Cylex Immuknow平衡同种异体移植物课件.ppt

In this case we have ImmuKnow values starting off in a low range, with the presence of PTLD occuring 2 years following transplantation. Of note, ImmuKnow is used well beyond the post-surgery “acute phase” to determine how best to manage patients…years after their transplant. In this case, PTLD set in 2 years following the transplant surgery. The physician backed off Tacrolimus and allowed the immune function to run into the normal range—please note, the y-axis on this graph ends at 400 and not 1000, here. By the time immune function was shown to reach about 200 ATP ng/mL, EBV (Epstein-Barr Virus) was undetectable. When the ATP value edged above 300 ng/mL, the physician began to increase the Tacrolimus dose but note that by this time, the PTLD was resolved. This essentially shows that backing off and increasing immunesuppressing allows the immune system to function stronger, or weaker, depending on the desired effect that is needed (e.g., to battle a virus or to avoid rejection or infection). This is a very busy slide, but the point of this table is to show different types of patient cases with various viruses—BK viremia, EBV, CMV and HCV—and to show their ATP (ImmuKnow) values when the patients first presented with these infections and then to show the ATP (ImmuKnow) values when the viruses have been resolved. Note the general increase in ATP. Also, you will find changes in immunosuppression that allow the resolution of these infections to occur (e.g., to allow the immune system to function at a greater level). In liver transplantation, there are distinctly different immune responses based on whether or not the patient has active HCV (hepatitus C virus) and the lowest ATP responses are associated with HCV re-activation. Box and Whiskers of Immune Response distributions Line in box = median (50th percentile) – value shown = median Top of Box = 75th percentile Bottom of Box = 25th percentile Top of whisker = 95th percentile Bottom of whisker = 5th percentile Number