This is the first IPTA newsletter of 2023, but my last one as the President of IPTA. Serving as your president for the last two years has been an enriching experience and a privilege, and for this, I am very grateful to each one of you. Together we have addressed significant challenges mostly caused by the COVID-19 pandemic that resulted in us postponing the IPTA 2021 Congress in Prague twice. This meeting was eventually changed to a virtual meeting and was a tour de force effort. The Congress was a smashing success, thanks to Mignon McCulloch, the IPTA Executive Council team, and the TTS staff.
The 12th Congress of IPTA is around the corner, and we are looking forward to meeting with you in Austin at the end of March. The meeting will take place March 25th -28th at the Hyatt Regency nestled on the shores of beautiful Lady Bird Lake. Thank you to the Chair of the Scientific Advisory Committee, Srinath Chinnakotla, the Co-Chairs Katherine Twombley, and Klara Posfay-Barbe, as well as the rest of the planning committee for their diligent efforts to ensure that the program provides an informative and engaging educational activity with world renowned experts. We also look forward to presenting the IPTA Society and Scientific awards.
There will be social activities during the congress. Certainly, don’t miss the IPTA Social Networking Event on Sunday, March 26 | 19:00-22:00 at the Chateau Bellevue Castle where we will eat, drink wine and dance - and bring all your friends and wear your cowgirl/cowboy outfit! This exclusive IPTA extravaganza networking event will showcase the great Southern hospitality for which Austin is known. And, if you have time, I encourage you to extend your stay to explore all that the city of Austin offers such as art galleries, museums and outdoor sports activities, as well as live music, amazing restaurants and of course, the typical Texas rodeo! If you have not registered, there is still time to do so on the IPTA 2023 Congress website. Remember, the registration will include IPTA membership for one year.
As the term draws to a close, one finds moments to reflect on my involvement with IPTA over the years. Becoming a transplant surgeon for children was something I never expected. Soon after I arrived in Pittsburgh, my mentor Tom Starzl asked me to take care of the pediatric patients, because as he put it: “You can be pretty good at it”! From that moment on, I began a journey which has enriched my life enormously. The field of liver transplantation began with children suffering from a fatal disease, biliary atresia, and they became the first ‘human experiments’ for liver transplants. The evolution of the field has occurred at a blinding speed, but pediatric patients still face big challenges. In poor or mid-resourced countries, organ transplantation may not be available for children. Even in well-resourced countries, like the USA, children are at a disadvantage in organ allocation schemes. Many immunosuppressive medications we use within our pediatric practice have not had proper clinical trials in children. These are just a couple of examples, among many others, why children with organ failure or after transplant belong to a vulnerable population. Thus, we need to support IPTA.
Advocacy, resolving ethical issues, creating educational guidelines for treatment of organ failure and post-transplantation, and developing tools to help children transition to adults are some of the initiatives where IPTA will have the biggest impact worldwide. Many of these goals can be accomplished through Outreach efforts. I am proud to being able to raise funds to support such outreach activities. Furthermore, IPTA is the only multidisciplinary organization dedicated to multiorgan transplantation with members that represent all the specialties involved in the care of these patients, including the allied health personnel who play a key role often providing the link between physicians, patients and their families.
Finally, I am humbled and honored to have served as your President for the last two years. I could not have done the work without the immense help I receive from the TTS staff, in particular Katie Tait, Isabel Stengler, and Catherin Parker, as well as the IPTA Executive Committee and the IPTA Council. I am delighted to pass the torch to our incoming President Lars Pape, from whom we can expect great things during his tenure.
Carlos O. Esquivel
IPTA President, 2021-2023
New ToR and Leadership Model -
The AHNP committee finalized their terms of reference in 2022. The new ToR emphasizes diversity of representation across geography and professions and sets out clear membership terms. Additionally, the ToR established a new process for committee leadership onboarding that will start following the 2023 Congress. Going forward an incoming co-chair will overlap their tenure with an existing co-chair, instead of both starting and leaving their two year term at the same time. The chair stepping down will remain part of the committee’s leadership as a non-voting member for the next year.
