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Tamzali Y, Pourcher V, Azoyan L, Ouali N, Barrou B, Conti F, Coutance G, Gay F, Tourret J, Boutolleau D. Factors Associated With Genotypic Resistance and Outcome Among Solid Organ Transplant Recipients With Refractory Cytomegalovirus Infection. Transpl Int 2023; 36:11295. [PMID: 37398559 PMCID: PMC10307959 DOI: 10.3389/ti.2023.11295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023]
Abstract
Genotypically resistant cytomegalovirus (CMV) infection is associated with increased morbi-mortality. We herein aimed at understanding the factors that predict CMV genotypic resistance in refractory infections and disease in the SOTR (Solid Organ Transplant Recipients) population, and the factors associated with outcomes. We included all SOTRs who were tested for CMV genotypic resistance for CMV refractory infection/disease over ten years in two centers. Eighty-one refractory patients were included, 26 with genotypically resistant infections (32%). Twenty-four of these genotypic profiles conferred resistance to ganciclovir (GCV) and 2 to GCV and cidofovir. Twenty-three patients presented a high level of GCV resistance. We found no resistance mutation to letermovir. Age (OR = 0.94 per year, IC95 [0.089-0.99]), a history of valganciclovir (VGCV) underdosing or of low plasma concentration (OR= 5.6, IC95 [1.69-20.7]), being on VGCV at infection onset (OR = 3.11, IC95 [1.18-5.32]) and the recipients' CMV negative serostatus (OR = 3.40, IC95 [0.97-12.8]) were independently associated with CMV genotypic resistance. One year mortality was higher in the resistant CMV group (19.2 % versus 3.6 %, p = 0.02). Antiviral drugs severe adverse effects were also independently associated with CMV genotypic resistance. CMV genotypic resistance to antivirals was independently associated with a younger age, exposure to low levels of GCV, the recipients' negative serostatus, and presenting the infection on VGCV prophylaxis. This data is of importance, given that we also found a poorer outcome in the patients of the resistant group.
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Affiliation(s)
- Yanis Tamzali
- Sorbonne Université, Paris, France
- Department of Infectious and Tropical Diseases, Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Medicosurgical Unit of Kidney Transplantation, Paris, France
- INSERM UMR 1146, Paris, France
| | - V. Pourcher
- Sorbonne Université, Paris, France
- Department of Infectious and Tropical Diseases, Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM UMR, Paris, France
| | - L. Azoyan
- Sorbonne Université, Paris, France
- Department of Infectious and Tropical Diseases, Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - N. Ouali
- Department of Nephrology Unité SINRA, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - B. Barrou
- Sorbonne Université, Paris, France
- Department of Infectious and Tropical Diseases, Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Medicosurgical Unit of Kidney Transplantation, Paris, France
- INSERM UMR 1038, Paris, France
| | - F. Conti
- Sorbonne Université, Paris, France
- Department of Hepatogastroenterlogy, Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Liver Transplantation Unit, Paris, France
| | - G. Coutance
- Sorbonne Université, Paris, France
- Department of Cardiosurgery, Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Fédération de Cardiologie, Paris, France
| | - F. Gay
- Sorbonne Université, Paris, France
- Department of Parasitology and Mycology, Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - J. Tourret
- Sorbonne Université, Paris, France
- Department of Infectious and Tropical Diseases, Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Medicosurgical Unit of Kidney Transplantation, Paris, France
- INSERM UMR 1146, Paris, France
| | - D. Boutolleau
- Sorbonne Université, Paris, France
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM UMR, Paris, France
- Department of Virology, Assistance Publique—Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Centre National de Référence Herpèsvirus (Laboratoire Associé), Paris, France
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Courbebaisse M, Bourmaud A, Souberbielle JC, Sberro-Soussan R, Moal V, Le Meur Y, Kamar N, Albano L, Thierry A, Dantal J, Danthu C, Moreau K, Morelon E, Heng AE, Bertrand D, Arzouk N, Perrin P, Morin MP, Rieu P, Presne C, Grimbert P, Ducloux D, Büchler M, Le Quintrec M, Ouali N, Pernin V, Bouvier N, Durrbach A, Alamartine E, Randoux C, Besson V, Hazzan M, Pages J, Colas S, Piketty ML, Friedlander G, Prié D, Alberti C, Thervet E. Nonskeletal and skeletal effects of high doses versus low doses of vitamin D 3 in renal transplant recipients: Results of the VITALE (VITamin D supplementation in renAL transplant recipients) study, a randomized clinical trial. Am J Transplant 2023; 23:366-376. [PMID: 36695682 DOI: 10.1016/j.ajt.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 01/11/2023]
Abstract
Vitamin D sufficiency is associated with a reduced risk of fractures, diabetes mellitus, cardiovascular events, and cancers, which are frequent complications after renal transplantation. The VITALE (VITamin D supplementation in renAL transplant recipients) study is a multicenter double-blind randomized trial, including nondiabetic adult renal transplant recipients with serum 25-hydroxy vitamin D (25(OH) vitamin D) levels of <30 ng/mL, which is randomized 12 to 48 months after transplantation to receive high (100 000 IU) or low doses (12 000 IU) of cholecalciferol every 2 weeks for 2 months and then monthly for 22 months. The primary outcome was a composite endpoint, including diabetes mellitus, major cardiovascular events, cancer, and death. Of 536 inclusions (50.8 [13.7] years, 335 men), 269 and 267 inclusions were in the high-dose and low-dose groups, respectively. The serum 25(OH) vitamin D levels increased by 23 versus 6 ng/mL in the high-dose and low-dose groups, respectively (P < .0001). In the intent-to-treat analysis, 15% versus 16% of the patients in the high-dose and low-dose groups, respectively, experienced a first event of the composite endpoint (hazard ratio, 0.94 [0.60-1.48]; P = .78), whereas 1% and 4% of patients in the high-dose and low-dose groups, respectively, experienced an incident symptomatic fracture (odds ratio, 0.24 [0.07-0.86], P = .03). The incidence of adverse events was similar between the groups. After renal transplantation, high doses of cholecalciferol are safe but do not reduce extraskeletal complications (trial registration: ClinicalTrials.gov; identifier: NCT01431430).
