Program
Overall Objectives
- Review and evaluate the latest clinical and basic science advances in transplantation science, medicine and surgery.
- Investigate recent developments in transplant biology, immunology and organ preservation.
- Examine the broad but critical issues in transplantation, including social and policy issues.
Saturday, May 1, 2010
Pre-Meeting Symposia
Essential Immunology for the Clinician
Key Players of The Immune Response
Educational Objectives
The participant will:
- Gain knowledge regarding the fundamental biology of organ graft rejection
- Be able to identify the three key signals required for T cell activiation and their manipulation in vivo
- Understand how B cells become activated and differentiated and identify the major pathways that are disrupted with current off label therapies utilized in transplantation
- Become familiar with the concept of immune system regulation and its impact in patients
Effector Mechanisms of Allograft Injury
Educational Objectives
The participant will:
- Learn to detect the potential targets of epithelial cell injury and how they may be manipulated to improve organ function
- Learn to recognize certain pathways involved in innate immune injury and how they may be manipulated in a clinical context
- Be able to recognize the key features leading to graft fibrosis and failure and how to minimize its impact in the clinical setting
Clinical Applications of Basic Immunology–Part I
Educational Objectives
The participant will:
- Understand the available therapeutic choices and how these choices may affect the immune response of the recipient in individual practices
- Be able to differentiate between new therapies that act on non-T-cell pathways of graft injury
- Become familiar with the tissue typing report and recognize the utility of the histocompatibility laboratory to facilitate clinical decision-making
- Learn how transplant tolerance works and how it may be achieved in the clinic
Clinical Applications of Basic Immunology–Part II
Learning Objectives
The participant will:
- Be able to distinguish the most frequently used methods for assessing gene expression and their potential impact for clinical practice
- Recognize potential assays for immune monitoring in organ allograft recipients
- Understand the immunologic response to viral infection after solid organ transplant and the potentially detrimental effects of viral infection on organ function
Transplantation Immunology for Basic Scientists
Update on the Role of Costimulatory Pathways in Transplantation Rejection and Tolerance
Learning Objectives
The participant will:
- Acquire knowledge regarding new research developments and concepts about the role of costimulatory pathways in transplantation
- Understand the emerging role of co-inhibitory or "negative" costimulatory molecules and their relevance and potential exploitation in preventing transplantation rejection and induction of tolerance
- Be able to compare costimulatory requirements of naïve versus memory T cells and understand the implications of each
- Understand the role of costimulatory signals in Thelper differentiation into Th1/Th2/Th17 and Tregs and its relevance to transplantation
Role of B Cells, Antibodies and Complement in Alloimmunity
Learning Objectives
The participant will:
- Improve competence through greater knowledge of B cell biology and the emerging role of antibodies in tolerance
- Be able to recognize the role of antibodies and complement in allograft injury
- Be able to evaluate recent novel treatments of humoral rejection and their applications within personal practices
Cellular and Humoral Innate Immune Response to Alloantigens
Learning Objectives
The participant will be able to:
- Define the role of innate immunity in alloresponses and its role in modulating adaptive immunity
- Interpret NK cells and assess their role in rejection and tolerance
- Assess recent advances in the understanding of modulatory functions of DCs and its potential for tolerance induction
- Describe the new emerging role of complements and their role in the the interplay between innate and adaptive immune responses to allografts
Advances in Stem Cell Biology
Learning Objectives
The participant will be able to:
- Analyze pluripotent cells and their therapeutic potentials in research and clinical settings
- Describe the functions of mesenchymal stem cells
- Evaluate the potential of hematopoietic stem cells for treatment of immune-mediated diseases
- Increase knowledge regarding stem cells by reviewing the ongoing clinical trials in transplantation
Updates in Clinical Transplantation
Learning Objectives
The participant will:
- Be able to assess current immunosuppression and determine if it is suboptimal due to drug toxicities and which may result in an inability to prevent chronic reject of allografts
- Learn new therapies and strategies to improve outcomes in patients at risk for antibody-mediated rejection
Pediatric Transplantation
Learning Objectives
The participant will be able to:
- Discuss the complications and side effects related to steroid use in children and understand the rationale behind steroid avoidance and steroid-free immunosuppression protocols
- Identify recent advances in immunosuppression that allow for steroid-free maintenance immunosuppression protocols
- Understand the role of immunosuppression in pediatric liver transplantation
- Delineate the rationale behind the practice of donation after cardiac death (DCD) and the relevant ethical and legal considerations
- Understand the medical considerations around the process leading to the practice of donation after cardiac death
- Discuss the current outcomes of transplantation utilizing organs procured from DCD donors
Strategies to Expand the Liver Donor Pool
Learning Objectives
The participant will be able to:
- Identify the utility of technical variant liver grafts
- Identify strategies for use of expanded criteria allografts in order to expand the donor pool
- Discuss ethical issues surrounding use of these grafts
Hot Topics in Infectious Disease: An Audience Response Program
Learning Objectives
The participant will:
- Gain knowledge of important clinical syndromes in transplant infectious disease and their impact on patient outcomes
- Improve performance through enhanced approaches to vaccination and travel advice for transplant recipients
- Understand alternative therapies for difficult-to-treat infections and be able to apply them in a clinical setting.
