As part of the on-going collaboration between TTS and our official Sections, and in order to provide TTS members with an update on areas of the field represented by TTS Sections, content for this issue of the Pulse has been submitted by the International Xenotransplantation Association.

Special CTRMS Feature

Pigs are Flying!

The excitement internationally surrounding xenotransplantation and the possibility of clinical trials has grown in response to prolonged graft survivals in preclinical models as well as the remarkable implantation of gene-edited pig kidneys and hearts into living human recipients. These successes provide a foundation for mechanistic studies and clinical trials to advance the entire field of transplantation.

The News!

Recent developments in xenotransplantation have included creation of pigs with various genetic modifications aimed at protecting transplanted organs from nonhuman primate and human immune responses, as well as several new immunosuppressive agents that block CD40/CD154 T cell co-stimulation pathways. Combining these approaches, survival of life-supporting kidneys in nonhuman primates has extended to more than a year and pig hearts have supported life for over 9 months in baboons. Preclinical studies in deceased human subjects have now included hearts, kidneys and livers maintained for increasing periods of time. The benefits and risks associated with pig organ xenografts will be uncertain without further clinical experience.

Great excitement accompanied the first two cases of clinical heart xenotransplantation at University of Maryland in Baltimore, USA. The world’s first transplant of a genetically-edited pig kidney in a living patient was performed at Massachusetts General Hospital (MGH) in Boston, USA. Following this, a critically ill xeno-kidney recipient at the NYU Langone Medical Center (NYU) in New York City, USA received both a ventricular assist device and gene-edited combined thymo-kidney xenograft. These grafts used organs from different gene-edited pigs with different immunosuppressive regimens. Subsequent news from China informed us that an auxiliary gene-edited porcine liver graft was successfully implanted in a gentleman with a resected hepatic tumor. The data emerging from these experiences are enhancing our understanding of the impact of genetic modifications and the immunosuppression required for the survival of porcine xenografts in humans. Advances in immunosuppression, infectious disease surveillance, and pig breeding have accelerated the field. These may also refine the requirements for prospective clinical trials in the field.

The Teams

These advances depend on expert teams at each center and, in general, important collaborations with industrial partners who have developed source animals, immunosuppressive agents, and diagnostic tools for the field. These advances would be impossible without the engagement of nurses and clinical staffs, psychiatry, ethicists, social workers and transplant financial services, laboratory workers, regulatory agencies, and veterinarians. Generous international collaborations between centers have facilitated development of clinical protocols.

The Recipients

None of these advances would have been possible without the courage of the recipients in these pioneering surgeries with their families and loved ones whose support has allowed these advances.

Community endorsement of these procedures has been remarkable – and encouraging communications have been received from each of the families of the recipients. These individuals will be an important part of the history of this field.


See Our International Xenotransplantation Association Sessions from TTS 2024

TTS 2024 Registrants - Click on links below for access


Just Released - Transplantation Direct - November Issue

The November issue of Transplantation Direct is now online. We have a number of articles on different aspects of kidney transplantation, including a systematic method to precisely assess pre-transplant biopsies, waitlisting, and graft loss after re-transplantation due to recurrent glomerulonephritis, procedures to reduce healthcare-associated infections after transplantation, understanding the “null-allelle," and the use of spatial transcriptomic profiling of kidney biopsies to better understand acute T cell-mediated rejection. In simultaneous pancreas-kidney transplant recipients, there are reports on beta cell function and autoantibody influences on outcomes, and the association of posttransplant weight changes on graft and metabolic outcomes. In liver transplantation, UNOS data was evaluated for the effects of donor-recipient size mismatches on short- and long-term outcomes in living donation cases. On the topic of organ donation, we have articles on reactions of family members of potential donors in the ICU to law changes of deemed consent, and the Swiss Organ Living Donor Health Registry has been comprehensively evaluated for pre- and post-transplant complications related to living donor kidney donation. This issue also contains an article where authors propose to use metagenomics shotgun sequencing to better understand the viral causes and predictive markers of PTLD development. All of these articles, and more, are freely available on the Transplantation Direct website in open access; please visit our website for complete details.

Table of Contents

Letter to the Editor

Kidney Transplantation

Liver Transplantation

Pancreas and Islet Transplantation

Organ Donation and Procurement

Laboratory Method



Open to all IPTA and TTS Members

TTS Members may sign up using the links below (Separate links for each day). IPTA Members were automatcially subscribed last week however if you did not receive an email you may still sign-up using the links below. Anyone who would like to attend may apply for IPTA or TTS prior to November 12 and once you application is submitted you may sign up with the links below.

Welcome to our first IPTA-VES - International Pediatric Transplant Association Virtual Education Symposium. This symposium is open to all members and trainees of the clinical and academic multi-disciplinary teams in pediatric transplantation. After many successful years of IPTA Fellow Meetings, we have arranged this teaching so it is available to all those skilled staff working with children and their families in the field of transplantation.

Stephen D. Marks

United Kingdom

Rupesh Raina

United States

Jenny Prüfe

Germany

Gillian Mayersohn

United States

Overview
  1. The International Pediatric Transplant Association (IPTA) Virtual Education Symposium is open to IPTA and TTS members.
  2. This interactive symposium is over two half days on Thursday and Friday 14 and 15 November 2024, commencing with two separate streams for medics and for allied health and nursing professionals.
  3. This is an educational symposium which aims to cover both basic and advanced subjects for all trainee and staff physicians and surgeons and as well as members of the allied health and nursing professionals, including psychosocial teams.

