April edition of Transplant Trial Watch now online
Posted by Simon Knight on March 31, 2012
The April edition of the Transplant Trial Watch is now online. Each month, the CET staff select 10 important randomised trials from the literature to summarise and assess their quality.
This month, trials include RCTs investigating the safety and efficacy of Advagraf and Belatacept in renal transplant recipients, and trial looking at steroid pretreatment of liver donors.
Download the new Transplant Trial Watch App now!
Posted by Simon Knight on March 31, 2012
We are pleased to announce the release of the new Transplant Trial Watch App for Android and iPhone. The app gives you access to the latest Transplant Trial Watch on your mobile device, with 10 important RCTs in the field of transplantation from the past month.
The App also allows you to send trials of interest to your colleagues via email and store your favourites for later viewing. There are links to the publishers site for abstracts and full text (access permitting).
Search the Apple App Store or Google Play Store for “Transplant Trial Watch” and download it now!
March edition of Transplant Trial Watch now online
Posted by Simon Knight on March 1, 2012
The March edition of the Transplant Trial Watch is now online. Each month, the CET staff select 10 important randomised trials from the literature to summarise and assess their quality.
This month, there are a number of trials looking at immunsuppression monitoring and factors affecting exposure, as well as an interesting trial looking at the benefits of antimuscarinics in renal transplant recipients with small volume bladders.
February 2012 Transplant Trial Watch now online
Posted by Simon Knight on February 3, 2012
The February 2012 Transplant Trial Watch is now online. Each month, the CET staff pick 10 recent randomised trials in transplantation and summarise them, assessing the methodological quality.
This month, there are trials in renal, hepatic and cardiac transplantation, including a comparison of CsA/AZA and Tac/MMF in renal transplant recipients and the impact of MMF pre-treatment in live-donor renal transplantation.
January Transplant Trial Watch now online
Posted by Simon Knight on January 9, 2012
The first Transplant Trial Watch of 2012 is now available on the CET website. This month’s RCTs include studies of donor pretreatment, immunosuppressive regimens and CMV prophylaxis.
Successful transplantation of a tracheobronchial airway
Posted by Peter Morris on December 9, 2011
This fascinating report appeared in the Lancet on line in the last couple of weeks (Jungebluth et al Nov 24, 2011). This is a single case report from a team led by Paolo Macchiarini who three years ago reported the first tissue engineered tracheal transplantation with a non immunogenic scaffold of allogeneic human donor trachea reseeded with bone marrow derived mesenchymal stem cells. A 36 year old male patient, previously treated for a tracheal tumour with debulking surgery and radiation therapy was referred with stridor; scans showed an extensive recurrent tumour involving the lower 5 cm of the trachea and extending into the right bronchus.
A synthetic scaffold of the trachea and bronchi of the appropriate size as determined by imaging of the patient’s own trachea was made in a bioreactor over a bifurcated mandril using a nanocomposite polymer. This was seeded with autologous mononuclear cells from the patient’s bone marrow 36 hours before transplantation was to take place. Immediately before transplantation a second bone marrow harvest was done and mononuclear cells were separated and the graft was reseeded with these newly obtained mononuclear cells. Granulocyte colony stimulating factor (GCSF) and epoetin beta were used to enhance the growth of the seeded cells.
At transplantation an extensive resection was done, which also included resection of the right intrapericardial pulmonary artery which was replaced by a Dacron graft. All the tumour margins were negative on frozen section. The synthetic reseeded airway was implanted with anastomosis to the right and left main bronchi and then to the proximal trachea. The patient was treated with subcutaneous injections of GCSF and epoetin-alpha starting the day before transplantation and every other day for two weeks. The immediate post operative recovery was complicated with a right upper lobe pneumonia which responded to antibiotic treatment and the patient was weaned of mechanical ventilation on the 5th post operative days. The patient is now 5 months after transplantation, is asymptomatic, breathing normally and is tumour free on scanning. Lung function is improved compared to the preoperative evaluation.
This is an exciting report, particularly bearing in mind that this was by standard criteria, a non-resectable tumour of the trachea. As the new trachea is a synthetic material seeded with autologous cells there is no requirement for immunosuppression and this must improve the chances of there being no tumour recurrence. There is no question that this is a novel approach for the resection of an otherwise inoperable tumour of the trachea and is an exciting development in tissue engineering.
Interleukin-2 and regulatory T cells
Posted by Peter Morris on December 9, 2011
In the December 1st issue of the New England Journal of Medicine are two very interesting reports. The first from Koreth et al (2011; 365:2055-66) has studied the use of low dose interleukin-2 (IL-2) in chronic graft versus host disease following allogeneic haematopoietic stem cell transplantation for haematologic cancer that was resistant to steroid therapy. Patients received subcutaneous IL-2 at three dose levels but all representing low doses of IL2. All patients had a major increase in the population of T regulatory (Treg) cells and of the 29 patients enrolled a number had a significant clinical response.
The second study from Saadoun et al (2011;365:2067-77) investigated the use of low dose IL-2 in 10 patients with hepatitis C virus (HCV) induced vasculitis that was resistant to conventional anti viral therapy, rituximab therapy or both. There was an increase in Treg cells in these patients and there was a reduction in cryoglobulinemia in 9 of the 10 patients and an improvement in vasculitis in 8 of the 10 patients in the study. There were no adverse effects.
These two studies are of course very much phase 1 studies but are good examples of what may become a feasible therapy in patients with conditions associated with an immune dysfunction and a deficiency of Treg cells. In the same issue Jeffrey Bluestone has written an excellent editorial covering these two papers and others that are relevant. The title of his editorial is the “Yin and Yang of Interleukin-2 mediated immunotherapy” This is very appropriate in that we are already familiar with the fact that IL-2 can lead to an expansion of effector cells in high doses but in low doses it stimulates the proliferation of Treg cells. He points out that overall, low dose IL2 appears to be safe and that serious complications or infections occurred in very few patients. Furthermore increasing Treg cells did not lead to a recurrence of hematologic cancer in the patients with graft versus host disease although the graft versus host disease was suppressed nor in the HCV vasculitis patients was there any evidence of a worse viral load following the expansion of the Treg population. However long term follow up is required to see if the delicate balance between Treg and T effector cells is maintained.
As interest in Treg cells and their potential use in immunotherapy grows, these two papers do represent a significant contribution to our knowledge in this area.
December Transplant Trial Watch now online
Posted by Simon Knight on December 7, 2011
The December edition of the Transplant Trial Watch is now available on the CET website.
This month, ten new important trials in the fields of Renal and Hepatic transplantation are listed and assessed for quality.
November Transplant Trial Watch now online
Posted by Simon Knight on November 4, 2011
The November edition of Transplant Trial Watch is now available on the CET site.
Each month, the CET staff summarise and appraise for quality ten of the most important trials published in the transplant literature.
Transplant Trial Watch now available on the CET website
Posted by Simon Knight on September 29, 2011
For some time now the CET has been producing a summary of ten of the months’ most important trials in transplantation for the European Society of Transplantation (ESOT).
We are pleased to announce that this Trial Watch is now available on the CET website. Each month, ten important trials in transplantation are appraised for quality and summarised by the CET staff. Links are provided to the original articles where available.