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Research

The pages below give an outline of the research being undertaken by the kidney units at Guys and St Thomas’ NHS Foundation Trust and King’s College Hospital Foundation Trust.


Translating research into improving health and well being

Research at Guy's and St Thomas'

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A number of research projects are searching for more effective ways to match kidney donors and recipients.

 

Organisation of Clinical Research

King's Health Partners is the name of our Academic Health Sciences Centre and this includes King’s College London (KCL, the University), and the hospitals: Guy’s and St Thomas’ (GSTT), King’s College (KCH) and the Maudsley (SLAM).

The doctors and research teams are usually employed by either the university or the hospital but often actually work in both. Within KCL is the MRC Centre for Transplantation headed by Professor Sacks and within GSTT is the Biomedical Research Centre (BRC) headed by Professor Lord, both of which provide infrastructure and resources for kidney research.

As one of the biggest kidney and pancreas transplant centres in the UK, naturally quite a lot of our research energy is focused on this area but we are also very active in other areas of nephrology. 

We have a fast growing clinical research programme in keeping with our aim to be at the forefront of treatment for kidney disease and transplantation. A selection of our current projects is listed below:

 

 Nephrology and Dialysis:

  • Dr Paramit Chowdhury is the local contact for a national study to assess whether high doses of intravenous iron can benefite haemodialysis patients (PIVOTAL).
  • Dr Joe Chilcot and Dr Joanna Hudson from the Institute of Psychiatry, Psychology and Neuroscience together with Dr Amy Carroll and Dr David Game in the renal unit have been looking at the effect of psychological interventions on the wellbeing of dialysis patients (iDiD: improving distress in dialysis). This study has recently completed and was published in several psychological journals. 
  • Dr Game is the principal investigator for the Rare Disease Register (RaDaR) at GSTT. This incorporates a database of rare and some not-so-rare kidney diseases which facilitates translational and epidemiological research into rare diseases through a comprehensive clinical database. Over 2017 Guy's renal unit has become the number one recruiter into RaDaR from over 70 reanl units in the UK.
  • Dr Michael Robson together with Dr Narayan Karunanithy in interventional radiology are leading a multi-centre study on how different radiology techniques can salvage dialysis fistulas that have narrowed (PAVE).
  • Dr Robson is studying mechanisms of kidney injury in inflammatory kidney diseases and is also the principal investigator for the SIMPLIFIED trial, along with co-investigator Theo Kassimatis, which is investigating the benefits of vitamin D in dialysis patients.
  • Dr Nicola Kumar is the prinicpal investigator for the H4RT trial, comparing haemodialysis to haemodialfiltration.
  • Linda Tarm, principal renal dietitian is looking at behaviour change and adherence to low phosphate diets in haemodialysis patients.

 

Transplantation:

