Causes of Graft Loss over 10 Years
in CsA-Treated Patients
Recurrent Other
disease
3%
6%
Death
27%
Acute
Rejection
11%
PNF
5%
Vascular
8%
CAN
40%
Marcén R et al. Transplantation 2001; 72:5762.
Presentation techniques
Some personal advice
I. Performance
II. Manuscript
III. Slides
Presentation techniques
Some personal advice
I. Performance
II. Manuscript
III. Slides
I. Performance
• Never turn your back on the audience
• Always look at the audience
(and the laptop)
I. Performance
• Never turn your back on the audience
• Always look at the audience
(and the laptop)
• Never use the laser pointer
• Always use your slides to make your point
Causes of Graft Loss over 10 Years
in CsA-Treated Patients
Recurrent Other
disease
3%
6%
Death
27%
Acute
Rejection
11%
PNF
5%
Vascular
8%
CAN
40%
Marcén R et al. Transplantation 2001; 72:5762.
Causes of Graft Loss over 10 Years
in CsA-Treated Patients
Recurrent Other
disease
3%
6%
Death
27%
Acute
Rejection
11%
PNF
5%
Vascular
8%
CVD
CAN
40%
CNInephrotox
Marcén R et al. Transplantation 2001; 72:57-62.
Metabolic Toxicities of
Immunosuppressive Drugs
Complication
CsA
Tac
Ster
MMF
SRL
DZB/
BAS
Nephrotoxicity
+
+
-
-
-
-
Hypertension
+
+
+
-
-
-
Hyperlipidaemia
+
?
+
-
+
-
Diabetes
+
+
+
-
-
-
Haematologic toxicity
-
-
-
+
+
-
CsA = cyclosporine A; Tac = tacrolimus; Ster = corticosteroids;
SRL/EVL = sirolimus/everolimus; AZA = azathioprine
Adapted from Danovitch GM. Transplant Rev 2000; 14:65–81.
Metabolic Toxicities of
Immunosuppressive Drugs
Complication
CsA
Tac
Ster
MMF
SRL
DZB/
BAS
Nephrotoxicity
+
+
-
-
-
-
Hypertension
+
+
+
-
-
-
Hyperlipidaemia
+
?
+
-
+
-
Diabetes
+
+
+
-
-
-
Haematologic toxicity
-
-
-
+
+
-
CsA = cyclosporine A; Tac = tacrolimus; Ster = corticosteroids;
SRL/EVL = sirolimus/everolimus; AZA = azathioprine
Adapted from Danovitch GM. Transplant Rev 2000; 14:65–81.
Metabolic Toxicities of
Immunosuppressive Drugs
Complication
CsA
Tac
Ster
MMF
SRL
DZB/
BAS
Nephrotoxicity
+
+
-
-
-
-
Hypertension
+
+
+
-
-
-
Hyperlipidaemia
+
?
+
-
+
-
Diabetes
+
+
+
-
-
-
Haematologic toxicity
-
-
-
+
+
-
CsA = cyclosporine A; Tac = tacrolimus; Ster = corticosteroids;
SRL/EVL = sirolimus/everolimus; AZA = azathioprine
Adapted from Danovitch GM. Transplant Rev 2000; 14:65–81.
Metabolic Toxicities of
Immunosuppressive Drugs
Complication
CsA
Tac
Ster
MMF
SRL
DZB/
BAS
Nephrotoxicity
+
+
-
-
-
-
Hypertension
+
+
+
-
-
-
Hyperlipidaemia
+
?
+
-
+
-
Diabetes
+
+
+
-
-
-
Haematologic toxicity
-
-
-
+
+
-
CsA = cyclosporine A; Tac = tacrolimus; Ster = corticosteroids;
SRL/EVL = sirolimus/everolimus; AZA = azathioprine
Adapted from Danovitch GM. Transplant Rev 2000; 14:65–81.
Metabolic Toxicities of
Immunosuppressive Drugs
Complication
CsA
Tac
Ster
MMF
SRL
DZB/
BAS
Nephrotoxicity
+
+
-
-
-
-
Hypertension
+
+
+
-
-
-
Hyperlipidaemia
+
?
