Posted by Simon Knight on August 3, 2015
This month, trials include conversion from Tacrolimus to Cyclosporine for renal transplant recipients developing new-onset diabetes and the use of Terlipressin during living-donor liver transplantation.
Posted by Simon Knight on July 2, 2015
Posted by Peter Morris on June 22, 2015
This is an interesting long term report of five patients who had bilateral hand allotransplants performed in the Lyon centre some years ago with a follow up ranging from three to 13 years. There were four men and one woman and all were young and the level of amputation was distal in three cases and mid forearm level in two patients. Patients essentially had the same immunosuppressive therapy with thymoglobulin induction and then tacrolimus, MMF and prednisone. Patient and graft survival was 100% and all recipients showed reasonable sensory motor recovery and partial recovery of intrinsic muscles in the hand and were able to perform a majority of activities of daily living. Most complications occurred in the first year after transplantation and all patients experienced at least one episode of acute rejection which was easily reversed with high dose steroids. One patient had six episodes of acute rejection. The risks associated with long term immunosuppression were studied and certainly appeared to be acceptable. The patients themselves found that the outcome was acceptable both socially and functionally. Regular angiograms failed to show any evidence of vasculopathy but the authors point out that this remains a continuing risk. This is in contrast to another study where evidence of vasculopathy was found. But the use of continuing triple therapy may have prevented the development of vasculopathy. This is an important long term follow up and as time goes by, far more information will be available about the long term function of hand transplants.
Posted by Liset Pengel on June 18, 2015
The Texas Transplantation Society is the first US society to provide access to the Transplant Library database for all its members. The Transplant Library will be introduced by Sir Peter Morris by video and by Mr Mark Schregardus, CEO of Evidentia Publishing during 28th Annual Scientific Meeting of the Texas Transplantation Society, July 23-26, 2015, Austin, Texas.
Posted by Peter Morris on June 12, 2015
Although the outcome of kidney transplantation in HIV positive patients who receive organs from HIV negative donors has been reported as being similar to the outcome in HIV negative recipients, this report from South Africa is the first long term follow up of HIV positive patients who receive kidneys from HIV positive deceased donors.
Over a six year period, 27 HIV positive patients underwent kidney transplantation from deceased donors who tested positive for HIV. All the recipients were HIV positive but were receiving antiretroviral therapy. Survivors were followed for a median of 2.4 years and patient survival was 84% at one year, 74% at five years. Graft survival after censoring for death was 93% and 84% respectively. Thus it is does seem that HIV positive recipients can be transplanted safely with a kidney from a HIV positive donor, which does provide an additional approach to renal replacement therapy in these patients.
Posted by Peter Morris on June 12, 2015
I was sad to hear that David Sackett died recently at the age of 80. He was arguably the father of evidence based medicine and the first chair of the Cochrane Collaboration steering group in 1993. He was appointed the first Professor of the newly founded Oxford Centre for Evidence Based Medicine in 1994, having come from the Department of Clinical Epidemiology and Biostatistics at McMaster University Department, which he founded in 1967. David was a delightful person whom I got to know well during his time in Oxford and there was no question that he changed the whole approach to the evaluation of evidence in medicine in Oxford. Many young clinicians adopted his approach to this new field, which he had made his own, and Evidence Based Medicine has now become almost an industry.
His contributions to medicine were enormous and he will be missed by all, but certainly never forgotten.
Posted by John O'Callaghan on June 12, 2015
A recent article in the BMJ by Abraha et al, using large amounts of data from RCTs, has shown that deviation from intention-to-treat analysis (ITT) can lead to apparently larger treatment effects. When compared to standard intention-to-treat analysis there was a significant difference in the apparent treatment effect. When a deviation from ITT was compared to no ITT, there was no significant difference.
Posted by Liset Pengel on April 15, 2015
Read the interview with Sir Peter Morris in Transplantation.
Posted by Simon Knight on April 8, 2015
Posted by Simon Knight on March 31, 2015
As you may be aware, the Centre for Evidence in Transplantation is co-ordinating the James Lind Alliance Priorities Setting Partnership in Renal Transplantation. The process aims to bring together pateints, carers and heathcare professionals to identify and prioritise areas for future research in kidney transplantation.
The second steering group meeting was held at the Royal College of Surgeons in London on the 30th March. The first survey was summarised – we received 498 uncertainties from 183 respondents, with an excellent mix of backgrounds (patient, carer and professional) and topics covering over 50 categories.
The steering group ran through the uncertainties submitted from the first survey and narrowed them down to 97 indicative uncertainties. Over the coming months, we will be working hard to identify existing evidence and develop a process for prioritisation.
We would like to thank everyone who took part in the first survey for your responses. If you would like to learn more about the PSP, and get involved, please visit the PSP website.