Secondary Logo

Journal Logo

What Clinical Changes Can We Expect in the Next 5 Years? A Review of the 26th International Congress of The Transplantation Society

Gill, John S. MD, MS

doi: 10.1097/TP.0000000000001526
In View: Review
Free
Social Media Collection

Scientific presentations at the 26th International Congress of The Transplantation Society held in Hong Kong from August 18 to 23, 2016, highlighted accomplishments, challenges and opportunities in contemporary clinical organ transplantation. With nearly 1600 original abstract submissions, this review summarizes notable presentations in addressing a diversity of issues including deceased and living organ donation, improving allograft survival and unmet clinical needs in organ transplantation.

1 Division of Nephrology, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.

Received 21 September 2016.

Accepted 27 September 2016.

Grant support and consultant for Astellas, Consultant Alexion.

Correspondence: John S. Gill, MD, MS, Professor of Medicine, University of British Columbia, Division of Nephrology, St. Paul's Hospital, Providence Building Ward 6a-1081 Burrard Street, Vancouver, BC, Canada V6Z 1 Y6. (jgill@providencehealth.bc.ca).

Scientific presentations at the 26th International Congress of The Transplantation Society (TTS) held in Hong Kong from August 18 to 23, 2016 highlighted accomplishments, challenges and opportunities in contemporary clinical organ transplantation.

With nearly 1600 original abstract submissions, this review summarizes notable presentations in addressing a diversity of issues including deceased and living organ donation, improving allograft survival and unmet clinical needs in organ transplantation.

Back to Top | Article Outline

ORGAN DONATION

The TTS meeting uniquely highlighted challenges in organ donation through formal presentations sponsored by the International Society of Organ Donation and Procurement, the Declaration of Istanbul Custodian Group, as well as presentations from organ donation service providers in Asia.

The shortage of transplantable organs is well recognized, and the location of the Congress in Asia illuminated international differences in organ donation with a reliance on living donation in developing countries in contrast to the importance of deceased donation in most developed countries. In the case of kidney disease establishment of dialysis facilities by for profit entities in developing countries without parallel development of organ donation and transplant services is an emerging concern that will require cooperation between professional societies (ie, the International Society of Nephrology, TTS) and governmental and nongovernmental agencies to ensure an integrated approach to chronic kidney disease management including an emphasis on prevention of end stage disease, with the most expensive treatment modality (dialysis) used primarily as a bridge to transplantation for those who develop end-stage renal disease.

The location of the meeting in Hong Kong highlighted the importance of establishing ethical and transparent organ donation and allocation services in all countries especially those with a history of unethical practices. The plenary presentation of Jeifu Huang together with a description of the China Organ Transplant Response System by Haibo Wang summarized Chinese efforts toward this goal, whereas presentations from India1,2 summarized regional progress in establishing deceased organ donation programs. The presentation of Alexander Capron related to financial neutrality in deceased organ donation directly addressed the issue of payments to deceased donor families, which is particularly relevant to countries with large migrant worker populations and countries developing deceased organ donation services.3 The sharing of best practices and the collegiality fostered at the TTS meeting among the international community of health professionals working in field of organ donation was a unique feature and strength of the TTS congress.

Noteworthy scientific presentations in deceased donation included a report on the Spanish experience with kidney transplantation from n =152 uncontrolled donors after circulatory death between 2012 and 2013.4 Among the n = 275 kidney transplant recipients, 3% had primary nonfunction, 78% had delayed graft function, and 1-year death-censored allograft survival was 87%. Death-censored allograft survival was lower among transplants from in hospital versus out of hospital donors, and among kidneys subject to in situ cooling preservation compared with hypothermic or normothermic regional perfusion. Presentations from the United States highlighted the importance of donation after circulatory death donors5 including the achievement of excellent outcomes with utilization of kidneys from donation after circulatory death donors older than 55 years.5

