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Badet L, Lefrancois N, Fassi-Fehri H, Cherasse A, Colombel M, Martin X. 5 Third renal transplantation: Is it really the best option? ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s1569-9056(04)90007-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Harzallah K, Badid C, Fouque D, Lefrancois N, Touraine JL, Laville M. Efficacy of mycophenolate mofetil on recurrent glomerulonephritis after renal transplantation. Clin Nephrol 2003; 59:212-6. [PMID: 12653266 DOI: 10.5414/cnp59212] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Recurrent glomerulonephritis in transplanted kidneys is not rare despite classical immunosuppressive drugs and depends on the etiology of nephropathy. Treatment of recurrence of renal disease on graft remains controversial. We report 6 cases of patients with recurrent glomerulonephritis after renal transplantation treated with mycophenolate mofetil (MMF). The glomerular diseases were Wegener's granulomatosis (n = 1), membranoproliferative glomerulonephritis type I (n = 1), focal and segmental glomerular sclerosis (n = 1), membranous glomerulonephritis (idiopathic membranous nephropathy (n = 1) and systemic lupus erythematous) (n = 1)) and immunoglobulin A nephropathy (n = 1). MMF was introduced because of intolerance of classical immunosuppressive treatment in 2 cases and because of its inefficiency in the other cases. MMF was introduced between 3 months and 36 months (13.5 +/- 7 months) after recurrence of the primitive glomerulonephritis. During combined MMF/cyclosporine/prednisone therapy, only 3 patients responded to MMF. MMF was disrupted precociously in 1 out of 3 patients who stabilized renal function because of discovery of lung cancer and in 2 out of the 3 other patients because of gastrointestinal intolerance and severe anemia. We supposed that MMF could represent a new effective alternative therapy of recurrent glomerulonephritis on renal graft in some cases.
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Affiliation(s)
- K Harzallah
- Service de Nephrologie, Hôpital Edouard Herriot, Lyon Cedex, France.
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Mourad G, Garrigue V, Squifflet JP, Besse T, Berthoux F, Alamartine E, Durand D, Rostaing L, Lang P, Baron C, Glotz D, Antoine C, Vialtel P, Romanet T, Lebranchu Y, Al Najjar A, Hiesse C, Potaux L, Merville P, Touraine JL, Lefrancois N, Kessler M, Renoult E, Pouteil-Noble C, Cahen R, Legendre C, Bedrossian J, Le Pogamp P, Rivalan J, Olmer M, Purgus R, Mignon F, Viron B, Charpentier B. Induction versus noninduction in renal transplant recipients with tacrolimus-based immunosuppression. Transplantation 2001; 72:1050-5. [PMID: 11579299 DOI: 10.1097/00007890-200109270-00012] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study was to compare the efficacy and safety of induction treatment with antithymocyte globulins (ATG) followed by tacrolimus therapy with immediate tacrolimus therapy in renal transplant recipients. METHODS This 12-month, open, prospective study was conducted in 15 centers in France and 1 center in Belgium; 309 patients were randomized to receive either induction therapy with ATG (n=151) followed by initiation of tacrolimus on day 9 or immediate tacrolimus-based triple therapy (n=158). In both study arms, the initial daily tacrolimus dose was 0.2 mg/kg. Steroid boluses were given in the first 2 days and tapered thereafter from 20 mg/day to 5 mg/day. Azathioprine was administered at 1-2 mg/kg per day. RESULTS At month 12, biopsy-confirmed acute rejections were reported for 15.2% (induction) and 30.4% (noninduction) of patients (P=0.001). The incidence of steroid-sensitive acute rejections was 7.9% (induction) and 22.2% (noninduction)(P=0.001). Steroid-resistant acute rejections were reported for 8.6% (induction) and 8.9% (noninduction) of patients. A total of nine patients died. Patient survival and graft survival at month 12 was similar in both treatment groups (97.4% vs. 96.8% and 92.1% vs. 91.1%, respectively). Statistically significant differences in the incidence of adverse events were found for cytomegalovirus (CMV) infection (induction, 32.5% vs. noninduction, 19.0%, P=0.009), leukopenia (37.3% vs. 9.5%, P<0.001), fever (25.2% vs. 10.1%, P=0.001), herpes simplex (17.9% vs. 5.7%, P=0.001), and thrombocytopenia (11.3% vs. 3.2%, P=0.007). In the induction group, serum sickness was observed in 10.6% of patients. The incidence of new onset diabetes mellitus was 3.4% (induction) and 4.5% (noninduction). CONCLUSION Low incidences of acute rejection were found in both treatment arms. Induction treatment with ATG has the advantage of a lower incidence of acute rejection, but it significantly increases adverse events, particularly CMV infection.