The ANHP committee partnered with the Society Pediatric Liver Transplantation (SPLIT) to host three webinars throughout 2022. The successful webinars were moderated by AHNP member Hannah Lee, NP in Heart Failure and Transplantation, at Columbia, NY. If you missed one, don’t forget to check them out here:
Member Spotlight -
AHNP were pleased to spotlight IPTA member Denise Alloway, Social Worker, this year. Check out her profile and encourage social workers in your programs to learn more about IPTA and to join the AHNP community!CLICK HERE TO VIEW THE BIO OF DENISE ALLOWAY
A message from the IPTA Publication Committee especially for young researchers presenting orals, mini orals, or abstracts at the next 2023 IPTA Congress -
IPTA promotes involvement of young researchers who work in places where publication is not considered a priority in the scientific community. For this purpose, a peer-mentoring program has been developed. Hereby, young researchers can access research projects improving their publication yield. There are four levels of mentoring, with increasing participation of the mentor from level 1 to 4, sharing authorship if applicable. At level four, virtual and/or face-to-face help is contemplated as a "visiting professor." The four levels are the following:
Don’t miss this opportunity of being mentored by those experienced researchers in the pediatric transplant community. Moreover, if you are part of an emergent pediatric transplant program, from a low or low-middle income country, it is important for you to know that a new type of article has been included in “Pediatric Transplantation”: Global Forum articles, coordinated and supervised by Dr. Burkhard Toenshoff. These articles would address the shortage of pediatric transplant data from low resource settings. Authors may describe the transplant processes (deceased and/or living donor), patient characteristics, donor profiles, and clinical outcomes of a single center, region, or country. The authors are at liberty to discuss the barriers to transplantation encountered, issues in setting up a new pediatric transplant program, and propose strategies to overcome these challenges, including opportunities for advocacy from the global pediatric transplant community.
Again, don’t miss this train. The support is there. Just get started.
The mission of the IPTA Outreach Committee is to facilitate access for children with end-stage organ failure to safe, ethical, and high-quality solid organ transplantation worldwide, particularly in less medically developed areas. Outreach Committee tools to achieve this mission include the Outreach Program for support of individual centers as well as developing Outreach projects with a broader scope.
The aim of the Outreach Program is to contribute to new pediatric transplant center development, but also to help existing centers seeking to expand their activity, or improve quality of transplant services. Currently, four projects are being supported through the OC program: Bangalore, India (sponsoring center: Dallas, Texas - kidney transplantation); Ibadan, Nigeria (Calgary, Alberta - kidney transplantation); Lviv, Ukraine (Brussels, Belgium - liver transplantation); and, Santander, Colombia (Toronto, Canada - cardiac transplantation).
Applications will soon open for the 2023 IPTA Outreach Program. Please keep a look out for news in the coming months.
The Outreach Committee has also been working on several projects deployed during the 2021-2023 term, including:
Kidney-transplanted Adolescents-Nonadherence and Graft Outcomes During the Transition Phase: A Nationwide Analysis, 2000-2020
Kindem IA, Bjerre A, Hammarstrøm C, Naper C, Midtvedt K, Åsberg A
Transplantation 2022 Dec 8:TP.0000000000004431. doi: 10.1097/TP.0000000000004431. Epub ahead of print. PMID: 36476728.
CLICK HERE TO VIEW ONLINE ARTICLE
Although adolescent and transition period remains the most vulnerable time for kidney graft dysfunction; medical literature exploring the cause for this is scarce, conflicting and often inadequate. Medication non-adherence (non-initiation, non-implementation, and non-persistence) continues to be the major suspect and can lead to an increased risk of rejections, reduced graft function, development of de novo donor-specific antibodies (dnDSAs), and in the worst case, graft loss. In this pan Norwegian registry study (comparing 371 individuals transplanted <26 years of age with 1459 transplanted between the age 26 to 50 years) medication non-adherence has been re-confirmed as the main cause of graft loss during the transition phase and accounted for 58% of the cases, versus 12% in the 26–50-y group, p<0.001. This got reflected in compromised 5 year graft survival in the adolescent group (89%; 95% confidence interval, 85%-92% versus 94%; 95% confidence interval 92%-95% respectively, p=0.01). The majority of the adverse events occurred shortly after transfer to the adult department, that is, 81% of the graft losses, 77% of the developed dnDSAs, and 60% of the acute rejections. Despite the limitations of retrospective design and dependence on case notes for diagnosis of adherence the strength of the study was its utilization of the robust Norwegian registry with almost 100% coverage and continuous information about outcomes during the transition period. Early last decade both International Pediatric Nephrology Association and International Society of Nephrology published comprehensive transition guidelines but this article by Kindem et al should be a reality check for all transplant physicians involved with pediatric kidney transplantation. Linking 58% of graft loss to non-adherence in this age group even in a resource replete set up like Norway underscores the large amount of work which still needs to be done in transition care and the need for according high priority to this topic.
International Pediatric Transplant Association
740 Notre-Dame Ouest
Montréal, QC, H3C 3X6