Costumed children laughed and frolicked under sunny October skies while the grown-ups caught up over hotdogs and soft drinks.

Part fall festival, part get-together, the Children's Heart Center's Family Reunion brought together young patients and their parents with the cardiologists, surgeons and staff members who worked to keep them healthy. Children's Heart Center is part of Batson Children's Hospital on the campus of the University of Mississippi Medical Center.

Hosted at the home of Children's Heart Center Medical Director Dr. Jorge Salazar, the event is a milestone for the center. “This is the first reunion we've had in five and a half years,” Salazar said, “because we've been so busy building a program.”

Patients who are in end-stage liver disease and hoping for a transplant are often weakened, malnourished, losing weight, easily fatigued, and have a diminished quality of life.

In the transplant world, they're experiencing “frailty.” But when it comes to deciding who should get a transplant and who should not, and who might be a better bet for doing well after surgery and who might not, should frailty be a top consideration?

And can frailty be fixed?

“One thing we've learned, which is not too surprising, is that frail patients are more likely to have complications, such as bacterial or fungal infections, or the need for dialysis,” Dr. Christopher Sonnenday, head of the liver transplant program at the University of Michigan-Ann Arbor, told doctors, nurses and others in the transplant community taking part in the University of Mississippi Medical Center's 2015 Mississippi Transplant Symposium Oct. 15 at the Jackson Medical Mall.

“Frailty impacts their mental health and quality of life, but does it affect survival? It turns out that it does.”

Sonnenday shared findings of a study he began in 2009 exploring frailty in liver transplant patients that examined 843 patients that were referred for a liver transplant and enrolled in the study. Of that number, 457 were put on a transplant waiting list, and 161 ultimately received transplants.

The study showed that the most frail transplant candidates aren't necessarily the oldest. It showed that the frailest patients weren't necessarily the ones with the highest Model for End-Stage Liver Disease score, which is used to measure the severity of liver disease. A MELD of 6 is lowest; the highest is 40.

Frail patients aren't any more likely to reject their organs that those deemed not frail, he said. But, the study indicated that high frailty and a high MELD score can predict poor survival, Sonnenday said. 

“So, how do we use that data?' he asked. “If they're frail and have a high MELD, should they be excluded? Or should their transplant be expedited?”

But, he said, there's another way to use frailty as a factor in liver transplant: To identify patients before surgery who need help with frailty, and then to get them that help. “The obvious question is - can we fix frailty?” he said. “Can we train patients to improve their frailty and suffer less adverse outcomes?”

Patients who know they're frail “sometimes ask before surgery, 'What can I do?'” Sonnenday said. “We rarely give them structured advice, and the likelihood of them doing something on their own is small.”

His studies show that through “prehabilitation” on the front end as opposed to only focusing on rehabilitation on the back end of surgery, frailty can be greatly diminished. It's the focus of a program at the University of Michigan's Transplant Center, and it has proven results, Sonnenday said. Pre-transplant patients deemed frail are helped before surgery to become more active, practice better nutrition, and are given emotional support. “They are paired with a coach, and their activity is tracked, their nutrition supplemented and their stress relief is supported,” he said.

As a result, he said, those patients often have a shorter hospital stay, are less likely to suffer post-surgery complications, and have an average $40,000 less in transplant and hospital costs. “We were able to increase their daily activity, including increasing their walking distance,” he said. “They kept a nutrition journal. We were impressed by their compliance.

“Probably the biggest factor here is that the patients love it,” Sonnenday said. “They all said it was a positive interaction for them, and that it was an improvement in their care. They felt more motivated, and thought it increased their well-being.”

Prehabilitation doesn't stop with the surgery, he cautioned. “We can't take our foot off the gas,” Sonnenday said. “It needs to be ongoing. In some patients, you have serial frailty. After surgery, some get less frail, but some don't.”

“The recognition of frailty and how it affects transplant candidates is a relatively new concept. However, it is critically important to understand,” said Dr. Christopher Anderson, chair of the Department of Surgery and medical director of the Medical Center's abdominal transplant program. “Concepts like this help us develop better strategies to both select and prepare patients for transplantation.”

Dr. Fred Rushton, a UMMC surgeon, is known for his ability to work as part of a team, facility for memorization and recall, professionalism and dexterity - all of which contribute to his flair for handling a precise and specialized instrument: the clarinet. 

He's also pretty good with a scalpel - as might be expected of the division chief and program director for the Division of Vascular and Endovascular Surgery.

But surgery, as much as he enjoys it, is his job. Music - listening to it and performing it - is his therapy and his thrill.

“When I come home from a bad day,” he said, “I go in my man cave and put on the Mahler symphonies or Beethoven's 7^th. It's how I relax.”

“Relax,” he says. Rushton is so attuned to music, he plays clarinet for three different ensembles: the Mississippi Community Symphony Band; the Mississippi Baptist Symphony Orchestra, which is part of the Mississippi Baptist Convention; and the Worship Orchestra of the First Baptist Church of Jackson, where he's a member

“He's an incredible musician,” said Dr. Lavon Gray, the church's minister of music. “I don't know how he has time to stay up with everything musically, but he obviously does.

“He's also been on medical missions, including to Haiti, where he ran clinics for a team from the church this past July. He's a jovial Christian gentleman who brings joy to anything he touches.”

A number of interesting events is scheduled for the upcoming week at the Medical Center.