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Affiliation(s)
- Marie Courbebaisse
- Paris University; Physiology Department, European Georges-Pompidou Hospital, APHP; INSERM U1151. Paris, France.
| | - Aurelie Bourmaud
- APHP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'Epidémiologie Clinique, Inserm, CIC 1426, F-75019 Paris, France; Université de Paris, ECEVE UMR 1123, INSERM. F-75010 Paris, France
| | - Jean-Claude Souberbielle
- Service des explorations fonctionnelles hôpital Necker-Enfants Malades, DMU Biophygen, GHU Centre Université de Paris APHP. Paris, France
| | - Rebecca Sberro-Soussan
- Université de Paris; Service de Transplantation Rénale et Néphrologie, Hôpital Necker Enfant Malades, APHP. Paris, France
| | - Valérie Moal
- Aix-Marseille Université - AP-HM - Hôpital Conception - Centre de Néphrologie et Transplantation Rénale. Marseille, France
| | - Yannick Le Meur
- Department of Nephrology, CHU de Brest; UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, Labex IGO. Brest, France
| | - Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR -BMT, University Paul Sabatier. Toulouse, France
| | - Laetitia Albano
- Service de Transplantation Rénale, CHU de Nice. Nice, France
| | - Antoine Thierry
- Service de Néphrologie, INSERM U1082 et Fédération Hospitalo-Universitaire BIOSUPORT. Poitiers, France
| | - Jacques Dantal
- CRTI (Centre de Recherche en Transplantation et Immunologie) INSERM UMR1064, Université de Nantes, Centre Hospitalier Universitaire de Nantes. Nantes, France
| | - Clément Danthu
- Department of Nephrology, Limoges University hospital; UMR INSERM 1092, RESINFIT, Limoges University hospital 2. Limoges, France
| | - Karine Moreau
- Unité de transplantation rénale, Hôpital Pellegrin, CHU de Bordeaux. Bordeaux, France
| | - Emmanuel Morelon
- Service de transplantation, néphrologie et immunologie clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon; INSERM U1111, Université Claude Bernard Lyon1. Lyon, France
| | - Anne-Elisabeth Heng
- Service de Néphrologie, Dialyse, Transplantation, CHU de Clermont-Ferrand; Université Clermont Auvergne. F-63000 Clermont-Ferrand, France
| | - Dominique Bertrand
- Nephrology, dialysis and kidney transplantation, Rouen University Hospital. Rouen, France
| | - Nadia Arzouk
- Service de Transplantation Rénale, hôpital La Pitié-Salpétrière, APHP. Paris, France
| | - Peggy Perrin
- Department of Nephrology and Transplantation, Strasbourg University Hospital; Fédération de Médecine Translationnelle, INSERM U1109, LabEx TRANSPLANTEX. Strasbourg, France
| | | | - Philippe Rieu
- Division of Nephrology, Reims university hospital, CRNS UMR 7369 MEDyC laboratory. Reims, France
| | - Claire Presne
- Nephrology Internal Medicine Dialysis Transplantation Department, Amiens University Hospital. Amiens France
| | - Philippe Grimbert
- Nephrology and Transplant Department, CHU Henri-Mondor, APHP; Université Paris Est Créteil, INSERM U955. Paris, France
| | - Didier Ducloux
- Department of Nephrology, CHU Besançon. Besançon, France
| | - Matthias Büchler
- Department of Nephrology and Transplantation, CHU Tours; University of Tours, EA4245 Transplantation, Immunology, Inflammation; FHU SUPORT. Tours, France
| | | | - Nacéra Ouali
- Nephrology department, SINRA, Hôpital Tenon. Paris, France
| | - Vincent Pernin
- University of Montpellier, Department of Nephrology, Dialysis and Transplantation, Montpellier University hospital; Institute for Regenerative Medicine & Biotherapy (IRMB), INSERM U1183. Montpellier, France
| | - Nicolas Bouvier
- Service de Néphrologie-Dialyse-Transplantation, CHU Caen Normandie; Université de Caen Normandie. Caen, France
| | - Antoine Durrbach