Sunday, May 2, 2010
Sunrise Symposia
Th17 and Alloimmunity: An Update
Learning Objectives
The participant will be able to:
- Discuss the biology of Th17
- Apply data from recent studies about the role of Th17 in transplantation rejection/prevention of tolerance in experimental models and humans
- Describe the concept of "plasticity"of Tregs/Th17 and its implication for transplantation
Losing Memory: The Ageing Immune Response
Learning Objectives
The participant will:
- Learn that increasing recipient age is linked to an improved graft survival and understand the impact on patient outcomes
- Recognize how donor age modifies the immune response
- Improve performance through greater knowledge of how the modified immune response in ageing population may require an adjusted immunosuppression
- Understand the link between telomere dysfunction, age, hematopoetic stem cells and disease and their impact on patient outcomes
Impact of the Lung Allocation Score and Ex Vivo Donor Lung Management
Learning Objectives
The participant will:
- Be able to identify candidates most likely to succeed with lung transplantation and identify relative and absolute contraindications to transplantation
- Understand new lung allocation system and its impact on pre and posttransplant outcomes
- Understand the role for ex vivo lung management in improving early posttransplant outcomes
Controversies in Management of HBV after Liver Transplantation
Learning Objectives
The participant will:
- Recognize how Hepatitis B impacts on graft function and long term outcomes following liver transplantation
- Understand the potential management strategies for Hepatitis B following liver transplantation
- Recognize how treatment strategies may have unexpected adverse outcomes and how to weigh the risks and benefits of such treatments
Donor-Derived Infections: What Should We Be Doing?
Learning Objectives
The participant will be able to:
- Describe the limitations of current screening practices
- Discuss the controversies surrounding nucleic acid testing of organ donors
- Evaluate the risk of viral transmission from organs within personal practices
Drug Monitoring in Distinct Patient Populations
Learning Objectives
The participant will be able to:
- Outline effective dosing strategies based on therapeutic drug monitoring for transplant recipients of different ethnic groups
- Identify the potential for genomic assays to identify individuals with altered pharmacokinetic profiles and to monitor and manage these individuals more effectively
- Explain the safe and appropriate roles for immunsuppressive management in individuals with HIV infections
Moving Towards National Kidney Paired Donation: Challenges and Controversies
Learning Objectives
The participant will:
- Gain knowledge on the current state of the UNOS national KPD pilot and the UNOS national KPD program, with particular focus on recruitment to date, match rates, matching algorithms used, and logistical challenges inherent in orchestrating kidney exchange on a national level
- Understand the logistical challenges associated with collaborating in multi-center KPD programs, but also the benefits, including those to the patient, the staff, the physicians, the institution, and the community
- Be able to differentiate between the various options for allowing, or allocating, non-directed donors to participate in KPD programs, particularly those of regional or national size, with particular focus on forward and reverse chain directions, ending chains in the list versus bridge donors, risks of donor dropout, chain breaks, and regional and racial disparities in terms of non-directed donor, live donor and KPD participants
Midday Symposia
11:00 am – 12:30 pm
Learning From the "Near Miss:" Case Reviews of Living Donors with Complex Complications
Learning Objectives
The participant will:
- Gain knowledge about the prevalence and severity of near-catastrophic complications in living liver donors
- Be able to discuss risk of near-catastrophic complications with potential living liver donors
- Learn to identify and manage a significant vascular complication in a living liver donor
- Be able to develop and implement strategies to prevent a significant vascular complication in living liver donors
- Learn to identify and manage a significant biliary complication in a living liver donor
- Be able to develop and implement strategies to prevent a significant biliary complication in living liver donors
