How can we improve the Transplant Library?

Posted by Simon Knight on May 5, 2016

We are seeking feedback from users of the Transplant Library, to help us to improve the experience for our many users. We would be very grateful if current users would take the time to complete a short survey about the library.

The survey can be accessed here.





May 2016 Transplant Trial Watch now available

Posted by Simon Knight on April 29, 2016

The May 2016 Transplant Trial Watch is now available online and via our app for iPhone, iPad and Android.

This months new trials include long-term follow-up from the Spare the Nephron trial, methods for promoting organ donation and mobile medical apps for encouraging sun protection behaviour.





Facial Transplantation Moves Forward

Posted by Peter Morris on April 14, 2016

This is quite a remarkable achievement in that the patient, a volunteer fire-fighter aged 41, had suffered severe burns across his entire face including the loss of eyelids, ears, lips, most of his nose and the entire scalp during a rescue search in a burning home in 2010. He had had some 80 reconstructive procedures on his face since the injury and all this reconstruction had to be excised at the time of  the transplant. Dr. Rodriquez, a surgeon at NYU Langone, with a team of some 100 colleagues and assistants, found a suitable donor and successfully carried out the donor operation and the transplant in adjoining theaters.  However, what is unusual in this particular case, among the 37 cases of facial transplant carried out worldwide, was the use of 3-D modelling to enable a good fit with the patient’s skeleton as some of the skeleton of the patients face had to be replaced or augmented in addition to the soft tissues. He still had his eyesight intact and so they were able to transplant the face with eyelids and relevant muscles and both ears in April 2014. This was indeed a tour de force. At the time of the report there had been no episodes of acute rejection and the functional result is impressive.

Dr Rodriquez is a graduate of the Medical College of Virginia and received his plastic surgeon training at the Johns Hopkins before moving to NYU Langone. He had performed a face transplant earlier in Baltimore before his move to NYU. The cost of the procedure and all related care was estimated to be around $1 million dollars. This is definitely a further step forward in establishing facial transplantation as an acceptable procedure in the right centre, but it remains an experimental procedure.

Bulletin of the American College of Surgeons, April 2016.





Hesperis course – special rate ends Thursday 31/3

Posted by Liset Pengel on March 29, 2016

Hesperis016 1180x350

This highly-recommended course covers the whole field of basic transplantation medicine and surgery. State-of-the-art lectures are combined with interactive workshops in small groups and sport educational games. Educators and delegates will have ample opportunity to meet, socialise and share ideas.

For more details or to register, go to http://bit.ly/Hesperis2016

The exciting programme includes:

  • HESPERIS GAMES – who will be the Best Transplant Team for HC2016?
  • Break out sessions in the afternoons
  • Special moments to meet, build your network, share and prepare relevant questions for the “Big Players”
  • Case presentations – submitted by the participants

 





Paul Terasaki Memorial Service

Posted by Peter Morris on March 14, 2016

A Memorial Service was held on March 6th at Royce Hall at UCLA. It was a marvellous service in memory of a great pioneer in organ transplantation and the tributes were all memorable. Some 1000 people attended. The service started with an opening song by the opera singer, Miss Lova Hyatt, ‘Amazing Grace’, and then the Master of Ceremonies, Fred Katayama, a nephew of Paul Terasaki, introduced the various speakers.  The programme started with Paul’s Methodist Minister, Gary Oba, giving the Invocation, and then a number of speakers spoke about his contributions to science and organ transplantation.  These included an address by the UCLA Chancellor Gene Block, a video from Tom Starzl, who is no longer able to travel, and then Walter Bodmer, Peter Morris, Mike Cecka, and one or two other friends and colleagues particularly from the Japanese American association. It was, indeed, a fitting Memorial Service to Paul Terasaki and was followed by a reception in the grounds outside Royce Hall.  All in all a great occasion, and a celebration of a great man’s career, not only as a scientist but also as a philanthropist.





March 2016 Transplant Trial Watch now available

Posted by Simon Knight on March 1, 2016

The March edition of the Transplant Trial Watch is now available via our website and the Trial Watch App.

This month’s trials include the effect of Omega-3 on hepatic regeneration after live liver donation, prophylactic azithromycin after lung transplantation, and the consequences of complete tacrolimus withdrawal in renal transplant recipients.





SONG-TX – developing a core outcome set for renal transplantation

Posted by Simon Knight on February 17, 2016

Many clinical trials have been conducted in kidney transplantation but a wide variety of different outcomes are reported and in different ways, and it is unclear whether they are important to people who have received a kidney transplant. There has been no agreement about what are the most important outcomes to measure and report in studies for kidney transplant recipients. Variability in outcome reporting makes interpretation, comparison and combination of studies in meta-analysis challenging.

The Centre for Evidence in Transplantation is pleased to announce that it is supporting an initiative to create a set of standardised, core outcomes for use in renal transplant trials, audits and registries – the SONG-TX initiative. More details about the project can be found on the project website. The process involves three phases:

  1. a systematic review to identify outcomes that have been reported in trials in kidney transplantation
  2. a three-round Delphi survey with stakeholder groups to distill and generate a prioritised list of core outcomes
  3. a consensus workshop to establish a core outcome set for kidney transplantation trials.

Registration for the first Delphi survey is now open. To take part, register your interest here.





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-of-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.





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