Posted by Simon Knight on September 2, 2014
This month, studies include an interesting analysis of the relationship between uric acid levels and CAN from the ABCAN trial, de novo Belatacept in liver transplantation and Alemtuzumab induction in lung transplantation.
Posted by Peter Morris on August 27, 2014
The World Congress in Transplantation, which was a joint meeting between the TTS, the ASTS and the AST took place in San Francisco from the 26th to the 31st of July. It was a huge meeting with some 7,000 people attending which made it quite difficult to meet people.
The opening ceremony was rather special and quite different to the usual displays of the culture of the host city/state in that two outstanding talks were given by the father of a donor and a recipient of a lung transplant.
The first was by Reginald Green, the father of a little child, Nicholas, who had died during a bandit attack while holidaying in Italy with his wife and two children in 1994. He and his wife decided that he should be an organ donor. This caused a sensation at the time in Italy as organ donation was one of the lowest in Europe. Seven Italians benefited from his organs and corneas. The father has since set up a foundation to further the cause of organ donation (http://www.nicholasgreen.org). This was a spellbinding account of this family’s sorrow but also demonstrating what he has done in the cause of organ transplantation to overcome the donor shortage, which is nowhere more evident than in Italy where the organ donation rate has quadrupled. There is a new edition of his highly acclaimed book “The Nicholas Effect”.
The second presentation was by a young woman, Charity Sunshine Tilleman-Dick, who is an opera singer. She opened her lecture with an aria from Rigoletto and then went on to explain how she was struck down with a lung condition early in her career and this required a double lung transplant. She returned to opera singing but several years’ later rejection was taking place and she had to have a second double lung transplant! Again this has been successful and she is back singing, and certainly the audience were in a position to vouch for her singing ability.
What a remarkable two stories. The large audience was spellbound as was the writer.
Posted by Liset Pengel on August 25, 2014
Dr Richard Perez presented a fascinating abstract on the use of of neonatal donor kidneys. The mean donor age was 20 days and 70% of kidneys came from DCD donors. Twenty recipients with a mean weight of 54 kg received infant kidneys. There has been no deaths but 4 early graft failures. The surgical complications rate was 55% and the rate of DGF was 40%. These promising results show that neonatal donor kidneys although challenging should be considered as a potential source of kidneys available for transplantation.
(Perez R, Santhanakrishnan C, Demattos A, McVicar J, Troppmann C. The neonatal intensive care unit (NICU) as a source of deceased donor kidneys for transplantation: initial experience with 20 cases)
Posted by Liset Pengel on August 25, 2014
Great success for the CET at the World Transplant Congress: all 4 poster abstracts that were presented at the WTC received distinction awards. These were:
* A comparison of University of Wisconsin and Marshall’s solutions for cold storage of deceased donor kidneys in the United Kingdom.
* What is the evidence for oxygenated hypothermic machine perfusion in kidney transplantation? A systematic review.
* Antifungal prophylaxis in liver transplantation: a systematic review and network meta-analysis.
* Social Media and online exposure as an early measure of the impact of transplant research.
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 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.