- Learn to identify and manage a significant anesthetic complication in a living liver donor
- Be able to develop and implement strategies to prevent a significant anesthetic complication in living liver donors
Revisiting Old Friends: Management of Current Immunosuppression – Audience Response Session
Learning Objectives
:The participant will:
- Recognize how Alemtuzumab induction protocols impact patient outcomes
- Become familiar with side-effects associated with Alemtuzumab use and how to manage them in personal practices
- Be able to distinguish between the risks and benefits of steroid withdrawal and learn strategies for patient management base on patient outcomes in steroid withdrawal trials
- Be able to assess the risk and benefits associated with mTOR inhibitors
The Promise of Stem Cells
Learning Objectives
The participant will:
- Gain knowledge of the fundamental biology of hematopoietic stem cells.
- Learn how researchers use stem cells to make islets
- Understand the potential of iPSC for transplantation and impact on time on the waiting list for transplant candidates.
Danger and the Allograft Response
Learning Objectives
The participant will:
- Understand the components of the innate immune response and their interactions with the adaptive immune response in organ transplantation
- Recognize the molecular targets elicited during an innate immune response and their relevance to transplantation
- Recognize the many roles complement may play in mediating organ graft injury
- Be able to examine how Toll Like Receptor activation may lead to allograft injury
- Be able to discuss how heat shock proteins mediate innate immune responses
Featured Symposium: Antibody-Mediated Rejection in Heart and Lung Transplantation
Learning Objectives
The participant will be able to:
- Define and describe the mechanisms that lead to production of alloantibodies in thoracic transplantation candidates and recipients
- Describe the risk factors for AMR, pathogenesis of AMR and diagnostic approaches that establish AMR
- Recognize the presentation, and treatment approaches to AMR in patients with heart transplantation
Featured Symposium: Implementing Vascularized Composite Allografts(VCA): A National Dialogue
Learning Objectives
The participant will:
- Recognize and be able to describe the current status of the government oversight of vascularized composite grafts
- Be able to summarize specificities of donor procurement and allocation as they relate to vascularized composite grafts compared with solid organ transplantation
- Be able to evaluate the pitfalls and challenges facing the clinical/broad implementation of VCA
Allied Health Symposium I: Waiting for Transplant: Maintaining Patient Readiness
Learning Objectives
The participant will be able to:
- Discuss the "health" of current wait list management in the United States (active vs. medically inactive ratio)
- Describe the widening gap of supply and demand and the effect on waitlist times
- Discuss pathways to develop a "transplantable waitlist"
- Discuss management of the "inactive list"
- Describe cutting edge processes to capably identify those patients most likely to be called are transplant ready
- Discuss novel strategies of maintaining a patient’s medical suitability for transplant
- Describe allocation strategies that improve predictably in transplanting patients
- Discuss adjusting the focus of management of the inactive and active patient wait list
- Identifying the incompatible donor/recipient
- Discuss the benefits and risk of donors and recipients
- Discuss the consent process and the exchange agreement
- Describe strategies to optimize channels of communication between centers
- Describe the highly sensitized patient
- Discuss the effect of induction therapy on patient survival
- Identify protocols for the highly HLA sensitized patient
- Describe therapy differences for those awaiting living-donor and deceased donor transplantation
Transplantation in Depth: Towards Tolerance in Transplantation: Who are the New Players?
Learning Objectives
The participant will:
- Understand novel mechanisms of tolerance induction in solid organ transplantation
- Be able to describe the function of plasmacytoid dendritic cells and how they may elicit pro-tolerogenic responses
- Be able to discuss how natural killer cells may impact the alloimmune response and may mediate tolerance
- Recognize how lymphatic structure impacts on tolerance induction and maintenance.
