Transplantation In Europe Research Articles

Past, current, and future trends in the prevalence of primary sclerosing cholangitis and inflammatory bowel disease across England (2015–2027): a nationwide, population-based study

Primary sclerosing cholangitis (PSC) is one of the leading indications for liver transplantation in Europe, and a major risk factor for cancer in inflammatory bowel disease (IBD). However, it is not known how the epidemiology of PSC will change as that of IBD evolves. The aim of this study is to provide nationwide statistics on the past and current prevalence of PSC and IBD across England, and forecast how this is likely to change over time. We accessed and analysed a nationwide population-based administrative healthcare registry, which houses prospectively accrued data since April 1st 2001. In so doing, the past and current prevalence of PSC-IBD and IBD alone was determined among 18-60-year-olds in England, alongside average annual percentage change rates (AAPC), between the 1st of January 2015 and 2020. Past and current prevalence data, alongside trends in incidence and event-free survival rates, were then used to forecast future prevalence between 2021 and2027. In 2015, the prevalence of PSC with prior IBD diagnosis was 5.0 per 100,000 population, rising to 5.7 when including those with IBD diagnosed after PSC. In 2020, prevalence increased to 7.6 (8.6 accounting for IBD developing after PSC), yielding an AAPC of 8.8. In 2027, PSC-IBD prevalence is forecast to be 11.7 (95% prediction interval [PI]: 10.8-12.7), and 13.3 when accounting for IBD developing after PSC (AAPC: 6.4; 95% PI: 5.3-7.5). Comparatively, the prevalence of IBD alone rose among 18-60-year-olds from 384.3 in 2015 to 538.7 in 2020 (AAPC 7.0), and forecast to increase to 742.5 by 2027 (95% PI: 736.4-748.0; AAPC: 4.7, 95% PI: 4.6-4.8). The rate of growth in PSC-IBD is predicted to exceed IBD-alone. Further research is needed to understand changes in disease epidemiology, including aetiological drivers of developing (invariably progressive) liver disease in IBD, and the implications of rising case burden on health care resources. This study was supported by an unrestricted grant provided by Gilead Sciences.

Transition from pediatric to adult care in patients with chronic intestinal failure on home parenteral nutrition: How to do it right?

BackgroundLife expectancy of children with chronic intestinal failure (CIF) on home parenteral nutrition has greatly improved. Children are now able to grow into adulthood which requires transfer from pediatric to adult health care. A guideline for structured transition is lacking and the demand for a more standardized care for this patient group is necessary. Therefore, we investigated the perceptions of health care professionals from various disciplines working in this specific field, concerning effective interventions regarding transition to adult health care. AimTo create a standardized protocol which provides practical guidance for health care professionals in order to bridge the gap between pediatric and adult health care and to facilitate successful transition of children with chronic intestinal failure. MethodsA survey consisting of 20 interventions for transition was sent out to members of the Intestinal Failure working group of European Reference Network for Rare Inherited Congenital (gastrointestinal and digestive) Anomalies (ERNICA) and the Network of Intestinal Failure and Intestinal Transplant in Europe (NITE) group - European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) healthcare professionals in 48 medical centers in various countries. Next to 20 interventions, an open-ended question to fill in any other suggestion with respect to most effective intervention was included. Interventions scoring higher than 80% by the participants were included in the protocol. Interventions scoring between 50% and 80% and other own suggestions were discussed during a consensus meeting and included when consensus, defined as unanimous agreement, was reached. Interventions scoring as effective by < 50% of participants were excluded directly. ResultsA total of 80 healthcare professionals from 33 medical centers (participation rate 69%) participated. The protocol consisted of modifiable components expected to be targets of interventions. The most important key outcomes of the survey were: 1) assessment of patient’s transition readiness and provision of knowledge to the patient by the pediatric team, 2) involvement of parents in the transition process, and 3) collaboration between the pediatric and adult chronic intestinal failure team. In addition it is advised that the transition process should start 1 to 2 years before transfer. A nurse specialist working in both services should form a bridge. All interventions must be tailor-made and based on the maturity of the patient. ConclusionThis study provides a protocol describing transition of children with chronic intestinal failure from pediatric to adult care. This international protocol will serve as practical guidance for pediatric chronic intestinal failure which will provide a more structured, optimal transition process. It is advised to use this protocol as a formal checklist that can be placed in the patient’s chart to review and track the transition process by CIF team members. Future research investigating transition readiness of CIF patients is needed.

