title: Use of an immune function assay to monitor immunosuppression for treatment of post-transplant lymphoproliferative disorder.
abstract: The first-line treatment for PTLD is reduction in immunosuppression, allowing partial reconstitution of cell-mediated immunity. However, there is a risk of inducing acute allograft rejection during clinical resolution of PTLD. A recently available assay, Immuknow, measures the cell-mediated immune response and could be used to monitor reduction of immunosuppression. We report a case of PTLD occurring in a pediatric kidney transplant recipient where the reduction in immunosuppression was serially followed using this assay and quantitative EBV-PCR. A rapid reduction to minimal immunosuppression was followed by resolution of PTLD. Later, when the cell-mediated immune response increased, with negative viral load, immunosuppression was gradually increased utilizing the assay to adjust dosing. Presently, there are no signs of PTLD and renal function remains normal.
authors.affiliation: Division of Organ Transplantation, Rhode Island Hospital, Providence, RI 02903, USA. agautam@lifespan.org
authors.forename: Amitabh
authors.initials: A
authors.lastname: Gautam
authors.forename: Paul E
authors.initials: PE
authors.lastname: Morrissey
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Brem
authors.forename: Staci A
authors.initials: SA
authors.lastname: Fischer
authors.forename: Reginald Y
authors.initials: RY
authors.lastname: Gohh
authors.forename: Angelito F
authors.initials: AF
authors.lastname: Yango
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Monaco
mesh_terms: D002675:Child, Preschool; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D019520:Living Donors; D008232:Lymphoproliferative Disorders / Q000188:drug therapy*; D008297:Male; D015166:Monitoring, Immunologic / Q000379:methods*
chemical_list: D007166:Immunosuppressive Agents