DRWF Research Manager Dr Eleanor Kennedy reports from the International Pancreas and Islet Transplantation Association Congress, in Lyon, France
Just a few days after weather experts record the all-time hottest temperature in France – a mercury-busting 45.9 C (114.6F) – and in the middle of an on-going heatwave across the country that has led to forest fires and caused train tracks to buckle, the world’s leading pancreas and islet transplant surgeons, physicians and scientists descend on Lyon in France.
The biennial International Pancreas and Islet Transplantation Association Congress kicks off with the award of the prestigious Richard Lillihei Lecture which, this year, is jointly awarded to Professors Angelika and Rainer Gruessner.
They start by defining the importance of registries in monitoring developments and outcomes in pancreas transplantation and registry roles in generating robust hypotheses for randomised clinical trials or for the performance of retrospective studies. The first international pancreas and islet transplant registry harks back to 1980, fifteen years after the first pancreas transplant procedure was carried out by Richard Lillehei, after whom this award is named. This has allowed for a very good understanding of how many procedures are carried out both in the USA where the award recipients work but also worldwide. But there is much still to do – as is so often the case with science and medicine!
Pancreas transplant outcomes need to continue to improves through the introduction of new immunosuppressive agents or protocols to minimise side effects and the introduction of molecular and genetic tests could also reduce the incidence of rejection. More pancreas transplants need to be carried out and novel pathways for personalised immunosuppressive therapy after pancreas transplantation need to be delineated.
But perhaps the biggest rallying call of the morning is for increased engagement with patients and there are many questions asked about educational efforts and media communication streams to reach out to those who are not yet aware about the possibilities of pancreas and islet cell transplantation as treatments for type 1 diabetes.
The afternoon of the first day really allows the UK to shine like the sun beating down on the Universite Catholique de Lyon where the conference is being held.
The Quality in Organ Donation (QUOD) study has been set up in the knowledge that, since organs of transplantable quality are in short supply, there is a need to study marginal donors to address the potential of these donor organs becoming suitable for transplantation without compromising the outcome. QUOD is a national biobank initiative based in Oxford and Newcastle with the aim to provide tissue samples for research projects identifying pathways of injury and repair in in donor organs. Funding from the Medical Research Council in the UK has allowed the expansion of the QUOD programme to collect samples of clinically declined whole pancreas organs for biobanking within QUOD. This money has allowed the team to perform basic characterisation of the donor tissue and to create a searchable Pancreas Pathology Atlas.
This world-leading project will provide a library of scanned immunohistochemistry slides of every pancreas obtained and a score given to each pancreas by a trained pathologist. This has allowed the development of a reproducible method to sample all anatomical regions of the pancreas and has initiated work on the deep characterisation of all collected tissue to start addressing different dimensions of disease and health.
From there, we are treated to an update on the NHS-commissioned integrated islet transplant programme in the UK. Within a few years of set up, the Joint Pancreas Allocation system was created for whole pancreas and islet cell transplantation, the latter of which involves an innovative hub and spoke model for islet isolation.
This involves eight centres across England and Scotland, three of which – Oxford, King’s College London and Edinburgh – act as isolation and transplant centres whereas the remaining five act solely as transplant centres that receive isolated islets from one of the three isolating units.
The UK’s National Institute for Health and Care Excellence (NICE) has given two primary outcome measures for islet transplantation, namely resolution of life-threatening hypoglycaemic unawareness and stabilisation of glycaemic control as measured by HbA1c. Insulin independence is not considered a primary outcome but is clearly one of immense interest both to the transplant teams and to patients alike.
Through this programme, the outcomes following routine islet transplant for the period 01 April 2010 to the 31st December 2017 are impressive:
- 81% of recipients had no severe hypoglycaemic events during the year using annual rates as a measure
- 84% witnessed a reduction in HbA1c
- 89% saw a reduction in their insulin dose
This led Professor Paul Johnston from the University of Oxford to conclude that the NHS Integrated Islet Transplant Programme is highly effective and available to all suitable patients across the UK. The close collaboration among all the centres and standardised pre- and post-transplant protocols appear to be key factors for success. And, as of April 2019, the NHS has commissioned Total Pancreatectomy and Islet Autotransplantation in four centres ensuring that the UK will continue to lead the way in these life-changing procedures.
And so Day 1 comes to a close and I wander out of the university building, blinking in the warm, evening sunshine. The streets outside the university are buzzing with delegates chatting about the day’s sessions, striking up new friendships and forging new collaborations!