儿童移植后因感染住院的人数在上升.pptVIP

儿童移植后因感染住院的人数在上升 免疫抑制剂作用机制 免疫机理 Cylex? 免疫细胞功能测定 鉴定 移植患者的免疫状况/ 风险 个体化 免疫抑制反应更加精确化 监控 免疫抑制系统响应-治疗过程中的变化情况 提供临床不明显症状的研究 最优化 给药方案 临床试验 取样有代表性-移植术后状况稳定的移植受体 肾, 肝 胰腺受体 ImmuKnow?: 不同人群的免疫响应 CD4 细胞计数与免疫响应无关 药物浓度不一定与免疫功能相关联 汇总分析 504 病人 2000次 ImmuKnow 测试 肾, 心, 肝, 小肠 移植后大于3年的病人 免疫响应与临床结果相关 移植受体发生感染和排斥几率 病人统计数据 69移植受体临床情况如下: 稳定 51 人 排斥 4 人 感染 14 人 ( 9 CMV, 2 parvovirus, 1 plasma BK, 1 late wound infection, 1 recurrent UTI ) The number of circulating CD4 cells following Campath-1H were significantly lower than pre-Tx levels. Pre-Tx 846 + 448 0-2 Months 11 + 21 2-6 Months 44 + 31 6 Months 113 + 83 Cylex assay was performed on 290 blood samples with a post-Tx follow-up from 2-18 months. 相对风险分析 BK 病毒感染与免疫功能低下是相关的 ImmuKnow?在管理治疗中的应用 诱导治疗与免疫响应 rATG Induction Responsiveness 病人: 19 year old Recipient of LRD Kidney 治疗方案: Treated with Alemtuzumab 病历史: Non-responsive to induction ImmuKnow: Increased Immune Response preceded creatinine increase and cellular rejection Rising ImmuKnow in Advance of ACR Individualizing ISP Therapy – Resolution of BK Polyomavirus Patient: Adult Recipient of CAD Kidney Therapy: Induction with rATG followed by Tacrolimus, MMF and Prednisone History: Presented with BK Viremia ~day 100 post-tx ImmuKnow: Monitored immune response to decreased ISP Therapy and clearance of BK virus Resolution of BK Viremia Patient: 3.5 year old Male LRD Kidney Transplant Therapy: MMF Tacrolimus Prednisone History: Diagnosed ~2.5 years post-transplant with PTLD ImmuKnow: Monitored immune response to decreasing ISP therapy and EBV viral load Monitoring Therapy Changes- Resolution of PTLD Liver Transplant Studies Independent Study Confirms Association of Low Immune Function with HCV Pre-Tx Immune Function Can Distinguish ACR from HCV Post-Tx Patient: A 62 year old Caucasian Female Liver Recipient Therapy: Double Therapy with Tacrolimus Prednisone History: HCV induced ESLD, decreasing immune response with increasing ALT/AST ImmuKnow: P