WS01 - Surrogate endpoints in transplantation: “how to define successful kidney transplantation”This consensus workshop will focus on endpoints solely on “how to define successful kidney transplantation”. This focuses on the innovative organ sources, like xenotransplants, 3D printed organs, lab grown organs, currently not used resuscitated organs using innovative perfusion techniques etc.
WS02 - CMV infection and disease – the impact on transplanted patientsCMV infection and disease in solid organ transplant recipients, Risk factors for CMV infection/disease, Diagnosis and immunological monitoring, Strategies for prevention of CMV infection and/or disease (prophylaxis versus preemptive treatment), Management of infections due to ganciclovir resistant CMV strains. The main objective is to describe the state of the art of the prevention and treatment of CMV infection in solid organ transplant recipients.
WS03 – Cancer and immunosuppression in solid organ transplant recipients
Transplant recipients are at increased risk of cancer, particularly virus-induced cancer such as post-transplant lymphoproliferative disorders and Kaposi sarcoma, and those that are caused both by impaired immunosurveillance and by direct DNA damage by anti-rejection drugs themselves, such as skin and lip cancers.
The treatment of those cancers may greatly benefit from immunosuppression reduction and and/or switch from calcineurin-based to mTOR-inhibitors based immunosuppression. However, a change in immunosuppression may increase the risk of rejection and the risk of severe adverse events. Therefore, it is unclear in which patients, in which stages of cancer disease, and to what extent immunosuppressive regimes should be changed.
On the other hand, there are cancers that do not have any clear link with anti-rejection treatment (such as lung, colon-rectum), because they have the same incidence as in the general population. In transplant recipients suffering from those cancers, it is even more difficult to decide upon what changes in immunosuppression should be carried out.
The scenario recently became even more challenging after the introduction of cancer immunotherapy, such as that based on checkpoint inhibition, which represents the most important innovation in oncology. Cancer immunotherapy engages the patient’s own immune system against the tumor rather than targeting the cancer directly.
Recipients of non-life saving organs such as kidney, and who suffer from advanced cancer may be considered eligible for treatment with these drugs. The question is how should maintenance anti-rejection treatment be reduced in order to let checkpoint inhibitors fully unleash T cells against cancer, but the same time minimize the risk of graft loss due to rejection, as activated T cells may destroy graft cells along with tumor cells.
The aim of this workgroup is to establish a consensus on key questions concerning cancer in solid organ transplant recipients namely, what are the changes of immunosuppressive therapy that can currently be recommended in transplant recipients with skin and non-skin cancers.Target audience
Transplant physicians, oncologists, hematologists.
Responsible Leader: Umberto Maggiore
Forum Moderators: Ilaria Gandolfini and Alessandra Palmisano
WS04 - Normothermic regional perfusion (NRP) in donation after circulatory death (DCD)
- Safety of NRP as a procedure (i.e. risk of organ loss)
- Organ utilization rates after NRP compared to DOP
- Post-transplant outcomes (both early and late) after NRP compared to DOP
- Organ viability criteria during NRP described in literature
Forum Moderator: Maria Irene Bellini
WS05 -It’s not only extended donor criteria, it’s extending the donor pool
Considering the characteristics of the donor, including age, previous diseases and Cardiovascular Risk factors (CRF), the Ideal deceased donor refers to a Donor after Brain Death (DBD) less than 40 years of age who died of cranial trauma and without CRF. A lack of ideal donors means that transplant teams are now grafting organs that would previously have been considered unacceptable.