  • Professor Tony Dorling is leading a study to identify patients whose kidney transplants may be at risk of failing, in order to optimize their medication and help their transplants last longer (OuTSMART). He has recently completed a study in ways to treat chronic rejection in transplant patients (RituxiCAN-C4). 
  • Dr Rachel Hilton, Professor Giovanna Lombardi and Dr David Game, assisted by Dr Maria Hernandez-Fuentes, are leading an international study to use cell therapy to protect newly transplanted patients from rejection (The ONE Study). The study is now closed to recruitment and the data are being analysed. A final study report will be published towards the end of 2018.
  • Dr Hilton is the local investigator for a national study of quality of life and other outcome measures post-transplant (ATTOM). This study has now closed to recruitment and the data are being analysed. Several important publications have already resulted. She is noe the local investigator for a study which follows on from ATTOM and focuses on quality in patients awaiting a simultaneous pancreas and kidney transplant. This study is being conducted in Cambridge, Edinburgh and Guy's. 
  • Mr Martin Drage, Professor Steve Sacks and Dr Richard Smith are looking at a new treatment for donated kidneys before transplantation in order to help them to work better and protect them from rejection (EMPIRIKAL). 
  • Professor Nizam Mamode, Mr Chris Callaghan and Professor Dorling, together with research registrar Mr Pankaj Chandak, are conducting a study using ex vivo normothermic perfusion (EVNP; perfusing organs at body temperature prior to transplantation) to precondition and therapeutically manipulate human kidneys to improve organ quality and enhance the number of transplant that we can perform.
  • Two studies aiming to improve outcomes in living donation are underway. The POWAR study is a multicentre, NIHR funded study aiming to decrease wound infections in living kidney donors ; Prof Mamode is chief investigator. He is also studying kidney injury after robotic and open transplantation, along with Mr Uwechuwe.  
  • Professor Mamode, Mr Nicos Kessaris and Mr Chandak are also using 3D printing to aid high risk transplantation.
  • Professor Nizam Mamode is leading a multi-centre study to test a new treatment to reduce the need for steroids to prevent transplant rejection (ReMIND).  He has recently completed a study on using a new drug to prevent rejection in highly sensitised transplant patients (Alexion studies) and is PI for a new study of a complement inhibitor.
  • Professor Mamode, Mr Chris Callaghan and Mr Nikolaos Karydis are looking at assessing and improving unspecified kidney donation in the UK (the BOUnD study), with help from Mr Gogainiceanu.
  • Professor Steve Sacks and his team together with Dr Paramit Chowdhury are investigating a number of genetic biomarkers that can predict the chance of developing rejection. This study should also allow more precise tailoring of immunosuppressive drug doses following transplantation and reduce the risks of under or over immunosuppressing individual patients (KALIBRE). KALIBRE has completed recruitment and the data is now being analysed for publication.  
  • Dr Bob Vaughan, Dr Olivia Shaw and colleagues in the Clinical Transplantation Laboratory have a number of ongoing research projects looking at how to better match kidney donors and recipients as well as refining the detection of anti-donor antibodies in the blood of kidney transplant recipients.
  • Professor Anthony Dorling has a long-standing interest in the role that antibodies play in transplant rejection and is looking at new ways to help understand when antibodies are harmful and when they may be helpful after transplantation. His group, along with Professor Mamode and Mr Nicos Kessaris, are about to begin a study of patients undergoing Antibody Incompatible Transplantation.
  • Dr Maria Hernandez-Fuentes, who has recently left the research team to take up a new post, together with Dr Hilton are studying ways to detect whether patients have become tolerant to their transplant over time to see if we can successfully reduce immunosuppressive drugs in selected patients (GAMBIT). The results of this study are being analysed with the aim of developing a simple blood test that can predict whether or not a transplanted patient can reduce or even stop their immunosuppressive medication.
  • Professor Graham Lord and his team are investigating the genes and proteins that are responsible for transplant rejection, heart disease and side-effects of immunosuppressive drugs in order to help design treatments to improve clinical care and survival of transplant patients.
  • Professor Graham Lord and Dr. Paramit Chowdhury are the leads for the NIHR Health Informatics Collaborative at the NIHR GSTT Biomedical Research Centre (BRC). This programme was set up to bring together expertise from five of the country’s leading NIHR BRCs, along with their associated NHS trusts and academic partners, to make NHS clinical data more readily available to researchers, clinicians and industry. The NIHR Health Informatics Collaborative focuses on five scientific themes: viral hepatology, acute coronary syndromes, ovarian cancer, renal transplantation and critical care. Access to a population of more than 20 million people across the five centres provides an extensive resource for high-quality clinical data, electronic patient records for frontline delivery and continuity of care across different NHS trusts, and the ability to assemble large patient cohorts for cross-site translational clinical studies with academic and industry partners (www.nihr.ac.uk/about/hic.htm).
  • Dr Antonia Cronin is conducting research into the ethics of kidney transplantation, with a particular interest in the use of kidneys from older deceased donors.
  • Dr David Game is the local principal investigator for a UK-wide randomised trial looking at treatments for acute antibody rejection. This trial has collaboration from every UK kidney transplant unit and it is hoped it will be the springboard for many future UK wide trials in the treatment of rejection.
  • Mr Chris Callaghan is the local PI for a KRUK-funded study comparing ex vivo normothermic perfusion (EVNP-warm perfusion) against standard cold preservation techniques to reduce the rate of delayed graft function in kidney transplants from donation after circulatory death donors. Mr Callaghan is also the local PI for another KRUK-funded study that uses EVNP to enable transplantation of kidneys that ahve been declined by all kidney transplant units in the UK (Quality Assessment Study - QAS).
  • Guy's Hospital is taking part in the national PITHIA (Pre-Implantation Trial of Histopathology In Renal Allografts) study. Thsi study examines whether the availability of a national pre-implantation kidney biopsy histopathology service changes the utilisation rate of kidneys from older deceased donors. This is funded by NIHR and the local PI is Mr Callaghan.

Links you might find interesting are listed below:

http://www.guysandstthomas.nhs.uk/research/research.aspx

http://www.kingshealthpartners.org/

http://www.guysandstthomasbrc.nihr.ac.uk/Homepage.aspx

http://transplantation.kcl.ac.uk/sections/site/about-us

http://www.kcl.ac.uk/lsm/research/divisions/timb/index.aspx

Twitter: @mrc_trans

Updated July 2018