March Transplant Trial Watch now online

Posted by Simon Knight on March 3, 2015

The arch 2015 edition of the Transplant Trial Watch is now available on the CET website and via the Trial Watch App.  Take a look now to see the latest trials from the world of solid organ transplantation!

Sirolimus use and cancer incidence in US kidney transplant recipients

Posted by Peter Morris on February 10, 2015

Recently we added to the Library as well as a blog  a very good individual patient meta-analysis of the use of sirolimus showing that it was associated with a reduction in cancer incidence but also with an increased rate of death after kidney transplantation.  Now we have a study of data from the US transplant registry concerning the use of sirolimus and the incidence of cancer. This is a large observational study but suggests that there is not strong evidence that sirolimus prevents cancer after transplantation, although it might be advantageous in patients with a high cancer risk. However an interesting observation was that there was an increased diagnosis of prostate cancer in patients receiving sirolimus.  Overall the reduction in cancer incidence, after excluding prostate cancer, was 26%. Thus again this large registry data report does not provide convincing evidence for the use of sirolimus to prevent cancer. There was no data on death rates.

Total Pancreatectomy and Islet autotransplantation

Posted by Peter Morris on February 9, 2015

This is an analysis of a subset of patients at the University of Minnesota School of Medicine in Minneapolis from their vast experience of pancreatic and pancreatic islet transplantation. This paper discusses the management of patients with hereditary/genetic pancreatitis due to several causes which not only produces chronic pain but also an increased risk of pancreatic cancer. They have performed total pancreatectomy and autogenous islet transplantation in 80 patients over 35 years and have compared them with patients who have had total pancreatectomy and islet auto transplantation for a non-genetic cause of pancreatitis. The results are really quite impressive in that there was total pain relief which was sustained in 90% of the patients and two thirds had partial or full beta cell function. These patients were younger than the comparative cohort, had a longer period of pancreatic pain and with more fibrosis and there was a trend towards a lower yield of islets. Insulin independence was related to the severity of the fibrosis, the duration of pancreatitis and a higher number of islet cell equivalents per kilogram bodyweight. There was a significant improvement in health related quality of life from baseline. None of the patients in the entire cohort had cancer of pancreatic origin during what was quite a long period of follow up. The authors feel that in patients with hereditary/ genetic pancreatitis consideration should be offered an earlier total pancreatectomy and autogenous islet transplantation when there will be less fibrosis and a better islet retrieval.

Surgeon meets a poor priest again

Posted by Peter Morris on February 9, 2015

This has nothing to do with transplantation but I was intrigued by reading this note in Vascular News (Feb 4, 2015) about a surgeon in Buenos Aires (Juan Parodi) who recollects that 34 years ago he was called by a friend of his who was an internist to ask if he could help a very poor priest who has fallen ill and could not afford any treatment in a private hospital.  Juan Parodi went to this small hospital and found a very sick priest who was septicaemia and anuric lying in an old bed. He had been on antibiotics but with no response and to cut a long story short he did an emergency laparotomy  and found a gangrenous gall bladder with localised peritonitis. Following cholecystectomy and drainage the patient improved rapidly and two days later was off dialysis, and was discharged 10 days after his surgery. This poor priest, Jorge Mario Bergoglio, became Pope Francis in 2013 and his friend called Parodi to remind him of the night when he operated on the priest who Parodi said he did not remember in any detail and certainly not his name.

Recently after attending a meeting in London, Parodi flew to Rome to have an invited audience with the Pope who did indeed remember his admission to hospital and Parodi operating on him and saving his life. The Pope said “I remember your face. That night I thought I was going to die and all of a sudden a crazy young surgeon arrives and starts to give orders and prepare the operating room”. This is a great story and hence I have taken the editorial privilege of putting it as a blog on the CET web page.

The February Transplant Trial Watch is now online

Posted by Simon Knight on February 5, 2015

The February 2015 edition of the Transplant Trial Watch is now available on the CET website and via our mobile app.  Keep up-to-date – read it now!

Evidence in Transplantation (EVIT) course: why should you attend? Read the answers from one of our previous participants.

Posted by Liset Pengel on February 2, 2015

Dr Luca Toti from the University of Rome and chair of Young Educated Professionals in Transplantation (YEP-IT), has very kindly answered 3 key questions.

1. What did you like best about the course?
The high level of interactivity experienced during the working groups confirmed the importance of the “team force”. Sharing ideas and projects with colleagues with different background and specialities enhances the approach to reach an optimal result and it’s exactly what I expect from every high level course as EVIT but it’s not easy to reach. It was a fair abstract competition! (and the winners were the right ones!!!)

2. Which new skills did you learn during the course?
I learned the importance of focusing and analysing the literature we have at our disposal and that is not always so evident. The PICO system is a good example. Meta-analysis is complex and the time we spent on it during the course is very important on everyday practice.

3. Who should attend the course?
I strongly believe that all professionals (not only the so called “junior”) should experience it. The EVIT course gives a complete overview on the current way to make researches for daily practice but mostly for excellent preparation. The acronym can also reads as Excellence Viewing In Transplantation.

Register for EVIT today:

Become part of our team: we are looking for an information specialist

Posted by Liset Pengel on January 29, 2015

We are looking for a dedicated information specialist to work with our team based in London.

The successful candidate will be responsible for keeping our Transplant Library database up to date with the latest high-quality evidence.

More information about the job and the person specification can be found here.

Presumed consent in organ transplantation is unnecessary and ethically unsound

Posted by Peter Morris on January 6, 2015

Professor John Fabre, Past President of the British Transplant Society, has written an extremely well argued case against presumed consent in organ donation stating that it is both clinically unnecessary and that it would compromise the ethics of clinical practice. The author argues in this article that rather than legislating for consented donors we should be addressing the misgivings and misunderstandings of families in order to improve their consent rate.  If the consent rate for deceased donation could be raised in the UK from around 55% to the Spanish rate of 85% this would have an enormous impact on the number of organs available.

This article is recommended reading for all those associated with organ transplantation.

Sirolimus associated with less malignancy but an increased mortality after kidney transplantation

Posted by Peter Morris on January 6, 2015

A group from Ottawa, led by Greg Knoll, have published an important systematic review of risk of cancer in patients who had sirolimus included with their immunosuppression de novo as well as those who were converted at some stage after transplantation to sirolimus. The study also included a meta-analysis of individual patient data. This was available from 5,676 patients from 21 randomised trials. Sirolimus was associated with a 40% reduction in the risk of malignancy and particularly in the reduction of the risk of a non-melanoma skin cancer, compared with patients who did not receive sirolimus. The most marked effect was seen in patients who were converted to sirolimus at some time following the transplant procedure.

However sirolimus was associated with a 43% increased risk of death compared with controls. The causes of death in sirolimus patients were either infection or cardiovascular. The authors suggest that although there is a reduction in the risk of malignancy, the increased risk of death in patients receiving sirolimus does not justify its use. This may well be true but this is a critically important study and no doubt will trigger others to look specifically at mortality in their patients who are receiving, or have received, an mTOR inhibitor.

Texas Transplantation Society – first society in the US to subscribe to the Transplant Library database

Posted by Liset Pengel on November 20, 2014

We are very pleased to announced that from January 1, all members of the Texas Transplantation Society will have access to the Transplant Library.

Texas Transplantation Society is the first American organization to offer access to its members. The subscription is made possible, in part, through funds donated to the Baylor Health Care System Foundation.

Read the official press release here.

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