Posted by John O'Callaghan on August 19, 2014
There were several presentations at the recent World Transplant Congress in San Francisco that discussed the latest developments in hypothermic organ preservation techniques. Using the Scientific Registry of Transplant Recipients, Gill et al of the Vancouver group examined the impact of Hypothermic Machine Perfusion (HMP) on the risk of DGF depending on the Kidney Donor Profile Index (KDPI). When corrected for confounders, HMP was associated with approximately 20-30% reduction in odds of DGF in all but the lowest KDPI decile; If KDPI was less than 0.3 and CIT less than 12 hours, there was no reduction in DGF.
A paired DCD kidney study from Guangzhou, China (Yuan et al) compared HMP with static cold storage (40 donors). Unfortunately the study was small and 16 kidneys were discarded before transplantation, resulting in overall low rates of DGF, but no discernible difference between the two arms of the study. In another paired DCD kidney study, Zhong et al of the Hunan group, China, presented reduced rates of DGF with HMP. In a parallel laboratory study they showed reduced vasospasm and oedema of sertoli cells/renal tubular epithelial cells as a potential mechanism of action.
Considerable experience with HMP for liver preservation was presented by James Guarrera and the Columbia University group. The so-called “orphan” extended criteria donor livers used had been turned down by all other centres in the UNOS region. The livers were perfused with vasosol for 3-7 hours and transplanted into recipients with MELD scores less than 35. These cases were matched to historical controls preserved by static cold storage. Biliary complications were significantly lower in the HMP group, as was post-operative stay. Patient survival and early allograft dysfunction were not significantly affected however. Sanna op den Dries and a collaboration between Groningen and Harvard Universities have added to our understanding of non-anastomotic biliary strictures by demonstrating that injury to peri-biliary glands and vascular plexus before liver transplantation was predictive of later stricture formation.
Posted by Peter Morris on August 17, 2014
Simon Knight and his wife Alia have just had another little girl, Elise Zoe, born on the 5th August late in the evening. Mother and daughter are doing well and the elder sister, Elodie, is enjoying having a little sister.
Congratulations from all to Alia and Simon on the birth of their new baby.
Posted by Simon Knight on August 5, 2014
In part 1, I discussed how to get set up for meta-analysis in R, by installing the necessary software and libraries.
In this post, I will take the reader through the steps for performing meta-analysis of binary data in R.
Posted by Peter Morris on July 23, 2014
John O’Callaghan has successfully defended his thesis entitled “Evidence based hypothermic preservation of the kidney and liver for transplantation” and has now been notified that he has been awarded the DPhil degree. His work in this area has been outstanding and he has produced a number of critically important papers arising from the work of his thesis.
Posted by Simon Knight on July 18, 2014
My pechant for open-source software led me to use the R statistical environment. In this series of blog posts, that I will update over the coming weeks, I will run through the steps of installing R and associated tools and getting set-up for meta-analysis. I will also explain how to create attractive forest and funnel plots for publication, and use some of the more advanced features such as mixed effects meta-analysis and tests for publication bias.
Posted by Simon Knight on July 10, 2014
The Royal Melbourne Hospital is arguably the major teaching hospital of the University of Melbourne and Melbourne Health now forms a complex not only comprising the Royal Melbourne Hospital, but the Royal Children’s Hospital, the Royal Women’s hospital as well as a number of research institutes (e.g. Walter and Eliza Hall Institute of Medical Research, Howard Florey Institute). As they launch the Parkville precinct as Australia’s leading biomedical research complex (it is right opposite the Medical School) they have established a Research Hall of Fame. The inaugural inductees on the 21st of June included Sir Peter Morris, Sir Gustav Nossal, Professor Priscilla Kincaid-Smith, Professor Ian Mackay, Professor Don Metcalf, the late Sir Macfarlane Burnet (Nobel Laureate), the late Dr John Cade and the late Sir Benjamin Rank as well as the first Professors of Surgery and Medicine at the University of Melbourne, namely the late Maurice Ewing and Richard Lovell. Other equally distinguished inductees were honoured at the Medical Foundation dinner on this special occasion.
Posted by Simon Knight on July 7, 2014
This month’s top ten trials include a systematic review of tuberculosis prophylaxis in renal transplantation, rituximab for desensitisation of cadaveric kidney recipients and the use of albuterol in DBD donors.
Posted by Liset Pengel on July 2, 2014
The deadline is approaching for ESOT’s European Transplant Fellow Workshop (ETFW), which is an advanced ESOT course for young professionals in transplantation about improving communication skills.
You can register for this course through the ESOT website.
Posted by Liset Pengel on June 26, 2014
From this month the Transplant Library includes invited commentaries by transplantation experts. The commentary includes a clinical impact rating and also indicates whether the trial is considered practice changing.
The randomised controlled trial “De novo sirolimus and reduced-dose tacrolimus versus standard-dose tacrolimus after liver transplantation: the 2000-2003 phase II prospective randomized trial” by Asrani and colleagues is considered practice changing by our expert and received a 5/5 clinical impact rating score.
You can read the full commentary in the Transplant Library. Get a trial account today!
Posted by Simon Knight on June 23, 2014
The next Frontiers in Transplantation course at King’s College will be held on the 1st and 2nd September 2014. The 2-day program includes discussion on recent developments in basic transplantation immunology alongside the latest cutting-edge clinical research.
If you are interested in attending, you can register at the King’s College website.