European Society for Organ Transplantation 2007

The widely anticipated 13th Congress of the European Society for Organ Transplantation and the 15th Congress of the European Transplant Coordinators Organisation was held in the ancient and charming city of Prague, in the Czech Republic from 28 September to 3 October 2007. A beautiful city, complemented by stunning architectural works and traditional artwork, Prague provided an ideal environment to host this joint conference. A comprehensive scientific program covering many topics surrounding organ transplantation and main body organs including the kidney, liver and heart was well presented, accompanied by a range of postgraduate activities. Scientific meetings between organizations such as the European Liver and Intestine Transplant Association, European Society for Heart and Lung Transplantation and European Pancreas and Islet Transplantation Association were held.

Invited lecturers and guest speakers discussed a range of interesting issues such as the relevance of the mass media in donation and transplantation, international organizations of organ procurement, myocardial dysfunction in donors, complications experienced during the post transplant period and new and improved immunosuppressant medications and regimes. During the congress proceedings, one of the first ever monographic symposiums was held between the ETCO and ESOT congresses, on a topic of mutual interest – organ preservation. Abstracts selected for the congress were presented in Plenary, Parallel and Poster sessions. All works represented the most recent and topical issues in their areas of interest. Poster sessions added a visually stimulating and educational component to the event. From the hundreds of stimulating and fascinating topics of interest that were discussed during the congress, the following is a selection of some fascinating abstracts. These cover areas including organ transplantation and important complications experienced during the post transplant course.