Time trends in preemptive kidney transplantation in Europe: an era registry study.

Preemptive kidney transplantation has better outcomes when compared to transplantation after dialysis. We aimed to examine trends in preemptive kidney transplantation between 2000 and 2019 in Europe and to provide an overview of associated policies, barriers and initiatives. Adult patients from 12 European countries who received a preemptive kidney transplant were included. The representatives of the registries providing these data were questioned on the policies, barriers and initiatives around preemptive kidney transplantation. Between 2000 and 2019, 20251 adults underwent preemptive kidney transplantation (11169 from living donors, 8937 from deceased donors). The proportion of first kidney transplantations that were preemptive more than doubled from 7% in 2000 to 18% in 2019, reflecting a similar relative increase for living donor kidney recipients (from 21% to 43%) and deceased donor kidney recipients (from 4% to 11%). Large international differences were found. The increase in preemptive kidney transplantation was observed across all age, sex and primary renal disease groups. Countries had similar criteria for preemptive waitlisting. Barriers mentioned included donor shortage, late referral to the transplant center and long donor or recipient work-up. Suggested initiatives included raising awareness on the possibility of preemptive kidney transplantation, earlier start and shorter work-up time for recipient and living donor. Over the last two decades the proportion of patients receiving a first kidney transplant preemptively has more than doubled, reflecting a similar relative increase for living and deceased donor kidney recipients.

Esteatosis hepática metabólica

Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a broad spectrum of liver conditions that ranges from simple steatosis to hepatic steatosis, fibrosis, and cirrhosis. It is currently the most common chronic liver disease worldwide and is expected to become the leading cause of liver failure and liver transplantation in Europe in the coming years. Furthermore, MASLD is a multisystemic disease whose main cause of morbidity and mortality is cardiovascular disease. Therefore, it has broad social and economic implications, representing a major challenge for global public health. This update summarizes current relevant aspects on the pathogenesis, natural history, and management of MASLD.

Pediatric kidney transplantation in Europe, a clinical snapshot pilot.

Pediatric kidney transplantations are rarely performed, and there is limited knowledge about the diversity in current clinical practices across Europe. This study aims to explore the utility of clinical snapshot studies in identifying these disparities, establishing a foundation for future snapshot studies and standardization efforts. A pilot clinical snapshot study was conducted, with invitations extended to all 109 pediatric kidney transplant centres in Europe. Each participating centre provided pre-, peri-, and postoperative data concerning their most recent thirty transplantations. The primary outcomes encompassed the evaluation of disparities in donor-recipient selection, surgical techniques, post-operative drainage procedures, and immunosuppressive therapy protocols. Secondary outcomes involved the analysis of rejection rates, incidence of infections, and graft survival. The study involved 439 patients from fifteen centres (14%) in twelve countries, with varying transplant volumes (range 1-29 transplantations per year) and follow-up periods. Significant differences were found among centres in terms of donor types, cold and warm ischemia time, pre-emptive transplant rates, and kidney transplant drainage methods. The rate of living donors varied between 3% and 90% and the median duration of cold ischemia ranged was 770 min after deceased donation and 147 min after living donation. Basiliximab was the dominant induction therapy, yet steroid withdrawal varied widely. Infection, rejection, and graft survival rates also varied significantly between centres. This study revealed substantial variation in clinical practices among European centres performing pediatric kidney transplantations. These findings could serve as a stimulus for international dialogue and collaboration.

Time-Varying Determinants of Graft Failure in Pediatric Kidney Transplantation in Europe.

