TRANSPLANT TRIAL WATCH.

To keep the transplantation community informed about recently published level 1 evidence in organ transplantation ESOT (https://esot.org/) and the Centre for Evidence in Transplantation (www.transplantevidence.com) have developed the Transplant Trial Watch. The Transplant Trial Watch is a monthly overview of 10 new randomized controlled trials (RCTs) and systematic reviews. This page of Transplant International offers commentaries on methodological issues and clinical implications on two articles of particular interest from the CET Transplant Trial Watch monthly selection. For all high quality evidence in solid organ transplantation, visit the Transplant Library: www.transplantlibrary.com.

Transplant Trial Watch.

To keep the transplantation community informed about recently published level 1 evidence in organ transplantation ESOT (https://esot.org/) and the Centre for Evidence in Transplantation have developed the Transplant Trial Watch (www.transplantevidence.com). The Transplant Trial Watch is a monthly overview of 10 new randomized controlled trials (RCTs) and systematic reviews. This page of Transplant International offers commentaries on methodological issues and clinical implications on two articles of particular interest from the CET Transplant Trial Watch monthly selection. For all high quality evidence in solid organ transplantation, visit the Transplant Library: www.transplantlibrary.com.

Noninvasive biomarkers in monitoring kidney allograft health.

PURPOSE OF REVIEW: A key aspect of posttransplant management is to identify and treat graft injury before it becomes irreversible. The gold-standard for detection is histology, but biopsy is uncomfortable for the patient and carries a risk of complications. Detection of changes at a molecular level may preempt histological injury, and thereby identify injury earlier. RECENT FINDINGS: Indicators of immune system activation, such as candidate chemokines CXCL9 and CXCL10, and by-products of neutrophil activity, have been related to acute rejection and early allograft function. Transcriptomic studies of multiple-gene panels have identified candidate combinations that have proven very promising in risk-stratification and prediction of acute rejection, as well as diagnosis of both T-cell-mediated and antibody-mediated rejection. Serum and urine cell-free DNA is also a promising area of investigation, particularly in antibody-mediated rejection. SUMMARY: Noninvasive, rapid, and accurate tests for risk-prediction and diagnosis in renal transplant allografts are urgently required. The ideal candidate is one that can be measured in either urine or blood, is cheap, and is both sensitive and specific for the condition of interest. Numerous strategies have been proposed, with varying degrees of clinical and preclinical success. A few that meet the essential criteria have been evaluated; a few have made it as far as clinical testing.

Full-wafer in-situ fabrication and packaging of microfluidic flow cytometer with photo-patternable adhesive polymers.

Integration of microelectronics with microfluidics enables sophisticated lab-on-a-chip devices for sensing and actuation. In this paper, we investigate a novel method for in-situ microfluidics fabrication and packaging on wafer level. Two novel photo-patternable adhesive polymers were tested and compared, PA-S500H and DXL-009. The microfluidics fabrication method employs photo lithographical patterning of spin coated polymer films of PA or DXL and direct bonding of formed microfluidics to a top glass cover using die-to-wafer level bonding. These new adhesive materials remove the need for additional gluing layers. With this approach, we fabricated disposable microfluidic flow cytometers and evaluated the performance of those materials in the context of this application. DXL-009 exhibits lower autofluorescence compared to PA-S500H which improves detection sensitivity of fluorescently stained cells. Results obtained from the cytotoxicity test reveals that both materials are biocompatible. The functionality of these materials was demonstrated by detection of immunostained monocytes in microfluidic flow cytometers. The flexible, fully CMOS compatible fabrication process of these photo-patternable adhesive materials will simplify prototyping and mass manufacturing of sophisticated microfluidic devices with integrated microelectronics.

Safe and sustainable increases in day case emergency surgery.

UNLABELLED: Selected patients referred to emergency general surgery departments are suitable for day case emergency surgery with no overnight hospital stay. There are no well-described sustainable pathways for these expedited operations and in many hospitals patients undergo unnecessary admissions and experience long waiting times. METHODS: The authors proposed a new, sustainable, day case emergency surgery pathway which was implemented to streamline the assessment, treatment and discharge of acute surgical referrals. It requires rapid assessment of the patient by a senior clinician, and ready availability of diagnostic services and operating facilities. To assess this pathway, the authors conducted a prospective audit of general surgical referrals to a district general hospital in the UK. RESULTS: During the inclusion period 746 emergency referrals were assessed, 281 (37%) of these underwent an operation. Over a 5-month investigation period, the audit found that approximately 27% of all emergency general surgery patients requiring an operation could be managed with day case emergency surgery. This figure was maintained throughout the duration of the study. Operations included incision and drainage of abscesses, incarcerated hernia repairs and appendicectomies. The average length of stay of all surgical admissions decreased from 5 days to less than 3 days and the median time to senior review was 30 minutes. DISCUSSION: The authors have developed a pathway involving permanent members of the surgical assessment team that is sustainable over a 5-month period. The pathway has allowed rapid assessment of patients and reduced unnecessary inpatient stay in a sustainable and reproducible manner.

A National Registry Analysis of Kidney Allografts Preserved With Marshall's Solution in the United Kingdom.

BACKGROUND: The preservation fluids most commonly used for renal allograft preservation in the UK are University of Wisconsin Solution (UW, £120 per liter) and Marshall's Solution (hyperosmolar citrate, £10 per liter). The aim of this study was to compare the outcomes of deceased donor renal allografts preserved with these fluids using data from the UK national transplant registry. METHODS: Data regarding transplants performed between January 1, 2005, and December 31, 2008, was analyzed (n = 5027 kidneys). Kidneys from Donation after Brain Death (DBD) and Donation after Circulatory Death (DCD) were included. After univariate analysis, multivariate logistic and linear regression models were fitted for adult recipients of first grafts (n = 3703 kidneys). RESULTS: Marshall's solution was associated with longer cold ischemic time, older donors, kidney-only donors, donors with hypertension, and DBD (all P < 0.01). After adjusting for confounding, the choice of preservation fluid was not associated with the risk of PNF (OR, 0.82; 95% CI, 0.46-1.46; P = 0.50), DGF (OR, 1.22; 95% CI, 0.96-1.56; P = 0.11), acute rejection (OR, 0.95; 95% CI, 0.76-1.19; P = 0.63), renal function at 1 year (coefficient, 0.97; 95% CI, 0.91-1.04; P = 0.41), or graft survival (DBD HR, 0.71; 95% CI, 0.46-1.10; P = 12; DCD HR, 0.99; 95% CI, 0.58-1.73; P = 1.00). CONCLUSIONS: Marshall's solution has been used for the preservation of large numbers of kidneys in the UK. It is associated with transplant outcomes that are equivalent to those with UW solution. Thus, on the basis of this analysis and cost, a strong case can be made for the continued use of Marshall's solution as a preferred fluid for renal allograft preservation.

Hypothermic machine perfusion of kidneys retrieved from standard and high-risk donors.

Hypothermic machine perfusion (HMP) of kidneys is a long-established alternative to static cold storage and has been suggested to be a better preservation method. Today, as our deceased donor profile continues to change towards higher-risk kidneys of lower quality, we are confronted with the limits of cold storage. Interest in HMP as a preservation technique is on the rise. Furthermore, HMP also creates a window of opportunity during which to assess the viability and quality of the graft before transplantation. The technology might also provide a platform during which the graft could be actively repaired, making it particularly attractive for higher-risk kidneys. We review the current evidence on HMP in kidney transplantation and provide an outlook for the use of the technology in the years to come.