Advancing Transplantation

Le résumé fourni par la source

INTRODUCTION This supplement reports on the proceedings of a meeting titled “Advancing Transplantation: New Questions, New Possibilities,” held at Karolinska Institutet in Stockholm, Sweden, on January 24 to 26, 2015, and sponsored by Astellas Pharma Europe Ltd. The meeting highlighted the challenges facing the transplant community and the need to respond to those challenges with new approaches, questions and possibilities. Over 450 kidney and liver transplant professionals from across Europe attended the meeting, which included talks from keynote speakers, scientific presentations, panel discussions, interactive sessions, and a poster session designed to allow delegates to exhibit their own clinic's data. Solid organ transplantation has evolved into one of the great accomplishments in clinical medicine and remains the only lifesaving treatment for many types of end-stage organ failure. Breakthroughs in transplant procedures and the development of effective immunosuppressive therapies have helped health care professionals achieve significant improvements in graft and patient survival posttransplant. This is evident across all indications, including kidney and liver transplantation.1,2 Continuing the advances in improving long-term survival remains a key challenge for transplant medicine today.2,3 Maintaining a transplanted graft over time is complex. Multiple risk factors influence graft survival before, immediately after and late after transplantation. The use of marginal donors, to reduce the disparity between demand and availability of organs, has added to this complexity and brought new challenges to the field of transplantation. Recent research in the kidney and liver transplant arenas has identified a number of risk factors that contribute to poor graft survival (Figure 1). These risk factors can lead to irreversible pathological damage to the transplanted organ, with a negative impact on patient outcomes. By managing these risk factors, we aim to improve the long-term survival of transplanted grafts for our patients.FIGURE 1: Risk factors associated with poor graft survival in kidney and liver transplantation. *Fortunately, most liver transplant patients with preformed DSA have uneventful resolution posttransplant; even liver patients with class II DSA with mean fluorescence intensity >10 000 [LABScreen single-antigen beads (One Lambda)] experience resolution two-thirds of the time.4 CNI, calcineurin inhibitor; DGF, delayed graft function; DSA, donor-specific antibody.Health care professionals need to continually reassess how to improve care for their patients while managing limited resources and embracing the new age of digital technology and big data. Only by understanding the risk factors that are modifiable and translating this into changes in the clinic will the perspectives for patients be further improved. “Best practice” care for transplant patients needs to be constantly updated, taking new clinical developments into consideration. Here, we present our findings with regard to the ongoing risk factors for poor long-term outcomes in kidney and liver transplantation and our suggestions for best-practice management for each of these risk factors. We also include speculations as to future innovations that have the potential to change patient management for the transplantation and wider health care communities. Improving long-term graft and patient survival remain the key challenges for transplant medicine today; maintaining a graft over time is complex with multiple risk factors that influence graft survival from organ procurement to posttransplant follow up To improve graft and patient survival, both traditional and emerging risk factors need to be identified and modified, including nonadherence to treatment, high variability of calcineurin inhibitor (CNI) exposure and underimmunosuppression or overimmunosuppression Only by identifying these risk factors early and monitoring for them routinely in clinical practice, will the patients at risk of poor long-term outcomes be determined A number of risk factors for poor graft and patient survival can be modified by the choice of immunosuppressive regimen used PART 1: ONGOING CHALLENGES WITHIN KIDNEY AND LIVER TRANSPLANTATION Beyond Randomized Controlled Trials: Looking at Data Differently Dr Philip F Halloran A key unmet need currently facing organ transplantation is the requirement to improve transplant management in an era where there are few new pharmaceutical company-sponsored phase II and III clinical trials. To achieve this, it will be necessary to optimize the use of new data to and in at the patient This new understanding lead to future and clinical by the that is for Randomized have many improvements in transplantation and to the we to as a data the has significant the of that the These are at the time of with most in the few are used to for long-term To this into most of the from has on in the of organ transplant patients are their posttransplant. The used can also the of the including the use of limited and or of are to include the of nonadherence and in for the have over in that their data are and a of the can also be by and data and that lead to from poor as these remain of data and be are most for as age and as patient and graft and have in the of phase III trials. it is to between the that be by the and of the of can be in the of age and graft of the factors of the is the age of the as the age of the and the risk there is a in liver The key is to the of this and the and of the with age are by the in organ of to to are to with that are to in This the influence of age and a that is by kidney the between age and age is that it is to a to be to the of organ The to this is to to risk factors into and and for in which an be of to in and have in the to transplantation of and that many data have for in a can these and and can and for and has to a of and the patients the key of the with and including and data. The in the be the can be used to the from the a class to each by a as to The be in an have the can be used as to the an this that to that by the requirement for we the that the changes of of the phase III clinical and data need to be as we the of the of in This is in a which that in impact survival with the of an with the of in that The is that the to be have for in the that are and and have on to the that challenge the of the of and in and This the of that and change as in be constantly for and of from and health has used in of medicine and have in the are and are The from be in and the of the and the be at the of the there are many phase III and of the new will from in the and with the to and the in the with a to the from and a of the or phase III the be with and and for that The be to and outcomes in the and to use that to change in will for are the The Dr we an era in transplantation where there are ongoing we also on of data and to clinical questions in an to further improve the long-term outcomes of our only with a of data that to over also long-term follow up that of The by the of and to a the experience of liver transplant Data are a which is by a scientific and for the liver and used and and graft and patient outcomes and the immunosuppressive The data held in the are to and with of an of that of the data held in the and the of between the data held by the the These findings a high of for the data held in the To our this is the only transplant with Data from the have in liver including the use of from marginal and the development of a to risk of a in an an of data from the long-term graft and patient survival data for all patients transplanted between January and The patient by the the posttransplant further patients in the even the to an in Data for the patients with of To only data from the both Data for patients patients and patients this the of patients a of graft survival with the over of treatment The of between the treatment to a in long-term graft in a risk of gra

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.