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We talked to Annemarie Weissenbacher, who was a DPhil student and Clinical Research Fellow in Transplant Surgery working on normothermic kidney perfusion.

Annemarie WeissenbacherHow did you develop an interest in kidney transplantation?

I studied medicine to become a transplant surgeon. This career path has been clear to me since becoming fascinated by one of the transplant pioneers, Professor Raimund Margreiter, in my early childhood. As well as heart and lung transplants, he and his team performed the world’s first successful multivisceral transplants on an adult patient in Austria. From this time point on, transplant surgery became the most innovative and inspiring speciality for me. I literally got hooked and still am.

My interest in kidney transplantation developed mainly during the first year of my residency. It is extremely rewarding to watch the kidney produce urine immediately after you release the vascular clamps and the new organ reperfuses well. The kidney itself is an amazing organ; in addition to making urine, removing toxins and extra fluid from our blood, controlling our chemical balance, the blood pressure, keeping the bones healthy and helping producing erythrocytes, there are plenty of interactions between the kidney and our immune system. This organ becomes even more interesting as a functioning allograft after transplantation.

Surgically, the kidney transplant is quite “easy” compared to other solid organ transplants, with the interesting and more challenging part, the functional and immunological follow up starting after the operation. The combination of hands-on medicine and the all-embracing assessment around it is for me the perfect description of a truly interdisciplinary and intriguingly field of transplant medicine.

As a DPhil student of Professor Peter Friend and Professor Constantin Coussios, you are working with colleagues from OrganOx to develop a normothermic kidney perfusion device. Tell us a little about this device and the work that you are contributing to the project.

As the kidney is my favourite organ and I have always been interested in research, I feel very lucky and honoured to have the opportunity to work with two outstanding professors who have been pioneering the field of normothermic organ preservation. After starting at Oxford as a clinical research fellow in 2015, they gave me the opportunity to work on normothermic kidney perfusion as a DPhil project with the aim of establishing a normothermic kidney perfusion prototype. The objectives are: perfusing human kidneys and maintaining/improving their parenchyma quality and enabling transportable normothermic preservation of human kidneys for 24 hours. It is the very first time I have worked in such a setting and my professors have not only become my supervisors, but they have also been excellent mentors. They encourage me to develop this project, and they also make sure I develop as a person - a composite of surgical and engineering science.

The rationale of underpinning normothermic perfusion is that this mode of preservation could enable normal cellular metabolism with recovery of cellular energy status, allows repair of reversible injury, and facilitates functional organ testing before transplantation. Multiple perfusion and biochemical parameters can be measured and therefore allow valuable assessment, while the kidney is on the ex vivo perfusion circuit. These tests are not possible to be done in a cold stored organ as a functional state cannot be reached under hypothermic conditions.

Working with OrganOx engineers has opened up a complete new world for me. My contributions to the project are the clinician’s perspective of how an organ should be perfused/preserved to reach the most physiological state possible and my clinical judgment for the viability assessment of an organ. It has been a steep learning curve so far and it has been very rewarding that every single developmental stage results in a more stable perfusion setting. In my point of view, the development of this kidney perfusion device demonstrates the perfect symbiosis of engineering, transplant surgery, science and biotechnology. If you want to achieve something, you have to work on it, persevere, be persistent and believe in working as a team (#strongertogether). I think my DPhil project clearly shows that medicine can be or should be part of the STEM (science, technology, engineering and maths) family as this is often discussed.

In your position as a Clinical Research Fellow, you also have the unique opportunity to be working with Professor Susan Fuggle on the development of donor specific antibodies after combined intestinal and abdominal wall transplantation. What aspects of this work do you enjoy?

As I have a genuine interest in the field of VCA transplantation (vascularised composite allotransplantation including hand, face, uterus transplant etc.), it was the perfect opportunity to start some research in this field along with consultant transplant surgeon Dr Georgios Vrakas and Professor Susan Fuggle. Professor Fuggle is a real role model for me and has become an exceptional mentor. Because of her accomplishments, she is a great example of how successful women can become in the field of transplantation. This is something I strongly believe in: follow your path, work on your topic and let results speak for themselves. Furthermore, I was delighted to be involved in clinical work at the Oxford Transplant Centre and I have been working closely with Dr Vrakas, who is dedicated to multivisceral and VCA transplant.

About our work: Combining an abdominal wall transplant, a typical VCA, with intestinal transplantation to achieve primary abdominal closure has become a feasible procedure. The Oxford Transplant Centre is the most experienced centre performing this procedure on a regular basis and is leading the field in terms of numbers and scientific work on this topic. Besides facilitating closure, the abdominal wall can be used to monitor intestinal rejection. As the inclusion of a VCA raises the possibility of an enhanced alloimmune response, we investigated the incidence and clinical effect of de novo donor specific HLA antibodies in a cohort of patients receiving an intestinal transplant with or without a VCA. We couldn’t demonstrate any evidence that the addition of a VCA to an intestinal transplant would increase the immunological burden and would lead to a higher rate of graft impacting donor specific antibodies.

What challenges do you face in balancing the clinical and research parts of your career?

When you love what you are doing and you are passionate about your field, you enjoy being busy. On the other hand, not having challenges could be very boring and it’s absolutely true that we are not growing when things are easy, we grow when we face challenges. Apart from the spark of a challenge and quotes aside, there are times when I feel overwhelmed by trying to keep up with clinical performance, get papers written, and grant applications submitted and, at the same time, not forgetting to be prepared for the next conference presentation and to network and socialise with collaborators, leaders in the field etc. There is no recipe for how to maintain balance easily. Personally, I de-stress by performing (outdoor) sports and designing and tailoring dresses. By utilising and refreshing the skills I was taught at fashion school, I manage to find the balance and strength to focus on both, clinical practice and research.

Where do you see yourself in five years’ time?

I envisage I will be working at an academic institution of excellence and be responsible for the kidney transplant programme, and hopefully I will see excellent results from the first clinical pilot trial that will use my normothermic kidney perfusion device. And of course, planning the next five years’ goals.

You are a member of the NDS Visibility of Women Working Group. Why did you decide to join the group and why do you feel is it important to increase the visibility of women in science and medicine?

I was attracted by the name of the working group: Visibility of women in science and medicine. The aim of this working group is to develop strategies that increase the visibility of women in the NDS with the purpose of promoting and celebrating the work and achievements of female staff. I couldn’t agree more with this strategy, as I cannot identify myself with organisations who desperately want to promote women just because of their gender. As I stated previously, Professor Fuggle has been my first female mentor since I have started my medical career. She is an excellent example of how to get to the top and how to hold a very successful leadership position in the realm of research.

I would like to contribute towards increasing the visibility of women in science and medicine and herein I list some thoughts: Any institution or leader requires a team with a good gender and ethnic mix, as it is important to seek for a mixed perspective that can challenge the established practice. In medicine, we should create a diverse environment that allows both genders to flourish; as result we should expect the development of innovation and creativity that are vital for projects to move forward. To achieve this, it takes more than just bringing more women forward just because of their gender; their accomplishments should be made more visible and speak for themselves. Young women, that are attracted to medicine and science, should be encouraged to follow their dreams and with increased visibility, they will know that their work will be appreciated and respected.

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