- Université Paris Saclay, France; INSERM UMR 1186, Gustave Roussy. Villejuif, France; Nephrology Department, Bicêtre Hospital APHP. Le Kremlin-Bicêtre, France
| | - Eric Alamartine
- CHU de Saint Etienne et CIRI - INSERM U1111 - CNRS UMR5308 - ENS Lyon/UCBL1/Université St Etienne. Saint Etienne, France
| | - Christine Randoux
- Service de Néphrologie, CHU Bichat Claude Bernard, APHP.Nord. Paris, France
| | - Virginie Besson
- Service de Néphrologie-Dialyse-transplantation, CHU d'Angers. Angers, France
| | - Marc Hazzan
- Université de Lille, INSERM, CHU Lille, U1286 - Infinite - Institute for Translational Research in Inflammation. F-59000 Lille, France
| | - Justine Pages
- APHP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'Epidémiologie Clinique, INSERM, CIC 1426. F-75019 Paris, France
| | - Sandra Colas
- Unité de Recherche Clinique Necker-Cochin, APHP. Paris, France
| | - Marie-Liesse Piketty
- Service des explorations fonctionnelles hôpital Necker-Enfants Malades, DMU Biophygen, GHU Centre Université de Paris APHP. Paris, France
| | | | - Dominique Prié
- Université de Paris; INSERM U1151, service des explorations fonctionnelles hôpital Necker-Enfants Malades, DMU Biophygen, GHU Centre Université de Paris APHP. Paris, France
| | - Corinne Alberti
- APHP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d'Epidémiologie Clinique, Inserm, CIC 1426, F-75019 Paris, France; Université de Paris, ECEVE UMR 1123, INSERM. F-75010 Paris, France
| | - Eric Thervet
- Paris University; Nephrology Department, European Georges-Pompidou Hospital, APHP; INSERM UMR 970, Paris Cardiovascular Research Center. Paris, France
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Moreno-Sabater A, Ouali N, Chasset F, Frances C, Senet P, Faucon C, Hennequin C, Bachmeyer C. Severe onychomycosis management with oral terbinafine in a kidney transplantation setting: Clinical follow-up by image analysis. Mycoses 2020; 64:309-315. [PMID: 33245794 DOI: 10.1111/myc.13220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Severe onychomycosis treatment in kidney transplant recipients (KTR) is challenging because of drug interactions and adverse events. Tacrolimus remains the antirejection treatment (ART) of choice in kidney transplantation but tolerance with systemic terbinafine for the management of severe onychomycosis has not been studied. OBJECTIVE This study illustrates severe onychomycosis management in a kidney transplantation setting and investigates systemic terbinafine tolerance profile in KTR. PATIENTS/METHODS We retrospective analysed clinical data of KTR with a confirmed diagnosis of severe onychomycosis. RESULTS We retrieved a total of 29 KTR with severe onychomycosis needing an oral treatment to manage onychomycosis. In 55.1% (16/29) KTR, altered renal biological parameters or lack of guidelines to manage severe onychomycosis were the main reasons to deterring clinicians from prescribing oral treatments. 13 patients received an oral terbinafine treatment (9, 3 and 1 with a tacrolimus, cyclosporine and everolimus-based ART, respectively). Clinical and biological follow-up did not reveal severe drug interactions. ART blood levels showed significant variations in 2 patients without clinical consequences in renal graft. Two patients reported mild adverse events but after only one dose of terbinafine. Using an open-source image analysis program, clinical evolution of onychomycosis could be retrospectively quantified and followed up. CONCLUSIONS The results presented here suggest that oral terbinafine can be proposed to treat severe onychomycosis with an acceptable tolerance profile in KTR with different ART such as tacrolimus and highlight the need of multicentric studies to establish guidelines for onychomycosis treatment in KTR.
