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Transplantation Treatment Policies in Children Research Study

This study group aims to discuss and formulate research questions on Tx treatment policies in 135 children with 138 Tx data, focusing on current therapy, rejection, infection causes, and pharmacokinetics. Research proposals include topics on infections after Tx, MBL-polymorphism, and immigrant outcomes. Management policies on Tx in children are also analyzed for improvements.

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Transplantation Treatment Policies in Children Research Study

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

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

  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

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

  6. Cause of infection

  7. Research Proposals 1. Pharmacokinetics/immigrants – Karlien 2. Infections after tx • prevalence and association tx failure BK viremia • Policies with regard to immunosuppression/therapy • Course • Addition data from German centres (?) • 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)

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

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

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