There were several exciting presentations related to preservation and repair of deceased donor organs: David Nasralla, a young investigator from the United Kingdom, presented results from a multicenter randomized controlled trial to compare the efficacy of normothermic machine perfusion with static cold storage in liver transplantation: the group treated with normothermic perfusion had superior outcomes including a lower peak AST (the primary outcome) and a less than half the rate of organ discard.6 Brasile and colleagues7 reported cellular regeneration in ischemically damaged human kidneys infused with mesenchymal stem cells during ex vivo warm perfusion. State of the art presentations by Berenguer8 and Muller9 summarized the potential and evolving experience with utilization of organs infected with hepatitis C and human immunodeficiency virus. The ability to expand utilization of organs previously thought to be unsuitable for transplantation will require research to determine which patients' groups will benefit as well as educational initiatives to ensure patients understand the risks of benefits of transplantation with these higher risk organs.

Strategies to increase living donation focused on removal of disincentives to living donation within the framework of financial neutrality, the use of older aged living kidney donors,10 and innovations to expand opportunities for patients with an incompatible living donor to find a match in kidney paired donation programs. The success of single center kidney paired donation programs in diverse settings was notable11,12 as was the importance of increasing patient participation through multicenter programs including the potential to involve donors and recipients in different countries13 to improve access for very hard to match patients. A presentation by Mizuta and colleagues14 that reviewed their experience with segmental liver allografts in pediatric recipients was a notable example of the sharing of international expertise at the Congress. Additional presentations highlighted evolving understanding and prediction of adverse health outcomes in living donors10,15 and advances to improve informed consent among living donors.

Exciting developments in xenotransplantation including the unprecedented ability to modify the genome using CRISPR/Cas technology has propelled the field to the cusp of clinical human trials. The creation of donor organs with multiple gene knockouts has allowed investigators to attenuate antibody, complement, and coagulation responses to improve xenograft survival. Significant advances in heart, liver, and kidney allograft survival have been achieved, but the first human trials are most likely to involve pancreatic islet cells, potentially within the next 2 years.

Back to Top | Article Outline

IMPROVING ALLOGRAFT SURVIVAL

Challenges in improving long-term allograft survival including the diminished relevance of existing therapeutic end-points and the need to identify and validate new surrogate outcomes, were highlighted in several presentations during the Congress. Potential surrogate biomarkers discussed at the Congress included anti-HLA antibodies,16-18 tests based on light microscopy19 and molecular diagnostics of allograft tissue obtained in protocol20,21 and for cause biopsies,22 as well as tests of peripheral blood23-25 and urine.26 Many of these biomarkers are still under evaluation using in vitro models27 and observational studies to determine their association with clinically relevant endpoints, but a few surrogates are being evaluated in clinical trials.28

The complexity of identifying and validating surrogate outcomes is related to incomplete understanding of the pathological processes that lead to premature allograft failure. Novel factors contributing to allograft failure discussed at the Congress included air pollution,23 whereas van den Brink29 and Bromberg30 reviewed current understanding of the microbiome. With increasing knowledge of disease pathogenesis,31,32 advancement of disease specific surrogates will lead to more focused trials involving selected patient groups most likely to respond to targeted therapeutic interventions. This could lead to trials that utilize biomarkers for patient enrichment rather than as surrogate outcomes. For example, Flavio Vincenti, described screening for CD57(+ve) PD1 (−ve) T cells to identify patients at risk for co-stimulation blockade resistant rejection, who would be excluded from future therapeutic trials involving costimulatory blockers, such as belatacept.33

There is continued high interest in anti-HLA antibodies as biomarkers: Ongoing research will refine the relevance of donor-specific antibody beyond mean fluorescence intensity including the importance of antibody titre/subclass and complement fixation. Given the limitation of current therapies to treat antibody-mediated rejection (especially chronic antibody mediated rejection), strategies to avoid antibody mediated rejection are anticipated including better characterization of HLA epitopes and epitope matching. Advancement of rapid donor and recipient epitope matching techniques will soon allow patients currently excluded from transplantation on the basis of allele specific antibodies to safely undergo transplantation. Notable among potential new therapies to treat antibody mediated rejection was the description of a pilot study from Lefaucheur and colleagues34 using a C1 inhibitor in patients nonresponsive to conventional therapy.