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Affiliation(s)
- Alicia Moreno-Sabater
- Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Sorbonne Université, Inserm U1135, Paris, France.,Service de Parasitologie-Mycologie, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Nacéra Ouali
- Service d'Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
| | - François Chasset
- Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Sorbonne Université, Inserm U1135, Paris, France.,Service de Dermatologie-Allergologie, AP-HP, Hôpital Tenon, Paris, France
| | - Camille Frances
- Service de Dermatologie-Allergologie, AP-HP, Hôpital Tenon, Paris, France
| | - Patricia Senet
- Service de Dermatologie-Allergologie, AP-HP, Hôpital Tenon, Paris, France
| | - Caroline Faucon
- Service de Dermatologie-Allergologie, AP-HP, Hôpital Tenon, Paris, France
| | - Christophe Hennequin
- Service de Parasitologie-Mycologie, AP-HP, Hôpital Saint-Antoine, Paris, France.,Centre de Recherche Saint-Antoine, CRSA, AP-HP, Sorbonne Université, Inserm, Paris, France
| | - Claude Bachmeyer
- Service de Dermatologie-Allergologie, AP-HP, Hôpital Tenon, Paris, France
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Lombardi Y, Fessi H, François H, Michel P, Ouali N, Petit-Hoang C, Rondeau E. Impact de la modalité du traitement de suppléance rénale sur le pronostic de l’infection à SARS-CoV2. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Doreille A, Raymond L, Yosu L, Xu X, Homs S, François H, Rafat C, Ouali N, Rondeau E, Mesnard L. Séquençage complet de l’exome dans les néphropathies indéterminées des jeunes adultes : séquençage d’abord et rétrophénotypage ensuite ? Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ferriere E, Luque Y, Jamme M, Ouali N, Rafat C, Hertig A, Rondeau E, Mesnard L. Temps d’ischémie tiède et fonction précoce du greffon rénal : étude monocentrique française. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Gaiffe E, Crepin T, Bamoulid J, Courivaud C, Büchler M, Cassuto E, Albano L, Chemouny JM, Choukroun G, Hazzan M, Kessler L, Legendre C, Le Meur Y, Ouali N, Thierry A, Anota A, Nerich V, Limat S, Bonnetain F, Vernerey D, Ducloux D. PRODIG (Prevention of new onset diabetes after transplantation by a short term treatment of Vildagliptin in the early renal post-transplant period) study: study protocol for a randomized controlled study. Trials 2019; 20:375. [PMID: 31227028 PMCID: PMC6588872 DOI: 10.1186/s13063-019-3392-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Post-transplant diabetes is a frequent and serious complication of kidney transplantation. There is currently no treatment to prevent or delay the disease. Nevertheless, identification of risk factors make it possible to target a population at risk of developing de novo diabetes. We hypothesized that a short-term treatment with vildagliptin may prevent new onset diabetes after transplantation (NODAT) in high-risk patients. METHODS/DESIGN This is a multicenter, double-blind, placebo-controlled randomized clinical trial. Patients undergoing first kidney transplantation will be included from ten French transplant centers. Included patients will be randomized (1:1) to receive either vildagliptin 100 or 50 mg/day (depending on glomerular filtration rate) during 2 months (the first dose being administered before entering the operating theatres) or placebo. Additional antidiabetic therapy could be administered according to glycemic control. The primary outcome is the proportion of diabetic patients 1 year after transplantation, defined as patients receiving a diabetic treatment, or having a fasting glucose above 7 mmol/l, and/or with an abnormal oral glucose tolerance test. Secondary outcomes include glycated hemoglobin, the occurrence of acute rejection, infection, graft loss and patient death at 3 months, 6 months, and 12 months after transplantation. Outcomes will be correlated to clinical and general characteristics of the patient, cardiovascular history, nephropathy, dialysis history, transplantation data, biological data, health-related quality of life, and the cost-effectiveness of prevention of diabetes with vildagliptin. DISCUSSION We have scarce data on the pharmacological prevention of post-transplant diabetes. If our hypothesis is verified, our results will have a direct application in clinical practice and could limit diabetes-associated morbidity, reduce cardiovascular complications, increase quality of life of renal transplant patients, and consequently promote graft and patient survival. Our results may possibly serve for non-transplant patients carrying a high-risk of diabetes associated with other co-morbidities. TRIAL REGISTRATION ClinicalTrials.gov, NCT02849899 . Registered on 8 February 2016.
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Affiliation(s)
- E. Gaiffe
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, F-25000 Besançon, France
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, CIC Biothérapie, INSERM CIC1431, F-25000 Besançon, France
| | - T. Crepin
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, F-25000 Besançon, France
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, CIC Biothérapie, INSERM CIC1431, F-25000 Besançon, France
| | - J. Bamoulid
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, F-25000 Besançon, France
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, CIC Biothérapie, INSERM CIC1431, F-25000 Besançon, France
| | - C. Courivaud
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, F-25000 Besançon, France
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, CIC Biothérapie, INSERM CIC1431, F-25000 Besançon, France
| | - M. Büchler
- CHU Bretonneau, Department of Nephrology and Clinical Immunology, EA 4245 Transplantation, Immunology, Inflammation, F-37044 Tours, France
| | - E. Cassuto
- Pasteur hospital, L’Archet hospital group, Department of Nephrology, Dialysis, and Renal Transplantation, F-06000 Nice, France
