Conference Report—The Past,Current,and Future Challenges in Transplantation: A Festschrift in Honor of Professor Paul Anthony Keown

Abstract

French

Purpose:

Canadian researchers have made significant contributions to the advancement of organ transplantation globally. The COVID-19 pandemic made transparent the importance of reflecting on our accomplishments and the current and future challenges that limit the lives of our patients and to celebrate individual and collective achievement.

Sources of Information/Methods:

On October 6, 2025, thought leaders in the field of organ transplantation assembled in Vancouver to recognize the contributions of Paul Keown, a clinician scientist and translational researcher, whose work has directly impacted thousands of transplant recipients worldwide.

Key Findings:

This article summarizes the invited speaker presentations and represents a unique opportunity to celebrate the past and to focus on current challenges and future opportunities to advance the field of organ transplantation.

Keywords

kidney transplantation immunogenetics translational research precision medicine clinician scientists

Introduction

We assembled in Vancouver, Canada, on October 6, 2025, in recognition of Professor Paul Anthony Keown’s distinguished contributions to the field of organ transplantation (Image 1). The date was chosen to coincide with the start of the 2025 Canadian Society of Transplantation Annual Scientific Meeting and facilitated the attendance of invited guests from across Canada and internationally. Professor Keown’s work has greatly impacted the professional development of the numerous students he has trained, enriched and inspired the work of his many collaborators and contemporaries in Canada and internationally, and directly benefited the lives of thousands of transplant recipients.

Image 1.

Professor Paul Keown Festschrift attendees, 6 October, 2025, in Vancouver, BC.

Professor Keown helped define the field of “applied immunogenetics” by bringing the rapidly evolving understanding of the highly variable Major Histocompatibility Complex/Human Leukocyte Antigen (MHC/HLA) genes to the clinic to facilitate lifesaving kidney transplants for patients with kidney failure. By bridging understanding of genetics and immunology, his work informed personalized medicine-based approaches to the diagnosis and treatment of organ transplant rejection. Professor Keown’s biography is provided in Supplemental Appendix 1.

The invited speakers are thought leaders in the field of organ transplantation and include colleagues and contemporaries of Professor Keown and his trainees. The full academic program concluded with summary reflections from Professor Keown and is shown in Supplemental Appendix 2. Each speaker was subsequently provided a summary of their presentation. We trust readers will appreciate the thoughtful and thought-provoking contributions of the speakers, which highlight Canadian contributions to transplantation, outline contemporary challenges, and discuss bold future directions to advance the field.

Calvin R. Stiller: Creating and Supporting Elite Translational Clinical Scientists in Canada—A National Priority

Dr Stiller paid tribute to Dr Keown as an elite exemplary clinician, scientist, and translational researcher as exemplified by the following quotations:

“Paul was a visionary, few realized how fierce was his ambition and audacious his goals because his humility and kindness was what they saw—above all he cared for and respected all who came under his leadership—he was and remains today a true gentleman.”

“His ground-breaking work in precision medicine virtually eliminate antibody induced rejection as a barrier to transplantation—a clinical result which are arguably unequalled in the field.”

“Paul reminds us that when discovery clinical care and enterprise are brought together Canada can lead the world.”

Dr Stiller focused his lecture on the critical role of clinician scientists in the advancement of medical science and as the catalysts that will transform Canada as an international leader in the life sciences. He emphasized the urgent need for a deliberate strategy to ensure the training, establishment, and maturation of elite translational clinician scientists and outlined 8 essential elements needed to ensure Canadian success:

Clear and structured training pathways that support clinician scientists from early career development to academic independence, as has been done in the United Kingdom and the United States—“Clinician Scientists cannot be expected to invent their own route through the academic wilderness.”

Protected research time of 50% to 75% during the first 5 to 7 years of academic appointments—“Protected time is not a luxury, it is the oxygen of discovery—without which the flame goes out.”

Structured multidisciplinary mentorship from formally trained mentors. The success of mentorship should be judged “not just by grants and publications but by whether mentees go onto their own independent careers.”

