1. Kidney Transplantation

2. Best treatment of chronic renal failure

3. HEMODIALYSIS

9. PERITONEAL DIALYSIS

12. Renal transplantation needs donor kidney

13. Organ Source
Cadaver
Living donor

14. Yalnız kalp atacak

15. HLA TYPING
HLA ANTIGENS A B C
DR LOCUS
HLA A21,A24,B7,B9,DR22

18. MAJOR HISTOCOMPATABILITY COMPLEX
Class I - present on almost all nucleated cells (interesting exceptions include sperm and the cells of the trophoblast).
Class II- present on Antigen Presenting Cells (macrophages, B cells, and dendritic cells).
Class III- are not surface molecules, but instead are various proteins typically which have some immunological role (C2,C4,Tumor necrosis factor alpha and beta, various HSPs)
Human HLA region [Highly Simplified version !]
---DP--DQ--DR C4--C2--Bf B--C--A---
Protein Products: DPa and DPb Complement HLA-B (a) DQa and DQb TNF a & b HLA-C (a) DRa and DRb HSP proteins HLA-A (a)

19. Human MHC genes are highly polymorphic

20. HLA TYPING A-MATCH…FULL B-MATCH..ONE ANTIGEN DIFFERENT
C-MATCH..TWO ANTIGENS DIFFERENT
…..SO ON
THE MORE CLOSER TO A-MATCH, THE MORE SUCCESSFULL KIDNEY TRANSPLANTATION

21. RECIPIENT SHOULD NOT HAVE ANY INFECTION

30. IMMUNUSUPRESSION

33. The TcR-CD3 complex on helper (CD4+) or cytotoxic/suppressor (CD8+) T cells

34. IMMUNOSUPRESSIVE AGENTS
T-CELL BLOCKERS
GLUCOCORTICOIDS
SITOTOXIC AGENTS
MONOCLONAL ANTIBODIES

35. T-CELL BOCKERS CYCLOSPORINE-A TACROLIMUS SIROLIMUS
CYCLOSPORINE AND TACROLIMUS ARE SELECTIVE CALCINEURIN INHIBITORS
INHIBITION OF Th INDUCTION WHICH IS ACTIVATED BY IL-2

36. NFAT :Nuclear factor of activated T-cells
FKBP: FK Binding protein

38. TOXIC EFFECTS OF TACROLIMUS AND CYCLOSPORINE
. NEPHROTOXICITY (C>T)
. NEUROTOXICITY (T>C)
. GASTROINTESTINAL PROBLEMS(T)
. HYPERTENSION(C>>T)
. HYPERKALEMIA(T)
. HPERGLICEMIA AND DIABETES(T>C)
. INFECTION AND MALIGN TUMORS(BOTH)

39. SIROLIMUS(RAPAMYCINE)
Blockage of mTOR kinase
Side Effects:
Hyperlipidemia
Anemia
Leucopenia, trombositopenia
Fever
GI effects,
Hypo and hyperkalemia

40. IMMUNOSUPRESSIVE EFFECTS OF GLUCOCORTICOIDS
-Inhibition of release of cytokines in T-Cells
-Inhibition of antibody production in B-Cells
-Inhibition of macrophages,monocytes,PMNL’s
-Blockage of complement system

41. SIDE EFFECS OF STEROIDS
-Cushing Syndrome
-Glucose intolerance
-Infections
-Osteoporosis
-Muscle weakness

42. Antineoplastic drugs as immunosupressive agents
-Mycophenolat Mofetil (Inhibition of IMP dehydrogenase)
-Azathioprine (Inhibition of nucleotid synthesis)
-Cyclophosphamide (Alkylating agents )
-Methotrexate (Inhibitor of dihydrofolate reductase)

43. BIOLOGIC IMMUNOSUPPRESSION
-Antilymphosite globulines(Polyclonal antibodies)
(Atgam, timoglobulin)
-Anti-CD3 monoclonal antibodies
(OKT3, muromonab-CD3)
all -mab, -imab and -umab suffixes
-Anti-Tac, Anti-CD25 monoclonal antibodies
(Basiliximab, daclizumab)
Anti-CD25 Monoclonal Antibodies (Basiliximab and Daclizumab)
Anti-CD52 Monoclonal Antibody Alemtuzumab (Campath-1h)
Anti-CD20 (Rituximab)
Monoclonal Antibodies to Adhesion Molecules
anti–LFA-1 mAb (efalizumab)
anti-CD4 mAb (priliximab)

46. PROF. DR. MEHMET A. HABERAL

48. 16 DECEMBER 2006

49. Kidney transplantation:
Meryem
(28 years old)
Kidney transplantation:
7 June 1997
Marriage :
2001
Baby : 2002

54. THE END