Tuesday 31 August, 2021
Day 3 at ESOT Congress 2021!
It was another packed programme of science during the penultimate day of ESOT Congress 2021.
Today’s Plenary Session focused on the redeployment of resources and lessons learnt from the COVID-19 pandemic, with discussion on how we can continue to provide transplant activities at a time when healthcare systems are pushed to their limits. COVID-19 was also a ‘hot topic’ in the day’s press, with a study presented at the Congress attracting headlines across the world.
Scroll through the Daily Recap to catch up on the action.
Re-deploying resources in the era of SARS-CoV-2
Starting this session, Massimo Cardillo delivered an introductory presentation to set the scene and map out the context behind the plenary session on COVID-19. He spotlighted the key impacts and learnings of the pandemic experience, highlighting the clear need for reform and investment.
The first speaker, Glenn Bonney delivered an insightful presentation looking at ‘Facing crisis: The need for a modelling approach’. After looking at the reduction of organ transplants during pandemic, Glenn discussed how the use of extended criteria livers was shown to decrease wait time for liver transplantation without adverse impacting posttransplant survival. From a model that he and his team developed, Glenn revealed the significant impact the pandemic had on waitlist mortality rates.
Next, we heard about the ‘Lessons learned from the management of the emergency: How to move forward the normality’ from Massimo Puoti. Amongst several key recommendations, he stressed that prevention, early diagnosis and anticipation of medical care need to be pursued for COVID-19 infection in transplant recipients and the importance of network flexibility and interprofessional cooperation in the transplant community.
The third speaker was Dorry Segev who presented a fascinating presentation on ‘Safety and efficacy of vaccination in the transplant population’. He demonstrated that while vaccines were shown to be very safe for transplant patients, they gave transplanted patients significantly less protection from breakthrough infection, hospitalisation and mortality. Based on this research, he highlighted the encouraging news that they have been able to justify and secure booster vaccine doses for transplant patients which have been shown to enhance protection from COVID-19.
We were also given an in-depth look at EU centrality in reshaping and relaunching the health system from the final speaker, Stefaan van der Spiegel. He explored the role of the EU in transplantation policy, highlighting that there are ongoing revisions to a number of EU directives on blood, tissues and cells. Stefaan then looked at the broader, non-legal EU policy objectives around transplantation before discussing the EU tools available, including the €5.3bn budget available as part of EU4Health programme.
Achieving ‘person-centred’ not ‘patient-centred’ care in the era of telemedicine
Following an introduction from the session Chairs, Annette Lennerling and Frank Dor, we heard from Angeliki Gkouziouta who explored the challenge of telemedicine and digital encounters. Angeliki looked at how we can tailor remote patient management through devices, co-morbidities, time course and organisations. She then spotlighted RETENTION, a project seeking to deliver an innovative platform supporting interventions based on enhanced continuous monitoring of patients, which aims to reduce mortality, hospitalisation rates and quality of life. Angeliki ended with an encouraging message that ‘patient centred care is right in front of us’!
Anna Forsberg then delivered a thought-provoking presentation on the art and science of person-centred care. During her talk, Anna broke down the difference between patient-centred care vs. person-centred care, issuing a powerful message that ‘as a person you can act as a patient, however it is not obvious that the patient is approached as a person’. Anna concluded by stating that person-centred can be defined, practised, evaluated by research and measured for quality of care, before providing her take-home message – ‘when we view the patient as a person, the care becomes more effective’.
During the third presentation from Fiona Loud on the importance of partnership, she raised a critical point that patient-centred care ‘is about focussing care on the need of the individual’ and that we must ‘treat the person who has the disease, not the disease’. Fiona reported on the results from a survey of kidney patients, which showed that many were worried and felt ignored during the pandemic, which she said must be addressed. She also stressed a word of caution around the use of technology, which can exacerbate inequalities and disadvantage certain groups, and that ‘Dr Zoom is not for everyone’. Fiona concluded that telemedicine has great potential, but it is about how we harness this potential that will shape its effectiveness.
The final presentation from Jessica Morley explored who is going to serve as ‘patient data manager’? Jessica suggested that this question can only truly be answered by big data, which provides more confidence in accuracy and representative data sets, but also presents ethical issues. The big challenge with big data now, she added, is the reliance on individual consent, which is clearly not conducive to generating large data sets. She went on to discuss further challenges such as ‘what is direct care and what is research?’ and what we should do about posthumous records? Jessica concluded by bringing the conversation back to consent – is it an individual choice? Is it a national issue (in the public good)? Or is it a global issue that needs to be addressed at the international level?
ESOT-ELITA consensus process on how to measure value in liver transplantation: Which methodology and which endpoints? The start up
During this Think Tank session, we heard a number of presentations before being treated to a robust and rigorous discussion on measuring value in liver transplantation, and which methodology and endpoints we should use.