- Understand the role of complement in mediating tolerance induction
- Be able to evaluation new strategies to mediate tolerance in human recipients of solid organ transplants
Monday, May 3, 2010
Sunrise Symposia
7:00 am – 8:15 am
Emerging Role of Tregs in Allograft Rejection and Tolerance
Learning Objectives
The participant will:
- Be able to describe new concepts as to how Tregs suppress immune responses
- Gain knowledge as to the role of mastergene Foxp3 in generation and function of Tregs and the implications to patients
- Learn various strategies and challenges to exploit Tregs for therapeutic purposes and improve patient outcomes
Life after Immunosuppressive Drugs: The Transplant Physician and the Tolerant Patient
Learning Objectives
The participant will:
- Be able to identify suitable patients for IS withdrawal in LTx
- Recognize the recent advances and the need for further study of human transplantation tolerance
- Improve performance by developing strategies to partner with the patient to develop manageable clinical tolerance protocols
Update on Hepatopulmonary Syndrome and Portopulmonary Hypertension
Learning Objective
The participant will:
- Learn the causes of HPS and PPHTN and how to identify it in clinical practice
- Be able to recognize the natural progression of disease of HPS and PPHTN and its impact on patients
- Be able to identify the mechanism of action of HPS and PPHTN therapies
- Be able to explain the cause, expected course of disease progression, and therapeutic options, including liver transplantation, to patients with HPS or PPHtn
Banff 2009: New Concepts and Directions in Kidney Biopsy Interpretation and their Clinical Impact
Learning Objectives
The participant will:
- Recognize the new schema has changed to improve clinical diagnosis and be able to have more meaningful dialogue with the transplant pathologist at their center
- Recognize the potential of genome transcriptomics as an adjunct to phenotype as described by histopathology, be familiar with basic methodological terminology, recognize the current challenges with implementing this new adjunctive diagnostic tool into routine practice
- Recognize key features in donor allograft biopsies that are associated with poor transplant outcome, understand the potential utility of molecular methods in predicting transplant outcomes, and recognize the clinical utility of time 0 biopsy in patient outcome and management
Ethical Dilemmas: Exploring the Boundaries of Risk for Transplant Recipients and Programs
Learning Objectives
The participant will:
- Recognize the often disparate forces at play in a transplant center when trying to chart a course of action. The participant will be able to identify potential conflicts between the interests of individual patients, and the interests of the transplant center
- Understand the risks associated with the use of marginal organs in comparison to other risks we ask patients to take and in relation to other risks of everyday life. The participant will be able to distinguish between perceived and actual risk in the context of comparative risk assessment for providing evidence-based informed consent to recipients for organs from varied classifications of deceased donors
- Align informed consent processes according to patient information needs and timing preferences, improve upon patient and clinician education about high risk donor organs, and articulate patients’ attitudes about informed consent and high risk organs
- Possess a framework for understanding the scope and limits of professional ethical duties toward potential or actual transplant tourists, and comprehend the implications of these duties for the policies of transplant centers and regulatory bodies
Cardiovascular Considerations in Solid Organ Transplantation
Learning Objectives
The participant will be able to:
- Define the role of various screening test in quantification of cardiovascular risk before solid-organ transplantation and identify approaches to reduce perioperative risk of adverse cardiovascular events
- Identify the cardiovascular effects of everolimus and sirolimus in a solid organ transplant recipient
- Describe the approaches that decrease the risk of cardiovascular events after kidney and liver transplantation
Strategies for Successful Transplantation in the Complex Pediatric Candidate
Goals and Objectives
The participant will:
- Recognize the options for prevention of recurrent FSGS, the implications of this disease in the setting of living versus deceased donor kidney transplantation, how to diagnose FSGS recurrence, the use of apheresis in the perioperative period and rituximab to prevent recurrence, and immunsuppression options in the setting of FSGS
- Understand the diagnosis of and options for prevention of recurrent atypical HUS
- Be able to evaluate the options for transplanting the pediatric patient with thrombophilia, including pre-transplant screening and anticoagulation options
Midday Symposia
11:00 am – 12:30 am
Transplant Jeopardy: Essential Infectious Disease
Learning Objectives
The participant will:
- Gain essential knowledge for transplant professionals regarding the complexities of transplant infectious disease