| | - L. Albano
- Pasteur hospital, L’Archet hospital group, Department of Nephrology, Dialysis, and Renal Transplantation, F-06000 Nice, France
| | - J. M. Chemouny
- CHU de Rennes, Department of Nephrology, F-35033 Rennes, France
| | - G. Choukroun
- CHU Amiens, Department of Nephrology, Dialysis, and Renal Transplantation, F-80054 Amiens, France
| | - M. Hazzan
- CHU de Lille, Nephrology department, University of Lille UMR 995, F-59000 Lille, France
| | - L. Kessler
- CHU Strasbourg, Department of Endocrinology, Diabetes and Nutrition, F-67000 Strasbourg, France
| | - C. Legendre
- Necker hospital, Department of Nephrology, Dialysis, and Renal Transplantation, F-75743 Paris, France
| | - Y. Le Meur
- Department of Nephrology, CHU de Brest, UMR1227, Université de Brest, Inserm, F-29609 Brest, France
| | - N. Ouali
- Tenon hospital, Nephrological Emergencies and Kidney Transplantation, F-75571 Paris, France
| | - A. Thierry
- CHU de Poitiers, Department of Nephrology, Dialysis, and Renal Transplantation, F-86021 Poitiers, France
| | - A. Anota
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, Methodology and quality of life unit, F-25000 Besançon, France
| | - V. Nerich
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, department of Pharmacy, F-25030 Besançon, France
| | - S. Limat
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, department of Pharmacy, F-25030 Besançon, France
| | - F. Bonnetain
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, Methodology and quality of life unit, F-25000 Besançon, France
| | - D. Vernerey
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, Methodology and quality of life unit, F-25000 Besançon, France
| | - D. Ducloux
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Federation Hospitalo-Universitaire INCREASE, F-25000 Besançon, France
- INSERM, UMR1098, EFS-BFC, University Burgundy Franche-Comte, LabEx LipSTIC, FHU INCREASE, F-25000 Besançon, France
- CHU Besançon, CIC Biothérapie, INSERM CIC1431, F-25000 Besançon, France
- Service de Néphrologie et transplantation rénale, Centre Hospitalier Régional Universitaire de Besançon, 3, boulevard Alexandre Fleming, 25030 Besançon, cedex France
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8
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Gérardin C, Moktefi A, Couchoud C, Karras A, Gatault P, Ouali N, Anglicheau D, Grimbert P, Audard V. Caractéristiques de la transplantation rénale chez 35 patients drépanocytaires : une étude française rétrospective multicentrique. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Mohamadou I, Matignon M, Malard S, Grimbert P, Moktefi A, Buob D, Ouali N, Rondeau E, Luque Y. Comparaison de deux stratégies d’induction pour les transplantés rénaux hyperimmunisés avec DSA pré-formés à fort titre. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Tamzali Y, Letavernier E, Jamme M, Ouali N, Hertig A, Mesnard L, Doizi S, Rondeau E, Luque Y. Hypocalcémie sévère post-transplantation rénale : un cas extrême de Hungry Bone Syndrome. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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11
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Polivka L, Moguelet P, Meritet JF, Ouali N, Francès C, Senet P. Giant orf tumour in an immunocompromised patient. J Eur Acad Dermatol Venereol 2017; 31:e515-e516. [PMID: 28544177 DOI: 10.1111/jdv.14361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- L Polivka
- Department of Dermatology, Tenon Hospital (AP-HP), Paris, France
| | - P Moguelet
- Department of Pathology, Tenon Hospital (AP-HP), Paris, France
| | - J F Meritet
- Department of Microbiology, Cochin Hospital (AP-HP), Paris, France
| | - N Ouali
- Department of Nephrology, Tenon Hospital (AP-HP), Paris, France
| | - C Francès
- Department of Dermatology, Tenon Hospital (AP-HP), Paris, France
| | - P Senet
- Department of Dermatology, Tenon Hospital (AP-HP), Paris, France
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12
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Galichon P, Amrouche L, Hertig A, Brocheriou I, Rabant M, Xu-Dubois YC, Ouali N, Dahan K, Morin L, Terzi F, Rondeau E, Anglicheau D. Urinary mRNA for the Diagnosis of Renal Allograft Rejection: The Issue of Normalization. Am J Transplant 2016; 16:3033-3040. [PMID: 27232948 DOI: 10.1111/ajt.13891] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/10/2016] [Accepted: 05/25/2016] [Indexed: 01/25/2023]
Abstract
Urinary messenger RNA (mRNA) quantification is a promising method for noninvasive diagnosis of renal allograft rejection (AR), but the quantification of mRNAs in urine remains challenging due to degradation. RNA normalization may be warranted to overcome these issues, but the strategies of gene normalization have been poorly evaluated. Herein, we address this issue in a case-control study of 108 urine samples collected at time of allograft biopsy in kidney recipients with (n = 52) or without (n = 56) AR by comparing the diagnostic value of IP-10 and CD3ε mRNAs-two biomarkers of AR-after normalization by the total amount of RNA, normalization by one of the three widely used reference RNAs-18S, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and Hypoxanthine-guanine phosphoribosyltransferase (HPRT)-or normalization using uroplakin 1A (UPK) mRNA as a possible urine-specific reference mRNA. Our results show that normalization based on the total quantity of RNA is not substantially improved by additional normalization and may even be worsened with some classical reference genes that are overexpressed during rejection. However, considering that normalization by a reference gene is necessary to ensure polymerase chain reaction (PCR) quality and reproducibility and to suppress the effect of RNA degradation, we suggest that GAPDH and UPK1A are preferable to 18S or HPRT RNA.