+
-
+
-
Diabetes
+
+
+
-
-
-
Haematologic toxicity
-
-
-
+
+
-
CsA = cyclosporine A; Tac = tacrolimus; Ster = corticosteroids;
SRL/EVL = sirolimus/everolimus; AZA = azathioprine
Adapted from Danovitch GM. Transplant Rev 2000; 14:65–81.
Daclizumab Reduces the Risk of
Biopsy-Proven Acute Rejection (BPAR)
•
•
Cumulative incidence of first BPAR
Pooled analysis of 12-month data from two pivotal trials
0.6
Probability
0.5
Placebo (n=268)
116 events
0.4
Daclizumab (n=267)
74 events
0.3
0.2
p = 0.0001
(stratified
logrank test)
0.1
0
0
50 100 150 200 250 300 350 400 450 500
Time after transplantation (days)
Ekberg H et al. Transplant Int 2000; 13:151–9.
Daclizumab Reduces the Risk of
Biopsy-Proven Acute Rejection (BPAR)
•
•
Cumulative incidence of first BPAR
Pooled analysis of 12-month data from two pivotal trials
0.6
Probability
0.5
Placebo (n=268)
116 events
0.4
Daclizumab (n=267)
74 events
0.3
0.2
p = 0.0001
(stratified
logrank test)
0.1
0
0
50 100 150 200 250 300 350 400 450 500
Time after transplantation (days)
Ekberg H et al. Transplant Int 2000; 13:151–9.
I. Performance
• Never turn your back on the audience
• Always look at the audience
• Never use the laser pointer
• Always use your slides to make your point
• Always time your performance at home
3 - 7 - 10 - 20 minutes sharp
I. Performance
• Never turn your back on the audience
• Always look at the audience
• Never use the laser pointer
• Always use your slides to make your point
• Always time your performance at home
• Always prepare your opening sentences
Opening sentence
You will always be nervous:
Sit in the front - look back
Prepare your opening sentence
- the rest will come by itself
Opening sentence
You will always be nervous:
Sit in the front - look back
Prepare your opening sentence
- the rest will come by itself
Mr chairman, ladies and gentlemen! (.)
For many years (.)
steroids have been the backbone (.)
of our manitenance IS (.)
Now is the time to challenge them (.)
Opening sentence
You will always be nervous:
Sit in the front - look back
Prepare your opening sentence
- the rest will come by itself
Members and guests (.)
I thank the organizers for inviting me (.)
and I thank all of you for joining us (.)
in this symposium tonight (.)
Do not repeat the title of your talk
Presentation techniques
Some personal advice
I. Performance
II. Manuscript
III. Slides
II. Manuscript
• Never read a manuscript of your talk
• Always use your slides as the manuscript
SYMPHONY Study Design
150-300 ng/ml for 3 months
100-200 ng/ml thereafter
A
Normal dose CsA
MMF
Steroids
50–100 ng/ml
Daclizumab
Low dose CsA
MMF
Steroids
3-7 ng/ml
Daclizumab
Low dose TAC
MMF
Steroids
4-8 ng/ml
Daclizumab
Low dose SRL
MMF
Steroids
B
C
D
Tx
6 mo
12 mo
Ekberg H et al Am J Transpl 2006, 6 (suppl 2), #49; 83.
Symphony study
Main inclusion criteria
♪ Renal transplant recipients 18  75 years
♪ Single-organ, kidney
♪ Living or deceased donors
Main exclusion criteria
♪ Panel reactive antibodies > 20%
♪ Cold ischaemic time > 30 hours
♪ History of malignancy
II. Manuscript
• Never read a manuscript
• Always use your slides as the manuscript
• Always describe your slide immediately
Calculated GFR
GFR (Cockcroft Gault) (ml/min)
(CockcroftGault)
100
90
p=0.0014
p<0.0001
p<0.0001
80
70
60
Normal-dose CsA
65
57
59
57
Low-dose CsA
Low-dose TAC
50
Low-dose SRL
40
30
20
10
0
12 months post-Tx
Ekberg H et al Am J Transpl 2006, 6 (suppl 2), #49; 83.