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Affiliation(s)
- G Mourad
- Service de Nephrologie et Transplantation, Hopital Lapeyronie, 371 Av. Du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
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Lebranchu Y, Aubert P, Bayle F, Bedrossian J, Berthoux F, Bourbigot B, Buchler M, Chalopin JM, Deteix P, Glotz D, Huraut De Ligny B, Kessler M, Lang P, Lefrancois N, Le Pogamp P, Moulin B, Mourad G, Olmer M, Sraer JD, Touchard G, Toupance O, Wolf P, Puget S. Could steroids be withdrawn in renal transplant patients sequentially treated with ATG, cyclosporine, and cellcept? One-year results of a double-blind, randomized, multicenter study comparing normal dose versus low-dose and withdrawal of steroids. M 55002 French Study Group. Transplant Proc 2000; 32:396-7. [PMID: 10715452 DOI: 10.1016/s0041-1345(99)00992-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Y Lebranchu
- Service de Nephrologie, CHU Bretonneau, Tours, France
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Thivolet C, Abou-Amara S, Martin X, Lefrancois N, Petruzzo P, McGregor B, Bosshard S, Dubernard JM. Serological markers of recurrent beta cell destruction in diabetic patients undergoing pancreatic transplantation. Transplantation 2000; 69:99-103. [PMID: 10653387 DOI: 10.1097/00007890-200001150-00018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Besides alloimmunity to transplanted pancreatic tissue, recurrent autoimmune beta cell destruction is an additional limitation to successful clinical pancreatic allografts in type 1 diabetic patients. METHODS We studied the prevalence of autoantibodies to glutamate decarboxylase (GAD) 65 and tyrosine phosphatase (IA-2) in 68 C-peptide-negative diabetic patients receiving pancreatic allografts. Sera from patients were obtained immediately before grafting. A second blood sample was analyzed at the time of graft failure in patients who returned to hyperglycemia and during the same follow-up period in those who experienced a functional pancreatic allograft. Patients were classified according to clinical outcome into chronic graft failure (group A, n=20), acute graft failure and/or arterial thrombosis (n=7), or functional pancreatic graft (group C, n=41). Sera from patients were screened for the presence of specific autoantibodies using an islet cell autoantibody assay, a combi-GAD and IA-2 test, and individual GAD and IA-2 assays. RESULTS Patients from group A had significantly higher combi-test values than patients from group C (13+/-16 vs. 4.5+/-12 units, P<0.02) and higher anti-GAD65 antibody (Ab) levels (0.19+/-0.3 vs. 0.04+/-0.13 units, P<0.01) immediately before grafting. After graft failure in group A, both anti-GAD65 and anti-IA-2 Ab levels increased from baseline, but only the increase in anti-IA-2 Ab levels reached statistical significance (0.28+/-0.12 vs. 15+/-34, P=0.03). When compared with group C, patients from group A had higher anti-GAD65 Abs (0.29+/-0.35 vs. 0.05+/-0.16, P<0.001) after graft failure. Interestingly, the number of double-Ab-positive patients rose from 5% to 35% in group A, whereas it remained at 5% in group C. In pancreatic transplants with bladder drainage, the presence of anti-GAD65 and/or anti-IA2 Abs was not associated with a reduction in urinary amylase levels. This suggests that a loss of endocrine function was not associated with exocrine failure in patients from group A. CONCLUSIONS We can conclude from the present study that peripheral autoimmune markers are useful in diabetic patients receiving pancreatic allografts.