Little is known about the time-varying determinants of kidney graft failure in children. We performed a retrospective study of primary pediatric kidney transplant recipients (younger than 18 years) from the Eurotransplant registry (1990-2020). Piece-wise exponential additive mixed models were applied to analyze time-varying recipient, donor, and transplant risk factors. Primary outcome was death-censored graft failure. We report on 4528 kidney transplantations, of which 68% with deceased and 32% with living donor. One thousand six hundred and thirty-eight recipients experienced graft failure, and 168 died with a functioning graft. Between 2011 and 2020, the 5-year graft failure risk was 10% for deceased donor and 4% for living donor kidney transplant recipients. Risk of graft failure decreased five-fold from 1990 to 2020. The association between living donor transplantation and the lower risk of graft failure was strongest in the first month post-transplant (adjusted hazard ratio, 0.58; 95% confidence interval, 0.46 to 0.73) and remained statistically significant until 12 years post-transplant. Risk factors for graft failure in the first 2 years were deceased donor younger than 12 years or older than 46 years, potentially recurrent kidney disease, and panel-reactive antibody >0%. Other determinants of graft failure included dialysis before transplantation (until 5 years post-transplant), human leukocyte antigen mismatch 2-4 (0-15 years post-transplant), human leukocyte antigen mismatch 5-6 (2-12 years post-transplant), and hemodialysis (8-14 years post-transplant). Recipients older than 11 years at transplantation had a higher risk of graft failure 1-8 years post-transplant compared with other age groups, whereas young recipients had a lower risk throughout follow-up. Analysis of the combined effect of post-transplant time and recipient age showed a higher rate of graft failure during the first 5 years post-transplant in adolescents compared with young transplant recipients. In contrast to deceased donor younger than 12 years, deceased donor older than 46 years was consistently associated with a higher graft failure risk. We report a long-term inverse association between living donor kidney transplantation and the risk of graft failure. The determinants of graft failure varied with time. There was a significant cumulative effect of adolescence and time post-transplant. The ideal donor age window was dependent on time post-transplant.

The toll of COVID-19 on organ donation and kidney transplantation in Europe: Do legislative defaults matter?

This study investigates the cascading effects of COVID-19 pandemic on organ donation and transplantation in Europe. We also check whether legislative defaults for organ donation have a role in these outcomes. For this purpose, we used data from 32 European countries, between 2010 and 2021, and estimated pooled OLS regressions. We find that COVID-19 pandemic reduced deceased organ donation rates by 23.4%, deceased kidney transplantation rates by 27.9% and live kidney transplantation rates by 31.1% after accounting for health system capacity indicators. While our study finds that presumed consent legislation under normal circumstances leads to notable benefits in terms of deceased kidney transplantation and organ donation rates, the legislative defaults did not have a significant impact during the pandemic. Additionally, our findings indicate a trade-off between living and deceased transplantation that is influenced by the legislative default.

Outcomes of subsequent neoplasms after umbilical cord blood transplantation in Europe.

Subsequent neoplasms (SNs) compromise long-term survivors after hematopoietic cell transplantation. We performed a retrospective analysis of SNs in 10 358 recipients ofumbilical cord blood transplantation (UCBT) from 1988 to 2018. SNs developed in 233patients and 84 were of pediatric age. Indications for UCBT were malignant hematological diseases in 199 patients (85%). Three groups of SNs were observed. Posttransplant lymphoproliferative disorders (PTLD) were reported in 145 patients in a median of 4 months after UCBT. Of these, 9 patients died from relapse, 83 from PTLD, and 24 from transplant-related causes. At last follow-up, 29 were alive; 5-year overall survival (OS) after PTLD diagnosis was 21%. Acute leukemia/myelodysplasia (AL/MDS) was diagnosed in 23 patients in a median of 28 months after UCBT and included 3 donor-cell AL. Four of 23 patients died from relapse of primary disease, 8 from progression of SNs, and 4 from TRM. Seven patients remain alive; the 5-year OS after AL/MDS diagnosis was 36%. Solid tumors (ST) were reported in 65 patients in a median of 54 months after UCBT. Most common tumor sites were lung, thyroid, bone, and soft tissue. A total of 33 patients died (26 owing to ST, 6 to relapse of primary disease, and 1 cause missing). At last follow-up, 32 of 65 patients were alive; the 5-year OS after the diagnosis of ST was 51%. In conclusion, despite their poor outcomes, SNs that occur after UCBT are extremely rare. Identification of risk factors and early detection may help to improve OS.

