← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Zachary C. Dietch, MD, Transplant Surgeon at Northwestern Medicine
00:10:19
Loading summary
Transcript18 lines
- [00:02]
A
Hello and welcome to the Becker's Healthcare Podcast. I'm Elizabeth Gregerson, a reporter here at Becker's and I'm Thrilled to interview Dr. Zach Dietsch, transplant surgeon at Northwestern Medicine, on the podcast today. Dr. Dietzsch, thank you so much for joining me. I'm so grateful to share your insights with our podcast audience.
- [00:23]
B
Thanks for having me. I'm happy to be here.
- [00:25]
A
Absolutely. And before we dive in, could you introduce yourself and just tell us a little bit about your background?
- [00:33]
B
Sure, yeah. My name is Zach Dietzsch. I'm a transplant surgeon at Northwestern. I've been here about six years. I did my most of my medical training on the coast, so residency, University of Virginia and then transplant fellowship out west before coming to Northwestern where I practice multi organ abdominal transplantation and that that consists predominantly of liver, kidney and pancreas transplantation.
- [01:01]
A
Great. Well, thanks for being here and I'd love to, if you, if we could kind of get the perspective from you of why you're here, what we're talking about, and the kind of transplant story that we're highlighting today.
- [01:14]
B
Yeah, no, I'm thrilled to be here to talk about a case today. We, you know, transplant has undergone a lot of really revolutionary changes in the last five years or so since I finished my training. And one of, one of those changes is offering liver transplantation for patients with unresectable colorectal liver mets disease that's confined to the liver. So I think we're going to talk about a case today that we recently performed here in Northwestern.
- [01:47]
A
Perfect. Yeah. And could you just kind of walk us through that case and, and what it looked like?
- [01:53]
B
Sure, yeah. Our patient was unfortunately a story we're hearing increasingly commonly these days. A young woman in her early 40s and mother of three who was diagnosed with stage four colorectal liver, colorectal cancer, who had extensive unresectable bilobar metastases to her liver and she underwent treatment. She had the resection of her primary tumor and did very well on systemic chemotherapy, but was left with liver only unresectable liver metastases. So at that point, you know, her treatment options were fairly limited. And historically these patients have faced fairly dismal long term prognoses. So five year survival rates of 10 to 20%. We're fortunately able to consider select patients in these circumstances for liver transplantation. And she was fortunately a candidate.
- [02:57]
A
Perfect. And from the health system perspective, because I'm a primarily I report on oncology for Becker's, but our audience ranges across all specialties. All parts of the C suite. What should hospital leaders and physician leaders know about investing in cancer screening and maybe different types of referral pathways when it comes to identifying these types of patients where a liver transplant is appropriate, and how can they think about finding those patients earlier?
- [03:35]
B
It's a great question. I think talk more about the referral pathways, because I think that's where this is so different and important to consider. You know, historically, transplant surgeons and transplant practitioners have not overlapped with medical oncologists and surgical oncologists in the management and treatment of colorectal liver metastases. So we're talking about specialties that have not historically worked together on this particular disease. So I think we're talking about a novel treatment for a disease where these specialties have not closely integrated. And so I think it's important to integrate the transplant perspective early on. So in these multidisciplinary tumor boards, when treatment plans are being formulated early for patients with extensive bilobar colorectal liver metastases, the topic of liver transplantation should be entertained early as a potential treatment option. So I think the big challenge is how do you integrate new specialties into the existing treatment pathways for these patients.
- [04:51]
A
Absolutely. And I appreciate you kind of bringing that up of, you know, how these specialties, the coordination that can happen behind the scenes earlier, how it can lead to opportunities like this. I think that's a great thing to call out, especially for our audience when we look at transplant programs specifically. Maybe somebody listening is considering, you know, adding this type of transplant to their program. What are the key, either clinical or operational considerations you think they should really understand before integrating it into their existing transplant program?
- [05:30]
B
Yeah, absolutely. I think, I think from a clinical perspective, you need, you need champions. So you need, you need surgical champions. Certainly on the transplant side, helpful if you're, you know, if your operations are set up with surgical oncologists to have surgical oncology champions, transplant hepatologists, we, we're fortunate here where we have a very well established and integrated multidisciplinary liver tumor clinics that have all of these specialties, plus interventional radiology, and importantly, a medical oncologist with expertise in transplantation. So from a clinical perspective, you need champions who can do that, write solid protocols based on recognized consensus guidelines. From an operational perspective, you know, I mentioned integrating all these specialties together in tumor boards and multidisciplinary discussions and reviews. And I think also from a, you know, transplant perspective, we, you need, you know, financial professionals who are able to navigate the compensation and insurance aspect of things. You know, we have learned this through experience and have successfully navigated dealing with insurance approvals for transplant for this indication. There is certainly high quality, peer reviewed evidence that establishes this treatment as a standard treatment option. But we've had to get approvals and file multiple appeals. And I think having expertise along those lines is essential as well.
- [07:24]
A
Absolutely. I feel like we could do a whole other podcast that's just about reimbursement and trying to get this type of care covered. So thank you for bringing that into it because it does move beyond the clinic into all these other kind of expert experts that you need to make something like this successful. I'd love to share with our audience as well how the patient's doing today.
- [07:54]
B
Yeah, so she's doing great. She is, I would say she's fully recovered from her transplant. She had a living donor liver transplant. So both donor and recipients have fully recovered or out of the hospital. She's planning to return home. She came from California for her treatment, but she'll be returning home soon and as of now, has no evidence of disease. Obviously, like any cancer patient, we have to watch her very closely for recurrence, and that's something we'll be on the lookout for. But as of now, she's doing, you know, basically as well as anyone could expect to be doing after a liver transplant. She's doing great.
- [08:37]
A
Wonderful. That's so great to hear. If you could share one final takeaway that you would want either physicians listening or health system leaders to know about expanding access to this type of care and maybe even if this type of care is something that is on the horizon of being standard or something that patients will ask for, what would you want them to know and take away?
- [09:04]
B
It's a great question. I think like any new novel therapy or treatment, it takes time for the medical community to gain the knowledge and comfort with it and for it to diffuse across medicine. So I think right now the key challenge is getting the word out about this treatment as a, as an option. I think it's coming down the pike. The more transplants for patients like Amy we do, the more patients we hear from from across the country and even internationally. So I think, I think there's, you know, this will never be a procedure that is extremely high volume, but it's going to be a sizable practice, you know, sizable share, I think, of the transplant, liver transplant volume in the coming future.
- [09:55]
A
Perfect. Well, thank you so much. I again appreciate you taking the time to speak with me and sharing your insights with the podcast.
- [10:03]
B
Of course. My pleasure. Thank you for having me.