Daily Recap

Monday 30 August, 2021

Welcome to Day 2 of ESOT Congress 2021!

Today marked the second day of ESOT Congress 2021.

The Congress featured an array of high-quality abstract presentations, think-tanks and the highly anticipated Leonardo Da Vinci Research Innovation Award. 

View the second edition of our Congress Daily Recap below to catch up on the day’s key moments and action. 

The end of Kaplan-Meier: New Endpoints in Transplantation

Following a short introduction from Anna Forsberg and Thierry Berney, Euan Ashley delivered a captivating presentation on ‘Big data analysis in definition of medical endpoints’ in which he convincingly demonstrated the effectiveness of digital devices and electronic health records in providing a rich, real-time window onto patient trajectories. He also highlighted how deep learning provides opportunities for analysis at scale and for the detection of signals undetectable by humans.

The next presentation from Alexandre Loupy explored fine-tuning endpoints in specific transplant settings. Alexandre spotlighted the importance of fine-tuning endpoints to improving both efficiency and patient outcomes in transplantation, including, as an example, the need to enhance allograft allocation through AI based simulation tools and virtual systems. Concluding his talk, Alexandre highlighted that fine tuning end points involves fine tuning ourselves as clinicians.

The penultimate presentation came from Maarten Naesens who considered ‘Novel endpoints for tailoring therapeutic interventions’. During his talk, Maarten stated that there has been a ‘quiet revolution’ in transplantation, demonstrating that graft failure rates have dropped from 45% in 1966, to 15% in 2015. Looking at the challenges to developing tailored therapeutic interventions and precision medicine further, Maarten indicated that the biggest goal was building consensus. Finishing his talk, Maarten delivered a strong message that medical advancements in the future will not be made by the clinician but by the patient – ‘we need to put the patient at the centre’.

The last presentation on ‘An education of [real] survival analysis: Learning it’s about life, not failure’ came from Jillianne Code, who began by discussing her history and experience as a heart failure patient and heart transplant recipient. Talking about the patient perspective and the work of the Heartlife Foundation, Jillianne showcased the ‘Patient Rights’ of a Canadian living with heart failure before echoing her powerful statement from the start that ‘it’s about life, not failure’ to conclude.

ESOT Leonardo Da Vinci Transplant Research Innovation Award

It was a pleasure to see all 8 abstracts striving to win the coveted ESOT Leonardo Da Vinci Transplant Research Innovation Award and we would like to extend a sincere thank you and pay tribute to all the speakers and their presentations:

Kevin louis – Il-21 driven expansion and reprogramming of t-bet expressing b cells during antibody-mediated rejection of kidney transplants

Sergi Betriu Méndez – Specific elimination of anti-hla antibody-producing b cells in an in vivo mouse model by using chimeric hla antibody receptor (char) t cells

Claire Albert – Enhanced delivery of nanomedicine to kidney graft endothelial cells during ex vivo perfusion

Nicola de Stefano – Extracellular vesicles from human liver stem cells reduce injury in a model of normothermic perfusion of rat ischemic livers

Elisabet van Loon – Peripheral blood inflammatory chemokines uncover allo-immune inflammation in the absence of histological lesions

Margherita Saracco – Screening for sars-cov-2 neutralizing antibodies in cirrhotic patients waiting for liver transplantation: impact on donor pool expansion

Marc Raynaud – Dynamic prediction of kidney-graft survival with artificial intelligence: an international study of deep cohorts of kidney recipients

karol Graňák – Regular physical activity in the prevention of post-transplant diabetes mellitus and associated metabolic conditions in kidney transplant recipients

Good luck to you all!

Transplant Organs of the Future

During the State-of-the-Art session on transplant organs of the future we heard three fascinating presentations.