- Delineate the various controversies regarding HIV in transplantation
- Understand the biology of hepatitis C and cytomegalovirus in transplant recipients and how it impacts patient outcomes
Treatment of Hepatitis C in Liver Transplant Candidates and Recipients
Learning Objectives
The participant will be able to:
- Appropriately select liver transplant candidates for interferon therapy
- Identify and manage the potential side-effects of therapy
- Discuss goals of interferon therapy with liver transplant candidates and recipients
- Appropriately select liver liver transplant recipients for interferon therapy
- Identify and manage the potential side-effects of therapy
- Evaluate new therapies for treatment of recurrent hepatitis C and their appropriateness for transplant candidates and recipients
- Capitalize of the efficacy of novel therapies to improve patient outcomes
- Identify and manage potential side effects, particularly in the liver transplant recipient population
Ischemia Reperfusion
Learning Objectives
The participant will:
- Understand the known molecular mechanisms of IRI and identify promising areas for therapeutic intervention
- Be able to asses the contributions of the inante and adaptive immune systems to ischemia reperfusion injury and repair processes
- Be able to compare and contrast current and emerging diagnostic tools for IRI
Incompatible Kidney Transplantation: A Long-Term Solution?
Learning Objectives
The participant will:
- Incorporate the long-term implications of desensitization of live donor kidney transplants across HLA barriers using plasmapheresis, with particular focus on clinical and histologic outcomes, and understand the changing role of splenectomy, comparison of outcomes to compatible transplants, and intention-to-treat comparison of outcomes with the "next best" option of waiting for a better kidney
- Recognize the long-term implications of crossing blood type barriers using antigen-specific immunoadsorption
- Understand the long-term implications of deceased donor kidney transplantation for broadly sensitized patients using high-dose intravenous immune globulin, including histologic outcomes as well as the role of rituximab
Featured Symposium: Pancreas Transplantation: Current Controversies
Learning Objectives
The participant will:
- Become familiar with the current evidence supporting pancreas transplantation for the treatment of Type 1 diabetes and strategies for implementation in personal practices
- Be able to address the question of the long term benefits associated compared with living donor kidney transplants.
Transplantation In Depth: Calcineurin Inhibitors: Love ‘em or Leave ‘em?
Learning Objectives
The participant will:
- Be able to discuss the etiology and mechanisms of calcineurin inhibitor toxicity including insights from rodent models and human clinical studies
- Recognize the current morphologic criteria of CNI toxicity and its impact on patient care
- Be able to compare the differences in both efficacy and side effect profile of CNIs
- Understand the potential for CNI avoidance and what agents may be valuable to replace them in clinical practice
- Be able to discuss and describe the syndrome of CNI nephrotoxicity and its clinical relevance in solid organ transplantation
Tuesday, May 4, 2010
Sunrise Symposia
7:00 am – 8:15 am
Clinical Trials of Regulatory T Cells
Learning Objectives
The participant will:
- Learn the safety and clinical outcome of regulatory T cells for GVHD after bone marrow transplantation compared to the safety and clinical outcome of Tr1 regulatory T cells for GVHD after bone marrow transplantation
- Understand the safety and clinical outcome of double negative regulatory T cells for GVL
Innovative Potential Solutions to Reduce Racial Disparities in Kidney Transplantation
Learning Objectives
The participant will be able to:
- Identify patient and healthcare system barriers limiting pursuit of transplant in dialysis patients; explain the effectiveness of a dialysis center educational program, explore transplant; and describe effective strategies for partnering with CMS and dialysis centers to provide effective transplant-related education to dialysis providers and patients
- Judge the effectiveness ofcommunity-based strategies for addressing racial and economic disparities in kidney disease and transplantation
- Develop and implement home-based strategies for reducing racial disparities in live donor kidney transplantation
Long-Term View of Pediatric Liver Transplantation
Learning Objectives
The participant will:
- Develop strategies to describe and discuss the typical long-term medical status of a pediatric liver transplant recipient to health professionals, patients, and parents
- Understand the spectrum of expected findings for long-term allografts to facilitate decisions regarding patient management in general and immunosuppression adjustments in specific
- Assess options for engaging in the typical long-term psychosocial status of a pediatric liver transplant recipient and his/her family to health professionals, patients, and parents
Lack of Innovation in Donor Management: Where is the Science and What are the Obstacles?