Prevalence (%)
High Prevalence of
Subclinical Rejection (SCR)
80
Prevalence SCR
60
1 mo
3 mo
1 yr
40
61 %
46 %
26 %
Acute rejection
SCR (acute)
20
SCR (borderline)
0
0.1 0.25 0.5
1
2
3
4
5
6
7
8
9
10
Time after transplantation (years)
Nankivell BJ et al. N Engl J Med 2003; 349:232633.
II. Manuscript
• Never read a manuscript
• Always use your slides as the manuscript
• Always describe your slide immediately
• Never start with comments
II. Manuscript
• Never read a manuscript
• Always use your slides as the manuscript
• Always describe your slide immediately
• Never start with comments
- let comments come last
- make one extra slide
Calculated GFR
GFR (CockcroftGault) (ml/min)
(CockcroftGault)
100
90
p=0.0014
p<0.0001
p<0.0001
80
70
60
Normal-dose CsA
65
57
59
57
Low-dose CsA
Low-dose TAC
50
Low-dose SRL
40
30
No significant
difference between
CsA and Low-CsA
20
10
0
12 months post-Tx
Ekberg H et al Am J Transpl 2006, 6 (suppl 2), #49; 83.
Prevalence (%)
High Prevalence of
Subclinical Rejection (SCR)
80
Prevalence SCR
60
1 mo
3 mo
1 yr
40
61 %
46 %
26 %
Acute rejection
SCR (acute)
20
SCR (borderline)
0
0.1 0.25 0.5
1
2
3
4
5
6
7
8
9
10
Time after transplantation (years)
Nankivell BJ et al. N Engl J Med 2003; 349:232633.
High Prevalence of
Subclinical Rejection (SCR)
Prevalence SCR
80
Prevalence (%)
High risk for AR after CNI w/d
1 mo
3 mo
1 yr
Lower risk
60
40
61 %
46 %
26 %
Acute rejection
SCR (acute)
20
SCR (borderline)
0
0.1 0.25 0.5
1
2
3
4
5
6
7
8
9
10
Time after transplantation (years)
Nankivell BJ et al. N Engl J Med 2003; 349:2326-33.
II. Manuscript
• Never read a manuscript
• Always use your slides as the manuscript
• Always describe your slide immediately
Why is this so important?
Because the audience cannot
read your slide and listen to you
at the same time
- > Competition
II. Manuscript
• Never read a manuscript
• Always use your slides as the manuscript
• Always describe your slide immediately
- > Competition
TV news + kids
TV news + Radio news
II. Manuscript
• Never read a manuscript
• Always use your slides as the manuscript
• Always describe your slide immediately
• Always send on one channel at the time
So read your text with them first
then give your comments
TV news first, then radio
Methods
• Acute rejection was defined as biopsy-
proven and treated events within 6 months
after transplantation excluding borderline
cases
Methods
• Acute Rejection
• Biopsy-proven
• Treated patients
• Within 6 mo.
• Excluding Borderline
II. Manuscript
• Never read a manuscript
• Always use your slides as the manuscript
• Always describe your slide immediately
• Send on one channel at the time
• Always use a strategy
(chapters, line of thoughts)
Strategy
This is a study that shows the benefit
•ofFirst,
saywithdrawal
what you are going to tell us
steroid
• Then tell us
… the study…
• Finally, say what you have told us
In conclusion, this study has shown
the benefit of steroid withdrawal.
Chapters
• Divide your talk into chapters
1. Background
2. Aim
3. Method
4. Results
5. Conclusion
Chapters
• Divide your talk into chapters
1. Background
- 2 slides
2. Aim
- 1 slide
3. Method
- 2 slides
4. Results
- 3 slides
5. Conclusion
- 1 slide
8 - 10 slides = 7 minutes
Presentation techniques
Some personal advice
I. Performance
II. Manuscript
III. Slides
III. Slides
• Never apologize for a busy slide
- discard it!
• Never say ’as you can see’
-it means nobody can see!
