K Scholar Team Science Awardees Bring Family Planning Care to Liver Transplant Recipients

By Nooshin Latour. Originally posted at UCSF Clinical & Translational Science Institute

UCSF Connie Frank Transplant Center

UCSF Connie Frank Transplant Center 

When UCSF transplant hepatologist Monika Sarkar, MD heard about the “CTSI K Scholar Team Science Awards”, a research study on family planning among women with liver transplants immediately came to mind. Sarkar who specializes in women with liver disease, had known that fellow K Scholar, Bixby Center member Dominika Seidman, MD, was also family a planning specialist in the Department of Obstetrics and Gynecology, with experience working on contraception access in other patient populations. Collaborating with Seidman, they designed a pilot study to shine light on fertility after liver transplant and the subsequent need for improved family planning counseling. After pitching the idea to the K scholar’s faculty and fellows, this idea garnered one of the two K Scholar Team Science Awards.

Fast forward to a few months later - Sarkar and Seidman’s study of current patient and provider knowledge and practice surrounding family planning has resulted in an implementation plan to incorporate family planning into the clinical care of female liver transplant recipients at UC San Francisco (UCSF).

Rapid Fire Research with Results

Once awarded, the team’s research project, “Improving Family Planning Care for Liver Transplant Recipients,” immediately went into action. The 148 surveys issued to female liver transplant patients between the ages 14-45 years sought to evaluate knowledge of fertility and pregnancy options in transplant patients, and whether women had received counseling during this process. Even though a woman’s menstrual cycle returns quite rapidly, even within weeks post-transplant, early and unplanned pregnancies can be associated with increased risks to the mother, liver graft, and baby. Therefore early education regarding need for contraception and pregnancy risks, as well as educating women regarding the favorable outcomes of planned pregnancies down the road, is key. Half of the patients responded to the survey, which showed that women felt they received inadequate information on family planning in relation to their transplant, and specifically desired reproductive counseling from their transplant providers.

This research pilot also provided relevant data to catalyze the development of the Complex Contraception Clinic (CC) at the UCSF Mount Zion campus, which aims to provide contraception and pre-conception counseling in medically complex women. Sarkar is now working on implementing at least a one-time consultation for future women in their early post-transplant period, as well as current reproductive-aged women that have received a prior liver transplant. The next phase of this study will be expanding surveys to the kidney transplant population, although the CCC is a currently available resource for all reproductive aged women with other organ transplants as well.

Sarkar emphasized the value in the “team science” approach, “I’ve learned so much from Nika especially on contraception and the family planning side, and how to broach sensitive topics. I’ve learned key features from the pediatrics side from Emily Perito, MD, a K Scholar alum also involved in the pilot, on how to work with adolescents and when to involve parents.”

From Seidman’s perspective, working with the team on this project highlighted the competing demands on patients with complex medical needs and their providers. “Everyone agrees that reproductive health care is important, but figuring out how to fit that care into a complex medical care plan is challenging,” said Seidman. “Monika and Emily knew the ins and outs of transplant management, and were able to identify a feasible intervention that would make sure reproductive age women with a liver transplant have their reproductive health needs assessed and addressed in a patient-centered way, that was also acceptable to providers."

The team also sees this specific patient population benefiting from family planning care nationwide. Sarkar will be working with the American Society of Transplantation to broaden this work across transplant centers.

“This innovative and trans-disciplinary project is exactly what we had in mind when we created our Team Science Award competition. We are delighted to support such a high-impact project which is highly likely to lead to additional research and extramural funding” said Doug Bauer, MD, director of the UCSF-CTSI K Scholars Program.

K Scholars Program and Team Science Awards

The Clinical and Translational Science Institute’s K Scholars program is designed to support the career development of junior faculty from all UCSF schools who are committed to building careers in clinical and translational research. The program provides support for scholars to conduct high quality research, foster and nurture multidisciplinary collaborations and explore novel research directions, and develop the range of skills necessary to achieve a successful independent academic research career. Types of support include partial salary funding, expert advice, mentoring and regular project review sessions with a multidisciplinary group of K Scholar peers.

The CTSI K Scholar Team Science Awards promotes innovative multidisciplinary research collaborations among participating K scholars. It aims to stimulate research innovation and creativity by connecting scholars with diverse training backgrounds and expertise to design and implement a scholarly project. The scope of the project varies depending on the interests and collaborative opportunities of the K scholars. Teams can propose pilot studies, clinical and or translational methodologic innovations, or other research projects that demonstrate the strength of multidisciplinary collaborations. Proposals have to demonstrate how linking two more disciplines or content areas provides new insights and discoveries that advance clinical and translational science.