A simple prognostic system in patients with myelofibrosis undergoing allogeneic stem cell transplantation: a CIBMTR/EBMT analysis

AbstractTo develop a prognostic model for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) for myelofibrosis (MF), we examined the data of 623 patients undergoing allo-HCT between 2000 and 2016 in the United States (the Center for International Blood and Marrow Transplant Research [CIBMTR] cohort). A Cox multivariable model was used to identify factors prognostic of mortality. A weighted score using these factors was assigned to patients who received transplantation in Europe (the European Bone Marrow Transplant [EBMT] cohort; n = 623). Patient age >50 years (hazard ratio [HR], 1.39; 95% confidence interval [CI], 0.98-1.96), and HLA-matched unrelated donor (HR, 1.29; 95% CI, 0.98-1.7) were associated with an increased hazard of death and were assigned 1 point. Hemoglobin levels <100 g/L at time of transplantation (HR, 1.63; 95% CI, 1.2-2.19) and a mismatched unrelated donor (HR, 1.78; 95% CI, 1.25-2.52) were assigned 2 points. The 3-year overall survival (OS) in patients with a low (1-2 points), intermediate (3-4 points), and high score (5 points) were 69% (95% CI, 61-76), 51% (95% CI, 46-56.4), and 34% (95% CI, 21-49), respectively (P < .001). Increasing score was predictive of increased transplant-related mortality (TRM; P = .0017) but not of relapse (P = .12). The derived score was predictive of OS (P < .001) and TRM (P = .002) but not of relapse (P = .17) in the EBMT cohort as well. The proposed system was prognostic of survival in 2 large cohorts, CIBMTR and EBMT, and can easily be applied by clinicians consulting patients with MF about the transplantation outcomes.

Impact of institutional case volume of solid organ transplantation on patient outcomes and implications for healthcare policy in Korea.

Solid organ transplantation is distinguished from other high-risk surgical procedures by the fact that it utilizes an extremely limited and precious resource and requires a multidisciplinary team approach. For several decades, institutional experience, as quantified by center volume, has been shown to be strongly associated with patient outcomes and graft survival after solid organ transplantation. The United States has implemented a minimum case volume requirement and performance standards for accreditation as a validated transplantation center. Solid organ transplantation in Europe is also governed by the European Union, which monitors patient outcomes and organ allocation. The number of solid organ transplantation cases in Korea is increasing, with patient outcomes comparable to international standards. However, Korea has outdated regulations regarding hospital facilities, and performance indicators including patient outcomes after transplantation are not monitored. Therefore, centers perform solid organ transplantation with no meaningful oversight. In this review, data regarding the impact of institutional case volume of kidney, liver, lung, and heart transplantation are summarized, followed by a description of current transplantation center regulations in the United States and Europe. The basis for the necessity of adequate transplantation center regulations in Korea is presented.

Development of Non heart-beating donor programs for kidney transplantation in Italy: A perspective view

Kidney transplantation is the best treatment available for patients with end-stage renal disease. There are three categories of donors: living donors (LD), brain death (DBD) or cardiac death (DCD) kidney donors. In this review we analyze the current scenario of DCD renal transplantation in Europe and in Italy. In Italy DCD donation has not yet been significantly developed because of the obstacle of the 20 minutes no touch period after cardiac arrest, before cannulating and perfusing organs to be recovered. This procedure is requested by current Italian law and is not going to be changed in the near future. We analyze problems rising from this law and suggest possible solutions.

An Analysis by the European Committee on Organ Transplantation of the Council of Europe Outlining the International Landscape of Donors and Recipients Sex in Solid Organ Transplantation.

Discrepancies in donation and transplantation by sex and gender have previously been reported. However, whether such differences are invariably the inevitable, unintended outcome of a legitimate process has yet to be determined. The European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) is the committee that actively promotes the development of ethical, quality and safety standards in the field of transplantation in Europe. Whilst the ultimate objective is to shed light on the processes underlying potential gender inequities in transplantation, our initial goal was to represent the distribution by sex among organ donors and recipients in the CD-P-TO Member States and observer countries. Our survey confirms previous evidence that, in most countries, men represent the prevalent source of deceased donors (63.3% in 64 countries: 60.7% and 71.9% for donation after brain and circulatory death, respectively). In contrast, women represent the leading source of organs recovered from living kidney and liver donors (61.1% and 51.2% in 55 and 32 countries, respectively). Across countries, most recovered organs are transplanted into men (65% in 57 countries). These observations may be explained, at least in part, by the higher burden of certain diseases in men, childbearing related immune sensitization in women, and donor-recipient size mismatch. Future research should establish whether gender-related socially-constructed roles and socioeconomic status may play a detrimental role reducing the access of women to transplantation.