The need for surrogates extends to investigators working in the field of tolerance induction and was reviewed in the context of liver transplantation by Sanchez-Fueyo.35 Although there are distinct blood and tissue signatures of tolerance, these signatures vary over time and biomarkers to predict the outcome of immunosuppressant drug withdrawal in individual patients are lacking. The current status of various strategies to induce tolerance was reviewed by Wood,36 important hurdles remain including reducing the intensity of conditioning, eliminating the risk of graft versus host disease, maintaining engraftment/chimerism and extending applicability to HLA mismatched patients. Chandra37 reviewed key considerations in designing tolerance induction protocols utilizing cell based therapies (ie T regulatory cells) including purity, stability, dosing, and safety of the cell based product, as well as patient selection. Chandra37 also raised that possibility of trials to reduce rather than replace the need for immunosuppressant drugs. The importance of trial design was further emphasized in presentations of the ONE study by Edward Geissler and Paul Harden,38,39 in which the efficacy of multiple cellular preparations will be assessed using a uniform study design. Results from ongoing trials in liver transplantation were presented: Yamashita and colleagues,40 provided an update of their experience with ex-vivo generated donor antigen-pulsed regulatory T cell in adult living donor liver donor transplant recipients whereas Feng et al41 reviewed the results from a multi-center trial in which 33 of 88 highly selected pediatric liver transplant recipients weaned from immunosuppression met the study definition of operational tolerance.

Repurposing of drugs developed for use in non-transplant settings, such as rheumatology and dermatology for use in organ transplantation may be an important strategy to advance the field. Robert Montgomery reviewed emerging experience with the use of tocilizumab, a humanized monoclonal antibody against the interleukin-6-receptor that has been extensively used in the treatment of arthritis.42 Interleukin-6 drives B-cell activation and differentiation to antibody producing plasma cells therefore tociluzumab may be useful in the treating antibody mediated rejection. Petra Renke reviewed the rationale for infliximab, a chimeric monoclonal antibody against TNF-α that has approved for use in inflammatory bowel disease, psoriatic and rheumatoid arthritis, in prevention of ischemia-reperfusion injury: A current Clinical Trials in Organ Transplantation randomized controlled trial sponsored by the National Institute of Allergy and Infectious Diseases (Clinical Trials in Organ Transplantation-19) will examine whether the addition of infliximab will improve allograft function in deceased donor kidney transplant recipients.43 Dr. Reinke also reviewed the experience in Berlin with infliximab in high-risk repeat kidney transplant recipients during the period 2013 to 2015.43 Patients who received the combination of T cell depletion with infliximab had long-term allograft survival comparable to nonsensitized first transplant recipients, but a comparison with high-risk repeat transplant recipients treated with T-cell depletion alone was not reported. The concomitant evaluation of new drugs for use in non-transplant clinical settings and organ transplantation has obvious appeal, but will require the involvement of investigators from multidisciplines, a willing industry partner as well as regulatory agency engagement to achieve.

Back to Top | Article Outline

UNMET CLINICAL NEEDS

The current stagnation in immunosuppressant drug development is both a concern and an opportunity to address the multitude of unmet clinical needs in the field of organ transplantation. This includes conduct of phase 4 trials using established immunosuppressant drugs as well as non-immunosuppressant drug trials. Noteworthy presentations included a randomized placebo controlled trial demonstrating the efficacy of paracalcitol in decreasing proteinuria in kidney transplant recipients,44 a randomized open label trial demonstrating the efficacy of the receptor activator of nuclear factor kappa-B ligand inhibitor denosumab in improving bone mineral density in de novo kidney transplant recipients,45 and a single center parallel group study demonstrating no difference in subtherapeutic or supra-therapeutic tacrolimus exposure between de novo kidney transplant recipients treated using CYP3A5 genotype based tacrolimus dosing versus conventional bodyweight based dosing.46 In a secondary analysis of pooled data from completed multicenter trials in patients with CD20 posttransplant lymphoproliferative disorder Trappe et al47 reported the safety of rituximab consolidation for patients already in complete response after rituximab induction.