A comprehensive skills curriculum. “Clinician scientists should be fluent in the language and methods that drive translational medicine forward” including biostatistics, clinical trial design, regulatory science, research ethics, health economics, implementation research, data science, and leadership. “We cannot allow methodological literacy to be optional . . . these are not side skills, these are as fundamental to a clinician scientist as anatomy is to a surgeon.”

Shared national infrastructure including access to data, biobanks, good manufacturing practice facilities, high-performance computing, and secure health data platforms. These core elements are beyond the reach of individual investigators—“they must be shared public utilities.”

Fair recognition: Our systems of promotion and tenure are still modeled on lone scientist first author publications, but “translational science is team science.” We must “explicitly value and reward contributions to team science, translational impact clinical implementation and commercialization.” The outcome should not only be publication in high impact journal, but whether your work changed care—“did the work move discovery to the bedside?”

Continuity and Capital: Canada needs a new model of robust bridge funding. Philanthropy, government, and private capital should come together to create “a continuum of support from training, to independence, to maturity.”

Intentional bridges between basic scientists and translational researchers. Canada must ensure discovery funding “if these roots wither the tree of translation cannot grow.” Basic and translational researchers are not competitors, and deliberate bridges must be built to ensure connectivity between them.

Dr Stiller emphasized that having strong building blocks alone is insufficient and that ensuring connectivity between translational research centers is essential. He introduced the concept of a Canadian Translational Medicine Corridor:

“a virtual dynamic functioning system with one collaborative governance, one accessible health data spine, one seamless career lattice for clinician scientists. The corridor would be digital from the ground up harnessing artificial intelligence and harmonized data to drive discovery. It would be explicitly economic as well as clinical feeding Canada’s biotech and innovation economy and through international linkages would be global in nature.”

He drew parallels between the corridor and establishment of our national railway system and emphasized alignment with Prime Minister Carney’s nation-building agenda. Academic institutions would each be supported to develop Medical and Related Science (MaRs)-like hubs. Each hub would have its individual focus, but the hubs would be inherently linked nationally and globally. With this corridor, Canada could establish itself as a “science respecting, free speech destination” that places life and health sciences as a priority for national support. It would include a national infrastructure grid, shared data, and harmonized ethics and biobanks, with embedded incubators and intellectual property support ensuring discoveries become patents, start-ups, and global therapies.

Dr Stiller emphasized the economic advantages of the corridor and stated that this was not tinkering but nation building a “translational science equivalent of a transcontinental railway” that would make Canada a leading translational medicine jurisdiction competitive with California and Cambridge. He asserted this vision would help propel Canada to be the highest-performing innovation economy among advanced nations. This corridor would require national leadership and a commitment to remove provincial and institutional barriers to harmonize resources as well as sustained funding from government, philanthropy, and industry support. “Our national resources built the first Canada; our intellectual medical risk capital and academic resources can build the next.”

Dr Stiller reviewed Dr Keown’s career contributions and highlighted some of his landmark achievements including the establishment of the multi-organ transplant center in London, Ontario, and leadership of randomized trials in cyclosporine, mycophenolate mofetil, and erythropoietin that served to unite the Canadian Transplant Community, as well as trials in animals and humans that were fundamental to understanding of type 1 diabetes as an autoimmune disease. He concluded his comments by stating that Paul Keown reminds us that when discovery, clinical care, and enterprise are brought together, Canada can lead the world. He emphasized the need for an audacious, unrelenting commitment to link our intellectual and health assets “to plant science on the summit of our ambitions”; if we do this, Canada will “set the pace” in global race of translational medicine and ensure that “Paul’s story will not be the exception but will serve as a model for a dynamic Canadian tradition of transformational excellence.”

