Tx studygroup 2

Karlien, Ann, Tonny, Jaap & Nikki

• To formulate research questions

• To discuss the Tx treatment policies

Goals

Tx data

• 138 Tx in 135 children

• Outflow: (20 to adult care, 1 died, 1 pre Tx failure)

Current therapy

HD: 5

PD: 1

Tx: 107

Rejection

Rejection interstitial humoral No biopsy result

M3 12/120 (10%) 8 2 2

M6 11/113 (10%) 5 2 4

M12 3/102 (%) 2 - 1

M18 2/73 (3%) 1 - 1

M24 6/58 (10%) 5 1

Tx failure

• N=7

• M0: 4 (reasons missing) • M3: 2 (1x vasc rejection, 1xmissing) • M24: 1 (chronic rejection)

Cause of infection

CMV EBV BK Viral

other

Bac

terial

Total

M3 4 2 2 14 43 65

M6 14 3 6 14 15 52

M12 3 1 5 17 29 55

M18 2 1 8 10 7 28

M24 1 2 2 5 11 21

Research Proposals

1. Pharmacokinetics/immigrants – Karlien

2. Infections after tx

a) prevalence and association tx failure BK viremia• Policies with regard to immunosuppression/therapy

• Course

• Addition data from German centres (?)

b) prevalence CMV infection:• Influence aciclovir prophylaxisi on disease activity

• Influence donor/recipient +/-

3. MBL- polymorphism

Research Proposals• Tx + MBL deficiency:

– Favour (bacterial) infection? (de Rooij ea)– less renal damage in ischemia-reperfusion?

• Aim; association between MBL-polymorphism + MBL activity vs.– Time to reach lowest s-creatinine post tx

– Number of bacterial infections with fever

– Number of rejections

• Genotype• MASP + MBL-MASP complex d 1 tx + 1/6m

Farmacokinetiek/-genetica

• Immigranten hebben meer acute rejecties, waarom?

• (zou onafhankelijk van donorbron zijn)

• Zelfde immsupp behandeling? (RichQ)

• Zelfde geschatte therapietrouw? (RichQ)

Aanvullende Methoden

• Selectie uit onderzoek: alle patienten die TCL gebruiken, trpl > 1,5 jaar geleden

• C0 en variabiliteit tussen mnd 6 en mnd 18

• C0/relatieve dosis (mg/kg.dag)

• Farmacogenetica CYP3a4, 3a5, ABCB polymorfismes uit spijtbloed

Management policies

• In 2007 management policies

• Treatment policies dialysis accepted by NDT

• NDT: Also transplantation data?

Management policies Tx

• More detailed questionnaire of Tx management policies

• Compared to literature

• Compared to RICH-Q data

Management policies topics

• Pre Tx (screening, medication, ….)

• Tx (donor, medication, ….)

• Post Tx (medication, follow up)

Please….

• Send me the management policies Tx

• Send a copy of all your protocols concerning transplantation to n.j.schoenmaker@amc.nl

>>Publication

New Tx form

Changes?

Variables to add?

>> Please let us know a.s.a.p.