Dr. Jeremy R. Chapman, Editor-in-Chief, Transplantation

The Potential Role of Efficacy and Safety Evaluation of N-Acetylcysteine Administration During Liver Procurement. The NAC-400 Single Center Randomised Controlled Trial.

Gómez-Gavara C, Herraiz AM, Hervás D, et al.
Transplantation: October 8, 2020 - Volume Online First

N-acetylcystine (NAC) has had many advocates over the years for many different purposes in protecting the kidney and the liver. This report provides the largest randomised controlled trial of protection of the liver during procurement from early allograft dysfunction as a primary endpoint, as well as markers of oxidative stress as secondary outcomes. NAC was tested in 113 and standard protocol in 101 patients. The definitive answers from this trial provide no support for its use to improve primary allograft dysfunction, but with cold ischemia greater than 6 hours there were impacts on Alanine Aminotransferase levels.

CLICK HERE TO VIEW

CLICK HERE TO VIEW (OPEN ACCESS)

CLICK HERE TO SIGNUP

CLICK HERE TO SIGNUP

Efficacy of Tocilizumab in Patients Hospitalized with Covid-19

John H. Stone et al.
NEJM October 21, 2020
DOI: 10.1056/NEJMoa2028836

This is a randomized, double-blind, placebo-controlled trial involving patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, hyperinflammatory states, and at least two of the following signs: fever (body temperature >38°C), pulmonary infiltrates, or the need for supplemental oxygen in order to maintain an oxygen saturation greater than 92%. Patients were randomly assigned in a 2:1 ratio to receive standard care plus a single dose of either tocilizumab (8 mg per kilogram of body weight) or placebo. 243 patients were enrolled; 141 (58%) were men, and 102 (42%) were women. The median age was 59.8 years (range, 21.7 to 85.4), and 45% of the patients were Hispanic or Latino. The hazard ratio for intubation or death in the tocilizumab group as compared with the placebo group was 0.83 (95% confidence interval [CI], 0.38 to 1.81; P=0.64), and the hazard ratio for disease worsening was 1.11 (95% CI, 0.59 to 2.10; P=0.73). At 14 days, 18.0% of the patients in the tocilizumab group and 14.9% of the patients in the placebo group had had worsening of disease. The median time to discontinuation of supplemental oxygen was 5.0 days (95% CI, 3.8 to 7.6) in the tocilizumab group and 4.9 days (95% CI, 3.8 to 7.8) in the placebo group (P=0.69). At 14 days, 24.6% of the patients in the tocilizumab group and 21.2% of the patients in the placebo group were still receiving supplemental oxygen. In conclusion, Tocilizumab was not effective for preventing intubation or death in moderately ill hospitalized patients with Covid-19.

Effect of Tocilizumab vs Standard Care on Clinical Worsening in Patients Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial

Carlo Salvarani et al.
JAMA Intern Med. Published online October 20, 2020.
doi: 10.1001/jamainternmed.2020.6615

This is a prospective, open-label, randomized clinical trial that randomized patients hospitalized between March 31 and June 11, 2020, with COVID-19 pneumonia to receive tocilizumab or standard of care in 24 hospitals in Italy. A total of 126 patients were randomized (60 to the tocilizumab group; 66 to the control group). The median (interquartile range) age was 60.0 (53.0-72.0) years, and the majority of patients were male (77 of 126, 61.1%). Seventeen patients of 60 (28.3%) in the tocilizumab arm and 17 of 63 (27.0%) in the standard care group showed clinical worsening within 14 days since randomization (rate ratio, 1.05; 95% CI, 0.59-1.86). Two patients in the experimental group and 1 in the control group died before 30 days from randomization, and 6 and 5 patients were intubated in the 2 groups, respectively. The trial was prematurely interrupted after an interim analysis for futility.

Estimating the infection-fatality risk of SARS-CoV-2 in New York City during the spring 2020 pandemic wave: a model-based analysiss

Wan Yang et al.
Lancet Infect Dis 2020 Published Online October 19, 2020
DOI: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30769-6/fulltext

This article studied 56 waitlisted patients and 80 kidney transplant recipients diagnosed with COVID‐19 between March 13‐ May 20, 2020. Despite similar demographics and burden of comorbidities between waitlisted and transplant patients, waitlisted patients were more likely to require hospitalization (82% vs. 65%, p=0.03) and were at a higher risk of mortality (34% vs. 16%, p=0.02). Intubation was required in one‐third of hospitalized patients in each group, nd portended a very poor prognosis. The vast majority of patients who died were male (84% waitlist, 100% transplant). Multivariate analysis demonstrated waitlist status, age, and male sex were independently associated with mortality. COVID‐19 has had a dramatic impact on waitlisted patients, decreasing their opportunities for transplantation and posing significant mortality risk.

Oct. 20 - Previous studies have examined the effects of cold and warm ischemia times on graft function following kidney transplantation. Results of those studies have suggested that extended cold ischemia time (CIT) or extended warm ischemia time (WIT) were independently adversely associated with graft survival. However, according to colleagues at the Royal London Hospital, London, United Kingdom, there are few data available on analyses of both cold and warm ischemia times.

READ THE FULL ARTICLE

Oct. 20 - Pediatric patients with end-stage kidney disease treated with kidney transplantation have improved quality of life and prolonged life expectancy. Aydincan Akdur, MD, and colleagues at Baskent University, Ankara, Turkey, conducted a study to examine surgical complications following pediatric kidney transplantation.

READ THE FULL ARTICLE

Oct. 14 - Both pancreas transplantation alone (PTA) and islet cell transplantation (ICT) have been associated with peri-operative declines in estimated glomerular filtration rate (eGFR), a decline that is less than that associated with medically managed diabetes. According to Rashikh Choudhury, MD, and colleagues in the department of surgery-division of transplantation surgery at the University of Colorado Hospital, Aurora, PTA and ICT have demonstrated long-term stabilization of chronic kidney disease (CKD) in patients with type 2 diabetes.

READ THE FULL ARTICLE

Oct. 22 - A team of University of Alabama at Birmingham researchers has shown a simple way to protect transplanted islets, by coating them with a thin skin of alternating layers of two biopolymers. As reported in the journal Diabetes, this coating delays allograft and autoimmune-mediated rejection in mouse models of T1D.

READ THE FULL ARTICLE

The International Pancreas & Islet Transplant Association (IPITA) Conference Organizing Committee is committed to bringing the community together virtually.

CLICK HERE TO VISIT THE WEBSITE

CLICK HERE TO VISIT THE WEBSITE

TTS members are invited to attend the FOCIS 2020 Virtual Annual Meeting – THE meeting in translational immunology!

The Federation of Clinical Immunology Societies exists to improve human health through immunology.

The FOCIS 2020 Virtual Annual Meeting on October 28-31, 2020, brings together an interdisciplinary group of world-renowned physicians and researchers to share the latest findings on diseases impacting the immune system.

CLICK HERE FOR DETAILS

CLICK HERE TO VISIT THE WEBSITE