James H. Lan: The Past, Present, and Future of the B.C. Provincial Immunology Laboratory

Dr Lan succeeded Paul Keown as Medical Director of the provincial immunology laboratory and discussed the evolution and future of immune risk assessment in kidney transplantation.¹ Dr Lan highlighted the limitations of clinical variables and calculated Panel Reactive Antibody (cPRA) to assess patient immunological risk. He shared data on the use of molecular matching to differentiate rejection risk in patients treated with rapid corticosteroid cessation in the real-world setting as well as a reanalysis of the pivotal rapid corticosteroid withdrawal randomized trial published by Woodle and colleagues.² Dr Lan reviewed major advances under Dr Keown’s leadership—the implementation of precision medicine and molecular matching (epitope- and T-cell-based algorithms) to stratify immune risk and guide personalized immunosuppression. Dr Lan described the laboratory transition to rapid, real-time sequencing technology in Vancouver, which enables timely, high-resolution donor and recipient matching within an expedited 4-hour time frame to allow more precise selection of antibody induction and maintenance immunosuppressive regimens. Dr Lan then addressed the use of molecular matching in organ allocation and the potential concern that the use of molecular matching techniques might exacerbate disparities in access to transplantation among ethnic minority groups. He presented data and simulations showing that improved donor and recipient molecular matching would likely not disadvantage patients from ethnic minority groups. Dr Lan concluded with heartfelt personal reflections on the importance of Dr Keown’s mentorship that started during his clinical training and continues today—“Paul is one of the most generous persons I have ever known.”

Anthony M. Jevnikar: Reflections on Predictions in Translational Transplantation Research

Dr Jevnikar opened with collegial comments of his first interactions with Paul Keown in London, Ontario, remembering him as a “rock star” who played guitar, organ (keyboards), and, of course, “solid organs.” Dr Jevnikar opened with the reflection that predictions are seldom accurate and those who submit them to the public risk embarrassment, as they can be overly optimistic or overly pessimistic. However, transplantation lends itself well to predictions given the current convergence of technologies in biotechnology, imaging, artificial intelligence (AI), and engineering. Predictions are particularly intriguing in the area of the changing face of transplant indications and curing of the original diseases that lead to organ failure. Patients are more likely to want their disease cured rather than be transplanted with a new organ. Also, there can be much speculation on the future of AI, organ repair and creation, xenotransplantation, organ preservation, and immune tolerance. It is obvious even now that AI will shape much of what is coming in transplantation including defining our research aims, directing research funding, and even changing staff levels. Also, predictions are likely becoming even more accurate with AI unless, of course, AI presents misinformation to us due to “alignment faking,” and we fail to recognize it. A framework for ethics is also urgently required. Although there is convergence of technologies that will lead to options for those with damaged organs, this will not generate a “one-fits-all” solution, as, in some cases, organ repair will be more important than providing discrete structures or even whole organs. The most radical of transplant predictions is that in the less distant future, it is unlikely that we will be transplanting organs from living or deceased donors.

Philip F. Halloran: Development of Molecular Diagnostics in Organ Transplantation

Dr Phil Halloran reviewed the history of the understanding of graft rejection as the key problem in organ transplantation and the importance of molecular diagnostics in organ transplantation.^3,4 He recounted key scientific milestones, beginning with classical debates on cells vs antibody in alloimmune responses, and how T-cell-mediated rejection (an interstitial inflammatory process) and antibody-mediated rejection (a microcirculation inflammatory process) came to be distinguished clinically, histologically, and molecularly.⁵ He traced progress through landmark discoveries such as the role of the effector T-cell in T-cell-mediated rejection and the role of anti-HLA antibody and of natural killer (NK) cells in antibody-mediated rejection.^6,7 Dr Halloran explained how gene expression profiling of biopsies has redefined diagnostic categories, helping to refine the histologic classification, shifting from simplistic dichotomies to recognition of continuous gradients of rejection and injury activity, and indicating potential targets for new therapies.⁸ He presented data from his collaborative studies on potential therapies for antibody-mediated rejection and described a promising clinical trial demonstrating that felzartamab (anti-CD38) can suppress antibody-mediated rejection by targeting NK cells without significantly reducing donor-specific antibody (DSA). This confirms the central role of the NK cell and indicates a highly promising new therapeutic strategy for long-term suppression of antibody-mediated rejection, now in phase 3 trials.⁹ Dr Halloran stressed that disease classification and mechanistic understanding are essential to the development of new therapies, but that the real objective must be the translation of these discoveries into improved patient outcomes.