P36 THE ELDEST HEART TRANSPLANTED PATIENT IN EUROPE: 36 YEARS SURVIVAL AND STILL GOING ON

Development of endomyocardial biopsy for acute rejection monitoring in the early Seventies, and above all use of cyclosporine in the clinical practice starting from 1980, introduced the modern era of heart transplantation. Following the initial positive outcomes, the first Italian transplant was performed in Padua by V.Gallucci on November 15th 1985. This pioneering success was rapidly repeated in Pavia, where M.Viganò performed the second transplant on Novembre 17th. Recipient was 20 years old man, suffering from dilated cardiomyopathy, on urgent transplant list. Cardiac index was 1.38 l/min/m2 and pulmonary vascular resistance 1.6 WU. Donor was a 14 years old boy died of brain injury. Total ischemic time was 125 minutes. Induction immunosuppression consisted of horse anti–lymphocyte immunoglobulins, whereas maintenance therapy included cyclosporine, azathioprine and steroids. Postoperative course was complicated by pericardial effusion and cholestatic jaundice. Later pulmonary aspergillosis occurred and due to the profound immunodepression was complicated by fungal localization at L2 vertebral body. The infection was treated with surgical removal of the secondary localization and amphotericin B administration. On December 6th severe acute rejection was found at biopsy and treated with i.v. steroid pulse. Length of ICU and hospital stay was 28 and 72 days, respectively. In 1998 HCV infection was detected and eradicated in 2017 with elbasvir/grazoprevir therapy. Complications of long term immunosuppressive treatment included dyslipidemia, myeloma and basal cell carcinoma. Due to long–term calcineurin inhibitors therapy progressive chronic renal failure occurred, leading to replacement therapy in 2015 and kidney transplantation in 2016. In 2015 the patient underwent percutaneous coronary intervention with stents implantation in two marginal branches and in the anterior descending artery in 2021. Everolimus was introduced to slow down progression of cardiac allograft vasculopathy. In 2020 he suffered from Covid–19, but the course of infection was uneventful being cough the only symptom. We report the eldest survivor after heart transplant in Europe. Our case demonstrates that despite early and long–term complications of immunosuppressive therapy, a careful and patient tailored management allowed an amazing outcome. Nowadays heart transplant remains the best treatment for end stage heart failure and allows to resume a nearly normal quality of life.

Survival After Lung Transplantation in Europe - Clad as Major Cause of Death

<h3>Purpose</h3> Lung transplantation (LTX) outcomes are poor in comparison to other solid organ transplantations. Our aim was to review survival, leading chronic complications, and major causes of death in Europe. A particular focus is put on Chronic Lung Allograft Dysfunction (CLAD) and its trends. <h3>Methods</h3> There is no dedicated European registry on lung transplantation, outcomes, and complications. Therefore, accessible data from ISHLT registry with focus on the European continent, European Registries and German Quality report were screened for lung transplantation survival data. Furthermore, a dedicated literature research on chronic complications following LTX and particularly CLAD was performed with focus on Europe. In a further step, clinical trial registries were screened for advanced trials addressing the leading form of CLAD - obstructive phenotype - Bronchiolitis Obliterans Syndrome (CLAD-BOS). <h3>Results</h3> Survival rate for LTX reaches 83.2% and 71% at 1 and 3 years, based on 3502 cases included between 2013 and 2016 in the ISHLT registry - European Continent, under exclusion of retransplant. Eurotransplant data from 2012 to 2016 comprising 3053 LTX from Austria, Belgium, Germany, and the Netherlands state survival rates of 83.5%, 76.8% and 62.5% at year 1, 2 and 5. Yet, pan-European data are lacking. Some large monocentric European studies report CLAD rates ranging from 38% at 3 years to 44% at longer follow-up. These findings are in line with US data. CLAD-BOS represented consistently the most prevalent phenotype, up to 80% of all CLAD cases. Although no dedicated European registry data are available, monocentric studies pinpoint CLAD as the single largest cause of death post-LTX. Within CLAD, BOS phenotype accounts for two-thirds of deaths based on reported autopsy analysis. Currently, two substances targeting CLAD-BOS are in phase 3 clinical investigation in Europe. <h3>Conclusion</h3> In Europe, 3-year post-lung transplantation survival is around 70% and 5-year survival at 63%. CLAD is consistently the most prevalent and fatal complication in lung transplant recipients. CLAD-BOS is the most frequent phenotype. New treatments to address chronic graft failure and primary cause of death in LTX, namely CLAD-BOS, are needed. Currently two therapeutic approaches are under investigation in phase 3 clinical trials aiming at CLAD-BOS in Europe.