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Affiliation(s)
- C Thivolet
- INSERM 449, Faculty of Medicine RTH Laënnec, Lyon, France.
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Dubernard JM, Martin X, Lefrancois N, Dawahra M, Feitosa LC. Future of pancreatic transplantation. Transplant Proc 1999; 31:3190-1. [PMID: 10616435 DOI: 10.1016/s0041-1345(99)00780-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J M Dubernard
- Service d'urologie et de chirurgie de la transplantation, Hospital Edouard Herriot, Lyon, France
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Tajra LC, Dubernard JM, Dawhara M, Lefrancois N, Badet L, Martin X. Long-term metabolic control and pancreatic graft survival according to surgical technique. Transplant Proc 1999; 31:3192-3. [PMID: 10616436 DOI: 10.1016/s0041-1345(99)00781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- L C Tajra
- Department of Urology and Transplantation Surgery Hopital Edouard Herriot, Lyon, France
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Martin X, Aboutaieb R, Soliman S, el Essawy A, Dawahra M, Lefrancois N. The use of long-term defunctionalized bladder in renal transplantation: is it safe? Eur Urol 1999; 36:450-3. [PMID: 10516458 DOI: 10.1159/000020029] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Evaluation of the use of defunctionalized bladder in renal transplantation, concerning surgical complications. METHODS In order to assess the complication rate of ureteral reimplantation in long-term defunctionalized bladder, we compared 20 patients on haemodialysis for more than 15 years (group I) with another 20 patients on haemodialysis for less than 5 years (group II). None of these patients had renal failure due to urological causes or neurogenic bladder. Non-stented extravesical ureteroneocystostomy was done routinely in all patients except 1 in group II who underwent Politano-Leadbetter ureteroneocystostomy and 7 patients in group I who underwent Politano-Leadbetter (3 patients) and pyelo-ureteral anastomosis using the recipient's native ureter (4 patients). The amount of residual urine was insignificant (<100 cm(3)) in both groups. RESULTS The mean postoperative bladder catheterization period was 7.8 days in group I and 4.2 days in group II. Postoperative urinary tract infections were observed in 9 cases of group I and in 4 cases of group II. No surgical complications occurred in patients of group II, while there were 6 patients with surgical complications in group I: stenosis after a pyelo-ureteral anastomosis (1 case), stenosis after a ureterovesical anastomosis with Politano-Leadbetter technique (1 case), urinary fistulae (3 cases; 1 with Politano-Leadbetter ureteroneocystostomy and 2 cases with pyelo-ureteral anastomosis), and vesico-ureteral reflux (1 case with Politano-Leadbetter ureteroneocystostomy). These 6 cases had the lowest bladder capacity (30-150 cm(3)) among our 40 patients. Graft losses were comparable between the two groups and were not due to surgical complications. CONCLUSION Small defunctionalized bladders can be used in kidney transplantation, but it may represent an increased surgical risk due to difficulty in performing ureteral reimplantation.
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Affiliation(s)
- X Martin
- Service d'Urologie et Chirurgie de la Transplantation, Hôpital Edouard-Herriot, Lyon, France
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Dubernard JM, Martin C, Lefrancois N, Thivolet CH, Dawahra M, Petruzzo P, Martin X. Advances in pancreas transplantation-1999. Indications and contraindications. J Pediatr Endocrinol Metab 1999; 12 Suppl 3:765-70. [PMID: 10626268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- J M Dubernard
- Service d'Urologie et Chirurgie de la Transplantation, Hôpital Edouard Herriot, Lyon, France
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Feitosa Tajra LC, Dawhara M, Benchaib M, Lefrancois N, Martin X, Dubernard JM. Effect of the surgical technique on long-term outcome of pancreas transplantation. Transpl Int 1998; 11:295-300. [PMID: 9704395 DOI: 10.1007/s001470050145] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
To date there is no general consensus as to the best surgical technique for pancreas transplantation. Patients with a pancreas transplant functioning for 3 years or more were retrospectively investigated to compare three surgical techniques: segmental graft with duct obstruction (DO), whole graft with bladder drainage (BD), and whole graft with enteric drainage (ED). Several parameters were studied: patient and graft survival, rejection, long-term surgical and medical complications, and endocrine function. The best results in terms of graft survival and quality of metabolic control were obtained in the group that underwent whole graft transplantation with ED. At 3 years, overall pancreas graft survival was 65% for ED, 60% for BD, and 47% for DO. This surgical method has become the preferred technique in our unit.
