Q.765. What is the prognosis of PTLD? How to improve?

 KIDNEY TRANSPLANT

 

Q.765. What is the prognosis of PTLD? How to improve?

A. Prognosis is poor, but can be improved by:

(1) Technique of monitoring EBV viral  load, to detect risk ptn.                                                        

(2) New therapies: Adoptive immunotherapy, 👈 using EBV-sp.  C.T.L.s. (cytotoxic “T” lymphocytes)

.. So, thorough pre-Tx. evaluation, avoid excessive im/m.+ standard Iry & IIry preventive strategies: ⮞  

v Cessation of smoking.  🚭

v Uterine cervix smear.

v If cancer occur ] Reduce im/m. greatly.

Q.766. What is meant by “Adoptive immunotherapy”?        👓

 

A.The exquisite specificity of cytotoxic T lymphocytes (CTLs) has led investigators to attempt to isolate cells é significant antitumor activity; infusion of these cells is referred to as ⮚adoptive immunotherapy. It has a possible role in refractory Hodgkin lymphoma, based upon the ability to generate clones of cytotoxic T-lymphocytes that’re sp. for Ep.-Barr virus latent Ags [LMP1& LMP2 or Reed-Sternberg cells]. Expanded clones of these cells may have a therapeutic role in Hodgkin lymphoma whose Reed-Sternberg cells express Ep.-Barr viral Ag.

Q.767. What else?     😉

A. I.X. Infectious complications(See also, Q.679), it depends on:

v Intensity of exposure é hospital & community. 

v Overall state of immunosuppression.                                                                                    

    Fishman & Rubin divided it periodically to : 0-1 m.  1-6  m   &  🠉6 m.

Q.768. Which factors can affect the net state of immunosuppression?

A. Net state of immunosuppression could be affected by:

1)   Im/m. dose, duration & type.

2)   Co-morbid dis.:  e.g. [D.M. – U.T.I.]

3)   Integrity of mucocutanous barriers.

4)   Infection with virus affecting the immune system.

Q.769. What is the “spectrum” of PTLD?

A. Spectrum of PTLD:      I. 😃  II. 😑  III. 😌

 I. Early (50 %)➤ [Infectious mononucleosis–like illness, Pth.: Preserved  architec-ture-“Polyclonal”. * ttt: (Reduce im/m. dose+acyclovir), Prognosis is good]. 😃

II. Polymorphic PTLD (30%)➤[infectious mononucleosis –like illness (+/-)- Wt. loss- Localized Sm.-Pth.: intermediate polyclonal- * ttt.: [Reduce dose of im/m.- + acyclovir-If poor response ➤ttt. like III.] 😑

III. Monoclonal PTLD (20%): [fever- Wt. loss- Localized Sm.– Monoclonal] Pth.: High grade lymphoma + marked atypia - poor prognosis.* ttt. [🠋im/m. to low dose steroid only + Combin. of : Surgery-Chemo./Radiothpy+ Rituximab.]  😌 

Q.770. When can a female recipient allowed to be pregnant?    

A. Certain criteria to be fulfilled:   ✋            

ΠGood general health 18 m. before conception.

 Stable allograft fuction, i.e. Pl. cr. £ 0.2 mg/dl.

Ž Minimal “H.T.” & minimal “proteinuria”.

 Immunization at maintenance dose.

 No pelvi-calyceal dilatation at a recent U/S.

N.B.:

-    👆  [H.T., pre-eclampsia, prematurity, low birth wt.] are more common in pregnant recipient.

-      In labor, take care of the ureter, kid. function, to avoid HUS & Ac. Rj.

-      MMF. ] Teratogenic. 👆

-      Aza, CNI & Steroids ] SAFE in Utero.     😃

                             

Q.771. What Lipid abnormalities can be seen after renal transplantation?

A. Abn. lipid profile is a common complication of R.Tx., but a causal association of dyslip. & CVS risk has not been proven. However, due to high incid. of athrsc. dis. events in R.Tx., we consider R.Tx. a coronary heart dis. equivalent risk. So, assessment & ttt of dyslipidemia in R.Tx. ptn. shd be part of ro