STATE OF THE ART

STATE OF THE ART 1 – Microbiome in transplantation: Friend Or Foe?

Created by: Menna Clatworthy, Cambridge, United Kingdom; Gavin Pettigrew, Cambridge, United Kingdom

Outline  |This is a high profile topic in biomedical research, as evidenced by the fact that many of the papers are published in the journals with the highest impact factors, Nature, Science, Cell etc.

Key Learnings

  • Diet, the microbiome and metabolism
  • The microbiome and response to cancer immunotherapy
  • Immunosuppression and the microbiome – do transplant medicines change our microbiome and does it matter?.
  • The microbiome and rejection risk in transplantation. Is there a link?

 

STATE OF THE ART 2 – Organ allocation algorythm

Created by: Franz Immer, Zurich, Switzerland; David Rodriguez-Arias, Granada, Spain

Outline  | Organ allocation is one of the key elements in-between organ donation and transplantation. As such, it takes place in a challenging framework. While it is guided by and must follow specific allocation principles, it o en takes place in circumstances where time and/or information is limited, and it usually involves an interdisciplinary group of health care professionals. Additional factors that may influence the allocation process can include logistics, availability of resources, and organisational structures.

Key Learnings

  • Very complicated math – reconfiguring organ allocation.
  • Ethical Dilemmas in Liver Transplant Organ Allocation: Is it Time for a New Mathematical Model.
  • Clinical impact of liver allocation algorythm on outcome.

 

STATE OF THE ART 3 – How to choose the right research model

Created by: Henri Leuvenink, Groningen, The Netherlands; Gavin Pettigrew, Cambridge, United Kingdom

Outline  | Animal models have limitations, and as advances in our understanding of human transplant immunology continue, these limitations become all the more apparent. Addressing the pertinent clinical research questions, such as the nature of the B cell response that underpins chronic rejection, is likely to need ever more specialized transplant models.

Key Learnings

  • Porcine models and what’s been achieved in the field of ex vivo normothermic perfusion
  • Non-human primates: advantages and disadvantages

 

STATE OF THE ART 4 – Stem cells and gene editing – PLURIPOTENT STEM CELLS MEET GENOME EDITING: A DISRUPTIVE WEDDING

Created by: Lorenzo Piemonti, Milan, Italy

Outline  | No field in health sciences has more interest than organ transplantation in fostering progress in regenerative medicine because the future of no other field more than the future of organ transplantation will be forged by progress occurring in regenerative medicine. It is extremely rare for a single experiment to be so impactful and timely that it shapes and forecasts the experiments of the next decade. Here, we will address how two such experiments—the generation of human induced pluripotent stem cells (iPSCs) and the development of CRISPR/Cas9 technology—have fundamentally reshaped our approach to biomedical research, stem cell biology, human genetics and potentially transplant medicine.

Key Learnings

  • Gene Editing
  • Gene Therapy
  • Cell Transplantation Across Species

 

STATE OF THE ART 5 – DCD: Push the boundaries


Created by: Franz Immer, Zurich, Switzerland; David Rodriguez-Arias, Granada, Spain

Outline  | How we reach our limits? Is there scope for expansion? How extended can be Extended Criteria? Is it for everybody?

Key Learnings

  • European Survey on DCD-practices in the member states of the CD-P-TO
  • Ethical issues in DCD-donation
  • Impact of procurement modalities and machine perfusion techniques on prediction of graft function and outcome

 

STATE OF THE ART 6 – Small Patients, Big challenges

Created by: Nicos Kessaris, London, United Kingdom

Outline  | Paediatric transplantation can be very challenging and is not performed in many countries. Promote discussions in collaboration with our international partners to shape a new Era.

Key Learnings

  • Paediatric transplant recipients in the 21st century
  • Immunosuppression challenges in paediatric transplantation
  • Kidney transplantation in children with vascular complications
  • Liver transplantation in complex paediatric recipients
  • Cardiothoracic transplantation in complex paediatric recipients

 

STATE OF THE ART 7 – Pharmaco Genomics – ARE WE READY FOR IMPlEMENTATION INTO CLINICALPRACTICE?


Created by: Luuk Hilbrands, Nijmegen, The Netherlands

Outline  | Adequate dosing of immunosuppressive drugs is key to the success of organ trans- plantation. During recent years new insight have been acquired concerning the effects of pharmocogenetic variations on the disposition of commonly used drugs. However, it remains a challenge to demonstrate the clinical relevance of pharmacogenetic testing for transplant patients. A unique situation in organ transplantation is the co-existence of the genotype of the donor and that of the recipient, both potentially affecting the pharmacokinetics and pharmacodynamics of a drug. Moreover, transplant patients frequently use multiple drugs besides their immunosuppressives. The pre-emptive genotyping of a panel of established clinically relevant pharmacogenomic markers holds promise for a next step in precision medicine.

Key Learnings

  • Is knowledge of the CYP3A4 and CYP3A5 genotype really useful in tacrolimus treated patients?
  • Which genotype is relevant: recipient or donor?
  • Pharmacogenomics of triazole antifungal agents – translation into clinical practice
  • Pre-emptive pharmacogenetic testing to reduce adverse drug reactions – a next step?

 

STATE OF THE ART 8 – New imaging techniques

Created by: Soren Sorensen Schwartz, Copenhagen, Denmark

Outline  | Traditional PET, CT, MR and ultrasound imaging have been used in relation to organ transplantation for years. However, new exciting development both in relation to tracers, in relation to analysis of data and development within the technique has occurred during recent years. Potentially it can be possible to image the immune response and the metabolic processes in transplanted organs in real time but also to dig our hidden information from traditional images. Also 3D ultrasound imaging combined with contrast may revail new information on transplanted organs. Although largely untested in relation to transplantation, these new techniques could prove of great value in relation to organ transplantation in clinic as well as in research.

Key Learnings

  • Immune imaging in transplantation – a game changer?
  • Radiomics – there is more in a picture than meets the eye
  • Hyperpolarized magnetic resonance imaging – potentials and pitfalls.
  • 3D ultrasound– ready for daily clinical use in organ transplantation?

 

STATE OF THE ART 9– Transplant success: the Patient’s definition

Created by: Luuk Hilbrands, Nijmegen, The Netherlands; Finn Gustafsson, Copenhagen, Denmark

Outline | Traditional outcome measures in organ transplantation include patient survival, graft survival, and graft function. Growing attention for the patient’s perspective of health and disease has led to the development of patient-reported measures which can be classified into two different categories: patient-reported outcomes (PROs), usually referring to health-related quality of life, and patient-reported experiences (PREs), referring to perception of the care that was received. Tools to measure PROs and PREs are labeled PROMs and PREMs. While there is a rapid expansion of the reporting of patient-reported outcomes in various medical areas, the use in or- gan trans- plantation is strikingly limited. This session focuses on the current status of PREMs and PROMs in organ transplantation: a premise or still a promise? In addition to measuring patient- reported outcomes after transplantation, it is relevant to know what patients actually expect from a trans- plantation. Importantly, for successful design and implementation of patient-reported out- comes in patient management and clinical research the participation of patients is an absolute prerequisite.

Key Learnings

  • How to measure health-related quality of life in organ transplant recipients.
  • Development and use of PROMS in patients with chronic kidney disease and kidney transplantation
  • What do patients expect from a transplant?
  • How to define a successful transplantation: the patient’s perspective
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