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Der Arbeitsalltag von Wissenschaftlerinnen und Wissenschaftlern hat sich in den letzten Jahren dramatisch verändert. Forschen, Schreiben und Publizieren sind mittlerweile stark durch netzbasierte Anwendungen geprägt. Das digitale Zeitalter aber hat nicht nur neue technische Werkzeuge hervorgebracht, sondern auch neue Wege eröffnet, um Wissen zu generieren und zu verbreiten. Dies gilt sowohl innerhalb der akademischen Welt als auch über diese hinaus. Das Arbeiten mit dem Netz stellt unsere bisherigen etablierten wissenschaftlichen Praktiken in Frage. Forschung wird zunehmend vernetzt, kollaborativ, multimedial, trans- bzw. interdisziplinär durchgeführt. Das vorliegende Handbuch beschreibt diese sich herausbildenden wissenschaftlichen Praktiken. Ziel der Autoren war es dabei, ein praxisnahes und leicht verständliches Handbuch zu schreiben.
Background: After kidney transplantation, immunosuppressive therapy causes impaired cellular immune defense leading to an increased risk of viral complications. Trough level monitoring of immunosuppressants is insufficient to estimate the individual intensity of immunosuppression. We have already shown that virus-specific T cells (Tvis) correlate with control of virus replication as well as with the intensity of immunosuppression. The multicentre IVIST01-trial should prove that additional steering of immunosuppressive and antiviral therapy by Tvis levels leads to better graft function by avoidance of over-immunosuppression (for example, viral infections) and drug toxicity (for example, nephrotoxicity).
Methods/design: The IVIST-trial starts 4 weeks after transplantation. Sixty-four pediatric kidney recipients are randomized either to a non-intervention group that is only treated conservatively or to an intervention group with additional monitoring by Tvis. The randomization is stratified by centre and cytomegalovirus (CMV) prophylaxis. In both groups the immunosuppressive medication (cyclosporine A and everolimus) is adopted in the same target range of trough levels. In the non-intervention group the immunosuppressive therapy (cyclosporine A and everolimus) is only steered by classical trough level monitoring and the antiviral therapy of a CMV infection is performed according to a standard protocol. In contrast, in the intervention group the dose of immunosuppressants is individually adopted according to Tvis levels as a direct measure of the intensity of immunosuppression in addition to classical trough level monitoring. In case of CMV infection or reactivation the antiviral management is based on the individual CMV-specific immune defense assessed by the CMV-Tvis level. Primary endpoint of the study is the glomerular filtration rate 2 years after transplantation; secondary endpoints are the number and severity of viral infections and the incidence of side effects of immunosuppressive and antiviral drugs.
Discussion: This IVIST01-trial will answer the question whether the new concept of steering immunosuppressive and antiviral therapy by Tvis levels leads to better future graft function. In terms of an effect-related drug monitoring, the study design aims to realize a personalization of immunosuppressive and antiviral management after transplantation. Based on the IVIST01-trial, immunomonitoring by Tvis might be incorporated into routine care after kidney transplantation.