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Affiliation(s)
- L C Feitosa Tajra
- Department of Urology and Transplantation Surgery, Hôpital Edouard Herriot, Lyon, France
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Tajra LC, Dubernard JM, Dawhara M, Benchaid M, Ishibashi M, Lefrancois N, Martin X. Long-term outcome of segmental duct injected pancreas: three to 13 years survival. Transplant Proc 1998; 30:297-8. [PMID: 9532049 DOI: 10.1016/s0041-1345(97)01278-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- L C Tajra
- Department of Urology and Transplantation Surgery, Hospital Edouard Herriot, Lyon, France
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Ishibashi M, Bosshard S, Fukuuchi F, Lefrancois N, Martin X, Touraine L, Dubernard JM. Incidence of CMV infection in simultaneous pancreas and kidney transplantation: comparative study of two surgical procedures of segmental pancreas versus whole bladder-drained pancreas. Transplant Proc 1996; 28:2859-60. [PMID: 8908101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Ishibashi
- Unité de Transplantation, Hopital Edouard Herriot, Lyon, France
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Dubernard JM, Rahbar M, Martin X, Laftavi MR, Lefrancois N. Pancreatic transplantation. Transplant Proc 1995; 27:2641-3. [PMID: 7482862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J M Dubernard
- Service of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France
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Laftavi MR, Chapuis F, Vial C, Rahbar M, Lefrancois N, Feitosa LC, Dubernard JM, Martin X. Diabetic polyneuropathy outcome after successful pancreas transplantation: 1 to 9 year follow up. Transplant Proc 1995; 27:1406-9. [PMID: 7878927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M R Laftavi
- Service d'urologie et Transplantation, Hopital Edouard Herriot, Lyon, France
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Martin X, Dubernard JM, Lefrancois N. Pancreatic transplantation: indications and results. Baillieres Clin Gastroenterol 1994; 8:533-60. [PMID: 8000098 DOI: 10.1016/0950-3528(94)90036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- X Martin
- Service de Urologie et de Chirurgie de la Transplantation, Hopital Edouard Herriot, Lyon, France
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Dubernard JM, Martin X, Lefrancois N, Cloix P, Brunet M. Technical aspects of pancreas transplantation. Transplant Proc 1994; 26:384-5. [PMID: 8171470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J M Dubernard
- Service d'Urologie et Chirurgie de Transplantation, Hopital E. Herriot, Lyon, France
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Kentouni-Noly JC, Cloix P, Martin X, Rabodonirina M, Lefrancois N, Sepetjan M. Analysis of nosocomial infections in renal transplant and pancreas transplant recipients. Transplant Proc 1994; 26:284. [PMID: 8108983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J C Kentouni-Noly
- Laboratoire d'Hygiène Hospitalière et de Santé Publique, Hôpital Edouard Herriot, Lyon, France
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Zambardi G, Meugnier H, Tissot-Guerraz F, Perraud M, Lefrancois N, Martin X, Freney J, Feleurette J. Intérêt du ribotypage pour l'étude des infections nosocomiales à Xanthomonas maltophilia. A propos d'une épidémie dans un Centre de Transplantation Rénale. Med Mal Infect 1993. [DOI: 10.1016/s0399-077x(05)81373-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Martin X, Lefrancois N, Dawhara M, Bret M, Brunet M, Desmettre O, Garnier JL, Pouteil-Noble C, Dubernard JM. Pancreas transplantation in the uremic patient: a random trial of total pancreas with bladder drainage versus duct obstruction of segmental grafts. Transplant Proc 1993; 25:1182-3. [PMID: 8442080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- X Martin
- Service d'Urologie et Chirurgie de la Transplantation, Hopital E. Herriot, Lyon, France
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Dubernard JM, Martin X, Lefrancois N, Dawahra M, Choukair M, Sousa-Castello A, Viguier JL, Cloix P. Pancreas transplantation: the choice of the best technique. Transplant Proc 1992; 24:769-70. [PMID: 1604608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J M Dubernard
