Latest / Becker’s Healthcare Podcast / Zachary C. Dietch, MD, Transplant Surgeon at Northwestern Medicine

Transcript

Zachary C. Dietch, MD, Transplant Surgeon at Northwestern Medicine · Becker’s Healthcare Podcast

• 0:01
  Hello, and welcome to the Becker's Healthcare podcast.
• 0:05
  I'm Elizabeth Gregerson, a reporter here at Becker's,
• 0:08
  and I'm thrilled to interview doctor Zach Dietch,
• 0:11
  transplant surgeon at Northwestern Medicine, on the podcast
• 0:15
  today.
• 0:16
  Doctor Deach, thank you so much for joining
• 0:18
  me. I'm so grateful to share your insights
• 0:20
  with our podcast audience.
• 0:22
  Thanks for having me. I'm happy to be
• 0:24
  here.
• 0:25
  Absolutely. And before we dive in, could you
• 0:27
  introduce yourself and just tell us a little
• 0:30
  bit about your background?
• 0:32
  Sure. Yeah. My name is Zach Deach. I'm
• 0:34
  a transplant surgeon at Northwestern. I've been here
• 0:36
  about, six years.
• 0:39
  I did my,
• 0:41
  most of my medical training,
• 0:42
  on the coast, so residency,
• 0:45
  University of Virginia and then transplant fellowship out
• 0:47
  west, before coming to Northwestern,
• 0:50
  where I
• 0:52
  practice,
• 0:53
  multiorgan abdominal transplantation, and that that consists predominantly
• 0:57
  of liver, kidney, and pancreas transplantation.
• 1:00
  Great. Well, thanks for being here. And I'd
• 1:02
  love to if you if we could kind
• 1:05
  of get the perspective from you of why
• 1:06
  you're here,
• 1:08
  what we're talking about, and the kind of
• 1:10
  transplant story that we're highlighting today.
• 1:14
  Yeah. No. I'm I'm thrilled to be here
• 1:15
  to talk about a a case today. We,
• 1:18
  you know, transplant has undergone a lot of,
• 1:21
  really,
• 1:22
  revolutionary changes in the last five years or
• 1:25
  so since I've I've finished my training. And,
• 1:28
  one of one of those changes is,
• 1:30
  you know, offering liver transplantation for patients with
• 1:34
  unresectable
• 1:35
  colorectal
• 1:36
  liver mets, diseases
• 1:38
  confined to the, to the liver. So, I
• 1:41
  think we're gonna we're gonna talk about a
• 1:42
  case today that we recently performed here in
• 1:44
  Northwestern.
• 1:46
  Perfect. Yeah. And could you just kind of
• 1:48
  walk us through that case and and what
• 1:50
  it looks like?
• 1:52
  Sure. Yeah. The our our patient,
• 1:55
  was, unfortunately, a story we're hearing increasingly commonly
• 1:59
  commonly these days.
• 2:00
  A young woman in her, early forties and,
• 2:04
  mother of three,
• 2:06
  who was diagnosed with
• 2:08
  stage four colorectal,
• 2:10
  liver,
• 2:11
  colorectal cancer
• 2:13
  with, who had extensive
• 2:15
  unresectable
• 2:16
  bilobar,
• 2:17
  metastases to her liver.
• 2:19
  And,
• 2:20
  she underwent
• 2:21
  treatment. She had the resection of her primary
• 2:24
  tumor and did very well on systemic chemotherapy,
• 2:27
  but was left
• 2:28
  with liver only
• 2:30
  unresectable,
• 2:31
  liver metastases. Yeah.
• 2:34
  So at that point, you know, her treatment
• 2:36
  options were fairly limited. Historically, these patients have
• 2:39
  faced fairly dismal
• 2:42
  long term prognosis,
• 2:43
  so five year survival rates of ten to
• 2:46
  twenty percent.
• 2:48
  We're fortunately able to consider select patients in
• 2:51
  these circumstances for for liver transplantation, and she
• 2:53
  was fortunately a candidate.
