Posted by Peter Morris on November 12, 2015
You will remember perhaps that I wrote a Blog about legislation passed in the USA some months ago such that industry will have to declare what it pays to doctors for lectures, travel, etc. and how much. This has now come into effect and there was an interesting article in the American Journal of Transplantation from the Johns Hopkins in June of this year in which the authors had a close look at what payments had been made to transplant surgeons in the USA over 5 months from August to December in 2013.. Transplant surgeons (n=297) received a total of $759,654. The median interquartile payment was $125 with a range from $39 to $1018. Seventeen surgeons received more than $10,000 and the highest payment to an individual surgeon was $83,520. Interestingly, but perhaps not surprisingly, consultants with the highest H index were associated with 30% higher chance of receiving more than $1000. I would hope that the authors will continue to follow this up as it will clarify some of the interactions between industry and transplant clinicians and they should include an analysis of transplant physicians as well as transplant surgeons,
Posted by Simon Knight on November 10, 2015
The Centre for Evidence in Transplantation are currently leading a project to identify and prioritise unanswered research questions in kidney transplantation to help guide future research. The Kidney Transplant Priorities Setting Partnership has identified 45 unanswered questions, submitted by patients, clinicians, donors and carers.
We are now trying to prioritise these questions to see which are most important for future research. Our prioritisation survey has already received nearly 200 responses, and we would love to see more opinions from transplant patients, carers, live donors, patients on the transplant waiting list and healthcare professionals from all disciplines involved in kidney transplantation.
To take the survey, please visit the Kidney Transplant PSP website.
Posted by Peter Morris on November 9, 2015
Sir Magdi Yacoub gave the Lister Oration on October 28 at the Royal College of Surgeons of England, after which he was presented by the Acting President, Mr. Steve Cannon, with the Lister Medal. The oration was entitled “The Glory and Threat of Science and Medicine”.
The Lister Medal is awarded every three to five years and is considered the most distinguished award in surgery in Great Britain and Ireland but is not confined to surgeons from those countries. It was founded by the Royal Society as a lasting mark of respect for the pioneer surgeon, Joseph Lister (1827 – 1912). His work on antiseptic surgery revolutionised surgery and provided the basis for modern sterile surgery. The award is selected by a Committee with members appointed by the Royal Society, the Royal College of Surgeons of England, the Royal College of Surgeons in Ireland, the University of Edinburgh, the University of Glasgow, and the Society of Academic and Research Surgery.
Professor Sir Magdi Yacoub received this award for his outstanding contribution to surgical science, in particular, to aspects of cardiac surgery and cardiac transplantation. He established at Harefield Hospital the largest cardiothoracic transplant programme in Europe and performed the first heart and lung transplant in the UK. His research activities have included tissue engineering of heart valves, myocardial regeneration and development of novel left ventricular assist devices.
In addition to his vast contributions to the clinical side of cardiac surgery, he also was responsible for establishing the Chain of Hope Charity which treats children with correctable cardiac conditions from developing countries. The Charity has established a number of cardiac centres in Africa, where local surgeons are trained with a major input from Professor Yacoub and his colleagues.
There is no question that Magdi Yacoub was an outstanding awardee of the prestigious Lister Medal, the 27th awardee since its establishment nearly 100 years ago.
Posted by Liset Pengel on November 5, 2015
Two recent systematic reviews were published on this important topic. The review by Lafranca and colleagues entitled “Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis”(BMC Medicine 2015;13(1):111) included 56 studies. The authors concluded that “Several of the pooled outcome measurements show significant benefits for ‘low’ BMI (<30) recipients. Therefore, we postulate that ESRD patients with a BMI >30 preferably should lose weight prior to RT”. The review by Hill and colleagues entitled “Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis” (Nephrol Dial Transplant 2015;30(8):1403-11) included 17 studies. They concluded that “Despite having a much higher likelihood of DGF, obese transplant recipients have only a slightly increased risk of graft loss and experience similar survival to recipients with normal BMI”. Both authors have left commentaries in the Transplant Library (http://www.transplantlibrary.com/article/26044837).
Join the discussion and leave your opinion in the Transplant Library. Login with your personal account details or through your society. Contact us if you have problems logging in or would like a free trial account.
Posted by Simon Knight on October 30, 2015
The November 2015 edition of the transplant trial watch is now available on the CET website and via our app for iPhone, iPad and Android.
Posted by Peter Morris on October 14, 2015
In August of 2015 I had the pleasure of being a guest speaker at the 50th Anniversary of Kidney Transplantation in New South Wales, Australia. This first kidney transplant operation was performed 50 years ago at Prince Henry Hospital by a team led by Professor Joe Murnaghan (a urologist) and Dr Doug Tracy (a vascular surgeon). The Prince Henry Hospital is now gone and has been replaced by the Prince of Wales Hospital, the teaching hospital of the University of New South Wales. The Jubilee celebration, organised by Professor Zoltan Endre and Professor Bruce Pussell over 2 days was outstanding, as many of the participants in the first transplant were still alive and made presentations. The first day of the meeting comprised presentations by kidney transplant recipients, donors, and staff including a description of the first transplant by Dr David Jeremy who was Medical Director of the Renal Unit and Dr. Bob Farnsworth who was Director of Surgery at the time. The recipient of the first transplant survived 31 years with that cadaver kidney! Many of the patients spoke and all in all it was a very enjoyable day. The second day was a Clinical and Scientific Symposium which again was made up of many outstanding contributions. It was a splendid two days which I and the large audience attending enjoyed thoroughly. A banquet at the old Prince Henry’s Hospital (now a hospitality centre) took place on the final night and this wound up the Jubilee celebration with appropriate splendour and conviviality.
Posted by Peter Morris on October 8, 2015
In a very interesting study with a novel observation, which is in press in the AJT, the authors present an analysis of the impact of the extraction time of kidney (the time from beginning of surgery with aortic cross clamping and perfusion/cooling of the kidneys to removal of kidneys and placing them in ice on the back table). Extraction times ranged from 14 to 123 minutes Prolonged extraction times do lead to an increased rate of delayed graft function and also a dramatic rise in primary non-function when the extraction time approached 120 minutes. This is an extremely important article, and the authors have revealed another important contribution to the incidence of delayed graft function and primary non-function of deceased donor kidneys, namely the extraction time.
Posted by Peter Morris on October 8, 2015
This is a fascinating study with significant implications for preservation studies. The authors show that organ donors after brain death subjected to mild cooling had significantly less DGF than donors subjected to conventional normothermia before organ retrieval. In fact the DMC stopped the study on the basis that efficacy had been demonstrated before completion of recruitment. The effect was much more striking in expanded criteria donors. What does this mean in terms of ongoing trials of machine preservation after organ retrieval in kidney transplantation? Would the two approaches be complementary or would ongoing trials need to be repeated in organ donors who have been mildly cooled before retrieval of the kidneys? Certainly this study has provided food for thought in the preservation world!
Posted by Simon Knight on October 2, 2015
The October 2015 edition of the Transplant Trial watch is now available online and via the Trial Watch app.
This month, new studies include long-term outcomes of sirolimus-based immunosuppression in renal transplant recipients, remote ischaemic preconditioning and therapeutic hypothermia in organ donors.
Posted by Simon Knight on September 22, 2015
We are pleased to announce that we have now included evidence-based guidelines relevant to solid organ transplantation in the Transplant Library. This means that you can now find all RCTs, systematic reviews and guidelines in the field in one place!
For more information about the guidelines included, please visit our guidelines page.