- Service d'Urologie et de Chirurgie de la Transplantation, Hopital E. Herriot, Lyon, France
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Sanseverino R, Martin X, Dawahra M, Caldara R, Lefrancois N, Sousa-Castello A, Dubernard JM. Reconstruction of the vascular pedicle of the pancreatic graft after combined harvesting with liver: comparison among different surgical options. Transplant Proc 1992; 24:805-7. [PMID: 1604622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- R Sanseverino
- Service d'Urologie et Transplantation, Hopital E. Herriot, Lyon, France
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Martin X, Lefrancois N, Choukair M, Dawahra M, Sousa-Castello A, Marechal JM, Dubernard JM. Segmental versus total duodenopancreatic grafts: a 2-year randomized study. Transplant Proc 1992; 24:782-3. [PMID: 1604614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- X Martin
- Service d'Urologie et de Chirurgie de la Transplantation, Hopital E. Herriot, Lyon, France
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Sousa-Castello A, Lefrancois N, Martin X, Caldara R, Pouteil-Noble C, Touraine JL, Dubernard JM. Metabolic results at 6 and 12 months after pancreas transplantation. Transplant Proc 1992; 24:839. [PMID: 1604632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- A Sousa-Castello
- Service d'Urologie et de Chirurgie de la Transplantation, Hopital E. Herriot, Lyon, France
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Abstract
A total of 182 pancreatic transplantations were performed between 1976 and 1990. Survival of the grafts was 45% at 5 years. Major causes of graft loss have been rejection and venous thrombosis. Death occurred in 24 patients and was usually related to vascular complications. The techniques of duodenopancreatic transplantation with enteric drainage, bladder drainage and the technique of segmental duct obstructed grafts were compared. A higher rate of surgical complications was observed with enteric drainage, whereas it is unclear from the data whether segmental grafts or duodenopancreatic grafts drained into the bladder lead to different results.
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Affiliation(s)
- X Martin
- Department of Urology and Transplantation Surgery, Hôpital E. Herriot, Lyon, France
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Zech JC, Trepsat D, Gain-Gueugnon M, Lefrancois N, Martin X, Dubernard JM. Ophthalmological follow-up of type 1 (insulin-dependent) diabetic patients after kidney and pancreas transplantation. Diabetologia 1991; 34 Suppl 1:S89-91. [PMID: 1936705 DOI: 10.1007/bf00587628] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We studied the effect of successful kidney and pancreas transplantation on visual function and diabetic retinopathy in 18 patients with long-term Type 1 (insulin-dependent) diabetes mellitus (17 to 38 years) and with advanced proliferative retinopathy. The average age of the patients was 42 years. Prior to transplantation, 5 eyes were in end-stage ophthalmic complication due to neovascular glaucoma. An ophthalmological follow-up was performed between 1-6 years post-surgery. Analysis of the results showed that the diabetic retinopathy had stabilized after transplantation in 12 cases (66%) with a supplementary photocoagulation in the majority of cases. The proliferation continued in 4 patients (22%) leading to blindness in 2 patients and recurrence of vitreous haemorrhages despite the photocoagulation in the other 2 cases. An improvement was observed on fluorescein angiography in a patient with pre-papillar glial proliferation without photocoagulation. Ten patients were reported to have a cataract and were operated on in two cases before transplantation; in one patient, the cataract increased following transplantation. In conclusion, the kidney and pancreas transplantation was not effective in our patients in reversing the clinical and angiographic signs of diabetic retinopathy. Moreover, a worsening of the lesions was observed in some cases; this was probably due to the irreversible microangiopathic lesions due to advanced evolution of diabetes.