Umberto Cillo started the presentations by outlining why agreeing on value endpoints matters, advocating that we need to move from a volume-based approach to a value-based approach in healthcare. Mario Strazzabosco then explored value-based care as a compass to guide healthcare decisions in liver transplantation, stating that ‘the key goal of healthcare is given by the patient’, which he suggests we have not considered enough when measuring outcome. Following this, Anna Forsberg looked at how we understand and measure the shared health needs of patients. Anna identified the importance of being taken seriously to empowering the patient and how the ‘The Being Taken Seriously Questionnaire – Patient Version’ offers the chance to put a person-centred approach at the core of care.
Nichon Jansen then explored how we can measure organ donation, suggesting that the first step required is increasing the number of donors and that we ‘need to shift the focus’. James Neuberger delivered the fifth presentation looking at ‘Models and metrics to evaluate organ transplantation – the UK experience’, in which he spotlighted the strengths and weaknesses of transplantation in the UK, before concluding that it has a well-established registry that publishes a lot of data, but that there is scope for improvement.
The last speaker was Marco Carbone who presented the discussion point for the Think Thank: ‘A proposed framework for improve value in liver transplantation’. After Marco outlined the proposed scope and steps to implement value-based healthcare, the panel commented that it ‘covers the most important elements of the transplant journey’, but they also stressed the importance of having robust endpoints to ensure strong patient outcomes. Anna Forsberg proposed that she would like to see ‘4 prompts with good validity and reliability’, while Mario Strazzabosco posed the question: ‘how do we combine acute conditions and chronic conditions’? before stating that we need to start ‘humbly’. The panel then added ‘that we need to focus on the functionality of the graft in practise’ and ensure the quality of life of the person is forefront and centre.
Moving on to the 4-step consensus outlined by Marco, the panel suggested that there needs to be an additional step 5 to evaluate the usefulness of the final set of indicators. The panel then debated whether to include living donors as part of the study, with experts stressing the value of live donor involvement vs. whether we need to be start with a more streamlined approach to deliver more effective outcomes. The question of a phased timeframe vs. simplicity was then analysed, before the panel discussed the role of the donor family in the framework. We then heard a passionate message on cost-effectiveness from Umberto who stated that whilst we have lots of indicators, we need to ensure we have more effective endpoints to deliver improved patient outcomes.
Concluding the session, Umberto and Mario summarised the highly productive discussions and that we now need to put the outcomes from this session and the next steps into practice.
Stronger Together PRO Award
The Stronger Together PRO Award is presented to the group of abstracts submitted by a single organisation with the best average score (minimum of five abstracts submitted by the institution). ESOT would like to congratulate the Transplant Research Group in Paris, France for winning the Stronger Together PRO Award for 2021!
During a Live Studio session yesterday, ESOT President Vassilios Papalois explained, “The award not only rewards the quality of science, but also the quality of teamwork within a transplant group.”
Alexandre Loupy and Carmen Lefaucheur joined Vassilios Papalois in the Studio on behalf of the group. “We are really honoured and proud to receive this award”, explained Alexandre Loupy. “As a team, we are all looking into the same direction in trying to improve patient outcomes”.
This is the third time the Transplant Research Group has won this prestigious award, who will be awarded a €5,000 prize.
Impact of COVID-19 on Transplantation
One of the day’s most highly anticipated abstract-based talks highlighted an alarming reduction in global organ transplants due to the impact of COVID-19. During the first wave of the pandemic, the number of solid transplants fell by 31% compared to the previous year, with transplants dropping by 15% throughout 2020 overall.
According to modelling calculations, the slowdown in transplants resulted in more than 48,000 years of patient life loss. Kidney transplantation showed the largest reduction in nearly all of the 22 countries included in the study, which was also published in the Lancet Public Health. Overall, there was a strong temporal association between increased Covid-19 infection rate and reductions in deceased and living solid organ transplants.
One of the study authors, Professor Alexandre Loupy, explained, “It’s clear that there are many indirect deaths associated with Covid-19 and our study confirms that the pandemic has far-reaching consequences on many medical specialties.”
Fellow author Dr Olivier Aubert stated, “Certain countries and regions managed to carry-out procedures despite major challenges presented by the pandemic. These findings warrant further analysis on a regional, national and global level to understand why reductions did or did not occur. Understanding how different countries and healthcare systems responded to Covid-19-related challenges can facilitate improved pandemic preparedness and how to safely maintain transplant programmes to provide life-saving procedures for patients.”
This study was featured in several national newspapers, including the Guardian (UK), Forbes (US), Al Jazeera (Qatar) and La Razon (Spain).
Tune in tomorrow for the final day of highlights from 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.
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Daily recap - Sunday 29 August
View highlights from the first day of the Congress
Daily recap - Monday 30 August
View highlights from the second day of the Congress