Don't miss SGLT Tools - PowerPoint slide library for SGLT2 inhibitors

Ask the Experts

  1. Diana
  2. General Nephrology Questions
  3. Friday, 05 July 2013
  4.  Subscribe via email
Dear Dr Jordan Weinstein,

I would like to ask you about the criteria of adequacy of immunosupression in renal transplantation. Should we always use blood analysis for lymphocytes subtypes (CD4+,CD8+,CD19+, CD3+ ,total lymphocyte count) to analyse the adequacy of the induction of immunosupression and can we use it to analyse efficiancy of maintainance immunosupressio therapy? If so which numbers of lymphosytes and its subpopulation should we try to reach in order to gain sufficient immunosupression in deceased renal transplantation?
Responses (4)
Accepted Answer Pending Moderation
Thank-you for your question Diana.

In our center, we do not measure adequacy of immunosuppression with measurement of lymphocyte population subtypes. While it might sound imprecise, we use fairly standard regimens (with few exceptions) in all and only modify Tacrolimus or Neoral based on their respective levels.

When lymphocyte subpopulation subtyping has been used in other transplant settings, the results have not been impressive (see link below - though admittedly old). If you have other information, please consider sharing with us.

Jordan
References
  1. http://ats.ctsnetjournals.org/cgi/reprint/45/1/11.pdf
  1. more than a month ago
  2. General Nephrology Questions
  3. # 1
Accepted Answer Pending Moderation
Dear Dr Jordan Weinstein,

Thank you very much for your reply! I have also read the article, it is very interesting, thank you.

In our transplantation center we also use standard protocols for immunosupression. Though, there is articles that we could use CD3+ and total lymphocytes counts for monitoring induction with thymoglobulin in high-risk recipients. Unfortunately, this methode of lymphocytes subtyping has just come to our hospital. We don't know all its implication in clinical practice. And since we are just starting with lymphocyte subtyping, I asked this question because maybe it is already widely used to analyse the adequacy of immunosupressive therapy and serve for dose adaption of immunosupression. But I understand your answer. Thank you once again.
  1. more than a month ago
  2. General Nephrology Questions
  3. # 2
Accepted Answer Pending Moderation
Our transplant center (St. Michael's in Toronto) is one of the largest in the country with well over 100 transplants per year. Our colleagues at Toronto General run a similarly large program and neither do routine lymphocyte subtyping in our transplant patients. That doesn't mean it isn't potentially useful; it just hasn't caught on here yet.

Dr. Jordan Weinstein
  1. more than a month ago
  2. General Nephrology Questions
  3. # 3
Accepted Answer Pending Moderation
Thank you for explanations. Maybe this technic will be used in future we'll see. From my part, if we have some results too according lymphocyte subtyping and it will be worth telling and not to be shamed I will write here.
  1. more than a month ago
  2. General Nephrology Questions
  3. # 4
  • Page :
  • 1


There are no replies made for this post yet.
Be one of the first to reply to this post!
Guest
Submit Your Response
Upload files or images for this discussion by clicking on the upload button below. Supports gif,jpg,png,zip,rar,pdf,jpeg,doc,docx,xls,xlsx
• Insert • Remove Upload Files (Maximum File Size: 10 MB) - NB: PLEASE REMOVE ALL IDENTIFYING DATA
ukidneyisup