Tx studygroup 2 Karlien, Ann, Tonny, Jaap & Nikki.

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1 Tx studygroup 2 Karlien, Ann, Tonny, Jaap & Nikki

2 To formulate research questions To discuss the Tx treatment policies Goals

3 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

4 Rejection interstitialhumoralNo biopsy result M312/120 (10%)822 M611/113 (10%)524 M123/102 (%)2-1 M182/73 (3%)1-1 M246/58 (10%)51

5 Tx failure N=7 M0: 4 (reasons missing) M3: 2 (1x vasc rejection, 1xmissing) M24: 1 (chronic rejection)

6 Cause of infection CMVEBVBKViral other Bac terial Total M3422144365 M61436 1552 M12315172955 M1821810728 M2412251121

7 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

8 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

9 Farmacokinetiek/-genetica Immigranten hebben meer acute rejecties, waarom? (zou onafhankelijk van donorbron zijn) Zelfde immsupp behandeling? (RichQ) Zelfde geschatte therapietrouw? (RichQ)

10 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

11 Management policies In 2007 management policies Treatment policies dialysis accepted by NDT NDT: Also transplantation data?

12 Management policies Tx More detailed questionnaire of Tx management policies Compared to literature Compared to RICH-Q data

13 Management policies topics Pre Tx (screening, medication, ….) Tx (donor, medication, ….) Post Tx (medication, follow up)

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15 Please…. Send me the management policies Tx Send a copy of all your protocols concerning transplantation to n.j.schoenmaker@amc.nl n.j.schoenmaker@amc.nl >>Publication

16 New Tx form Changes? Variables to add? >> Please let us know a.s.a.p.