What's New, What's Hot in Solid Organ Transplantation? Summary of the American Transplant Congress 2011.

Breakthroughs in basic and clinical science in solid organ transplantation were presented at the American Transplant Congress 2011. Key areas of presentation included the pathogenesis of late allograft failure, immune regulation and tolerance, pathways in allograft injury, electing appropriate patients for transplantation, determining the best allocation schemes to maximize effective utilization, organ preservation, monitoring the alloimmune response and immunosuppressive management. In this review, we present highlights of the meeting. These presentations demonstrate the exciting promise in translating from the bench to affect patient care.

Clinical implications of advances in the basic science of liver repair and regeneration.

Recent advances in our understanding of the basic mechanisms that control liver regeneration and repair will produce the next generation of therapies for human liver disease. Insights gained from large-scale genetic analysis are producing a new framework within which to plan interventions. Identification of specific molecules that drive regeneration will increase the options for live-donor liver transplantation, and help treat patients with small-for-size syndrome or large tumors who would otherwise have inadequate residual mass after resection. In a complementary fashion, breakthroughs in the ability to manipulate various cell types to adopt the hepatocyte or cholangiocyte phenotype promise to revolutionize therapy for acute liver failure and metabolic liver disease. Finally, elucidating the complex interactions of liver cells with each other and various matrix components during the response to injury is essential for fabricating a liver replacement device. This focused review will discuss how a variety of important scientific advances are likely to impact the treatment of specific types of liver disease.

Guidance on the creation of evidence-linked guidelines for COIN.

This guidance on the creation of evidence-linked guidelines was issued to the COIN Specially Working Groups charged in 1995 with producing clinical guidelines for breast, colorectral, lung, prostate and testicular cancer and generic guidelines for the delivery of radio- and chemotherapy on behalf of the Faculty of Clinical Oncology of The Royal College of Radiologists and the Joint Council for Clinical Oncology. The first of these guidelines, for lung cancer, is published elsewhere in this issue.

The COIN workstation: state of the future art.

This is a description of the clinical workstation now under development by the Clinical Oncology Information Network (COIN) Project at the Clinical Oncology Centre, North Middlesex Hospital, London, UK. It comprises: introduction; background; technical requirements; design; what the workstation does; how the workstation does it; future plans; glossary; and 26 figures showing screen shots of the workstation in use. The following article sets out the guidance on the creation of evidence-linked guidelines issued to the COIN Specialty Working Groups charged in 1995 with producing clinical guidelines for breast, colorectal, lung, prostate and testicular cancer and generic guidelines for the delivery of radio- and chemotherapy on behalf of the Faculty of Clinical Oncology of The Royal College of Radiologists and the Joint Council for Clinical Oncology. The first of these guidelines, for lung cancer, is published elsewhere in this issue.

Acute myocardial infarction following paclitaxel administration for ovarian carcinoma.

Evidence linking paclitaxel to cardiotoxicity arose from early Phase I trials in which continuous cardiac monitoring was performed because of the high incidence of major hypersensitivity reactions. A variety of cardiac manifestations have been reported, ranging from asymptomatic sinus bradycardia to fatal myocardial infarction. The following case report describes an acute myocardial infarction occurring shortly after paclitaxel therapy.

Malignant lymphomatous polyposis: diagnosis and response to chemotherapy.

Malignant lymphomatous polyposis is a low-grade lymphoma with aggressive features. It may mimic polyposis coli on a barium enema and colonoscopic examination. An histological diagnosis may be made from a tissue biopsy taken via the colonoscope. We discuss the methods of diagnosis, the clinical behaviour and response to chemotherapy.

Audit: the use of radiotherapy for NSCLC in the UK.