Firstly, Julia Radan delivered a presentation on xenotransplantation. She postulated that porcine transplants are a realistic option and highlighted 4 factors that need to underpin this approach: stable genetic modifications of donor pigs (as few as necessary); non-nephrotoxic immunosuppressive protocol; successful tissue and organ transplantation; and control of genetically determined organ growth. Showcasing the results of her research, Julia demonstrated that there was consistent success in orthotopic cardiac xenotransplantation and that its clinical use was within reach.

The second presentation from Hiromitsu Nakauchi looked at ‘Interspecies organ generation using cell competitive niche’. During his talk, Hiromitsu revealed that the cell competitive niche induces almost entirely donor-derived organs in Igf1r-null mouse chimeras, and after demonstrating that cell competitive niche does not work for some organs, he stated that innate immunity may be one component of xenobarrier. Concluding his presentation, Hiromitsu left the audience with a key message that ‘understanding and manipulation of xenobarrier may be the key to the generation of human organs in livestock animals’.

The final presentation was delivered by Nuria Montserrat who explored Organoids. After discussing our understanding of cell differentiation potential to generate tissues in the lab and the discovery in the last 10 years that organoids were possible and viable, Nuria provided a breakdown of the stepwise methodology to generate kidney organoids.

Nuria Montserrat finished her talk with an encouraging message that we are now in a ‘very nice position to generate fundamental knowledge’ relating to the development, application and delivery of organoids to the transplant community.

 

Cardiovascular risk in abdominal transplantation

This morning, we saw a joint Think-Tank session with the European Association of Preventative Cardiology (EAPC) and the European Society of Cardiology on cardiovascular risk in abdominal transplantation. The session, introduced by Luciano Potena, addressed the issues of risk stratification, the prevention of cardiovascular complications prior to transplantation and post-operative management. “The spirit of this Think-Tank section is not just to provide a lecture, but to foster discussion and debate on the controversial issue of cardiovascular prevention and stratification”, explained Luciano Potena.

Among the presentations, Ailish Nimmo discussed how kidney transplant recipients have a high pre-test probability of coronary heart disease, and as higher risk individuals can still benefit from transplantation we need to ensure equitable use of resources without rationing treatment, and Giacomo Germani explored risk stratification for ischemic heart disease in patients with end-stage liver disease. Following the six speaker presentations, the floor was opened for a half-hour discussion panel, which aimed to feed into creating guidelines and future recommendations from ESOT on how to manage cardiovascular risk in kidney and liver transplantation. 

Transplant Organs of the Inequalities in Asian Donors and Black Kidney Graft Recipients 

One key study presented today showed black transplants recipients and patients who received kidneys from Asian donors had a significantly higher risk of kidney graft failure within seven years. The research included 20,304 kidney organs transplanted between 2001-2015 in the UK. Unadjusted survival analysis demonstrated significantly poorer long-term allograft outcomes associated with Asian and black donors, compared to white donors.

The 7-year graft survival was 71.9% from Asian donors, 74.0% from black donors and 80.5% from white donors. When Cox Regression Analysis (a statistical technique) was used to account for other factors and give more insight into the true nature of the associations with outcomes, the hazard ratio was 1.37 for Asian donors (a 37% increased risk of the donor organ failing compared to white donors), and 1.21 for black recipients (a 21% increased risk of organ graft failure compared to white recipients). Lead study author Mr. Abdul Rahman Hakeem, a Consultant Hepatobiliary and Transplant Surgeon at St James’s University Hospital NHS Trust, Leeds, United Kingdom, says the disparity revealed is due to a combination of factors which put ethnic minorities at a disadvantage when it comes to transplants.

This research was featured online today in the Sunday Times and The Daily Telegraph (UK), as well as other worldwide news outlets.

 

That’s all for today! Tune in tomorrow for more exciting highlights from the ESOT Congress 2021

About ESOT Congress 2021

The ESOT Congress 2021 features the latest research and innovation from the most prominent scientists and physicians in the field of organ transplantation. Guaranteed to motivate and inspire, this landmark meeting provides a unique opportunity to connect science and medicine.

Share your Congress experience on social media using the official #ESOTCongress

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