Top Ten Priorities in Kidney Transplant research from the Kidney Transplant PSP

Posted by Simon Knight on February 4, 2016

On the 3rd February 2016, a group of 20 kidney transplant recipients, donors and professionals took part in a consensus workshop at the Royal College of Surgeons of England, in London. The group considered the top 25 ranked treatment uncertainties from the PSP prioritisation survey, and after much lively debate agreed a top ten list of priorities for the future of research in kidney transplantation.

The top ten priorities agreed by the group were as follows:

  • What is the best way to treat vascular or antibody-mediated acute rejection?
  • How can immunosuppression be personalised to the individual patients to improve the results of transplantation?
  • How can we prevent sensitisation in patients with a failing transplant, to improve their chances of another successful transplant (e.g. removal of the transplant, withdrawal of immunosuppressive medicines or continuation of these medicines?)
  • Can we improve monitoring of the level of immunosuppression to achieve better balance between risk of rejection and side effects? (e.g. T-cell or B-cell ELISPOT, point-or-care tacrolimus monitoring, MMF monitoring)
  • How can we improve transplant rates in highly sensitised patients?
  • What are the long-term health risks to the living kidney donor?
  • How can we encourage tolerance to the transplant to prevent or reduce the need for immunosuppression? (e.g. by use of T-regulatory cells, induction of haemoxygenase 1)
  • What is the best combination of immunosuppressive drugs following kidney transplantation? (e.g. azathioprine or mycophenolate, belatacept, generic or proprietary (brand-name) drugs)
  • What techniques to preserve, condition and transport the kidney before transplantation allow increased preservation times and/or improve results? (e.g. machine perfusion, normothermic reconditioning, addition of agents to the perfusate)
  • Can bioengineered organs be developed to be as safe as human-to-human transplants? How can this be achieved?

We would like to extend a big thank-you to all those who took part in the PSP process, including the steering group, all those who responded to the surveys and the group who attended the final workshop.

For more information on the project, please visit the PSP website.

Paul Terasaki – death of a great in organ transplantation

Posted by Peter Morris on February 2, 2016

It is with great sadness that just after reporting the death of Richard Batchelor I have to report the death of another old friend and colleague, Paul Terasaki, Professor of Surgery at UCLA. Paul died on January 25, 2016 at the age of 86. Paul Terasaki was one of the giants in the history of organ transplantation and made wide-ranging contributions to the field.

He was born in in Los Angeles in 1929 to poor Japanese immigrant parents and then at the age of 12 was placed with his family in what was called euphemistically a relocation camp, one of many which held Japanese Americans during the Second World War. After the war they moved to Chicago and when he graduated from High school he entered premedical school at the University of Illinois. However Chicago was too cold for the Terasakis and they moved back to Los Angeles where he was accepted as a transfer student at UCLA, and never left. He completed his BA, Masters and PhD in zoology there and then with the help of William Longmire, the Chief of Surgery, who recruited him into his department as a scientist; he was accepted by Peter Medawar, FRS and Nobel Laureate, as a post-doctoral fellow in London for a year. This shaped his subsequent career in transplantation research as Medawar was regarded as the father of transplantation immunology. He returned to William Longmire’s department of surgery at UCLA, very proud that he was a PhD and not an MD. He rapidly rose up through the ranks and soon was a Professor of Surgery, a rare appointment in those days for a scientist.

Paul was one of the true pioneers of HLA typing and he and John McClelland, his senior technician, invented the micro cytotoxicity technique which became the standard tissue typing technique throughout the world until the advent of molecular typing some 30 years later. He was a truly lateral thinker and was continually introducing new innovative approaches to the field. What is not realised is that he was responsible for the work in his laboratory that introduced static cold storage with a fluid known as Collins solution after the young Australian research fellow, Geoff Collins, who did the experimental work in Paul’s laboratories. Paul wanted an easily obtained longer preservation time of the kidney so that HLA typing of the donor could be done in time to select an appropriate recipient. This was a radical change to preservation techniques which at the time were based on machine preservation and very quickly static cold storage became the norm.

His activities in the latter part of his career were directed at the role of antibodies in chronic allograft rejection a concept to which he was firmly committed, and he more than anyone changed our thinking on the role of antibodies in graft rejection. Amongst his other contributions were the establishment of the UCLA tissue typing laboratory and the UCLA renal transplant registry, before there was federal registry.

Paul was a giant in the field and received many awards for his work, including the Medawar prize. In 1984 he was elected as President of The Transplantation Society (TTS). He founded the One Lambda Company which produced products for tissue typing and One Lambda became the world leader in the field. He also created the Terasaki Foundation which provided support for research in HLA. His philanthropy was enormous and included a $50 million bequest to UCLA to establish a Life Sciences building now named in his honour, and the Paul and Hisako Terasaki Center for Japanese studies in 2006.

