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Life After Miracle

Investigators are studying whether alternative therapies help patients after their transplants.

By Mark Engebretson, University of Minnesota Academic Health Center

In 1974, a mother said a prayer, asking that her 9-year-old daughter’s diabetes be cured. On Valentine’s Day 2001, that prayer was partially answered.

“On the day of love I received the gift of love and life from my kidney donor,” says the daughter, Kris Abrahamson, now 38. The gift came from a living donor, who answered an ad placed by Abrahamson’s mother in a small-town Wisconsin newspaper.

On Fathers’ Day that year, the prayer was answered completely when a father donated his son’s cadaver pancreas to Abrahamson. Following her second successful transplant surgery in four months at Fairview-University Medical Center, Abrahamson was healing and living a new life free of diabetes.

End of story? Not quite.

Forty years ago, University of Minnesota physicians conducted the first kidney transplant in Minnesota history. Today, the procedure seems nearly routine. As the number of transplants increase and survival rates climb, there’s an increasing number of transplant recipients living and they’re living longer. But many experience chronic conditions, including hypertension, depression, and sleep deprivation. Some conditions can be attributed to taking drugs such as immunosuppressants—which can cause significant side effects—and some to the stress of income loss, physical limitations, fear of organ rejections, and high medical costs.

“Transplant recipients receive a lot of medications and many of the problems they experience are related not to the new organ—which can be working very well—but from imperfect medications,” says Cynthia Gross, a professor in the University’s College of Pharmacy and School of Nursing. While “transplantation has been a miracle, the attention now needs to shift to this population who are living with a transplant—it’s no longer an acute, surgical issue, but a lifelong issue.”

Gross first began looking at quality of life issues related to transplant recipients in the early 1990s. Today, she’s the lead investigator on a $2.2 million, five-year study that will measure the impact of mindfulness-based meditation and yoga on quality of life for solid-organ transplant recipients. Funded by the National Institutes of Health, it is one of the largest mindfulness-based stress reduction studies done on any population and it’s the first large clinical trial with transplant patients.

Mindfulness-based stress reduction was effective in improving the quality and duration of sleep, according to a pilot study of 20 transplant recipients by Gross and co-investigator Mary Jo Kreitzer, director of the University’s Center for Spirituality and Healing and associate professor in the School of Nursing. An additional result, although not statistically significant: participants said they experienced decreases in anxiety and depression.

“We were encouraged that there were decreases in all of the variables and the decrease seemed to persist over time,” says Kreitzer, who says that her interest in pursuing the study was sparked partly by results from a separate survey showing that 88 percent of transplant recipients are using alternative therapies. “What our pilot study results mean for patient care is that there are other options to consider and that our work with patients isn’t finished.”

Cynthia Gross, left, and Mary Jo Kreitzer are investigating whether alternative therapies can help post transplant patients.

Participants in the larger study, scheduled to begin in January [2004], will be randomized into one of three groups of 50. One group will learn and practice mindfulness-based meditation and yoga techniques popularized by author and University of Massachusetts integrative-medicine expert Jon Kabat-Zinn.A second will study the Living a Healthy Life with Chronic Conditions approach developed at Stanford University, an innovative, peer-led education program that emphasizes exercise, diet, and enhanced communication with health providers. The third group, the inactive control group, will be randomized into one of the first two groups after six months.

Along with providing a means to objectively study results, the formalized clinical trial aims to answer critics’ claims that alternative therapies are not backed by scientific evidence.

“I think the one criticism about these alternative approaches to medicine is that they have not been rigorously tested,” says Hassan Ibrahim, a kidney specialist in the Medical School, who is helping to recruit patients for the new study. “However, this is such an amazingly well-designed trial that it will address the question scientifically. If there are more studies like Cynthia’s, more doctors will be open to complementary medicine.”

Gross acknowledges the challenge. “I think health professionals are reluctant to recommend a particular therapy if there are doubts about its safety or usefulness. Our study, depending on the results, could give the scientific community evidence that this is something you can safely recommend.”

Meanwhile, Ibrahim is working on his own large drug-based study to address chronic rejection that some kidney and pancreas transplant recipients experience. He notes that other University researchers are currently exploring alternatives to immunosuppressant drugs.

Henry Emmons, a psychiatrist trained by Kabat-Zinn and adjunct professor at the Center for Spirituality and Healing, will teach the mindfulness-based stress reduction program. “Mindfulness-based meditation is kind of a way of taking a front-row seat and observing your mind, including the negative thoughts, and doing it without judging yourself or the experience,” Emmons says. Negative thoughts “are automatic and have no basis in truth very often. Partly the meditation is training to place the mind and thoughts into perspective to make them less important, so that they have less power over us.”

Each week for eight weeks, study participants receive training from Emmons on meditation and yoga techniques and they are also encouraged to practice at home. Participants will be followed for a full year.

“The reason that I am doing so well is because I do complementary things, such as acupuncture and meditation,” says Abrahamson. “I don’t have a lot of the side effects that others do.” After reading about the pilot study, Abrahamson approached Gross and Kreitzer to share her story and ended up being recruited to teach the Stanford program.

“What makes the Stanford program unique,” says Gross, “is that they stress the person conducting the class should be an individual who has a chronic illness. It’s more effective than having a health professional just get up and lecture.”

Gross says that she and Kreitzer hypothesize that they’ll find some benefit from each of the two programs. “They may be different kinds of benefits. In future studies, we may be able to identify what works best for a given individual and tailor treatment.”

For now, they’ll focus on ways to improve on miracles.

Republished with permission from Pictures of Health, a University of Minnesota publication. For more information about the program, contact the study coordinator at 612-624-6115.