Learning Objectives
  1. Basic and advanced immunology and immunosuppression
  2. Post-transplantation rejection and infection
  3. Post-transplant lymphoproliferative disorder
  4. Latest clinical information on nutrition, adherence, quality of life and sexual health
  5. Psychosocial aspects of transplantation
  6. Ethical and practical aspects of transplantation in low resource settings
  7. When to accept deceased donor organs for transplantation
  8. Academic guidance on writing grants, abstracts and manuscripts

Accreditation
Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by Amedco LLC and International Pediatric Transplantation Association (IPTA). Amedco LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Amedco Joint Accreditation #4008163.
Professions in scope for this activity are listed below.

Physicians
Amedco LLC designates this live activity for a maximum of 8.00 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses
Amedco LLC designates this activity for a maximum of 8.00 ANCC contact hours.

American Board for Transplant Coordinators
The American Board for Transplant Certification (ABTC) has approved this educational offering for up to 8.00 Category 1 Continuing Education Points for Transplant Certification (CEPTCs).


Abstract Submission

ABSTRACT SUBMISSION DEADLINE: OCTOBER 31

Successful applicants will be notified by Nov 8th

Please submit abstracts here:
SUBMIT YOUR ABSTRACT

Guidance on abstract submission:
  1. Abstracts will not be accepted unless conform to these guidelines.
  2. Please submit abstracts, written in English with Arial font 10 in Word document with abstract title limited to 30 words (without abbreviations in title) and abstract length up to 500 words (including any pictures, charts or tables noting only one jpg picture, chart or table allowed) with up to five total authors.
  3. Please state the presenting author and if this author is trainee physician / trainee surgeon / medical student / allied health professional / nursing professional / student nurse / student allied health professionals.
  4. Please state category of abstract: kidney / liver / heart / lung / liver / stem cell / bone marrow / multi-organ / ethics / psychosocial.
  5. Please structure your abstract as Aims / Methods / Results / Conclusions.

Thursday, November 14, 2024 • 09:00–13:00 EST

Local time (Corresponding local time at your current location)
The duration of these sessions is scheduled for 4 hours.

Friday, November 15, 2024 • 09:00–13:00 EST

Local time (Corresponding local time at your current location)
The duration of this session is scheduled for 4 hours.

In case you missed it ... TTS2024 Recordings

Member Access to TTS 2024 Recordings

Access Virtual Recordings (Oct 21-23)
In-person Recordings

TTS 2024 Attendee Access

The recordings from the in-person and virtual parts of the Congress are available in the TTS 2024 WebApp.
TTS 2024 Congress Recording Sponsored by:

Transplantation Journal Highlights

Transplantation - Social Media Content

Targeting Macrophages in Organ Transplantation: A Step Toward Personalized Medicine
Organ transplantation remains the most optimal strategy for patients with end-stage organ failure. However, prevailing methods of immunosuppression are marred by adverse side effects, and allograft rejection remains common. It is imperative to identify and comprehensively characterize the cell types involved in allograft rejection, and develop therapies with greater specificity. There is increasing recognition that processes mediating allograft rejection are the result of interactions between innate and adaptive immune cells.
Inflammatory Gene Expression in Livers Undergoing Ex Situ Normothermic Perfusion Is Attenuated by Leukocyte Removal From the Perfusate
Ex situ normothermic perfusion (ESNP) is a method to evaluate and potentially recondition organs before transplantation. However, increased expression of inflammatory molecules, including by tissue-resident immune cells, may occur during the perfusion process, potentially negating the beneficial effects of perfusion.

Transplantation Direct - Social Media Content

Revisiting the Prognostic Influences of Donor-Recipient Size Mismatch in Deceased Donor Liver Transplantation
Liver transplantation (LT) outcomes are influenced by donor-recipient size mismatch. This study re-evaluated the impact on graft size discrepancies on survival outcomes.
The Cost-effectiveness of Valganciclovir Prophylaxis Versus Preemptive Therapy in CMV R+ Kidney Transplant Recipients Over the First Year Posttransplantation
In kidney transplant recipients with positive serology (R+) for the cytomegalovirus (CMV), 2 strategies are used to prevent infection, whose respective advantages over the other are still debated. This study aimed to evaluate the cost-effectiveness and cost utility of antiviral prophylaxis against CMV versus preemptive therapy, considering CMV infection–free survival over the first year posttransplantation as the main clinical outcome.

ISN-TTS Sister Transplant Program Presentation

Grand Rounds in Transplant Nephrology – an ISN-TTS Sister Transplant Centres Initiative: Post-transplant diabetes in paediatric kidney transplant recipients

Post transplant Diabetes (PTDM) is a well-recognized complication after Kidney transplantation. Recent updates include recognition of impaired glucose tolerance, optimization of immunosuppression, prevention of  PTDM and incorporation of new glucose lowering agents. Peri-transplant hyperglycemia is being increasingly identified and treated in paediatric population. We discuss a case series of children who developed post transplant hyperglycemia. Two of them were asymptomatic, two of them had high tacrolimus levels and two of them required insulin therapy. Optimization of immunosuppression and insulin therapy resulted in resolution of hyperglycaemia. 

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