Congress presenters also highlighted areas for improvement in future clinical trials including better reporting of adverse events48 and increased reporting of patient centered outcomes.49 Increased understanding of the difficulty patients has with taking their immunosuppressant medications as prescribed and the importance of fluctuations in drug exposure require development of new strategies that are better tolerated by patients, allow for more reliable drug exposure, or maintenance immunosuppression to be safely reduced.50 In addition, research to inform optimal long-term care models that are based on clinical stability as well as patient individual care needs may improve long-term patient outcomes.

Back to Top | Article Outline

SUMMARY

The 26th Congress of the Transplantation Society was a tour de force of knowledge translation and academic interaction. The Congress provided a comprehensive international perspective on the accomplishments, challenges, and opportunities in clinical organ transplantation from the quest for tolerance and promise of xenotransplantation to the reality that our outcomes remain comparable to those of persons with a primary diagnosis of cancer.

As outlined in O'Connell's51 Presidential Address, the transplant community must create new strategies to generate high-level evidence to change the current status quo. This will require collaboration between industry, regulatory agencies, funders and investigators. Potential initiatives include international collaboration in investigator initiated clinical trials, secondary analyses of existing data sets from completed trials to generate new hypothesis and to inform future clinical trial design, and utilization of existing infrastructure such as transplant registries to enable clinical research. Finally, education and engagement of our patients are necessary: Patient apathy toward participation in clinical research is in part the result of our willingness to promote transplantation as a cure with the short-fall of organs as the only barrier to success. Redesign of our clinical programs to increase patient awareness of the numerous unmet clinical needs in our field, active engagement of patients in the design of clinical research projects and inclusion of patient centered outcomes in future trials will be central to future advances in clinical organ transplantation.

Back to Top | Article Outline

ACKNOWLEDGMENTS

The author acknowledges the support of Catherin Parker and all of the investigators who shared their opinions and provided access to their presentations in support of this work.