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Affiliation(s)
- J C Zech
- Hôpital Edouart Herriot, Lyon, France
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Caldara R, Martin X, Secchi A, Lefrancois N, Touraine JL, Pozza G, Dubernard JM. Metabolic control after kidney and pancreas transplantation: whole series results and effects of segmental duct obstruction versus whole pancreas with bladder diversion technique. Diabetologia 1991; 34 Suppl 1:S51-2. [PMID: 1936695 DOI: 10.1007/bf00587619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
From October 1976 to December 1990 181 pancreatic transplants were performed in our centre on 171 Type 1 (insulin-dependent) diabetic patients. Oral glucose tolerance test evaluated 1 year after surgery in 31 subjects showed an impaired glucose tolerance at 120 min (blood glucose 9.5 +/- 0.6 mmol/l). Similar results were obtained in seven patients 3 years after transplantation (blood glucose at 120 min 8.3 +/- 1.08 mmol/l). 24h metabolic profiles performed at the same intervals showed near normal blood glucose levels and good insulin release. Preliminary data concerning a randomized, comparative study between whole pancreas with bladder diversion and segmental pancreas transplantation, showed better metabolic control in the patients who received the whole pancreas, probably due to the greater islet mass grafted.
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Affiliation(s)
- R Caldara
- Istituto Scientifico San Raffaele, Milan, Italy
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28
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Vial C, Martin X, Lefrancois N, Dubernard JM, Chauvin F, Bady B. Sequential electrodiagnostic evaluation of diabetic neuropathy after combined pancreatic and renal transplantation. Diabetologia 1991; 34 Suppl 1:S100-2. [PMID: 1936669 DOI: 10.1007/bf00587631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To assess the long-term evolution of diabetic polyneuropathy after a combined kidney-pancreas transplant, an electrophysiological study was performed in 20 diabetic patients before transplant, and 1 (n = 18), 2 (n = 16), 3 (n = 10) and 4 years (n = 5) at a later date. Motor and sensory scores were calculated for conduction velocity and amplitude to determine the physiopathological process. During evolution the scores were not found to be decreasing. Motor and sensory velocity scores were significantly improved (p less than 0.05) 1 and 2 years after the graft, when score values tended to stabilize. Motor and sensory amplitude scores, which are more sensitive for axonal loss assessment were slightly but not significantly improved.
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Affiliation(s)
- C Vial
- Laboratory of Electromyography, Hôpital Neurologique, Lyon, France
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29
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Caldara R, Sanseverino R, Lefrancois N, Martin X, Martinenghi S, Dubernard JM. Pancreas transplantation: long-term results. Clin Transplant 1991; 5:260-4. [PMID: 10147641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The rationale behind pancreatic transplantation is to provide a self-regulated, endogenous source of insulin and other islet hormones, thus restoring normal metabolism with the ultimate goals of prevention, stabilization or reversal of secondary degenerative complications. We report clinical and metabolic data of 8 patients submitted to simultaneous kidney and pancreas transplantation in our institute, who had a pancreatic graft function for 4 (1 case) and 5 (7 cases) years. To assess the impact of transplanted pancreatic mass on long-term function, we also included 10 patients from a comparative study between segmental pancreas transplantation (group A, 5 pts) and whole pancreas with enteric diversion transplantation (group B, 5 pts), who had pancreatic function for 2 and 3 yr. All patients are alive. Seven of these patients are off insulin, while one patient lost pancreatic function during an operation performed to correct an arterial stenosis of the graft. HbAlc levels were normal during the entire follow-up period (5.2+/-0.14% at 4 yr; 5.1+/-0.6% at 5 yr). In 24-hour metabolic profiles we observed near normal blood glucose levels, with good insulin release at 4 yr and a mild hyperglycemia at 5 yr (BG at 9 p.m.: 8.8+/-1.3 mmol/l). OGTT performed in 5 patients, 4 yr after pancreas transplantation, showed an impaired glucose tolerance, while the same test performed at 5 yr, showed higher values (BG 120 minutes: 14.7+/-0.2 mmol/l). Group A and group B patients are all alive, with good renal and pancreatic function.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Caldara
- Istituto Scientifico San Raffaele, Milano, Italy
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30
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Abstract
Oral hairy leukoplakia (OHL) is seen almost exclusively in patients infected with HIV. A case is reported of OHL occurring in a patient who was seronegative for HIV and who had a renal graft. This occurred following an increase in his treatment with immunosuppressive drugs.