David N. Rush: Sub-Clinical Rejection

Dr Rush provided an overview of advances in the understanding of unsuspected rejection of the kidney with the use of renal biopsies in patients with grafts with normal function that he pioneered at the University of Manitoba.¹⁰ These biopsies, done at set times after transplant (“per protocol”), have provided evidence of the existence of “silent” (referred to now as “subclinical”) rejection, which was shown to be deleterious to the graft over the long-term. The prevalence of subclinical rejection has changed over time with the introduction of more potent immunosuppression, and this was an important factor that limited the ability to demonstrate a difference in outcomes in the multi-center Canadian study of early protocol biopsies.¹¹

Nonetheless, subclinical rejection is still an important clinical concern, and efforts are being made to find a non-invasive way (ie, without a biopsy) to diagnose it. These approaches include the study of blood genes, urinary proteins, and other approaches. Secondary analyses of the trial data revealed a potentially important effect of the renin-angiotensin system. Drugs blocking this pathway have not typically been considered as “immunosuppressive agents.” Dr Rush reviewed the basic and translational science evidence that angiotensin II (ANGII) stimulated T-lymphocytes by a calcineurin-dependent mechanism and evidence that ANGII receptor blockade reduces interferon gamma production in lymphocytes, suggesting that drugs that block the renin-angiotensin system may protect the graft while minimizing some of the toxicities of calcineurin inhibitors.^12,13 These observations informed the design of a subsequent multi-center Canadian trial that randomized in a 2 × 2 design de novo transplant recipients to low- vs standard-dose (LOW vs STD) prolonged-release tacrolimus and to angiotensin-converting enzyme inhibitors/angiotensin II receptor 1 blockers (ACEi/ARBs) vs other antihypertensive therapy.¹⁴ This study found that the combination of low tacrolimus dosing, combined with renin-angiotensin blockade, reduced progression of interstitial fibrosis and tubular atrophy relative to reduced tacrolimus exposure without renin-angiotensin system blockade. Dr Rush concluded by sharing the current immunosuppressant protocols at the University of Manitoba that include the use of renin-angiotensin blockers.

Peter Nickerson: Advancing Precision Medicine in Kidney Transplantation

Dr Nickerson discussed the integration of clinical transplantation medicine with HLA laboratory science in Canada, highlighting its strengths and ongoing role in advancing precision medicine. He acknowledged the role of Dr Keown and many Canadian clinician scientists in establishing this paradigm. He reviewed the development of molecular risk stratification—especially eplet and amino-acid mismatch analysis for HLA class II loci—to predict DSA formation and graft rejection.^15,16 Dr Nickerson presented findings from multiple cohorts (Canadian, US, European, Asian) showing that molecular mismatch scores robustly predict DSA and different rejection risks independent of traditional clinical factors.^17-20 He described how combining recipient age with molecular mismatch allows finer stratification of immune risk and informs individualized immunosuppression strategies.²¹ He also reported on clinical trial designs aimed at safely reducing immunosuppression in low- and intermediate-risk groups and emphasized tailoring medication intensity and monitoring to risk category, potentially improving outcomes and cost-effectiveness.^22,23 Dr Nickerson concluded by highlighting the need for larger studies, improved epitope analytics, and personalized post-transplant care as next steps for the field.

Edward Cole: Prospective Canadian Clinical Trials

Dr Cole reviewed many of the Canadian contributions to renal transplantation through multiple prospective clinical trials: Cal Stiller led the randomized trial of cyclosporine A vs azathioprine plus steroids, which uniquely showed improved graft survival with cyclosporine.²⁴ Phil Halloran played a leading role in the pivotal studies of mycophenolate mofetil in cyclosporine treated patients.²⁵ Paul Keown led the international development of cyclosporine microemulsion demonstrating its reduction in acute rejection episodes.²⁶ Alan MacDonald demonstrated reduced acute rejection in the sirolimus randomized trial.²⁷ Phil Halloran was also among the leaders of the Symphony study that showed that low-dose tacrolimus treatment was associated with the lowest acute rejection rate and best renal function.²⁸

Greg Knoll performed an individual patient meta-analysis of cyclosporine withdrawal from sirolimus-based therapy, showing improved renal function but increased acute rejection at 1 year. He also showed reduced malignancy but a higher death rate in the sirolimus arms of these studies.²⁹ Other separate studies, led by Knoll, showed no benefit of ramipril on renal outcomes, and that immunosuppression beyond 1 year in failed allografts did not reduce death or infection or prevent an increase in anti-HLA antibodies.³⁰

