March2022 2022 March Issue 02 Issue 02
www.renalinterventions.net www.renalinterventions.net
In this issue:
New directions for access grafts
page 10
page 4
THIS YEAR’S CHARING CROSS symposium (CX 2022; 26–28 April, London, UK, in-person and virtual) will feature a range of key debates in vascular access—primarily pertaining to dialysis patients, but also venturing into other, more novel uses. The CX 2022 Vascular Access Masterclass programme is set to home in on the plethora of innovations that have emerged in vascular access over the past few years, including in the creation of an access—particularly with minimally invasive techniques—but also in maintenance and salvage, with new stents, balloon devices and pharmacological products that have recently become commercially available. Leading physicians from across the globe will present late-breaking data and first-hand experiences, as well as debating and attempting to provide answers to some of the most pressing challenges in the vascular access space. Among the topics scheduled to feature prominently during the second day of the CX symposium (27 April) are vein dilation devices intended to improve arteriovenous fistula outcomes for patients, clinical research assessing drug-eluting balloons in vascular access maintenance, and the various indications that vascular access holds promise for beyond kidney disease. The Vascular Access Masterclass programme will be moderated by CX executive board members Nicholas Inston (Birmingham, UK) and Domenico Valenti (London, UK).
“We really want to tackle all the things that are at the cutting edge of clinical practice in vascular access.”
Profile:
Charmaine Lok page 12
Dialysis:
Houston, we have a problem page 18
Successful xenotransplant procedures provide hope in “unmitigated crisis” of kidney graft shortages
CX Masterclass to examine key challenges in vascular access sphere
Nicholas Inston
CALL TO ACTION: GIRFT report in focus
800,000 Americans defined as having kidney failure
600,000 of them are on dialysis
Fewer than
100,000 are waitlisted
for kidney transplantation. Of those, less than 25,000 are transplanted each year Follow Renal Interventions on all our social media platforms for the latest news, insight and events in kidney care
The global shortage of donor organs has plagued kidney care providers and their patients for years, if not decades, creating long transplant waiting lists and leaving dialysis as the only remaining treatment option—a situation that has become all the more concerning given the recent shift towards transplantation as the much-preferred approach of the two. The past few months have, however, provided a beacon of hope on this front, with a handful of groundbreaking procedures in the USA demonstrating the potential held by xenotransplantation as a means for reducing the need for human donor kidneys.
J
anuary 2022 saw researchers from the University of Alabama at Birmingham (UAB)—led by Jayme Locke (UAB, Birmingham, USA)— publish a study detailing their successful transplantation of genetically modified, clinical-grade pig kidneys into the abdomen of a brain-dead human recipient in the American Journal of Transplantation (AJT). The investigational procedure itself had been performed months prior, in the final days of September 2021, with the subsequent report then undergoing peer review. And, as per a UAB statement, it demonstrated the potential held by xenotransplantation as part of ongoing efforts to overcome global organ supply shortages. “This game-changing moment in the history of medicine represents a paradigm shift and a major milestone in the field of xenotransplantation, which is arguably the best solution to the organ shortage crisis,” said Locke. “We have bridged critical knowledge gaps and obtained the safety and feasibility data necessary to begin a clinical trial in living humans with end-stage kidney disease.” Publication of this study in AJT followed hot on the heels of another similarly momentous development in the field of xenotransplantation. On 25 September 2021, Robert Montgomery (New York University [NYU] Langone Health, New York City, USA) led a surgical team in completing a two-hour procedure whereby a genetically engineered pig kidney was grafted onto blood vessels in the upper leg, outside the abdomen, of a
deceased patient being maintained on a ventilator. “This is a transformative moment in organ transplantation,” said Montgomery. “The medical and scientific communities have been working toward xenotransplantation to sustain human life for more than 50 years. There have been many hurdles along the way, but our most recent procedure significantly moves these endeavours forward. This research provides new hope for an unlimited supply of organs, a potential gamechanger for the field of transplantation, and those now dying for want of an organ.” An “unmitigated” global crisis Speaking to Renal Interventions, Locke outlined the dire predicament facing the global kidney care community, and US kidney disease patients in particular. About 37 million Americans currently have chronic kidney disease, she details, and, while more than 800,000 of these are defined as living with kidney failure, the majority never even make it to the transplant waiting list due to severe shortages of human donor organs. Furthermore, while the need for them has soared, the number of usable, donated organs available for transplantation has not grown sufficiently over the past half century. According to data compiled by the Organ Procurement and Transplantation Network of the US Department of Health and Human Services, there were more than 90,000 people awaiting a life-saving kidney transplant in the USA as of late-2021. “Fewer than 100,000 people are wait-listed for kidney transplantation and, of those, less than 25,000 are transplanted each year,” Locke said. “The bottom line is that [this] is an unmitigated crisis. Finding an alternative source of organs is needed, and xenotransplantation offers the opportunity to have a cure available to everyone in need.” And, when asked what the future may look like for kidney disease patients if this current upward trend in xenotransplantation continues, Locke added: “Quite literally, we could actually have a supply of donor kidneys that meet this demand.” Xenotransplantation breaks new ground As director of the Comprehensive Transplant Institute in UAB’s Department of Surgery, Locke played a pivotal role in the most recent breakthrough in xenotransplantation. In their AJT study, Continued on page 2