The Standard and the Expanded Criteria donor are, in contrast, relative concepts that may evolve with time. A standard organ connotes an organ of average quality relative to the spectrum currently utilised for transplantation; while an expanded graft connotes an organ of lower than average quality, coming from a donor with characteristics known to be associated with suboptimal transplant outcomes. Expanded-criteria donors (ECDs) originally refer to kidneys from donors older than 60y or patients older than 60 with a significant medical history who have two of the following three features: (cerebrovascular accident as the cause of death, pre-existing hypertension, or terminal serum creatinine greater than 1.5 mg/dl.). The coincidence of multiple risk factors like older donors (>60 years old), obesity with steatosis, CRF and severe atherosclerosis, further exacerbates the extent of Ischemia–Reperfusion injury (IRI) in the graft, especially in some organs with extreme sensitivity to ischemia and reduces the chances of a successful outcome.
We have to move one step further and balance which is the acceptable limit the risk of transmission of infectious disease or for cancer. It’s a need, and the same time controversial, to go more in depth evaluating and assessing patients with past -history of cancer (defining types, time free of illnesses ...) or patients with past or actual HVC and HVB or HIV as possible donors. Maybe we need a different term for this kind of donors and recipients: Extended Criteria Donors. They fall into 2 categories of risk: (1) graft dysfunction and (2) cancer and infectious disease transmission.
Because we have been involved in a COVID-19 pandemic, it’s mandatory to learn how to manage this new situation in the field of donor assessment and define clear rules regarding recovered patients or sicker ones. It’s important in this specific subject to distinguish between paediatric and adults donors because guidelines seems to be different.
On the other hand, we can improve the “quality “of organs before the retrieval in the ICU, optimising the management preventing the IRI. Regarding BDD implementing a common and pre-emptive management of possible and potential donors based on targeted objectives (haemodynamic, respiratory…) looking for the normality during all the process before and after brain death determination. Regarding cDCD process using the available techniques to optimise the assessment of the organs or even to improve them in the theatre before retrieval. This will led us to increase the efficiency of the donation process.
The other side of the coin is the recipient. We need to define a specific allocation model, to tailor the best match between this grafts and recipients, taking into account direct effect on important clinical outcome: acute rejection, delayed graft function, and patient and allograft survival or some penalties due to recipient characteristics associated with no survival benefit following a non-standard –criteria donor transplantation, specific combination of donor and recipient factors that are likely to yield detrimental results.
Target audience: Trainees, students, researchers, clinicians and other health care professionals working in the field of solid organ transplantation worldwide.
Responsible Leaders: Nuria Masnou and Giuseppe Feltrin
Moderator: Omar Taco
WS06 - HLA desensitizationDespite a marked increase in the number of living-donor allografts (LDAs) transplanted annually, many potential recipients with otherwise suitable donors are relegated to the ever-expanding deceased-donor waiting list because of preformed human leukocyte antigen (HLA) antibodies. These are acquired via pregnancy, transfusion, and/or prior transplant. The presence of these anti- HLA antibodies in the potential recipient's blood is called HLA sensitization. If not adequately suppressed, the presence of such antibodies is likely to result in antibody- mediated rejection (ABMR) and early graft loss. ABMR was recognized early in the history of transplantation as hyperacute rejection caused by the presence of preformed antibodies, most typically in the form of antibodies to donor HLAs. Introduction of pretransplant crossmatch techniques has essentially eliminated hyperacute rejection.
Forum Moderator: Edoardo Melilli
The ESOT Executive has decided to form a TLJ 2.0 working group to explore the way the COVID 19 pandemic has affected organ donation and transplantation (including the organ regeneration modalities) and the way it will shape the landscape of our vocation and practice in the years ahead of us.
The group will utilise current initiatives and resources to which ESOT has been a leader or a partner (registries, ESOT COVID 19 platform, webinars, collaboration with the scientific community etc.) as well as all available resources.
The aim is to offer a critical analysis of the available data and what has happened so far, and offer a vision and recommendations for the future in an ongoing / dynamic way. The group will work in parallel with the other working groups for the ESOT TLJ 2.0 and we aim to refine, finalise and present its work at the TLJ 2.0 event in Prague.
We have invited Colleagues with different areas of interests and expertise and we also have patient representation.
Responsible Leader: Vassilios Papalois
Forum Moderator: Maria Irene Bellini