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Affiliation(s)
- J Kanitakis
- Department of Dermatology, Ed. Herriot Hospital, Lyon, France
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31
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Raffaele P, Pouteil-Noble C, Lefrancois N, Bosshard S, Betuel H, Aymard M, Dubernard JM, Touraine JL. Influence of a randomized monoclonal or polyclonal program of therapy on cytomegalovirus infection in kidney transplantation. Transplant Proc 1991; 23:1361-2. [PMID: 1846465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- P Raffaele
- Transplantation Unit, E. Herriot Hospital, Lyon, France
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32
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Sanseverino R, Martin X, Caldara R, Faure JL, Lefrancois N, Dubernard JM. Technique of pancreas revascularization after combined liver and pancreas harvesting in the same cadaveric donor. Clin Transplant 1991; 5:55-9. [PMID: 10147635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Combined liver and pancreas harvesting in the same donor is nowadays a routine procedure in our institution. In terms of sharing of the vascular pedicule the priority is given in the majority of cases to the liver graft. Thus vascular reconstruction of the pancreatic graft is often required before transplantation. From February 1987 to June 1990 we transplanted 62 pancreases coming from a donor where also a liver graft had been harvested; 46 were segmental grafts prepared by duct injection with neoprene, 14 were pancreatico-duodenal grafts with bladder diversion of the exocrine secretion, and 2 were whole pancreas scheduled for bladder diversion and secondarily reconverted to duct injection (1 whole and 1 segmental graft) for poor duodenal blood supply. Among the 47 segmental grafts (46 + 1 reconverted from whole to segmental), in only 10 cases was the celiac axis with an aortic patch possible; conversely in 37 cases the splenic artery had been divided at its origin during the harvesting; bench surgery for vascular reconstruction was realized in 33 cases. Among the 14 pancreatico-duodenal grafts with bladder diversion and the whole pancreas with duct obstruction, in 5 cases the celiac axis and the superior mesenteric artery were harvested on the same aortic patch; in 10 cases the splenic artery was divided at its origin during the harvesting, requiring bench surgery for reconstruction.
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Affiliation(s)
- R Sanseverino
- Department of Urology and Transplantation, Hopital Edouar Herriot, Lyon, France
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33
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Secchi A, Dubernard JM, Melandri M, Lefrancois N, Martinenghi S, Martin X, Traeger J, Pozza G. Long-term metabolic effects of segmental pancreas transplantation. Transplant Proc 1990; 22:1591-2. [PMID: 2389414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A Secchi
- Clinica Medica VII, H San Raffaele, Milano, Italy
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34
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Dubernard JM, Martinenghi S, Martin X, Gelet A, Lefrancois N, Sanverino R, Betuel H, Pozza G. Pancreatic transplantation in Lyon: the whole series. Transplant Proc 1990; 22:595-6. [PMID: 2326996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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35
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Dubernard JM, Sanseverino R, Martinenghi S, Martin X, Marechal JM, Camozzi L, Melandri M, Gelet A, Lefrancois N, Touraine JL. Duct obstruction of segmental grafts in pancreas transplantation. Transplant Proc 1989; 21:2799-800. [PMID: 2650367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J M Dubernard
- Hôpital Edouard Herriot, Service d'Urologie, Lyon, France
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36
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Touraine JL, Garnier JL, Lefrancois N, Finaz de Villaine J, Dubernard JM, de Thé G, Lenoir G. Severe lymphoproliferative disease and Kaposi sarcoma in transplant patients. Transplant Proc 1989; 21:3197-8. [PMID: 2650450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J L Touraine
- Transplant Unit, Hôpital E. Herriot, Lyon, France
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37
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Dubernard JM, Melandri M, Lefrancois N, Sanseverino R, Martin X, Camozzi L, Touraine JL. Immunosuppression in pancreas transplantation. Transplant Proc 1988; 20:457-60. [PMID: 3291281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- J M Dubernard