Back to Top | Article Outline

REFERENCES

1. Proneth A, Holub I, Zeman F, et al. Extended pancreas donor program—the EXPAND study, a prospective multicentre trial [551.3]. Transplantation. 2016;100(7S):S327.
2. Maloo M, Jain D, Swarankar ML, et al. Increasing deceased donor transplant activity in India: the Rajasthan story [422.13]. Transplantation. 2016;100(7S):S186.
3. Capron A. Financial Neutrality for Deceased Donor Families. Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/787. Accessed September 21, 2016.
4. Vidal C, Del Rio F, Andres A, et al. Kidney transplantation from uncontrolled donors after circulatory death: the Spanish experience. Transplantation. 2016;100(7S):S92.
5. Orlowski JP, Muse CC, Whaley JF, et al. Experience with donation after circulatory death (DCD) in donors aged 56-65: a preliminary report on kidney utilization and initial outcomes. Transplantation. 2016;100(7S):S94.
6. Nasralla D, The Consortium for Organ Preservation in Europe (COPE) Liver Research Group, Ploeg R, et al. A multicentre randomised controlled trial to compare the efficacy of normothermic machine perfusion with static cold storage in human liver transplantation: early outcomes. Transplantation. 2016;100(7S):S111.
7. Brasile L, Henry N, Stubenitsky B. Stem cell-mediated regeneration of ischemically damaged human renal allografts during ex vivo warm perfusion. Transplantation. 2016;100(7S):S98.
8. Berenguer M. Magnitude of the Problem (Solved & Unsolved Issues) in Solid Organ Transplantation. Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/3. Accessed September 21, 2016.
9. Muller E. HIV Positive Donors and the Impact of the Second Viral Strain on Recipient Kidneys. Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://confman.tts2016.org/mobis/lecture/566. Accessed September 21, 2016.
10. Holdaas H. Donation from old living donors: how safe is it? Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/591. Accessed September 21, 2016.
11. Fronek J, Janousek L, Zamecnikova R, et al. Paired Kidney Exchange “program—single Czech institution experience with 50 paired transplants since 2011. Transplantation. 2016;100(7S):S6.
12. Kute V, Patel HV, Shah PR, et al. World record: 77 kidney paired donation transplantation in year 2015 at one transplant center in India: a model for the developing world to prevent commercial transplantation. Transplantation. 2016;100(7S):S184.
13. Alabadi A, Akkaria Kb, Alotaibi F, et al. Simulation of international kidney exchange between Saudi Arabia and the United States using actual incompatible pair data. Transplantation. 2016;100(7S):S185.
14. Mizuta K, Urahashi T, Ihara Y, et al. Pediatric liver transplantation using segmental grafts in Japan: a single-center experience with 270 patients. Transplantation. 2016;100(7S):S135.
15. 400.1 Kasiske B. Predicting Individualized Lifetime Risk of End-Stage Renal Disease in Kidney Donor Candidates. Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/743. Accessed September 21, 2016.
16. Viglietti D, Loupy A, Bentlekewski C, et al. Post-transplant monitoring of donor-specific anti-HLA antibodies and their characteristics improves risk stratification of kidney allograft loss. Transplantation. 2016;100(7S):S32.
17. Loupy A, Viglietti D, Glotz A, et al. Complement-binding donor-specific anti-HLA antibodies are associated with severe kidney allograft arteriosclerosis. Transplantation. 2016;100(7S):S32.
18. Fichtner A, Susal C, Hocker B, et al. Association of C1q fixing donor-specific HLA antibodies with late graft failure in pediatric renal transplant recipients. Transplantation. 2016;100(7S):S138.
19. Tan C, Rodriguez R. C4d positive staining is a poor prognostic indicator in cardiac transplant recipients. Transplantation. 2016;100(7S):S272.
20. Loupy A. Role of Protocol Biopsies for Guiding Therapy and Prognosis in Renal Allograft Patients. Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/710. Accessed September 21, 2016.
21. Maluf D, Gehrau R, Mas V. Importance of DNA methylation patterns and association with graft injury severity after liver transplantation. Transplantation. 2016;100(7S):S113.
22. Halloran P, Reeve J, Madill-Thomsen K. Microarray assessment of kidney transplant indication biopsies in real time: first results of the INTERCOMEX Study. Transplantation. 2016;100(7S):S414–S415.
23. Bara C, Przyylek B, Bothig D, Scheibner Y, Haverich A. Air pollution can support a chronic rejection after heart transplantation. Transplantation. 2016;100(7S):S270.
24. Sirota M, Sigdel T, Fire A, et al. VDJ immune repertoire sequencing predicts patients at risk of alloimmune injury. Transplantation. 2016;100(7S):S292.
25. Lau A, Haas K, Shawler T, et al. Mass cytometry reveals NK cell and T cell subsets in pediatric liver transplant patients with acute rejection. Transplantation. 2016;100(7S):S134.
26. Townamchai N, Leelahavanichkul A, Supapol J, et al. Urine IP-10 as the biomarker for ABMR in kidney transplant recipient with DGF. Transplantation. 2016;100(7S):S34.