Learning Objectives
The participant will
- Understand the approaches and challenges related to donor interventional strategies for reducing or preventing ischemia-reperfusion injury.
- Be able to assess a variety of approaches that could be used in donor interventions
Posttransplant Glomerular Diseases
Learning Objectives
The participant will be able to:
- Describe clinical factors that increase the risk of recurrent glomerular disease after kidney transplantation
- Assess the pathogenesis of transplant glomerulopathy and the role of anti-donor antibodies
- Evaluate the incidence and natural history of posttransplant glomerular disease caused by hepatitis C
Transplantation: Essentials of Financing and Governance
Learning Objectives
The participant will be able to:
- Identify the role of HRSA, UNOS and CMS in the oversight of transplantation.
- Articulate the history of and current day practices related to the monitoring of transplant programs
- Identify the risks associated with program non-compliance with the metrics of each governing organization
- Demonstrate how basic business principles have direct application to the throughput of transplantation.
- Identify the on-line resources available to assess patient throughput and market comparison.
- Identify the on-line resources to monitor quality indicators/compliance metrics.
- Develop a model that can be used for ongoing evaluation of any transplant program
- Demonstrate the down stream effect created by transplant patients and the impact it has across multiple services (orthopaedics, cardiology, obstetrics, dermatology, pulmonary medicine, etc.) over many years
Controversies in Transplantation: Can a Regulated System for Living Donor Incentives Work?
Learning Objectives
The participant will:
- Understand and be able to evaluate international models that incorporate incentives to encourage donation from live kidney donors
- Be able to evaluate the issues in developing a test regulated market incorporating incentives in living donor kidney transplantation in the US and the arguments in favor of and against such a program
- Be able to extrapolate the potential international consequences of a regulated market in the US
Allied Health Symposium II: Health Care Reform: Erosion or Empowerment
Learning Objectives
The participant will be able to:
- Discuss the human right to access care versus the responsibility of health care as a commodity
- Describe the viability a high acuity, low volume, high cost transplant program faring in the social health care reform environment
- Describe how the current health care system does not provide equal access to care andhow the current system of health insurance restricts access based on race, ethnicity, and economic status
- Define "high" patient risk profiles discuss assumptions about the cost effectiveness of high risk patient selection
Wednesday, May 5, 2010
Sunrise Symposia
The Evolving Role of Biological Therapies in Transplant Immunosuppression
Learning Objectives
The participant will:
- Recognize some of the basic mechanisms and names of agents being tested for transplantation or in the pre-clinical pipeline and their role in patient care.
- Understand the basic biology behind clinical costimulatory blockade and understand the current clinical trials information
- Recognize the risks associated with these agents and understand the complexity in bringing new agents to the clinical setting
Xenotransplantation: Advances and Challenges
Learning Objectives
The participant will:
- Gain an understanding of new therapies for xenografts and be able to discuss the importance of non-gal epitopes
- Understand pathways of endothelial activation and discuss advances made in pre-clinical islet transplants
Liver Allocation and Distribution: Reshuffling the Deck Chairs
Learning Objectives
The participant will be able to:
- Discuss the current liver allocation system as well as alternative distribution systems and their potential impact.
- Distinguish the allocation for HCC patients
- Evaluate allocation according to net survival benefit
Tuberculosis Control in Transplantation
Learning Objectives
The participant will
- Be able to judge the risk of tuberculosis before and after transplantation with respect to immunosuppression and pathogen prevalence
- Be familiar with the traditional and novel assays to diagnose latent tuberculosis infection including limitations, advantages of either approach in immunocompromised patients
- Compare the advantages and disadvantages of the use of either approach in clinical practice
- Learn state of the art strategies for the treatment of latent and active tuberculosis in the setting of transplantation