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

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

Cause of infection CMVEBVBKViral other Bac terial Total M M M M M

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 >>Publication

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