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Affiliation(s)
- P Galichon
- INSERM U1155, Hôpital Tenon, Paris, France.,Université Pierre et Marie Curie, Paris 6, Sorbonne Universités, Paris, France.,Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - L Amrouche
- INSERM U1151, Hôpital Necker, Paris, France
| | - A Hertig
- INSERM U1155, Hôpital Tenon, Paris, France.,Université Pierre et Marie Curie, Paris 6, Sorbonne Universités, Paris, France.,Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - I Brocheriou
- INSERM U1155, Hôpital Tenon, Paris, France.,Université Pierre et Marie Curie, Paris 6, Sorbonne Universités, Paris, France.,Service d'anatomie pathologique, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M Rabant
- Laboratoire d'anatomie pathologique, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - N Ouali
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - K Dahan
- Service de Néphrologie et Dialyses, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - L Morin
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - F Terzi
- INSERM U1151, Hôpital Necker, Paris, France
| | - E Rondeau
- INSERM U1155, Hôpital Tenon, Paris, France.,Université Pierre et Marie Curie, Paris 6, Sorbonne Universités, Paris, France.,Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D Anglicheau
- INSERM U1151, Hôpital Necker, Paris, France.,Service de Néphrologie et Transplantation Adulte, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,RTRS "Centaure", Labex "Transplantex", Hôpital Necker, Paris, France
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13
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Hellemans R, Hazzan M, Durand D, Mourad G, Lang P, Kessler M, Charpentier B, Touchard G, Berthoux F, Merville P, Ouali N, Squifflet JP, Bayle F, Wissing KM, Noël C, Abramowicz D. Daclizumab Versus Rabbit Antithymocyte Globulin in High-Risk Renal Transplants: Five-Year Follow-up of a Randomized Study. Am J Transplant 2015; 15:1923-32. [PMID: 25707875 DOI: 10.1111/ajt.13191] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 12/07/2014] [Accepted: 12/24/2014] [Indexed: 01/25/2023]
Abstract
We previously reported a randomized controlled trial in which 227 de novo deceased-donor kidney transplant recipients were randomized to rabbit antithymocyte (rATG, Thymoglobulin) or daclizumab if they were considered to be at high immunological risk, defined as high panel reactive antibodies (PRA), loss of a first kidney graft through rejection within 2 years of transplantation, or third or fourth transplantation. Patients treated with rATG had lower incidences of biopsy-proven acute rejection (BPAR) and steroid-resistant rejection at 1 year. Patients were followed to 5 years posttransplant in an observational study; findings are described here. Treatment with rATG was associated with a lower rate of BPAR at 5 years (14.2% vs. 26.0% with daclizumab; p = 0.035). Only one rATG-treated patient (0.9%) and one daclizumab-treated patient (1.0%) developed BPAR after 1 year. Five-year graft and patient survival rates, and renal function, were similar between the two groups. Overall graft survival at 5 years was significantly higher in patients without BPAR (81.0% vs. 54.8%; p < 0.001). In conclusion, rATG is superior to daclizumab for the prevention of BPAR among high-immunological-risk renal transplant recipients. Overall graft survival at 5 years was approximately 70% with either induction therapy, which compares favorably to low-risk cohorts.
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Affiliation(s)
- R Hellemans
- Dienst Néphrologie, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - M Hazzan
- Service de N, é, phrologie, Hôpital, Lille, France
| | - D Durand
- Service de Néphrologie-HTA-Dialyse-Transplantation, CHU-Toulouse Rangueil, Toulouse, France
| | - G Mourad
- Département de Néphrologie et Transplantation, CHRU-Hôpital Lapeyronie, Montpellier, France
| | - P Lang
- Service de Néphrologie, Hôpital Henri Mondor, Créteil, France
| | - M Kessler
- Département de Néphrologie, Hôpital Universitaire de Nancy, Nancy, France
| | - B Charpentier
- Service de Néphrologie, CHRU de Bicêtre, Bicêtre, France
| | - G Touchard
- Service de Néphrologie-Transplantation, CHU de Poitiers, Hôpital Jean-Bernard, Poitiers, France
| | - F Berthoux
- Service de Néphrologie, CHRU-Hôpital Nord, Saint-Etienne, France
| | - P Merville
- Service de Néphrologie, Hôpital Pellegrin, Bordeaux, France
| | - N Ouali
- Service de Néphrologie A, Hôpital Tenon, Paris, France
| | - J-P Squifflet
- Cliniques Universitaires St Luc, Brussels, and Department of Abdominal Transplantation, CHU Sart Tilman, Liege, Belgium
| | - F Bayle
- Service de Néphrologie, CHU de Grenoble, Grenoble, France
| | - K M Wissing
- Dienst Nefrologie, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - C Noël
- Service de N, é, phrologie, Hôpital, Lille, France
| | - D Abramowicz
- Dienst Néphrologie, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
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14
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Xu-Dubois YC, Peltier J, Brocheriou I, Suberbielle-Boissel C, Djamali A, Reese S, Mooney N, Keuylian Z, Lion J, Ouali N, Levy PP, Jouanneau C, Rondeau E, Hertig A. Markers of Endothelial-to-Mesenchymal Transition: Evidence for Antibody-Endothelium Interaction during Antibody-Mediated Rejection in Kidney Recipients. J Am Soc Nephrol 2015; 27:324-32. [PMID: 25995444 DOI: 10.1681/asn.2014070679] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 04/11/2015] [Indexed: 01/06/2023] Open
Abstract
