News and Announcements

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:.	NTR office has been relocated to Level 5, Menara Wisma Sejarah, 230 Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia. The new telephone and fax numbers are 03-2681 5948 and 03-2681 5949 (fax).
:.	Launching of the 1st Report of National Transplant Registry 2004 The 1st Report of National Transplant Registry was finally published. The report was launched officially by Minister of Health, Y.B. Dato’ Dr. Chua Soi Lek at Auditorium Utama, Selayang Hospital on 20th December 2005 The event was jointly organized by Malaysian Society of Transplantation, National Transplant Registry and National Transplant Resource Centre, HKL. A total of 200 participants were present to witness the launching of the report. They were mainly doctors and paramedics from various MOH hospitals, universities and private centres that are involved in transplantation services in the country. Following the launching, Dato’Dr.Zaki Morad spoke on the “Challenges in Setting up NTR”. The editor, Dr. Hooi Lai Seong, gave an introduction on the overall of the report. Then each section of the report was presented by various speakers; Blood and Marrow Transplantation by Dr. Alan Teh Kee Hean, Cornea Transplantation by Dr. Shamala Retnasabapathy, Heart & Lung Transplantation by Mr. Mohamed Ezani Md.Taib, Heart Valve Transplantation by Mr. Mohamed Ezani Md.Taib, Liver Transplantion by Dr. Tan Seok Siam, Renal Transplantation by Dr. Goh Bak Leong, Bone & Tissue Transplantion by Dr. Suzina Sheikh Ab.Hamid, and Cadaveric Organ and Tissue Donation by Dr. Lela Yasmin Mansor. The seminar ended with a note of thanks from the chair, especially to all the speakers and participants. View photos in the picture gallery.
:.	ACRM NTR is an affiliated member of the Association of Clinical Registries, Malaysia (ACRM), which was established in 2005. ACRM was conceived through the joint efforts of a variety of Health and IT professionals with an interest in the development of clinical databases and disease registers in Malaysia. For further information about ACRM, please visit http://www.acrm.org.my/
:.	XX International Congress of the Transplantation Society 5-10 September 2004 Vienna, Austria Why Vienna? This year actually marked the 50th anniversary of the first identical twin kidney transplant, which demonstrated to the world the first time that long-term function of a grafted organ in humans was possible. And Vienna, the ever enticing and glamorous cultural capital of Europe was chosen to be the host not only because of its sweet Viennese breeze that come off the outdoor café which served the appetizing and famous Sacher Cake with a mix of classical music, but Vienna was also the place where the first successful kidney transplant in dogs was carried out one hundred years ago, which marked the birth of transplant surgery. There were more than 4000 participants from around the world attending this exciting meeting. The Congress boast a robust scientific programme featuring 6 plenary sessions, 30 state of the art symposia, 483 oral presentations, and more than 1250 posters. It covered the full gamut of transplantation basic science and clinical application. The Congress highlights include: • Discussion of the ethics of live donations for liver and renal transplantation. Organ trafficking and donor coercion was the major concerns. A special early morning session was held on the second day where the report of the Amsterdam Forum on the live kidney donor was presented. Kidney transplant community met in Amsterdam from April 1-4, 2004 for this Forum. The main objective was to develop an international standard of care for the live kidney donor. The international transplant community recognizes that the use of kidneys from living donor needs to be performed in a manner that will minimize the physical, psychological, and social risk to the donor and does not jeopardize the public trust of the healthcare personnel. The donation decision should be done in an environment that enables the potential donor to decide in an autonomous manner. There were 6 consensus statements in this report (refer Transplantation vol 78, Number 4, August 27, 2004 for the full report). The Forum also recommended that transplant center should form a Donor Advocate to minimize the occurrence of “conflict of interest” and to provide a healthcare professional advocating the welfare of the potential donor. In order to minimize coercion and enhance autonomous decision-making, a “cooling off period” and assessment of donor retention of information should be routinely practice. Another important statement is Medical Judgement versus Donor Autonomy. It is stated that donor consent and autonomy is necessary, but not sufficient, to proceed to kidney donation. Medical evaluation and concurrence is essential. Donor autonomy does not overrule medical judgement and decision-making (note: in my opinion this is the most important statement in the report, GBL). Lastly this Forum also proposed the establishment of Donor Registry. • Xenotransplantation Promising and exciting results of recent efforts to transplant swine organs to primates. (Note: that is all I am going to tell you!) • Tolerance New data on tolerance by chimerism and co-stimulation blockage. Over the last decade, scientists had moved beyond the conventional co-stimulatory molecules (CD 28/CD80 and 86, CD154/CD40) and co-inhibitory molecule (CTLA4/CD80 and 86). Many new molecules which belong to the B7 and TNF receptor superfamilies, which potentially can play a pivotal role in tolerance induction were identified. Some of the new exiting molecules to remember are OX40(TNFSF4, CD134), 4-1BB(TNFSF9, CD137 and LIGHT(TNFSF14). There is an international collaboration designed to accelerate the clinical development of immune tolerance therapies (ITN). The aim of this ITN is to shift from the current immunosuppressive practice which works on the basis of blanket suppression of the immune response to a new paradigm which uses “tolerance agent”, i.e. one that can produce long-term survival of transplanted organs, without continuous therapy, without the development of chronic rejection and without evidence of immuno-incompetence. One of the approach is Chimerism which simply means persistent donor cells in recipients. The current strategies use 2 steps approach: firstly, obliterate normal immune system with immunosuppressive drugs, antibody (ATG, anti-CD2, Campath 1h) and irradiation, and secondly, provide renewable source of tolerogen (donor specific antigen e.g. blood, bone marrow, stem cells, etc). • Humoral rejection • Diagnosis of antibody-mediated rejection is dependent on a triad: circulating donor specific antibody, characteristic pathology (C4d staining), and characteristic clinical picture (acute antibody-mediated rejection, hyperacute rejection, transplant glomerulopathy). Management is usually suboptimal. Prevention is the key, and can best be achieved by identifying individual at risk and using heavier induction and maintenance immunosuppression (e.g. FK506 and MMF, anti-CD20). Other strategies include removal of antibody with pheresis, use of IVIgs. The mechanisms involved are still poorly understood. The need for further research and large scale trials to evaluate strategies to manage this condition will be one of the major developments in the next decade. • Registry Scientific presentation • There is abundance of report from various registries around the world and most of these are of highest quality scientific data. Among some of the interesting papers are: • Observation by Paul Terasaki et al that unrelated donors yield higher graft survival rates than parental donors in patients with IDDM, polycystic kidney disease and FSGS. One of the possible explanations is susceptibility to kidney damage exists in these 3 conditions is also inherited from the parent. Terasaki et al even go to the extend to recommend that unrelated donor should be preferred over parental donor in these 3 conditions. • Observation by Lentine et al (base on USRDS data) showed that recipient age, DM as cause of ESRF, history of angina and peripheral vascular disease, older donor, cadaveric donor, DGF, post-transplant DM and graft failure are independent predictors of post transplant myocardial infarction. Female, Afro-American, Hispanic and employment are associated with lower risk. Interestingly, duration of dialysis before transplant, HLA matching, CMV status, and type of maintenance immunosuppressions are not predictors for post transplant MI. • Woodward et al based on USRDS data observed that the increasing usage of tacrolimus in US in recent years do not show advantage in graft survival when compared to cyclosporin. Furthermore, in Woodward’s conclusion, he stated that given the higher cost of FK compared to CsA and the similar risk of graft failure, further studies should be conducted to define those patient groups for which FK might be cost-effective. This is most interesting as in Chapter 6 of the 11th NRR report, we observed that those who received tacrolimus or MMF had better graft survival than those on cyclosporin. And when this was adjusted for other co-variates, the advantages with FK and MMF become more apparent. I attributed this observation to MOH practice where FK and MMF are reserved for patients with higher risk of graft rejection. • New Compound • FK778 by Fujisawa is currently in Phase II trial and the results so far is promising. This will further extend Fujisawa immunosuppression armamentarium. The molecule has some similarity with MMF. One of the most important observations by the Transplantation Society in recent years is the striking differences in the transplantation activities between the developed and developing countries. Hence, the Transplantation Society is embarking on an international effort to make safe organ transplantation available worldwide. Led by Drs. Carl Groth and Jeremy Chapman, the Society has been working with WHO and other prospective partners to lay the groundwork for the Global Alliance in Transplantation (GAT). The Vienna Congress heralded a new era of globalization for the Society. This was the first meeting to establish a Global Alliance in Transplantation (GAT) with the following missions: 1. development of a world registry for all organ transplants 2. development of live donor registry 3. educational enhancement by the creation of fellowships and sister institutions 4. development of standard and guidelines for transplantation Prepared by, Goh Bak Leong
	Source: TRU	23/11/2004
:.	NTR – Cornea Transplant Workshop: Briefing on the Cornea Transplant Clinical Registry Forms Date : 20th August 2004 Time : 9.00 am – 12.15 noon Venue : Auditorium 1, HKL   The objective of having this workshop is to introduce the Cornea Transplant Notification Form and Cornea Transplant Outcome Forms to all the MOH doctors and paramedics who are involved in the Cornea Transplant services. A total of 20 doctors and 24 nurses / medical assistants attended this workshop. Dr. Shamala gave a presentation on cornea transplantation after her welcoming speech. During her presentation, she stressed on the importance of registry. She added that by collecting a comprehensive local data would improve the medical services benefited by the patients. This was followed by an introduction of NTR by Dr. Sanjay from Clinical Research Centre. The participants were later briefed on the Cornea Transplant Notification and outcome form by Dr.Shamala. After explaining the data elements on the forms, there was a hands-on training session for the group. They were asked to fill up the Notification and Outcome Form according to the case study presented. Dr.Sahimi highlighted the important points of the form to the group during the Q & A session. Dr. Goh Pik Pin ended the session by presenting the findings and outcome of the National Cataract Surgery Registry data. Overall, the workshop was successful as we received many constructive criticism suggestions from SDP to improve future notification.