- Service de la Transplantation, Hôpital Edouard Herriot, Lyon, France
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38
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Melandri M, Lefrancois N, La Rocca E, Martin X, Sanseverino R, Camozzi L, Faure JL, Secchi A, Gelet A, Bottani G. Clinical experience in pancreas transplantation in Lyon: long-term survival of duct injected pancreatic grafts. Acta Diabetol Lat 1988; 25:69-80. [PMID: 3043989 DOI: 10.1007/bf02581248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ninety-seven pancreatic grafts in 92 insulin-dependent diabetic patients were performed during the last 11 years. Eighty-three of these grafts were carried out after neoprene duct injection, the other patients underwent pancreato-duodenal transplantation. In 80 cases, a double pancreas and kidney graft was performed. Five different immunosuppressive protocols were subsequently applied. Actuarial survival of patients and pancreata was 75.1% and 47%, after one year and 54.6% and 22.1%, respectively, 4 years after transplantation. Slightly better results were observed in double pancreas and kidney transplantation. The survival of both patients and pancreas improved when the most recent immunosuppressive protocols including cyclosporin A and only small doses of steroids were applied. The main causes of loss of the pancreatic graft were rejection, vascular thrombosis and death of the patient with functioning organ. Metabolic studies showed good insulin secretion with normal or impaired glucose tolerance as well as good short and half-term glycemic control. Whole pancreas grafts with enteric diversion yielded prompter and higher insulin secretion but the incidence of surgical complications was increased. In comparison to the data recorded at 6 months after pancreas transplantation, 5 patients of our series with still functioning organ showed an equally satisfactory and unchanged glycemic control after more than 4 years from surgery. In these patients, the previously high insulinemic values decreased to normal levels. However, 3 of these patients showed a decrease in post-prandial peaks as confirmed also by OGTT. However, mean blood glucose level was not altered. In our series the suppression of exocrine pancreatic secretion by neoprene duct injection did not appear to represent a relevant cause of decrease in endocrine function. The results obtained do not yet allow us to draw definite conclusions as to the efficacy of pancreas transplantation in the treatment of degenerative complications in diabetic patients.
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Affiliation(s)
- M Melandri
- Chirurgie de la Transplantation, Hôpital E. Herriot, Lyon, France
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39
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La Rocca E, Dubernard JM, Samseverino R, Camozzi L, Faure JL, Lefrancois N, Martin X, Finaz J, Touraine JL. Results of simultaneous pancreaticorenal transplantation--Lyon, France. Transplant Proc 1987; 19:44-7. [PMID: 3303550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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40
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Dubernard JM, La Rocca E, Gelet A, Faure JL, Long D, Martin X, Lefrancois N, Blanc N, Monti L, Touraine JL. Simultaneous pancreas and kidney transplantation: long-term results and comparison of two surgical techniques. Transplant Proc 1987; 19:2285-7. [PMID: 3274509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- J M Dubernard
- Service d'Urologie et de Chirurgie de la Transplantation, Hôpital Edouard Herriot, Lyon, France
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41
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Lefrancois N, Touraine JL, Cantarovich D, Cantarovich F, Faure JL, Dubernard JM, Dureau G, Colpart JJ, Bouvier R, Traeger J. Transmission of medulloblastoma from cadaver donor to three organ transplant recipients. Transplant Proc 1987; 19:2242. [PMID: 3274501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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42
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Cantarovich F, Bizollon C, Cantarovich D, Lefrancois N, Dubernard JM, Mizony Busnardo ME, De Arteaga J, Suso E, Mpio I, Traeger J. RIA plasma cyclosporine values six hours after oral administration (T6)--an easy solution to a difficult therapeutic problem: a retrospective and prospective study. Transplant Proc 1987; 19:1723-5. [PMID: 3274415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- F Cantarovich
- Clinique Nephrologique, Hôpital Edouard Herriot, Lyon, France
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