A questionnaire on the management of NSCLC was sent to all clinical oncologists in the UK. Responses were received from 121 individuals with at least one representative response from each of 54 British radiotherapy units. Results were then discussed at an open meeting attended by a cross section of clinical oncologists; a synopsis of responses to the questionnaire and discussion at this meeting is contained in this report. A majority of respondents estimated treatment of NSCLC to make up 10%-25% of their work-load. Radical and palliative treatments could be clearly distinguished, and aims of treatment, selection criteria and radiotherapy schedules were consistent with recommendations in the published literature. More than 90% of treatments were with palliative rather than radical intent. Radical treatment schedules could be divided according to dose (< 50 Gy, 50-55 Gy and >55 Gy), number of fractions (< 20, 20, > 20 fractions), overall time < 4/52, 4/52, > 4/52), dose per fraction (> 2.75 Gy, 2.1-2.75 Gy, < or = 2 Gy) and target volume (tumour alone, tumour and hilar nodes, or tumour, hilar and mediastinal nodes). Divided thus, radical techniques fell into three broad groups, each of the three techniques supported by a body of literature. Choice of schedule could be related to a heterogeneous referral pattern and unresolved controversies, identified as debate on the value of treating mediastinal lymphadenopathy with high dose radiation, the value of 'subradical doses' of radiation for microscopic disease, and the relative importance of volume treated, total dose, dose per fraction and overall treatment time in achieving an optimal therapeutic ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

The Clinical Oncology Information Network (COIN) Project: background, purpose and products.

The Clinical Oncology Information Network (COIN) Project of The Royal College of Radiologists is developing evidence-based practice guidelines, clinical core data sets to audit compliance and a dedicated clinical workstation with a client-server architecture that will collect the data sets as an automatic by-product of the routine delivery of care. Guidelines for the treatment of breast, colorectal, lung and prostate cancer and for the delivery of chemotherapy and radiotherapy will be published in 1999. Version 2 of a demonstrator workstation is in use at the North Middlesex Hospital, London.

Combination chemotherapy of squamous cell carcinoma of the bronchus with cisplatinum and bleomycin followed by radiotherapy: results of a pilot study.

Thirteen patients were entered into an uncontrolled pilot study to investigate the response to, and toxicity of, a combination of cisplatinum (20 mg/m2) and bleomycin (6 mg/m2) infused daily for 5 days and repeated every 21 days up to a maximum of 4 cycles, in the treatment of squamous cell carcinoma of the bronchus. This regimen was subsequently followed by a split course of local irradiation. All patients have been followed to death. Six patients showed a partial response to chemotherapy while 7 showed no response or progressive disease. The median survival was 5 months. The median survival of the responders was 15 months and that of the nonresponders 3 months. Two patients developed the syndrome of inappropriate antidiuretic hormone secretion from which one died. The longest survivor, who died 26 months after the commencement of chemotherapy, had severe mediastinal and pulmonary fibrosis.

Evaluating living kidney donors: relationship types, psychosocial criteria, and consent processes at US transplant programs.

We conducted a survey of 132 US kidney transplant programs to examine how they evaluate and select potential living kidney donors, focusing on donor-recipient relationships, psychosocial criteria, and consent processes. There is heterogeneity in donor-recipient relationships that are considered acceptable, although most programs (70%) will not consider publicly solicited donors. Most programs (75%) require a psychosocial evaluation for all potential living donors. Most programs agree that knowledge of financial reward (90%), active substance abuse (86%), and active mental health problems (76%) are absolute contraindications to donation. However, there is greater variability in how other psychosocial issues are considered in the selection process. Consent processes are highly variable across programs: donor and recipient consent for the donor evaluation is presumed in 57% and 76% of programs, respectively. The use of 13 different informed consent elements varied from 65% (alternative donation procedures) to 86% (description of evaluation, surgery and recuperative period) of programs. Forty-three percent use a 'cooling off' period. Findings demonstrate high variability in current practice regarding acceptable donor-recipient relationships, psychosocial criteria, and consent processes. Whether greater consensus should be reached on these donor evaluation practices, especially in the context of more expansive use of living donor kidney transplantation, is discussed.