Austrian Analysis of the GUARDIAN Registry: Heart Transplant Effects in Europe from the Global Pandemic

PurposeDuring the global COVID-19 pandemic heart transplantation in Europe was affected due to difficultly traveling internationally and greater delays associated with crossing borders. During a similar time frame our center also adopted the Paragonix SherpaPak Cardiac Transport System (SHRP) for regular use rather than conventional ice storage (ICE). This study aims to compare heart transplant baseline characteristics and outcomes for the 18 months prior to the global pandemic with the 18 months since the pandemic began.MethodsThe Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN) study is a retrospective, multi-institutional registry. We analyzed patients transplanted in Austria pre-pandemic, from 1 SEP 2018 to 1 MAR 2020 (PRE), with patients transplanted during the pandemic, from 1 MAR 2020 to 1 SEP 2021 (C19).Results83 patients (42 PRE, 41 C19) met these criteria to be included in the analysis. The PRE cohort utilized donor organs from statistically longer travel distances (PRE=323 v C19=179 miles, p=0.02). Despite the shorter travel distances, ischemic times were same (PRE=195 v C19=189 min, p=0.60), likely indicating the additional burdens for traveling across borders. During the PRE period the SHRP was only used for marginal cases and in the C19 period it was adopted for regular use. The proportion of cases utilizing SHRP was statistically higher in the C19 cohort (PRE=19% v C19=80%, p<0.001). The PRE cohort showed numerically higher rates of newly placed ECMO post-transplant (16.1% v 11.8% p=0.18), incidence of PGD (16.7% v 4.9%, p=0.08), incidence of severe PGD (4.8% v 2.4%, p=0.57), and rates of the use of cardioversion intra-operatively to start the donor heart (19.0% v 9.8%, p=0.32) for PRE v C19 respectively. In-hospital survival was similar (92.9% v 90.2%, p=0.67).ConclusionThe global COVID-19 pandemic caused a substantial impact on the access to donor hearts in Europe due to the ability to travel internationally. Despite this limitation on donor heart access, we saw trends towards improved outcomes in this period compared to the pre-pandemic period. This period was also highly correlated with the implementation of the Paragonix SherpaPak Cardiac Transport System as a preservation method which may have helped mitigate some of the negative effects of reduced donor access.

Trend in Lung Transplantation in Europe 2015 - 2019, Type of Transplant and Organ Source

