After pediatric kidney transplantation, immunosuppressive therapy is given to avoid acute and chronic rejections. However, the immunosuppression causes an increased risk of severe viral complications and bacterial infections and is associated with serious side effects. It is therefore crucial to achieve the optimal individual balance between over- and under-immunosuppression and thereby avoid unnecessary exposure to immunosuppressive drugs. In routine use, steering of immunosuppressants is performed primarily by monitoring of trough levels that mirror pharmacokinetics (although not, however, pharmacodynamics). Other diagnostic and prognostic markers to assess the individual intensity of immunosuppression are missing. Potential methods to determine immune function and grade of immunosuppression, such as analysis of the torque teno virus (TTV) load, QuantiFERON Monitor®, and ImmuKnow® as well as virus-specific T cells (Tvis), are currently being evaluated. In some studies TTV load, QuantiFERON Monitor® and ImmuKnow® were associated with the risk for post-transplant rejections and infections, but randomized controlled trials after pediatric kidney transplantation are not available. Post-transplant monitoring of Tvis levels seem to be promising because Tvis control virus replication and have been shown to correlate with virus-specific as well as general cellular immune defense, which represents the individual’s susceptibility to infections. Additional Tvis-monitoring provides an innovative opportunity to personalize the antiviral management and the dosing of the immunosuppressive therapy after pediatric kidney transplantation to avoid unnecessary therapeutic interventions and identify over-immunosuppression.

中文翻译：

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监测小儿肾移植受者免疫抑制的新方法——基本概念和新兴数据

小儿肾移植后，给予免疫抑制治疗以避免急性和慢性排斥反应。然而，免疫抑制会导致严重病毒并发症和细菌感染的风险增加，并与严重的副作用有关。因此，在过度免疫抑制和免疫抑制不足之间实现最佳个体平衡至关重要，从而避免不必要地接触免疫抑制药物。在常规使用中，主要通过监测反映药代动力学（尽管不是药效学）的谷水平来控制免疫抑制剂。其他用于评估个体免疫抑制强度的诊断和预后标志物缺失。确定免疫功能和免疫抑制等级的潜在方法，例如分析扭矩特诺病毒 (TTV) 负荷，目前正在评估 QuantiFERON Monitor® 和 ImmuKnow® 以及病毒特异性 T 细胞 (Tvis)。在一些研究中，TTV 负荷、QuantiFERON Monitor® 和 ImmuKnow® 与移植后排斥和感染的风险相关，但没有儿童肾移植后的随机对照试验。Tvis 水平的移植后监测似乎很有希望，因为 Tvis 控制病毒复制，并且已被证明与病毒特异性以及一般细胞免疫防御相关，这代表了个体对感染的易感性。