Table 2. Multivariate Risk Estimates for Endpoint of Overall Graft Loss*
Variable*
[Reference Group]
Hazard
Estimate
95% Confidence Interval
P Value
Cyclosporine
[Tacrolimus]
0.979
(0.861, 1.112)
.7428
MMF
[No antiproliferative medication]
0.794
(0.661, 0.953)
.0133
Cold Ischemia time >37 hours
[Ischemia time <12 hours]
1.451
(1.034, 2.036)
.0315
PRA level >30
[PRA level = 0]
1.337
(1.110, 1.610)
.0022
1 HLA-A mismatch
[0 HLA-A mismatches]
1.382
(1.106, 1.727)
.0044
This is actually a slide
that was used in a congress
2 HLA-A mismatches
[0 HLA-A mismatches]
1.506
(1.202, 1.887)
.0004
2 HLA-DR mismatches
[0 HLA-DR mismatches]
1.359
(1.123, 1.645)
.0017
Recipient African American
[Recipient Caucasian]
1.403
(1.212, 1.625)
<.0001
Recipient age 55-65
[Recipient age 18-35]
1.503
(1.214, 1.860)
.0002
Recipient age 65+
[Recipient age 18-35]
1.702
(1.330, 2.177)
<.0001
Primary recipient diagnosis: polycystic kidneys
[Glomerular diseases]
0.514
(0.375, 0.704)
<.0001
Primary recipient diagnosis: diabetes
[Glomerular diseases]
1.308
(1.073, 1.593)
.0078
*Table displays main variable of interest and significant (α < .05) covariates in the model.
Multivariate risk estimates for graft loss
Variable
[Reference Group]
Hazard
Estimate
95%
Confidence
Interval
P Value
CsA
[vs Tac]
0.979
(0.861, 1.112)
.7428
MMF
[vs None]
0.794
(0.661, 0.953)
.0133
CIT >37 hours
[vs <12 hours]
1.451
(1.034, 2.036)
.0315
PRA level >30
[vs PRA level = 0]
1.337
(1.110, 1.610)
.0022
1 HLA-A MM
[vs 0 HLA-A MM]
1.382
(1.106, 1.727)
.0044
2 HLA-A MM
[vs 0 HLA-A MM]
1.506
(1.202, 1.887)
.0004
2 HLA-DR MM
[vs 0 HLA-DR MM]
1.359
(1.123, 1.645)
.0017
Somebody et al ATC 2004
Multivariate risk estimates for graft loss
Variable
[Reference Group]
Hazard
Estimate
95%
Confidence
Interval
P Value
CsA
[vs Tac]
0.979
(0.861, 1.112)
.7428
MMF
[vs None]
0.794
(0.661, 0.953)
.0133
CIT >37 hours
[vs <12 hours]
1.451
(1.034, 2.036)
.0315
PRA level >30
[vs PRA level = 0]
1.337
(1.110, 1.610)
.0022
1 HLA-A MM
[vs 0 HLA-A MM]
1.382
(1.106, 1.727)
.0044
2 HLA-A MM
[vs 0 HLA-A MM]
1.506
(1.202, 1.887)
.0004
2 HLA-DR MM
[vs 0 HLA-DR MM]
1.359
(1.123, 1.645)
.0017
Somebody et al ATC 2004
Multivariate risk estimates for graft loss
Variable
[Reference Group]
Hazard
Estimate
95%
Confidence
Interval
P Value
CsA
[vs Tac]
0.979
(0.861, 1.112)
.7428
MMF
[vs None]
0.794
(0.661, 0.953)
.0133
CIT >37 hours
[vs <12 hours]
1.451
(1.034, 2.036)
.0315
PRA level >30
[vs PRA level = 0]
1.337
(1.110, 1.610)
.0022
1 HLA-A MM
[vs 0 HLA-A MM]
1.382
(1.106, 1.727)
.0044
2 HLA-A MM
[vs 0 HLA-A MM]
1.506
(1.202, 1.887)
.0004
2 HLA-DR MM
[vs 0 HLA-DR MM]
1.359
(1.123, 1.645)
.0017
Somebody et al ATC 2004
Multivariate risk estimates for graft loss
Variable
[Reference Group]
Hazard
Estimate
95%
Confidence
Interval
P Value
CsA
[vs Tac]
0.979
(0.861, 1.112)
.7428
MMF
[vs None]
0.794
(0.661, 0.953)
.0133
CIT >37 hours
[vs <12 hours]
1.451
(1.034, 2.036)
.0315
