Designation
Vice-Provost (Health Sciences) and Dean
Distinguished Professor of Medicine and Immunology
Flynn Family Chair in Renal Transplantation
Institution
University of Manitoba
Qualification
Bachelor of Sciences in Medicine, Biochemistry, University of Manitoba (1986)
Medical Doctor, University of Manitoba (1986)
Internal Medicine, FRCPC, University of Manitoba (1990)
Nephrology, FRCPC, University of Manitoba (1991)
Transplant Research Fellowship, Harvard Medical School (1995)
Special field of interest
- Kidney transplant immunobiology
- HLA immunogenetics and histocompatibility
- Acute and chronic allograft rejection
Abstract
| Title: |
Optimizing Immunosuppression to Avoid Infection and Rejection |
| Body: |
Over the last 60 years immunosuppression has evolved to the point where tacrolimus (Tac) and mycophenolic acid (MPA)-based therapy are considered the standard of care to effectively control the immune response and prevent rejection. However, while prolonging graft survival
the combination of Tac/MPA can result in off-target effects [i.e., GI toxicity, renal toxicity, and infections (e.g., BK virus nephropathy)] that leads to physician-guided drug minimization and/or patient non-adherence. This in turn results in increased rates of de novo donor specific antibody and biopsy proven acute rejection. The purpose of this lecture will be to review the data the supports Tac/MPA-based immunosuppression and discuss its optimal use to navigate the requirement to provide sufficient drug therapy to control the alloimmune response while avoiding overimmunosuppression, which leads to off-target effects. |
| Title: |
HLA Molecular Mismatch - A Risk Stratification Tool to Optimize Immunosuppression |
| Body: |
Immunosuppression has escalated to the highest level tolerated to ensure minimal rates of rejection. The community then adjusts immunosuppression in a reactive manner - increasing therapy when there is rejection and decreasing immunosuppression when infection or drug toxicity arises. However, we know that recipients are a heterogenous population: our challenge is to administer the right therapy for the right transplant recipient - i.e. personalized immunosuppression. This lecture will discuss how HLA molecular mismatch can be used as a prognostic and predictive biomarker that can be employed as a tool for precision medicine in transplantation. |
| Title: |
The Negative Impact of TCMR in the Modern Era of Immunosuppression |
| Body: |
Despite improvements in immunosuppression that have resulted in low levels of clinical rejection post-transplant, there remains a relatively high prevalence of subclinical T-cell mediated rejection (TCMR) detected by surveillance biopsies (~30%). This lecture will discuss the relative impact of TCMR relative to antibody mediated rejection in terms of death censored and all cause graft loss. It will further discuss how this knowledge translates into several key unmet needs demanding novel drug development if the field is to transform current outcomes. |