	Source: TRU	7/9/2004
:.	Concurrent Workshop for Renal Transplant Nurses on 8th Scientific Meeting of the Malaysian Society of Transplantation    Date : 5th August 2004    Time : 2 pm – 6 pm    Venue : Hotel Shangri-La’s Rasa Sayang, Penang In conjunction with the 8th Scientific Meeting of the Malaysian Society of Transplantation on 5-7 August 2004, NTR organized a workshop for the renal transplant nurses. The objective of this workshop is to introduce the new Clinical Registry Forms (Renal Transplant Notification Form, Renal Transplant Outcome Form and Renal Transplant Annual Return Form). A total of 32 nurses attended the workshop, of which 25 nurses were from MOH hospitals, 3 from private medical centres and 4 from universities. This workshop was sponsored by the Malaysian Society of Transplantation (MST), National Transplant Registry (NTR) and pharmaceuticals companies ( Janssen-Cilag and Roche). Dr.Goh BL briefed all the nurses on the Clinical Registry Forms (CRF). This was followed by hands-on session for the nurses to fill in the form according to the case study presented. All the participants were very enthusiastic to do the exercise. The participants were given very informative talk on “CPG On Live Donor Workup”, “Recipient Preparation” and “Post Transplant Care” from Dr.Wong Hin Seng, Dr.Shahnaz Shah and Dr.Hooi Lai Seong respectively.
	Source: TRU	7/9/2004
:.	NTR-BMT Web Application Launching on 30 April 2004 NTR proudly launched its first web application for the Blood and Marrow Transplantation. Dato’ Dr. Zaki as co-chair for the NTR gave his welcoming speech to all the BMT doctors and nurses from various hospitals and institutions. Dr.Lim Teck Onn as head of CRC also presented the slide and titled “Disease& Treatment Registry Thru the Web, The Way Forward”. View the Slide Presentation The expert members of the BMT gave their full support to make this web application launched smoothly. Now the BMT team members who are registered in NTR as a user can access their own centre data through web. NTR wish to take this opportunity to thank all the doctors, nurses and the team members of CRC and TRU who made this launching successful. NTR wish all the BMT team members keep up their good job to support the NTR.
	Source: TRU	27/5/2004
:.	1st Governance Board meeting on 25 March 2004 NTR 1st Governance Board meeting was held in HKL. A total of 28 members attended to the meeting. They are representing from various societies which involving organ or tissue transplantation in Malaysia. Chairman of the NTR, Tan Sri Dato’Dr. Yahya Awang given a brief introduction of NTR to the members. The objectives of the meeting were to formalize the NTR Governance Board and briefed the members of the Governance Board Manual regarding the role and responsibilities as a member. The next meeting is scheduled in two months time to follow up on the outstanding issues.
	Source: TRU	26/4/2004
:.	The 1st NTR Expert Panel meeting, held from 16th- 17th January at Vistana Hotel, Kuala Lumpur has been successfully carried out. NTR expert panel consists of 6 disciplines of organ/tissue transplantation in Malaysia. They are Blood and Marrow Transplant, Heart and Lung Transplant, Liver Transplant, Renal Transplant, Cornea Transplant and Bone/Tissue Transplant. This meeting is to gather all the experts from various hospitals, institutions and universities to initiate the NTR. Committee for each respective discipline has been formed. (Please refer to the Expert Panel list) The role of the Expert Panel is : 1. To undertake Quality Control of the Clinical Registry Form and the Data Dictionary 2. To undertake Quality Control of the reported data 3. To undertake literature review in the relevant area 4. To interpret the results generated by NTR’s statistician 5. To write the section of the NTR report relevant to his or her expertise 6. To specify the data reporting producer 7. To facilitate access to source documents for the Transplant Registry Unit (TRU staffs to do the data verification All the members of the expert panel contributed their great ideas to formulate the Clinical Registry Form for each respective disciplines. The meeting has achieved its objectives. NTR sponsor meeting was carried out on the same day. The official sponsors of NTR are as below: 1. National Transplant Coordinating Committee 2. Medical Development Division, MOH 3. Malaysian Society of Transplantation 4. Clinical Research Centre, HKL. The sponsor group also nominated the names for Governance Board of the NTR. Governance Board meeting will be held on March 2004. TRU would like to take this opportunity to thank all who had kindly contributed to make NTR a reality. View the meeting photos in the picture gallery.
	Source: TRU	12/2/2004