The groups of Kumar and Humar established optimal prophylaxis in cytomegalovirus (CMV)-mismatched recipients, as well as the benefit of both a high-dose flu vaccine and a third COVID vaccination in transplant recipients.^31-33 Jordan Feld and colleagues were among the first to demonstrate that kidneys from hepatitis C-positive donors could be safely transplanted into negative recipients with pre-emptive initiation of treatment.³⁴ Andreas Laupacis documented the improved quality of life and cost benefit in patients receiving renal transplants.³⁵ In addition to reduced rejection, Paul Keown demonstrated the cost benefit of basilixumab.³⁶

Finally, important work has highlighted no increase in hypertension in living kidney donors, regional disparities in transplant referral rates, and the prognostic benefit of DSA in the absence of panel reactive antibodies.^1,37,38

Dr Cole concluded his presentation by stating his review was necessarily incomplete. He noted that Canadian investigators have played an important role in developing and conducting clinical trials. He remarked on the many contributions of Dr Keown as a key member of the Canadian transplant community that has advanced the field of kidney transplantation globally.

Arthur J. Matas: Rapid Discontinuation of Prednisone After Kidney Transplantation

Successful non-twin kidney transplantation occurred with the development of prednisone and azathioprine immunosuppression. However, the high doses of prednisone used at that time were associated with a myriad of side effects. Subsequently, there were numerous studies of prednisone minimization—either low doses at transplant or late withdrawal, with the goal of minimizing prednisone-related side effects without decreasing recipient survival (RS) or graft survival (GS). Although there were anecdotal reports of success, randomized trials of prednisone in selected recipients were associated with increased acute rejection (AR) and decreased GS. Birkeland (2001) first reported success with prednisone avoidance (antibody, CNI, and no prednisone).³⁹ Trials of avoidance (either no prednisone or rapid discontinuation within the first week [RDP]) with antibody/cyclosporine/mycophenolate, compared with maintenance prednisone (MP), were associated with increased AR but no difference in GS. Similar trials with antibody/tacrolimus/mycophenolate, in relatively low-risk recipients (adults and children), found no difference between RDP and MP in RS or GS or in kidney function.^40-42 In some of these trials, there was also no difference between groups in AR; in all, no difference in steroid-resistant rejection. Benefits of RDP included decreased New Onset Diabetes Mellitus (NODM), lipids, hypertension, bone disease, and obesity, and in children, improved growth. Registry studies have found no difference in RS or GS between RDP and MP in “high-risk” groups (eg, African Americans, potential recurrent disease, high body mass index [BMI], older recipients, expanded criteria donor (ECD) kidneys). Although most randomized trials were <5 years, 15-year follow-up of 1 study (Woodle and colleagues) showed no difference between groups in RS or GS.² Similarly, there was no difference in 20-year RS or GS in the University of Minnesota RDP population compared to contemporaneous MP-treated controls.⁴³ The data suggest that there is no reason to use MP in the vast majority of kidney transplant recipients.

Richard N. Formica Jr: Maximizing the Use of Donated Kidneys

The non-use rate of deceased donor kidneys has increased significantly in the United States over the past 5 years. This has prompted Organ Procurement Organizations (OPOs) to allocate organs, primarily kidneys, out of sequence. The reasons for this are varied; however, a primary cause of this is the increasing complexity of donor kidneys coupled with new regulations imposed on OPOs. While allocation out of sequence may reduce kidney non-use, it violates federal law, the National Organ Transplantation Act (NOTA), which requires sequential allocation of all organs to patients on the waiting list. However, sequential allocation is inefficient for medically complex kidneys because it causes increased cold ischemic time and contributes to organ non-use.

To address this problem, Dr Formica and colleagues developed a novel rescue algorithm for deceased donor kidney transplantation that uses the non-use rate to determine a rescue trigger threshold to rapidly place donated kidneys at risk for non-use. Once triggered, allocation occurs in sequential batches, sized proportionately to the non-use rate. Using a validated organ allocation simulation program, the algorithm was evaluated using data from the Organ Procurement Transplant Network (OPTN).

