ESOT 2013 Report – Pushing the limit in clinical science

by Peter Friend, Oxford, UK – The 16^th ESOT Congress in Vienna 2013 was one of ESOT’s most comprehensive arrangements to date, with more than 3,500 attendees and exhibitors from all over the world. Professor Peter Friend from Oxford, former president of the British Transplantation Society and one of the organisers behind the highly successful 15^th ESOT Congress in Glasgow in 2011, highlighted some of the most important presentations in Vienna from a clinician’s perspective.

A key theme during the Vienna congress was the need for more donor organs, and closely linked to this, strategies for managing the risk when extending the criteria for organ donation. A presentation by Chris Watson from Cambridge in the UK pointed out that although a high-risk organ may pose a risk to the recipient, it may still offer a better prospect of survival than remaining on the waiting list whilst holding out for a lower-risk organ. To push the boundaries and ensure all available organs are utilised in an equitable way, clinicians must use all the available evidence and not merely rely on received opinion, share the decision-making with colleagues and the recipient, and ensure that any incentives to unduly conservative organ policies are removed.

Controlling the immune response post transplantation remains a vitally important issue for clinicians. A study carried out by Professor Friend’s own group at Oxford showed that development of de novo donor-specific antibodies (DSA) following pancreas transplantation was significantly associated with poorer graft outcomes. In this study, which is the largest to date to have studied the link between DSA and outcomes in a pancreas transplant population, patients who developed de novo DSA showed one-year graft survival rates of 78.3% compared with 94.7% in patients who did not. Similarly, the three-year graft survival was 63.6% with de novo DSA compared with 92.5% without (p=0.001). The study won the award for the Best Abstract at the congress.

Amongst the many exciting emerging technologies, including limb transplantations where all patients regained sensory function, and truly life-changing face transplants with excellent cosmetic results, Professor Friend was also pleased to note signs of resurgence of an old procedure, namely liver transplantation for colorectal liver metastases. A team at the Oslo University Hospital followed 21 patients who underwent liver transplantation for colorectal liver-only metastases not eligible for resection in an open prospective study. The five-year survival rate in this group was 60%, compared with 4% in a group of matched controls treated with chemotherapy (p<0.001), suggesting that liver transplantation offers a superior treatment option in this patient population.

In addition, Professor Friend mentioned the growing clinical experience with belatacept in kidney transplantation, the use of stem cells and T-regulatory cell therapy to replace drugs, and advancements in the field of organ preservation and reperfusion as important themes that are likely to have a significant impact the future of transplantation medicine. Professor Friend concluded that from a clinical point of view, the 16^th ESOT congress at Vienna had more than lived up to its motto of ‘pushing the limits’ in transplantation.