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. 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) MAJOR HISTOCOMPATABILITY COMPLEX

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 1. T-CELL BLOCKERS 2. GLUCOCORTICOIDS 3. SITOTOXIC AGENTS 4.MONOCLONAL ANTIBODIES

35. T-CELL BOCKERS 1. CYCLOSPORINE-A 2. TACROLIMUS 3. SIROLIMUS CYCLOSPORINE AND TACROLIMUS ARE SELECTIVE CALCINEURIN INHIBITORS INHIBITION OF Th INDUCTION WHICH IS ACTIVATED BY IL-2

36. TOXIC EFFECTS OF TACROLIMUS AND CYCLOSPORINE. NEPHROTOXICITY (S>T). NEUROTPXICITY (T>S). GASTROINTESTINAL PROBLEMS(T). HYPERTENSION(S>>T). HYPERKALEMIA(T). HPERGLICEMIA AND DIABETES(T>S). INFECTION AND MALIGN TUMORS(BOTH)

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

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

39. 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

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

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

42. -Antilymphosite globulines (Atgam, timoglobulin) -Anti-CD3 monoklonal antibodies (OKT3, muromonab-CD3) -Anti-Tac, Anti-CD25 monoklonal antibodies (Basiliximab, daclizumab) ANTITHYMOCYTE ANTIBODIES

45. PROF. DR. MEHMET A. HABERAL

47. 16 DECEMBER 2006

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

53. THE END