I first met Paul in Longmire’s department in 1966 and became a disciple thereafter. He leaves his wife Hisako, who was always an enormous support to him and always graciously entertaining the innumerable research fellows and visitors to Paul’s laboratories, and 4 children, Mark, Keith, Taiji and Emiko. His quiet sense of humour and his knowledge will be sorely missed by all of us in the field.

Placebo controls in surgical trials

Posted by Simon Knight on February 2, 2016

There is an excellent article in this month’s Bulletin of the Royal College of Surgeons of England about the use of placebo surgery in clinical trials of surgical interventions. The article discusses many of the practical and ethical issues around the use of placebo procedures, including when they should and should not be considered. Interestingly, only 75 studies employing a placebo control procedure were identified in the literature across all surgical specialities.

The article is accompanied by a position statement from the RCS Policy Unit, aiming to increase awareness and adoption of surgical controls in trials. Both articles are well worth a read.

February 2016 Transplant Trial Watch now online

Posted by Simon Knight on February 2, 2016

The February 2016 edition of the Transplant Trial Watch is now available. This month’s ten new trials include a comparison of parathyroidectomy and cinacalcet for management of post-transplant hyperparathyroidism, heamoxygenase-1 upregulation in renal transplant recipients and sirolimus for liver transplant recipients with hepatocellular carcinoma.

Death of Richard Batchelor (1931 – 2015)

Posted by Peter Morris on January 10, 2016

Ricard Batchelor died just before Christmas (December 21, 2015) after a short illness. This was unexpected and is a very sad loss to the worldwide transplant community. Richard was not only a colleague of mine for many years but a very old friend, and hence I feel doubly sad at our loss of a pioneer in transplant immunology and a good and supportive friend. Richard was born in 1931 and had much of his early education in India before returning to the UK where his secondary education was at Marlborough College and thence  to Cambridge University and Guys Hospital to study medicine.  On graduation from Medical School in 1956, after initial training posts in medicine and surgery at Guy’s, he did his National Service in the RAMC as a clinical pathologist. He was then appointed as a MRC research student in  the laboratory of Dr Peter Gorer FRS, a pioneer in tumour immunology, at Guys Hospital. These studies led Richard, now a committed scientist, into transplant immunology.  He was a senior lecturer in Pathology at Guys Hospital until 1967, when he was appointed as Director of the Blond McIndoe Research Institute at the Queen Victoria Hospital, East Grinstead and also as a Professor  of the Royal College of Surgeons of England. He built this unit  into a powerhouse of transplant immunology between 1967 and 1979, when he became Professor of Tissue Immunology at the Royal Postgraduate Medical School. In 1982 he became  Professor of Immunology and Chairman of the department to succeed John Humphrey. He held that post until his retirement in 1994, when he became Emeritus Professor in the same department but continued to maintain an active interest in everything to do with transplantation and auto-immunity. Much of his early work was related to the induction of tolerance and the mechanism of rejection in experimental transplant models but, in addition, he was a pioneer in the development of tissue typing in organ transplantation and was the first to demonstrate an influence of HLA matching on the outcome of corneal grafts. He had a major interest in the association of HLA with autoimmune disease and  also took part in a number of anthropological studies of HLA in South East Asia with myself (e.g. New Guinea and Fiji). 

He was a former President of the International Transplant Society, the British Transplant Society and the Society of Histocompatibility and Immunogenetics and European Editor of Transplantation from 1963 – 1998.  Following retirement he became  a member of the Council of the Arthritis Foundation, and later a Trustee of the Kennedy Institute in London. Richard had a delightful personality and was a kind and gentle man.  His contributions to both transplantation and auto-immune disease were enormous, and his wise words will be missed in both fields.

January 2016 Transplant Trial Watch now available

Posted by Simon Knight on January 6, 2016

The CET team would like to wish everyone a Happy New Year! A new year means that this month’s Transplant Trial Watch is now out.

New studies include a systematic review of outcomes in obese kidney transplant recipients, CNI and steroid-free immunosuppression in renal transplantation, and a direct mail campaign to improve donor registration.

Evidence in Transplantation (EVIT) Course: 8-9 April 2016

Posted by Simon Knight on January 6, 2016

Do you want to increase your skills in evidence-based decision-making?


Attend the “Evidence in Transplantation (EVIT) course”, which is held at the Royal College of Surgeons of England on 8-9 April, 2016 and jointly organised by ESOT and the Centre for Evidence in Transplantation. This interactive course covers clinical research methods, including clinical trial design and interpretation, literature searching, critical appraisal, systematic reviews and statistics for evidence appraisal.

More information & registration

Educational bursaries of up to £500 are available for trainee members of the British Transplantation Society (more info).

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December 2015 Transplant Trial watch now available

Posted by Simon Knight on December 2, 2015

The December 2015 edition of the Transplant Trial Watch is now available online. This month’s trials include the first RCT of robotic donor nephrectomy, Belatacept in Liver Transplantation and tPA for DCD kidney donors.

Why not download our app for iPhone, iPad and Android?

The Sun Continues to Shine

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.

Help us to prioritise the most important questions in kidney transplantation

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.

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