Selection of Abstracts

Anaemia in Kidney Allograft Recipients with Deteriorating Graft FunctionAnaemia is an important complication seen in kidney allograft recipients, especially those with deteriorating allograft function. The exact sequence of events is hard to predict, and no consensus or recommendations to prevent anaemia in these patients exists. The situation can be further exacerbated by medications, where switching from treatments such as calcineurin inhibitors to mTOR inhibitor therapy (mTOR is a large polypeptide, serine/threonine-specific kinase acting to regulate functions such as cell growth, proliferation and survival) further decreases haemoglobin levels. A retrospective study was conducted by Kolodziej et al, involving 93 patients that were switched from calcineurin inhibitors to mTOR- inhibitor based therapy. This was performed primarily due to a steady increase in creatinine. These patients were compared to 443 stable kidney allograft recipients. In comparison to the stable kidney recipients, patients with a steady increase in creatinine had a lower haemoglobin at baseline, prior to the switching (11.83 g/dl versus 12.6 g/dl). The mean increase in creatinine prior to switching was 16% whilst the mean decrease in haemoglobin was 6.5%. After switching of therapies, the haemoglobin dropped significantly in patients receiving rapamycin (12.1g/dl versus 10.9 g/dl). High trough levels of mycophenolic acid correlated with a low haemoglobin. No correlation was seen between haemoglobin and levels of cyclosporin A, tacrolimus, rapamycin or certican. In conclusion, haemoglobin levels are already decreased in patients with deteriorating allograft function, prior to switching from calcineurin inhibitors to mTOR inhibitor therapy. Certain medications such as rapamycin can further intensify this decrease. In patients with low haemoglobin levels and rising creatinine levels, it is recommended that administration of erythropoietin and/ or iron supplementation should be considered, especially in patients undergoing a switch from calcineurin inhibitors to mTOR inhibitor therapy. Epoetin Alpha Administration Protects Against Ischaemic Renal Injury in the DogThere has been a mounting body of research that demonstrates the protective effects of Epoetin alpha (Epo) against ischaemic tissue injury. A study was conducted to confirm the presence of Erythropoietin receptors (Epo-R) on canine renal tissue, and to investigate whether Epo can alter the clinical outcome of ischaemic renal injury in vivo. Twenty dogs underwent a right nephrectomy and clamping of the left renal artery for one hour, followed by reperfusion for five days. Animals were randomized to receive 5000 units/kg of Epoetin alpha (Eprex) one hour prior to ischaemia (total = 9) or no treatment (total =11). Blood was drawn to determine blood urea nitrogen (BUN) and creatinine concentrations. These results were then plotted on a concentration versus time graph. The areas under these graphs were used as the primary outcome measure. Epo-R protein in renal tissue was assayed by Western blotting, and immunohistochemistry used to demonstrate the anatomical pattern of expression. From the study, canine renal tubular cells were found to express the Epo-R prior to, and following ischaemic renal injury. The area under the BUN curve was significantly lower in the Epo group compared to untreated controls. The area under the creatinine curve was also decreased, but not statistically significant. We are aware that kidneys are the main source of erythropoietin production in the adult.The Epo receptor is expressed on renal tubular cells, and administration of Epo can protect against ischaemic renal injury. Thus treatments such as Eprex may not only play a very important role in protecting against renal injury, but also be of important benefit in solid organ transplantation. An area of immense achievement in organ transplantation is the development of more advanced and tolerable immunosuppressant medications and regimes.CORRETA Trial (Corticosteroid Reduction with Tacrolimus) Immunosuppression Regimen in Kidney Transplant Recipients In renal transplantation, corticosteroids are one of the cornerstone immunosuppressive therapies available for patients. However, there are unwanted side effect and increases in morbidity. Newer immunosuppressants such as tacrolimus and mycophenolate mofetil (MMF) may also be effective in renal transplant patients, allowing corticosteroid sparing. The Correta Trial was a prospective, multi-centre randomized trial conducted by Valter et al, involving 60 out of 100 planned primary kidney transplant recipients. The median age of patients was 39.1 years. The primary aim of the study was to compare early corticosteroid reduction in renal transplant patients who were randomized to immunosuppression with Tacrolimus and MMF. All patients receiving Tacrolimus / MMF were randomized into two groups: Group one was subjected to early 7th post-transplant day steroid reduction (total = 31) and Group 2 remained on long term steroid maintenance (total = 29). Endpoints that were evaluated included: combined analysis of death, graft loss and severe acute rejection at 6 and 12 months. Side effects and the incidence of severe adverse effects were also monitored. One death occurred in each group, and only one case of severe rejection occurred in group one. There was no statistically significant difference demonstrated between the two groups. Rejection episodes were 41.0% in group 1 and 20.7% in group 2. Clinical outcomes such as blood pressure, creatinine levels and HbA1c results were not significantly different between the two groups at 12 months. Overall, there was no significant deterioration or increased risk of poorer outcome associated with early steroid reduction in kidney transplant recipients. The use of Tacrolimus and MMF allows us to reduce the doses of steroid therapy in these patients, without compromising their function. Further research into the usage of these immunosuppressant regimes with steroid therapy is still being conducted, to further investigate these promising results. References

1. Kolodziej S, Stracke S, Keller F, Mayer JM. Anemia in kidney allograft recipients with deteriorating graft function, 13th Congress of the European Society for Organ Transplantation and 15th Congress of the European Transplant Coordinators Organisation, Prague, Czech Republic, 28 Sept – 3 Oct 2007.
2. Forman CJ, Johnson DW, Nicol DL. Epoetin alpha administration protects against ischaemic renal injury in the dog, 13th Congress of the European Society for Organ Transplantation and 15th Congress of the European Transplant Coordinators Organisation, Prague, Czech Republic, 28 Sept – 3 Oct 2007.
3. Garcia VD, Carvalho DBM, Goncalves RT, Cavalcanti RL, Campos HH, Abud-Filho M, Lobao-Neto AA. CORRETA trial (corticosteroid reduction with tacrolimus): prospective brazilian multicenter, randomized trial of early corticosteroid reduction vs regular corticosteroid dosage maintenance on a tacrolimus (prograf) and mycophenolate mofetil (cellcept) immunosuppression regimen in kidney transplant recipients – interim analysis, 13th Congress of the European Society for Organ Transplantation and 15th Congress of the European Transplant Coordinators Organisation, Prague, Czech Republic, 28 Sept – 3 Oct 2007.