PRA level >30
[vs PRA level = 0]
1.337
(1.110, 1.610)
.0022
1 HLA-A MM
[vs 0 HLA-A MM]
1.382
(1.106, 1.727)
.0044
2 HLA-A MM
[vs 0 HLA-A MM]
1.506
(1.202, 1.887)
.0004
2 HLA-DR MM
[vs 0 HLA-DR MM]
1.359
(1.123, 1.645)
.0017
Somebody et al ATC 2004
Multivariate risk estimates for graft loss
Variable
[Reference Group]
Hazard
Estimate
95%
Confidence
Interval
P Value
CsA
[vs Tac]
0.979
(0.861, 1.112)
.7428
MMF
[vs None]
0.794
(0.661, 0.953)
.0133
CIT >37 hours
[vs <12 hours]
1.451
(1.034, 2.036)
.0315
PRA level >30
[vs PRA level = 0]
1.337
(1.110, 1.610)
.0022
1 HLA-A MM
[vs 0 HLA-A MM]
1.382
(1.106, 1.727)
.0044
2 HLA-A MM
[vs 0 HLA-A MM]
1.506
(1.202, 1.887)
.0004
2 HLA-DR MM
[vs 0 HLA-DR MM]
1.359
(1.123, 1.645)
.0017
Somebody et al ATC 2004
Creatinine levels
in posttransplant periods by CNI
Cyclosporine
Standard
Deviation
Tacrolimus
Follow-Up
Period
Mean
6 mo
1.67
1.54
1.55
0.71
1 yr
1.69
0.87
1.57
0.79
2 yr
1.73
0.78
1.63
0.82
3 yr
1.82
1.04
1.65
1.23
4 yr
1.78
0.85
1.64
0.87
5 yr
1.79
0.89
1.54
0.65
Mean
Standard
Deviation
Kaplan and Meier-Kriesche ATC 2004
Creatinine levels
in posttransplant periods by CNI
Cyclosporine
Standard
Deviation
Tacrolimus
Follow-Up
Period
Mean
6 mo
1.67
1.54
1.55
0.71
1 yr
1.69
0.87
1.57
0.79
2 yr
1.73
0.78
1.63
0.82
3 yr
1.82
1.04
1.65
1.23
4 yr
1.78
0.85
1.64
0.87
5 yr
1.79
0.89
1.54
0.65
Mean
Standard
Deviation
Kaplan and Meier-Kriesche ATC 2004
Creatinine levels
in posttransplant periods by CNI
Cyclosporine
Standard
Deviation
Tacrolimus
Follow-Up
Period
Mean
6 mo
1.67
1.54
1.55
0.71
1 yr
1.69
0.87
1.57
0.79
2 yr
1.73
0.78
1.63
0.82
3 yr
1.82
1.04
1.65
1.23
4 yr
1.78
0.85
1.64
0.87
5 yr
1.79
0.89
1.54
0.65
Mean
Standard
Deviation
Kaplan and Meier-Kriesche ATC 2004
III. Slides
• Never apologize for a busy slide
• Never say ’as you can see’
• Always use simple slides
Daclizumab Reduces the Risk of
Biopsy-Proven Acute Rejection (BPAR)
•
•
Cumulative incidence of first BPAR
Pooled analysis of 12-month data from two pivotal trials
0.6
Probability
0.5
Placebo (n=268)
116 events
0.4
Daclizumab (n=267)
74 events
0.3
0.2
p = 0.0001
(stratified
logrank test)
0.1
0
0
50 100 150 200 250 300 350 400 450 500
Time after transplantation (days)
Ekberg H et al. Transplant Int 2000; 13:151–9.
Daclizumab Prevents Acute Rejection
Pooled analysis at 12-mo. from two pivotal trials
0.6
Probability
0.5
Placebo (n=268)
0.4
Daclizumab (n=267)
0.3
0.2
p = 0.0001
0.1
0
0
50 100 150 200 250 300 350 400 450 500
Time after tx (days)
Ekberg H et al. Transplant Int 2000; 13:151–9.
III. Slides
• Never apologize for a busy slide
• Never say ’as you can see’
• Always use simple slides
• Think about key words
Conclusion
For both LD transplants and CD paired
kidneys, there was no difference in 5year graft or patient survival to be found
between primary CsA or tacrolimus
therapy. There is some evidence that
tacrolimus may be associated with
improved renal function as compared to
CsA.