• 2:57
  Perfect. And,
• 2:59
  you know, from the health system perspective, because
• 3:02
  I'm a primarily I report on oncology for
• 3:04
  Becker's, but our audience, you know,
• 3:07
  ranges across all specialties,
• 3:10
  all parts of the the c suite.
• 3:13
  What should hospital leaders and physician leaders know
• 3:16
  about kind of investing in cancer screening and
• 3:19
  maybe different types of referral pathways
• 3:22
  when it comes to identifying
• 3:24
  these types of patients where, you know, a
• 3:27
  liver transplant
• 3:28
  is appropriate? And how how can
• 3:30
  they think about finding those patients earlier?
• 3:34
  It's a it's a great question. I think,
• 3:36
  I'll talk more about the referral pathways because
• 3:39
  I think that's where this is,
• 3:41
  so different and important to consider.
• 3:43
  Mhmm.
• 3:44
  You know, historically,
• 3:46
  transplant,
• 3:48
  surgeons and transplant practitioners have not overlapped
• 3:52
  with medical oncologists and surgical oncologists in the
• 3:55
  management and treatment of colorectal liver metastases.
• 3:58
  So the we're talking about specialties that have
• 4:01
  not historically worked together on this particular disease.
• 4:06
  So I think for from,
• 4:08
  you know, we're talking about a novel treatment
• 4:11
  for a disease where these specialties have not
• 4:14
  closely integrated. And so I think
• 4:16
  it's it's important to integrate the transplant
• 4:19
  perspective
• 4:20
  early on.
• 4:22
  So in these multidisciplinary
• 4:24
  tumor boards,
• 4:26
  when treatment plans are being formulated
• 4:28
  early for patients with bio you know, extensive
• 4:31
  biolobar colorectal liver metastases,
• 4:35
  The topic of liver transplantation
• 4:37
  should be entertained early
• 4:39
  as a potential treatment option. So I think
• 4:41
  the big challenge is how do you integrate,
• 4:44
  new specialties into the existing treatment pathways,
• 4:48
  for these patients?
• 4:50
  Absolutely. And I appreciate you kind of bringing
• 4:53
  that up of, you know, how these specialties
• 4:55
  the coordination that can happen behind the scenes
• 4:58
  earlier, how it can lead lead to,
• 5:00
  opportunities like this. I think that's a a
• 5:02
  great thing to call out, especially for our
• 5:04
  audience.
• 5:06
  When we look at transplant programs specifically,
• 5:09
  maybe
• 5:10
  somebody listening is considering, you know, adding this
• 5:15
  type of transplant to their program.
• 5:17
  What are the key either clinical or operational
• 5:20
  considerations
• 5:22
  you think they should really understand
• 5:25
  before integrating it into their existing transplant
• 5:28
  program? Yeah. Yeah. Absolutely. I think,
• 5:32
  I think from a clinical perspective,
• 5:34
  you need you need champions.
• 5:36
  So you need you need surgical champions.
• 5:42
  Certainly on the transplant side,
• 5:44
  helpful if your you know, if your operations
• 5:46
  are set up with surgical oncologist, have surgical
• 5:49
  oncology champions,
• 5:51
  transplant hepatologists.
• 5:54
  We're fortunate here where we have a very
• 5:56
  well established and integrated multidisciplinary
• 5:59
  liver tumor clinics that have all of these
• 6:02
  specialties plus interventional radiology and,
• 6:05
  importantly, a medical oncologist,
• 6:08
  with expertise in transplantation.
• 6:10
  So,
• 6:11
  from a clinical clinical perspective, you need champions
• 6:14
  who can do that,
• 6:16
  right solid
• 6:17
  protocols based on,
• 6:19
  you know, recognized consensus guidelines.
• 6:22
  From an operational perspective,
• 6:25
  you know, I mentioned
• 6:26
  integrating all these specialists together in tumor boards
• 6:29
  and
• 6:30
  multidisciplinary
• 6:31
  discussions and reviews.