Antibody-mediated rejection (ABMR) is a leading cause of allograft loss. Treatment efficacy depends on accurate diagnosis at an early stage. However, sensitive and reliable markers of antibody-endothelium interaction during ABMR are not available for routine use. Using immunohistochemistry, we retrospectively studied the diagnostic value of three markers of endothelial-to-mesenchymal transition (EndMT), fascin1, vimentin, and heat shock protein 47, for ABMR in 53 renal transplant biopsy specimens, including 20 ABMR specimens, 24 cell-mediated rejection specimens, and nine normal grafts. We validated our results in an independent set of 74 unselected biopsy specimens. Endothelial cells of the peritubular capillaries in grafts with ABMR expressed fascin1, vimentin, and heat shock protein 47 strongly, whereas those from normal renal grafts did not. The level of EndMT marker expression was significantly associated with current ABMR criteria, including capillaritis, glomerulitis, peritubular capillary C4d deposition, and donor-specific antibodies. These markers allowed us to identify C4d-negative ABMR and to predict late occurrence of disease. EndMT markers were more specific than capillaritis for the diagnosis and prognosis of ABMR and predicted late (up to 4 years after biopsy) renal graft dysfunction and proteinuria. In the independent set of 74 renal graft biopsy specimens, the EndMT markers for the diagnosis of ABMR had a sensitivity of 100% and a specificity of 85%. Fascin1 expression in peritubular capillaries was also induced in a rat model of ABMR. In conclusion, EndMT markers are a sensitive and reliable diagnostic tool for detecting endothelial activation during ABMR and predicting late loss of allograft function.
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Affiliation(s)
- Yi-Chun Xu-Dubois
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_S1155, Paris, France; INSERM, UMR_S1136, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - Julie Peltier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Hospital, Renal Intensive Care Unit and Kidney Transplantation, Paris, France
| | - Isabelle Brocheriou
- Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris 06, UMR_S1155, Paris, France; AP-HP, Tenon Hospital, Department of Pathology, Paris, France
| | | | - Arjang Djamali
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
| | - Shannon Reese
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and
| | - Nuala Mooney
- INSERM, UMR_S1160, Paris, France, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Zela Keuylian
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_S1155, Paris, France
| | - Julien Lion
- INSERM, UMR_S1160, Paris, France, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Nacéra Ouali
- Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Hospital, Renal Intensive Care Unit and Kidney Transplantation, Paris, France
| | - Pierre P Levy
- INSERM, UMR_S1136, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
| | - Chantal Jouanneau
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_S1155, Paris, France
| | - Eric Rondeau
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_S1155, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Hospital, Renal Intensive Care Unit and Kidney Transplantation, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris 06, UMR_S1155, Paris, France
| | - Alexandre Hertig
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR)_S1155, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Hospital, Renal Intensive Care Unit and Kidney Transplantation, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Université Paris 06, UMR_S1155, Paris, France;
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15
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Xu-Dubois YC, Baugey E, Peltier J, Colombat M, Ouali N, Jouanneau C, Rondeau E, Hertig A. Epithelial phenotypic changes are associated with a tubular active fibrogenic process in human renal grafts. Hum Pathol 2013; 44:1251-61. [PMID: 23332931 DOI: 10.1016/j.humpath.2012.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 10/16/2012] [Accepted: 10/17/2012] [Indexed: 01/11/2023]
Abstract
Some recently published works contest the epithelial origin of myofibroblasts, which are the major extracellular matrix producers. However, our previous studies showed that, in tubular cells, some phenotypic changes reminiscent of epithelial-to-mesenchymal transition constitute an interesting early marker that predicts the progression of fibrosis in renal grafts. We hypothesized that activated epithelial cells could directly contribute to fibrogenesis, although they remain within the tubules. Using immunohistochemistry, we studied the association between epithelial phenotypic changes (de novo expression of vimentin and intracellular translocation of β-catenin) and the production of profibrotic molecules (connective tissue growth factor, HSP47, and laminin), in tubular epithelial cells from 93 renal grafts biopsied of 77 patients. We observed the de novo production of connective tissue growth factor, HSP47, and laminin in the tubular epithelial cells displaying epithelial phenotypic changes. The score of vimentin was significantly correlated with those of connective tissue growth factor (r = 0.785, P < .0001), HSP47 (r = 0.887, P < .0001), and laminin (r = 0.836, P < .0001). The level of tubular expression of mesenchymal cell markers and profibrogenic molecules, but not graft histologic lesions according to Banff acute or chronic scores, was correlated with graft dysfunction and proteinuria at the time of biopsy (r = -0.611, P < .0001 for vimentin with estimated glomerular filtration rate) (r = 0.42, P = .0006 for vimentin with proteinuria). Our results demonstrate that the epithelial phenotypic switch is associated with an active fibrogenic process in tubular epithelial cells and with graft injury indicators. Perpetuation of this tissue injury-repair response may drive fibrogenesis in renal grafts. This "repair response" represents an interesting marker for renal graft surveillance.