Kaplan and Meier-Kriesche ATC 2004
Conclusion
• For both LD transplants and CD paired
kidneys, there was no difference in 5-year
graft or patient survival to be found between
primary CsA or tacrolimus therapy.
• There is some evidence that tacrolimus may
be associated with improved renal function
as compared to CsA.
Kaplan and Meier-Kriesche ATC 2004
III. Slides
• Never apologize for a busy slide
• Never say ’as you can see’
• Always use simple slides
• Always write like a poet - think key words
Conclusion
• For both LD transplants and CD paired
kidneys, there was no difference in 5year graft or patient survival to be found
between primary CsA or tacrolimus
therapy.
Not good
• There is some evidence that tacrolimus
may be associated with improved renal
function as compared to CsA.
Kaplan and Meier-Kriesche ATC 2004
Conclusion
For both LD transplants and DD paired kidneys (.)
there was no difference (.)
in 5-year graft or patient survival (.)
to be found between CsA or tacrolimus therapy.
Poetry
There is some evidence (.)
that tacrolimus may be associated (.)
with improved renal function as compared to CsA.
Kaplan and Meier-Kriesche ATC 2004
Conclusion
For both LD transplants and CD paired kidneys,
there was no difference
in 5-year graft or patient survival
to be found between CsA or tacrolimus therapy.
Poetry
Key words
There is some evidence
that tacrolimus may be associated
with improved renal function as compared to CsA.
Kaplan and Meier-Kriesche ATC 2004
Conclusionary Remarks: Conversion from
CNI- to MMF- Maintenance-Monotherapy
•
•
•
•
Long-term observations of patients converted from CNI-to MMF-monotherapy
confirm our previous early experience with this kind of an i.s. maintenance
therapy as an efficacious and safe treatment after cadaveric kidney
transplantation, - in particular:
Early amelioration of renal allograft function as well as early reduction of
recipients´ high atherogenic profile (=improvement of hypertension and high
blood lipids!) are not only being maintained over the years (3,4 y) after
conversion but tend to improve further later on;
There is no evidence of late subclinically-ongoing acute rejection events as
demonstrated by protocol biopsies taken 2 years after conversion in about 50 %
of the patients;
Long-term amelioration of recipients´ atherogenic profile may let assume a
reduction in morbidity and mortality due to late cerebro-cardio-vascular
accidents and, thus, may contribute to an improved life expectancy of kidneytransplanted patients. Indeed,5 years after the start of the trial,there is already a
trend for improved patient survival (= no patient death so far.)
Senior Lecturer at a Course
Conversion from CNI to
MMF Monotherapy
• MMF monotherapy was safe and
•
•
•
effective
Continued improvement of hypertension
and hyperlipidemia after CNI withdrawal
No subclinical rejection at 2 years
Improved patient survival due to less
CVD
Conversion from CNI to
MMF Monotherapy
• MMF monotherapy was safe and
•
•
•
effective
Continued improvement of hypertension
and hyperlipidemia after CNI withdrawal
No subclinical rejection at 2 years
Improved patient survival due to less
CVD
Much better - but no Poetry
No Key Words
No spacing between paragraphs
Conversion from CNI to
MMF Monotherapy
• MMF monotherapy was safe and effective
• Continued improvement of hypertension and
hyperlipidemia after CNI withdrawal
• No subclinical rejection at 2 years
• Improved patient survival due to less CVD
III. Slides
• Never apologize for a busy slide
• Never say ’as you can see’
• Always use simple slides
• Always write like a poet - think key words
• Always use animation to simplify
(not to impress)
Binet I et al ; Polyomavirus disease under new
immunosuppressive drugs
Transplantation 1999 ; 67: 928
Retrospectiv analysis of 616 Tx from 8595
No polyoma virus infection
From 9598; 5 cases with polyoma (% ??)
All had prior rejections
All switched from CsA to Tacro
4 switched from Aza to MMF
4 grafts are lost/1 has s-creat 302 mol/l
Binet I et al ; Polyomavirus disease under new
immunosuppressive drugs
Transplantation 1999 ; 67: 928
Retrospectiv analysis of 616 Tx
From 198595: No polyoma virus infection
From 199598: 5 cases with polyoma
All had prior rejections
All switched from CsA to Tacro
4 switched from Aza to MMF
4 grafts were lost
GFR and Graft Survival
tacrolimus vs CsA
 Interstitial fibrosis and CAN translates into
differences in GFR and graft survival:
GFR
12 mo.