Use of this algorithm reduced the non-use of kidneys across all Kidney Donor Profile Index (KDPI) strata. Because this approach uses medical criteria, donor organ characteristics, and the biological effects of increasing cold ischemic time, it is consistent with NOTA. Overall, the non-use of the recovered KDPI >0.35 kidneys decreased from 38% to as low as 19%. For all kidneys, the non-use rate reduced from 28% to 14%. Using lower thresholds and larger batch sizes resulted in progressive decreases in non-use rates of donor kidneys with KDPI >0.65. Increasing the batch size has its largest effect at higher KDPI deciles.

Deirdre Sawinski: Hepatitis C and Human Immunodeficiency Virus in Kidney Transplantation

Dr Sawinski surveyed the evolving use of kidneys from donors with infectious risk factors, focusing on hepatitis C (HCV) and human immunodeficiency virus (HIV)-positive organs. She chronicled the shift from exclusion of HCV+ organs to their widespread contemporary use, driven by advances in direct-acting antiviral therapy for HCV and robust evidence of safety in transplantation.^44,45 Dr Sawinski reviewed prospective clinical trials as well as retrospective cohort studies, potential complications, and evolving practice models for utilizing HCV-positive kidneys in transplantation, specifically addressing the advantages or prophylactic or pre-emptive therapy, insurance challenges, and cost considerations, and highlighted the need for registries or long-term follow-up data. She discussed parallel progress in HIV+ donor to HIV+ recipient transplantation initiated by a landmark study from Dr Elmi Muller and colleagues from South Africa, which has been extended by data from the United States showing similar transplant outcomes in HIV-positive recipients who received kidneys from HIV-positive and HIV-negative recipients.^46,47 Dr Sawinski highlighted the ethical and clinical challenges, short-term outcome data, and potential expansion in living donation as evolving areas of interest. Dr Sawinski concluded the presentation by emphasizing that the implementation of clinical innovation requires communicating risk-benefit decisions with clarity to our diverse patient groups, and the importance of implementation science in preserving equity in access to lifesaving transplantation.

Christopher Blosser: Transplant and Cancer—An Integrated Health Care and Research Model for Precision Medicine

Solid organ transplant recipients face more than double the risk of cancer due to immunosuppressive therapies that prevent graft rejection but predispose patients to malignancies, including skin and solid tumors as well as post-transplant lymphoproliferative disorder (PTLD). There has been no significant change in the incidence of cancer after transplantation in the past 30 years.⁴⁸

Transplant oncology bridges organ transplantation and cancer care, offering opportunities for precision medicine through collaborative research and patient-centered innovation. The multidisciplinary approach integrates oncology and transplant expertise, tailoring treatment plans to patients’ life goals. Therapeutic strategies often include advanced immunotherapies, such as immune checkpoint inhibitors (ICIs) and engineered cellular therapies. The Fred Hutchinson Cancer Center’s (FHCC) Cancer and Organ Transplant Clinic—a pioneering model—provides integrated care for patients navigating cancer and transplant challenges.

On the research frontier, efforts to understand the immune-oncologic interplay have revealed pathways for targeted interventions. Biomarkers for early cancer detection and therapies that balance oncologic control with graft integrity are emerging priorities. Dr Blosser founded the Center for Innovations in Cancer and Transplant (CICT) at the University of Washington and the FHCC in 2021 to address these unmet needs, advancing patient-centered research and fostering collaboration through registries and consortia (cancerandtransplant.org). Dr Blosser presented data showing similar levels of programmed cell death protein 1 (PD-1) receptor occupancy with different doses of an ICI. These observations led to the genesis of an ongoing trial to determine the safety and efficacy of reduced-dose ICI compared to standard-dose ICI for patients with skin cancer.

Dr Blosser concluded his lecture by emphasizing that transplant oncology strives to redefine outcomes for this vulnerable population by balancing survival, quality of life, and graft preservation. Through the intersection of clinical expertise and research innovation, the field is transforming health care and expanding possibilities for patients.

