1 Karolinska University Hospital, Stockholm, Sweden.2 Karolinska Institutet, Stockholm, Sweden.3 Alberta Transplant Applied Genomics Centre, Edmonton, Canada.4 Frankfurt University Hospital and Clinics, Frankfurt, Germany.5 University of Heidelberg, Heidelberg, Germany.6 Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.7 Red de Investigación Renal (REDinREN), Instituto Carlos III, Madrid, Spain.8 Hospital Universitari de Bellvitge, University of Barcelona, Spain.9 Service de Néphrologie-Transplantation, Hôpital Necker, Paris, France.10 University Hospitals Leuven, Leuven, Belgium.11 University Hospital of Saint-Etienne, Jean Monnet University, France.12 Western Infirmary, Glasgow, United Kingdom.13 Fundació Puigvert, Barcelona, Spain.14 University of Uppsala, Uppsala, Sweden.15 King’s College Hospital, London, United Kingdom.16 Baylor University Medical Center Dallas, Dallas, TX.17 Transplantcenter, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.18 Department of Medical and Biological Sciences, University Hospital of Udine, Udine, Italy.19 Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.20 Directorate of Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, United Kingdom.21 Department of Pathology, University of Pittsburgh, Pittsburgh, PA.22 Experimental Surgery, University Hospital Regensburg, University of Regensburg, Regensburg, Germany.23 Ahead of Time GmbH, Starnberg, Germany.24 Better Value Healthcare, Oxford, United Kingdom.
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INTRODUCTIONThis supplement reports on the proceedings of a meeting titled “Advancing Transplantation: New Questions, New Possibilities,” held at Karolinska Institutet in Stockholm, Sweden, on January 24 to 26, 2015, and sponsored by Astellas Pharma Europe Ltd. The meeting highlighted the challenges facing the transplant community and the need to respond to those challenges with new approaches, questions and possibilities. Over 450 kidney and liver transplant professionals from across Europe attended the meeting, which included talks from keynote speakers, scientific presentations, panel discussions, interactive sessions, and a poster session designed to allow delegates to exhibit their own clinic's data.Solid organ transplantation has evolved into one of the great accomplishments in clinical medicine and remains the only lifesaving treatment for many types of end-stage organ failure. Breakthroughs in transplant procedures and the development of effective immunosuppressive therapies have helped health care professionals achieve significant improvements in graft and patient survival posttransplant. This is evident across all indications, including kidney and liver transplantation.1,2 Continuing the advances in improving long-term survival remains a key challenge for transplant medicine today.2,3Maintaining a transplanted graft over time is complex. Multiple risk factors influence graft survival before, immediately after and late after transplantation. The use of marginal donors, to reduce the disparity between demand and availability of organs, has added to this complexity and brought new challenges to the field of transplantation. Recent research in the kidney and liver transplant arenas has identified a number of risk factors that contribute to poor graft survival (Figure 1). These risk factors can lead to irreversible pathological damage to the transplanted organ, with a negative impact on patient outcomes. By managing these risk factors, we aim to improve the long-term survival of transplanted grafts for our patients.Health care professionals need to continually reassess how to improve care for their patients while managing limited resources and embracing the new age of digital technology and big data. Only by understanding the risk factors that are modifiable and translating this into changes in the clinic will the perspectives for patients be further improved. “Best practice” care for transplant patients needs to be constantly updated, taking new clinical developments into consideration. Here, we present our findings with regard to the ongoing risk factors for poor long-term outcomes in kidney and liver transplantation and our suggestions for best-practice management for each of these risk factors. We also include speculations as to future innovations that have the potential to change patient management for the transplantation and wider health care communities.