27. Borkar M, Tibbles LA, Srivastava V, et al. Prospective treatment and novel biomarkers of BK polyomavirus associated nephropathy. Transplantation. 2016;100(7S):S319.
28. Linder P, Ekberg J, Jespersen B, et al. A novel non-invasive blood transcriptional assay, kSORT, monitors alloimmune response in the SAILOR randomized multicenter EU trial. Transplantation. 2016;100(7S):S86.
29. van den Brink M. Will Manipulation of Microbiome Play a Role in Management of Transplant Recipient? Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/688. Accessed September 21, 2016.
30. Bromberg J. How the Microbiota Shape the Alloresponse. Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/679. Accessed September 21, 2016.
31. Moussa O, Twombley K, Nadig S, et al. Regulation of microRNA hsa-mir-663a by HLA class I antibodies in endothelial cells. Transplantation. 2016;100(7S):S134.
32. Schachtner T, Stein M, Reinke P. Kinetics of CMV-specific t-cells from pre-to-posttransplantation predict outcomes in CMV-seronegative kidney transplant recipients. Transplantation. 2016;100(7S):S196.
33. Vincenti F, Shaffer D, Qazi Y, et al. The effect of everolimus and tacrolimus exposure levels on renal histology parameters 6 months post-transplantation. Transplantation. 2016;100(7S):S250.
34. Lefaucheur C, Viglietti D, Gosset C, et al. C1-inhibitor in acute antibody-mediated rejection non-responsive to conventional therapy in kidney transplant recipients: A pilot study. Transplantation. 2016;100(7S):S148.
35. Sanchez-Fueyo A. Tolerance: Can We Predict or Induce It? Are Any Approached Ready for Prime Time? Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/656. Accessed September 21, 2016.
36. Wood K. Many horses in the race: what are the favorites? Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/569. Accessed September 21, 2016.
37. Chandran S. Innovative trial designs in tolerance studies: how will efficacy be demonstrated? Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/570. Accessed September 21, 2016.
38. Geissler E. Update from the ONE Study: Are Cellular Therapies Safe?. Talk presented at: 26th International Congress of The Transplantation Society; August 18–23, 2016; Hong Kong, HK. https://confman.tts2016.org/mobis/lecture/548. Accessed September 21, 2016.
39. Bushell A, van der Net J, Game D, et al. The UK ONE Study trial: safety and feasibility of regulatory T (Treg) cell therapy in renal transplantation [356.7]. Transplantation. 2016;100(7S):120.
40. Yamashita K, Zaitsu M, Goto R, et al. A clinical trial of cell therapy-based tolerance induction in living donor liver transplantation: long-term follow-up results [445.3]. Transplantation. 2016;100(7S):S244.
41. Feng S, Bucuvalas J, Demetris Aj, et al. Primary outcome of iWITH: A 12 center North American clinical trial of immunosuppression withdrawal in stable pediatric liver transplant recipients [555.1]. Transplantation. 2016;100(7S):S348–S349.
42. Montgomery RA. Tocilizumab. Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/592. Accessed September 21, 2016.
43. Reinke P. Repurposing Drugs for Transplant Indications - Inflizumab. Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/593. Accessed September 21, 2016.
44. Arnol M, Oblak M, Mlinsek G, et al. Paricalcitol versus placebo for reduction of proteinuria in kidney transplant recipients: a double-blind, randomized controlled trial. Transplantation. 2016;100(7S):S214–S215.
45. Wuthrich R, Frey D, Mueller T, et al. Effect of the RANKL inhibitor denosumab on early loss of bone mineral density and skeletal microstructure in first-year kidney transplant recipients. Transplantation. 2016;100(7S):S215.
46. Shuker N, Baan C, Bouamar R, et al. A randomized-controlled trial comparing the efficacy of CYP3A5 genotype-based with bodyweight-based tacrolimus dosing after living donor kidney transplantation. Transplantation. 2016;100(7S):S246.
47. Trappe R, Dierika D, Zimmermann H, et al. Sequential therapy and risk-stratification in PTLD: Pooled analysis of 222 patients treated in the prospective, international, multicentric PTLD-1 trials. Transplantation. 2016;100(7S):S260–S261.
48. Howell M, Yeo R, Tong A, et al. Adverse events of maintenance immunosuppression following kidney transplantation reported in randomized controlled trials: a systematic review. Transplantation. 2016;100(7S):S162.
49. Sautenet B, Craig J, Evangelidis N, et al. Scope and heterogeneity of outcomes reported in Cochrane systematic reviews of kidney transplantation. Transplantation. 2016;100(7S):S265.
50. Shuker N, Shuker L, van Rosmalen J, et al. A high intra-patient variability in tacrolimus exposure is associated with poor long-term outcome of kidney transplantation. Transplantation. 2016;100(7S):S163.
51. O'Connell P. Presidential Address. Talk presented at: 26th International Congress of The Transplantation Society; August 18-23, 2016; Hong Kong, HK. https://tts.guide/lectures/view/657. Accessed September 21, 2016.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.