• 6:33
  And I think also from a, you know,
• 6:35
  transplant
• 6:37
  perspective, we,
• 6:38
  you need, you know, financial
• 6:42
  professionals who are able to navigate the,
• 6:46
  the compensation
• 6:47
  and insurance aspect of things. You know, we
• 6:50
  have
• 6:51
  learned this through experience and have successfully
• 6:54
  navigated dealing with, insurance approvals for transplant for
• 6:58
  this indication. There is certainly high quality,
• 7:03
  peer reviewed evidence that establishes
• 7:06
  this treatment as
• 7:08
  a standard treatment option,
• 7:11
  but we've had to, you know,
• 7:14
  get approvals,
• 7:16
  and file multiple appeals, and and,
• 7:19
  I think having expertise
• 7:20
  along those lines is is essential as well.
• 7:23
  Absolutely. I feel like, you know, we could
• 7:26
  do a whole other podcast that's just
• 7:29
  about reimbursement
• 7:30
  and and trying to get,
• 7:33
  this type of care covered. So I
• 7:35
  thank you for bringing that into it because,
• 7:37
  you know, it does move beyond the clinic
• 7:39
  into all these other kind of
• 7:41
  expert,
• 7:44
  experts that you need to make something like
• 7:45
  this successful.
• 7:47
  Yep. I'd love to share with our audience
• 7:49
  as well how the patient's doing today.
• 7:53
  Yeah. So she's she's doing great. She is,
• 7:56
  you know, she I would say she's fully
• 7:57
  recovered from her transplant. She had a a
• 8:00
  living donor liver transplant. So so both donor
• 8:03
  and recipients,
• 8:04
  have fully recovered, are
• 8:07
  out of the hospital. She's,
• 8:09
  you know, planning to return home. She came
• 8:11
  from, California
• 8:13
  for for her treatment, but she'll be returning
• 8:15
  home soon. And as of now, has no,
• 8:18
  evidence of disease.
• 8:20
  Obviously, like any cancer patient, we have to
• 8:22
  watch her very closely for Mhmm. Recurrence, and
• 8:25
  that's,
• 8:27
  something we'll be on the lookout for. But
• 8:29
  as of now, she's doing, you know, basically
• 8:31
  as well as anyone,
• 8:32
  could expect to be doing after a liver
• 8:34
  transplant. She's doing great.
• 8:36
  Wonderful. That's so great to hear.
• 8:38
  If you could share, you know, one final
• 8:41
  takeaway that you would want either physicians listening
• 8:44
  or health system leaders
• 8:46
  to know about expanding access to this type
• 8:50
  of care and maybe even
• 8:51
  if this type of care is something, you
• 8:53
  know, that is on the horizon of of
• 8:56
  being
• 8:56
  standard,
• 8:58
  or something that patients will ask for? What
• 9:00
  would you want them to know and take
• 9:01
  away?
• 9:03
  It's a it's a great question. I think
• 9:06
  like any new novel,
• 9:08
  therapy or treatment, it takes time,
• 9:11
  for the medical community to,
• 9:14
  gain the knowledge and
• 9:16
  comfort with it and for it to diffuse
• 9:19
  across,
• 9:20
  medicine. So I think right now, the key
• 9:22
  challenge is getting the word out about this,
• 9:25
  treatment as a as an option. I think
• 9:27
  it's coming down the pike.
• 9:30
  The the more transplants for
• 9:32
  patients like Amy we do, the the more
• 9:35
  patients we hear from from across the country
• 9:37
  and even internationally.
• 9:39
  So I think I think there's you know,
• 9:41
  this will never be
• 9:42
  a procedure that is extremely high volume, but
• 9:45
  it's going to be a
• 9:47
  a sizable you know, sizable share, I think,
• 9:49
  of the transplant liver transplant volume in the
• 9:51
  in the coming future.
• 9:54
  Perfect. Well, thank you so much. I, again,
• 9:57
  appreciate you taking the time to speak with
• 9:59
  me, and sharing your insights with the podcast.
• 10:02
  Of course. My pleasure. Thank you for having
• 10:05
  me.