corrales, M.D. Sr. Staff Transplant
Pulmonologist
Dimitrios Apostolou, M.D., FACS Sr. Staff Transplant

Sr. Staff Cardiothoracic Transplant Pulmonologist
Surgeon

ADVANCED HEART FAILURE/HEART TRANSPLANTATION & Jennifer Cowger, M.D., M.S. BONE MARROW STEM CELL TRANSPLANT Edward Peres, M.D.
MECHANICAL CIRCULATORY SUPPORT
Medical Director, Mechanical Nalini Janakiraman, M.D. Sr. Staff Bone Marrow Stem Cell
David E. Lanfear, M.D.
Circulatory Support Director, Bone Marrow Stem Transplant Specialist
Section Head, Advanced Heart Cell Transplant
Failure and Transplant Cardiology

Celeste T. Williams, M.D. Yelena Selektor, M.D. Shatha Farhan, M.D. Josephine Emole, M.D.

Medical Director, Heart Sr. Staff Transplant Cardiologist Sr. Staff Bone Marrow Stem Sr. Staff Bone Marrow Stem

Transplant Cell Transplant Specialist Cell Transplant Specialist

Cristina Tita, M.D. Gillian Grafton, D.O.

Sr. Staff Transplant Cardiologist Sr. Staff Transplant Cardiologist

HENRY FORD TRANSPLANT INSTITUTE 63

HenryFord.com/Transplant