About the Transplantation Research Initiative

In 2010, the III Institute Advisory Board identified solid organ and hematopoietic stem cell transplantation (HSCT) as a field in which strategic investment and targeted programming could improve clinical outcomes. Transplantation is the preferred treatment for end-stage organ failure and HSCT is an established therapy for many conditions, and can be a cure for certain cancers. However, challenges remain in meeting the increasing demand for organs, cells and tissues and in achieving long-term graft survival accompanied by a good quality of life for transplant recipients.

Every year, thousands of Canadians receive transplants of solid organs, stems cells and pancreatic islet cells. End-stage renal, liver, lung, heart, pancreatic and small intestine failure can be treated by organ replacement. For cancer, hematopoietic stem cell transplantation can be a cure. The most rapidly growing group of organ recipients is those over 60 years of age – a segment of the population likely to increase dramatically in the next 20 years. Renal transplants are the most common of the solid organ transplants, representing about 75% of the total. Liver transplantation has undergone tremendous innovation in technique as well as pre- and post-surgical care. As a result, the procedure has vaulted to the forefront as the treatment of choice for end-stage liver disease in Canada.1 Heart transplantation has grown to encompass both ends of the age spectrum for increasingly complex cardiac diseases, with infant transplants now recognized as having superior long-term outcomes than heart transplants performed at any other time of life. Lung transplants are now used as treatment for end-stage lung diseases such as cystic fibrosis and emphysema. Small intestine transplantation is an emerging and evolving field with the potential to improve the outcomes of children and adults with intestinal failure. Between 1999 and 2008, there were 51 such procedures performed in Canada, with half of the recipients being under 18 years of age.

With more than 4,000 Canadians on wait-lists for organ transplants, our national organ donor rate (deceased) cannot meet the demand. Canada's low deceased organ donation rate cannot be attributed to a lack of public support for organ donation, but while many people agree that they would like to donate their organs, very few actually undertake the actions necessary to do so.2 Research is needed to increase deceased donor rates and the organs retrieved per donor, and improve the safety and practice of living donation. Research is also needed to improve the quality of transplanted organs and tissues and reduce the risk of rejection. If drug toxicity could be minimized and compliance increased, transplants would last longer, avoiding the need for repeat transplants and ensuring the longest possible healthy life for each transplant recipient.

In addition to solid organ transplants, 1200-1400 hematopoietic stem cell transplants (HSCT) are performed each year in Canada, primarily for cancer therapy. Additional forms of cell therapy such as islet cell and stem cell transplantation are becoming more common. Bone marrow transplantation has become an established form of therapy for aplastic anemia, certain autoimmune disorders, bone marrow failure syndromes, immune deficiencies and dysregulation, hemaglobinopathies, and metabolic disorders and is now widely used to treat cancer, including leukemia, lymphoma and solid tumours such as neuroblastoma and brain tumours. Although the two fields share many of the same challenges with respect to graft rejection, recurrent disease, graft-versus-host disease, treatment toxicities and infection, donor quality issues in HSCT are less severe than for solid organ transplantation. The donor source for HSCT can be autologous or allogeneic and has now expanded to include umbilical cord blood. There is also an international network of registries, of which Canada is a member. Canadian Blood Services operates the "One Match Stem Cell and Marrow Network", which includes the unrelated stem cell donor registry and the nascent national cord blood bank.

There are many unanswered research questions in the field - spanning basic mechanisms of transplant injury and repair, clinical challenges, health policy and services issues, and ethics. As there are significant gaps in the current CIHR funding through the open competitions, transplantation was identified as a field where strategic investment could have a significant impact. III is dedicated to supporting research and building capacity in the field of solid organ and HSCT n with the aim of improving clinical outcomes in transplantation through innovative research programs. The long-term goal for III and partners will be to build capacity in underserved areas, create new collaborations across themes and disciplines, and address research gaps that are currently not adequately funded through the CIHR open competitions.

  1. Canadian Institute for Health Information, Treatment of End-Stage Organ Failure in Canada, 1999 to 2008—CORR 2010 Annual Report (Ottawa, Ont.: CIHI, 2010).
  2. Final Report: Views Toward Organ and Tissue Donation and Transplantation Prepared for Canadian Blood Services by Ipsos Reid, July 20, 2010 http://www.bloodservices.ca/CentreApps/Internet/UW_V502_MainEngine.nsf/resources/Releases/$file/IPSOS+Report.pdf

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