Purpose NEWSLETTER TRANSPLANT provides annual lung donation and transplantation figures on a country basis, distributed per single and double lung transplantation and referencing Donors after Cardiac Death (DCD) as an organ source. These comprehensive data were used to analyze trends in lung transplantation (LTX) for the time-period 2015 - 2019, single versus double LTX and the impact of DCD on transplant volume. The focus was put on European countries. Methods Systematic review of all lung transplant data for the 5-year time-period for Europe defined as EU 27 countries plus Norway, Switzerland and United Kingdom was performed. Data was considered on a country level for overall transplant, single lung transplantation (SLTX) and double lung transplantation (DLTX). Countries allowing use of DCD organs were identified and the impact on total transplantation assessed. Results Number of lung transplantations moved from 1901 cases in 2015 to 2208 in 2019. This represents an increase of 307 transplants (14%). 16 out of 27 EU countries had active LTX programs in 2015. Further countries including Bulgaria, Hungary, Romania, and Slovenia started their own lung transplanting program in the time-period considered and reported their cases. SLTX keeps decreasing, from 296 cases to 260, accounting for only 11.8% of total LTX. Most single transplants are being performed in Spain and Ireland. All growth is coming from DLTX expanding from 1604 to 1945 cases in Europe. Most European countries adopted the opt-out system. This is the case for the leading transplanting countries. Five countries still have an opt-in ruling and Slovenia a mixed system. DCD organs account for 239 transplants or 10.8% of total LTX in 2019 compared to 7.3% in 2015. Eight out of 23 countries report transplantation of DCD organs in 2019. The contribution of DCD to total lung transplant in these eight countries varies from 2.6% to 43.8%. It is particularly high in The Netherlands with 44%, Belgium 28%, the United Kingdom 23%, and Spain 18%. Conclusion Europe has seen a substantial increase in lung transplantation between 2015 and 2019. Most countries have adopted the opt-out system. Eight countries reported the use of DCD organs, which have largely contributed to the overall growth and could play more of a role in the future. Overall growth has impacted only DLTX whereas SLTX keeps decreasing. New countries have joined the transplanting community. NEWSLETTER TRANSPLANT provides annual lung donation and transplantation figures on a country basis, distributed per single and double lung transplantation and referencing Donors after Cardiac Death (DCD) as an organ source. These comprehensive data were used to analyze trends in lung transplantation (LTX) for the time-period 2015 - 2019, single versus double LTX and the impact of DCD on transplant volume. The focus was put on European countries. Systematic review of all lung transplant data for the 5-year time-period for Europe defined as EU 27 countries plus Norway, Switzerland and United Kingdom was performed. Data was considered on a country level for overall transplant, single lung transplantation (SLTX) and double lung transplantation (DLTX). Countries allowing use of DCD organs were identified and the impact on total transplantation assessed. Number of lung transplantations moved from 1901 cases in 2015 to 2208 in 2019. This represents an increase of 307 transplants (14%). 16 out of 27 EU countries had active LTX programs in 2015. Further countries including Bulgaria, Hungary, Romania, and Slovenia started their own lung transplanting program in the time-period considered and reported their cases. SLTX keeps decreasing, from 296 cases to 260, accounting for only 11.8% of total LTX. Most single transplants are being performed in Spain and Ireland. All growth is coming from DLTX expanding from 1604 to 1945 cases in Europe. Most European countries adopted the opt-out system. This is the case for the leading transplanting countries. Five countries still have an opt-in ruling and Slovenia a mixed system. DCD organs account for 239 transplants or 10.8% of total LTX in 2019 compared to 7.3% in 2015. Eight out of 23 countries report transplantation of DCD organs in 2019. The contribution of DCD to total lung transplant in these eight countries varies from 2.6% to 43.8%. It is particularly high in The Netherlands with 44%, Belgium 28%, the United Kingdom 23%, and Spain 18%. Europe has seen a substantial increase in lung transplantation between 2015 and 2019. Most countries have adopted the opt-out system. Eight countries reported the use of DCD organs, which have largely contributed to the overall growth and could play more of a role in the future. Overall growth has impacted only DLTX whereas SLTX keeps decreasing. New countries have joined the transplanting community.

Twenty-year temporal and regional trends in heart transplantation in Europe: results from the Global Observatory on Donation and Transplantation (GODT)

Abstract Introduction Heart transplant (HT) remains the only cure for patients with advanced heart failure. However, limited supply of donors continues to be the main obstacle to growing transplant programs around the world. Since population changes are not uniform, describing temporal trends in availability of donors and in number of transplanted hearts will provide better understanding of regional variations in organ availability and allocation. Purpose We aim to evaluate temporal and regional trends in number of brain-dead donors (BDDs) and its association with the number of heart transplants (HTs) in Europe between 2000 and 2019. Methods Global Observatory on Donation and Transplantation (GODT) represents the world's most comprehensive source of data on organ donation and transplantation. Available data were collected for all European countries for the years (2000–2019) except for the year 2005. Geographical classification (north, west, central, south) was made according to EuroVoc definition. Trends of HTs and BDDs were assessed using Joinpoint Software of the National Cancer Institute to calculate the annual percentage change (APC) and reported as per million population (PMP). The linear correlation coefficient was assessed using R studio. Results Over the past two decades, there was a 35% increase in HTs PMP rate in Europe from the year 2000 to 2019 with an APC of 1.4% (95% CI [1.1–1.7], P&amp;lt;.0001). This change was more pronounced in Central Europe, where HTs PMP rate increased from 0.65 in 2000 to 2.93 in 2019 (APC 9.9% (95% CI [8.1–11.8], P&amp;lt;.0001)) and in Northern Europe, where HTs PMP rate increased from 2.97 in 2000 to 5.18 in 2019 (APC 2.7% (95% CI [1.8–3.7], P&amp;lt;.0001)) (Figure 1). Despite the increase in BDDs in Europe between 2000–2019 (from 3.62 to 12.25 donors PMP) (Figure 2), the association between increased BDDs and HTs varied between regions, with a very strong association in Central Europe (r=0.95, P&amp;lt;0.0001) and strong correlation in Northern Europe (r=0.64, P=0.003). However, positive correlation between BDDs and HTs was not seen in Southern or Western Europe (r=−0.52, p-value=0.02, r=0.02, p-value=0.94, respectively). Conclusion The number of BDDs has increased in Europe in the past two decades with a concomitant increase in HT volumes. A regional variation in the relationship between the number of BDDs and HTs was observed among European subregions, such that it was most pronounced in Central Europe. Understanding the reasons underlying these disparities can potentially inform improvement in organ allocation systems throughout Europe. Funding Acknowledgement Type of funding sources: None.