24 mo.
CsA
53
48
Tacrolimus
66
66
0.05
0.05
P-value
Baboolal K, et al. Kidney Int 2002;61:686–96
GFR and Graft Survival
tacrolimus vs CsA
 Interstitial fibrosis and CAN translates into
differences in GFR and graft survival:
GFR
Graft survival
12 mo.
24 mo.
12 mo.
24 mo.
CsA
53
48
92%
88%
Tacrolimus
66
66
100%
96%
0.05
0.05
P-value
Baboolal K, et al. Kidney Int 2002;61:686–96
GFR and Graft Survival
tacrolimus vs CsA
 Interstitial fibrosis and CAN translates into
differences in GFR and graft survival:
GFR
Graft survival
12 mo.
24 mo.
12 mo.
24 mo.
CsA
53
48
92%
88%
Tacrolimus
66
66
100%
96%
0.05
0.05
P-value
Colours to simplify
Baboolal K, et al. Kidney Int 2002;61:686–96
A Meta-Analysis
of steroid withdrawal trials
Acute rejection (9 studies, n=1461)
%
95% CI p
_________________________________________
AR after SRW
14
1017
<0.001
_________________________________________
Graft survival (9 studies, n=1899)
RR
95%CI
_________________________________________
RR graft failure
1.38
1.081.67 <0.012
_________________________________________
Kasiske et al, JASN 2000
A Meta-Analysis of
steroid withdrawal studies
Acute Rejection (9 studies; n=1,461)
Acute Rej
%
95% CI
p
14
1017
<0.001
A Meta-Analysis of
steroid withdrawal studies
Acute Rejection (9 studies; n=1,461)
Acute Rej
%
95% CI
p
14
1017
<0.001
Graft Survival (9 studies, n=1,899)
Graft Loss
RR
95% CI
p
1.38
1.081.67
<0.012
III. Slides
• Never apologize for a busy slide
• Never say ’as you can see’
• Always use simple slides
• Always write like a poet - think key words
• Always use animation to simplify
• Always use colours to simplify
• Always use the full area of the slide
Demographics of old Organ
Donors
No. of donor grafts
female/male
donor age (y)
last s-creatinine
trauma death
local donor
CIT (h)
n=83
34/49
67  7 (5081)
1.13  0.69 (0.44.7)
24/83 (29%)
68/83 (81%)
15.0  5.9 (430)
Demographics
of Old Organ Donors
No. of donor grafts
female/male
donor age (y)
last s-creatinine
trauma death
local donor
CIT (h)
n=83
34/49
67  7 (5081)
1.13  0.69 (0.44.7)
24/83 (29%)
68/83 (81%)
15.0  5.9 (430)
Presentation techniques
Some personal advice
I. Performance
II. Manuscript
III. Slides
I. Performance
• Never turn your back on the audience
• Always look at the audience
• Never use the laser pointer
• Always use your slides to make your point
• Always time your performance at home
• Always prepare your opening sentences
I. Performance
• Never turn your back on the audience
• Always look at the audience
• Never use the laser pointer
• Always use your slides to make your point
• Always time your performance at home
• Always prepare your opening sentences
II. Manuscript
• Never read a manuscript
• Always use your slides as the manuscript
• Always describe your slide immediately
• Always send on one channel at the time
• Always use a strategy
II. Manuscript
• Never read a manuscript
• Always use your slides as the manuscript
• Always describe your slide immediately
• Always send on one channel at the time
• Always use a strategy
III. Slides
• Never apologize for a busy slide
• Never say ’as you can see’
• Always use simple slides
• Always write like a poet - think key words
• Always use animation to simplify
• Always use colours to simplify
• Always use the full area of the slide
III. Slides
• Never apologize for a busy slide
• Never say ’as you can see’
• Always use simple slides
• Always write like a poet - think key words
• Always use animation to simplify
• Always use colours to simplify
• Always use the full area of the slide
Always be yourself
- take advantage
of your personal talents
Enjoy!
Thank you
for your attention