Roslyn B. Mannon: Late Allograft Failure Mechanisms and Interventions

Dr Roslyn Mannon addressed the mechanism of late allograft failure of the kidney transplant, identifying multiple unmet needs in the field including intervention and proactive management and risk assessment. While graft and patient survivals continue to improve for patients, they have noticeably improved less proportionately to the suppression of rejection. Chronic allograft injury is a term that has changed over time, with the removal of chronic allograft nephropathy (“CAN”) and more specificity to mediators of late graft injury. Dr Mannon reviewed prior preclinical studies in mouse kidney allografts, identifying the role of ongoing T-cell and contributions of antibody-mediated injury of donor MHC proteins, and outlined the challenges and limitations of anti-fibrotic therapies that do not affect the insult or the associated inflammation.⁴⁹ Large clinical cohorts such as the Decline in Kidney Allograft Function (“DEKAF”) have been informative regarding the etiologies of late injury in humans as well as the prognostic impact of donor-specific antibody and inflammation in areas of fibrosis.^50-52 The ability to detect injury to the graft prior to changes in kidney function is an unmet need to provide opportunities for earlier intervention. These include using histopathology and molecular diagnostics and leveraging machine learning for diagnostic precision.^53,54 Finally, she discussed the challenges in translating mechanistic discoveries into effective interventions and stressed the need for precision approaches, better monitoring, and targeting modifiable contributors to late graft loss.

Paul A. Keown: Closing Reflections

Dr Paul Keown offered personal reflections spanning his career, structured as a “tale of 3 cities”: Manchester, London (Ontario), and Vancouver. He recounted his formative training years, transformative moments (eg, cyclosporine trial), and the collaborative environment that enabled transplantation advancements in Canada. Paul discussed the evolution of transplantation science, from early clinical struggles to molecular medicine and genomics, and articulated 3 visionary strategies for the future: (1) integrating genome sciences and molecular matching; (2) adopting advanced therapeutics and moving toward tolerance; and (3) restructuring population-level care using technology and real-time data. His address emphasized mentorship, gratitude, Canada’s research strengths, and a call for ongoing innovation, collaboration, and patient-centered care.

Supplemental Material

sj-docx-1-cjk-10.1177_20543581261434082 – Supplemental material for Conference Report—The Past, Current, and Future Challenges in Transplantation: A Festschrift in Honor of Professor Paul Anthony Keown

Supplemental material, sj-docx-1-cjk-10.1177_20543581261434082 for Conference Report—The Past, Current, and Future Challenges in Transplantation: A Festschrift in Honor of Professor Paul Anthony Keown by John Gill, Calvin Stiller, James Lan, Anthony Jevnikar, Philip F. Halloran, David Rush, Peter Nickerson, Edward Cole, Arthur J. Matas, Richard Formica, Deirdre Sawinski, Christopher D. Blosser, Roslyn B. Mannon and Paul A. Keown in Canadian Journal of Kidney Health and Disease

Supplemental Material

sj-docx-2-cjk-10.1177_20543581261434082 – Supplemental material for Conference Report—The Past, Current, and Future Challenges in Transplantation: A Festschrift in Honor of Professor Paul Anthony Keown

Supplemental material, sj-docx-2-cjk-10.1177_20543581261434082 for Conference Report—The Past, Current, and Future Challenges in Transplantation: A Festschrift in Honor of Professor Paul Anthony Keown by John Gill, Calvin Stiller, James Lan, Anthony Jevnikar, Philip F. Halloran, David Rush, Peter Nickerson, Edward Cole, Arthur J. Matas, Richard Formica, Deirdre Sawinski, Christopher D. Blosser, Roslyn B. Mannon and Paul A. Keown in Canadian Journal of Kidney Health and Disease

Footnotes

Acknowledgements

The authors wish to acknowledge the Canadian Society of Transplantation for their logistical support in organizing this meeting and the administrative support of Sari Nobell, Karen Sherwood, and Angela Ogniben. Karen Sherwood also provided editorial support (conceptualization, writing—original draft preparation, and writing—review & editing).

ORCID iD

John Gill

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The meeting was funded by Vancouver Transplant Nephrologists, Astellas Canada, and Knight Pharmaceuticals.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

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