Maternal versus paternal living kidney transplant donation is associated with lower rejection in young pediatric recipients: A Collaborative Transplant Study report.

Approximately 1700 children per year with end-stage kidney disease undergo kidney transplantation in Europe and the United States of America; 30%-50% are living donor kidney transplantations. There may be immunological differences between paternal and maternal donors due to transplacental exchange of cells between the mother and fetus during pregnancy leading to microchimerism. We investigated whether the outcome of living-related kidney transplantation in young children is different after maternal compared with paternal organ donation. Using the international Collaborative Transplant Study (CTS) database, we analyzed epidemiological data of 7247 children and adolescents aged <18years who had received a kidney transplant from either mother or father. Risk of treated rejection episodes and death-censored graft failure were computed using the Kaplan-Meier method and multivariable Cox regression. In the recipient age group 1-4years, the rate of treated rejection episodes in recipients of kidneys from maternal donors (N=195) during the first 2years post-transplant was significantly lower (hazard ratio HR=0.47, p=.004) than in patients receiving kidneys from paternal donors (N=179). This association between donor sex and risk of treated rejections was not observed in children aged 5-9years. The 5-year death-censored graft survival in children aged 1-4years with a maternal or paternal donor was comparable. Maternal kidney donation in young pediatric renal transplant recipients is associated with an approximately 50% lower rate of treated rejection than paternal kidney donation. Whether this phenomenon is due to maternal microchimerism-induced donor-specific hyporesponsiveness must be evaluated in prospective mechanistic studies.

Shedding light on dark matter - faecal microbiota transplantation in Europe.

Shedding light on dark matter - faecal microbiota transplantation in Europe.

Practice patterns of corneal transplantation in Europe: first report by the European Cornea and Cell Transplantation Registry.

To report practice patterns of corneal transplantation in Europe. Corneal clinics in 10 European member states (MS), the United Kingdom, and Switzerland. Multinational registry study. Corneal transplant procedures registered in the European Cornea and Cell Transplantation Registry were identified. Preoperative donor and recipient characteristics, indication and reason for transplantation, and surgical techniques were analyzed. A total of 12 913 corneal transplants were identified from 10 European Union MS, the United Kingdom, and Switzerland. Most countries were self-sufficient with regard to donor tissue. Fuchs endothelial corneal dystrophy was the most common indication (41%, n = 5325), followed by regraft (16%, n = 2108), pseudophakic bullous keratopathy (12%, n = 1594), and keratoconus (12%, n = 1506). Descemet stripping automated endothelial keratoplasty (DSAEK, 46%, n = 5918) was the most commonly performed technique, followed by penetrating keratoplasty (30%, n = 3886) and Descemet membrane endothelial keratoplasty (9%, n = 1838). Vision improvement was the main reason for corneal transplantation (90%, n = 11 591). Surgical technique and reason for transplantation differed between indications. This report provides the most comprehensive overview of corneal transplantation practice patterns in Europe to date. Fuchs endothelial dystrophy is the most common indication, vision improvement the leading reason, and DSAEK the predominant technique for corneal transplantation.