Case Scenario: Post transplant monitoring and rejection
Case Study: 20 year old son of a business mogul comes for his 3 month transplant follow-up. His transplant has been going well. They want to know how you plan to monitor and prevent rejection and what is the current best practice to ensure he does not have a rejection. Immunological workup is below.
| Sensitization History | None | |||||
| HLA Typing | A | B | C | DR | DQ | DP |
| Donor (B+) | 02:03, 24:02 | 38:02, 49:01 | 07:01, 07:02 | 13:01, 15:02 | 05:01, 06:03 | 02:01, 04:01 |
| Recipient (B+) | 02:01, 02:03 | 13:01, 15:02 | 04:03, 08:01 | 12:02, 12:02 | 03:01, 03:01 | 13:01, 13:01 |
| XM | T cells | B Cells | ||||
| CDC XM | Negative | Negative | ||||
| Flow XM | Negative | Negative | ||||
| Single Antigen Bead | None | None | ||||
Questions & Answers
Q1. How frequently should KFT and urine testing be performed?
Ans: Personal opinion: at least monthly.
Q2. How frequently should tac level be tested and tac dose adjusted?
Ans: Till stable frequently or after dose change, then once every 6 months.
Q3. Should we perform additional testing, BK virus, SAB, Cell free dna and if so, how frequently and how do we utilize the results to guide treatment?
Ans: Personal opinion: would do it before any major immunosuppression change or at times when plan to reduce immunos (tac targets or mmf reduction or a few months after reductions to assess if any activation of immune system has happened