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Affiliation(s)
- Yi-Chun Xu-Dubois
- AP-HP, Hôpital Tenon, Urgences Néphrologiques & Transplantation Rénale, F-75020, Paris, France; INSERM, UMR S 702, F-75020, Paris, France.
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16
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Fouad Z, Hertig A, Richard M, D’hyturbide G, Mesnard L, Peltier J, Ridel C, Ouali N, Rondeau E. Non reprise primaire de la fonction rénale du greffon : étude monocentrique. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Rafat C, Vimont S, Ancel P, Xu-Dubois Y, Mesnard L, Ouali N, Denis M, Vandewalle A, Rondeau E, Hertig A. Ofloxacin: new applications for the prevention of urinary tract infections in renal graft recipients. Transpl Infect Dis 2011; 13:344-52. [DOI: 10.1111/j.1399-3062.2011.00602.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Abstract
Fabry disease (FD) is an X-linked lysosomal storage disease caused by deficient activity of the enzyme alpha-galactosidase A. Although the disease has progressive effects on most organ systems in the body, data is limited regarding skeletal involvement in this rare disorder. We describe four family-related patients, three men and one premenopausal female, sharing a classic phenotype of FD. Dual-energy X-ray was performed in all cases and osteoporosis or osteopenia were found in all patients and osteoporotic fractures in one. One patient also showed both neuropathic joint disease and osteonecrosis. Several mechanisms that may explain osteoporosis and osteoarthropathy in the setting of FD are emphasized.
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Affiliation(s)
- K Sacre
- Department of Internal Medicine, Bichat-Claude Bernard Hospital, APHP, University Paris-7, Paris Cedex 18, France
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19
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Sacre K, Lidove O, Giroux Leprieur B, Ouali N, Laganier J, Caillaud C, Papo T. Expression squelettique de la maladie de Fabry. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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d'Ythurbide G, Coppo P, Adem A, Callard P, Dantal J, Chantrel F, Godin M, Braun-Parvez L, Moulin B, Moskovtchenko P, Ouali N, Rondeau E, Hertig A. Chronic lymphocytic leukemia: a hazardous condition before kidney transplantation. Am J Transplant 2008; 8:2471-5. [PMID: 18782293 DOI: 10.1111/j.1600-6143.2008.02383.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Long-term survival of patients with chronic lymphocytic leukemia (CLL) is over 10 years, and such patients are thus potential kidney recipients in the case of superimposed end-stage renal disease. However, the renal and patient outcome in this condition is unknown. We report the charts of four patients with CLL who were engrafted in France with a deceased-donor kidney and underwent routine triple immunosuppressive therapy. The results show that these patients developed severe infectious episodes (fatal in one case) and tumoral complications including rapid progression of CLL in two cases. Moreover, the graft may be infiltrated and damaged by monoclonal B cells: one patient lost his graft 14 months after transplantation. Various therapeutic options (modifications of the immunosuppressive regimen, anti-CD20 antibodies, irradiation of the graft) showed little (if any) efficacy. Therefore, we believe that CLL is a too hazardous condition to envisage solid organ transplantation with a routine immunosuppressive regimen, and we propose a more appropriate approach.
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Affiliation(s)
- G d'Ythurbide
- Urgences Néphrologiques & Transplantation Rénale, AP-HP, Hôpital Tenon, F-75020, Paris, France
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21
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Ghisdal L, Touchard G, Goujon JM, Buob D, Durand D, Mourad G, Lang P, Kessler M, Snanoudj R, Berthoux F, Merville P, Ouali N, Squifflet JP, Bayle F, Bourgeon B, Rifle G, Peeters P, Delahousse M, Legendre C, Bourbigot B, Noël C, Abramowicz D. Premier épisode de rejet aigu après transplantation rénale : étude des caractéristiques histopathologiques en fonction du risque immunologique du patient. Nephrol Ther 2008; 4:173-80. [DOI: 10.1016/j.nephro.2008.02.001] [Citation(s) in RCA: 2] [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] [Received: 01/24/2007] [Revised: 10/22/2007] [Accepted: 02/09/2008] [Indexed: 11/25/2022]
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22
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Pellé G, Vimont S, Levy PP, Hertig A, Ouali N, Chassin C, Arlet G, Rondeau E, Vandewalle A. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant 2007; 7:899-907. [PMID: 17286620 DOI: 10.1111/j.1600-6143.2006.01700.x] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [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: 01/25/2023]
Abstract
Urinary tract infections (UTIs) and acute pyelonephritis (APN) often occur after renal transplantation, but their impact on graft outcome is unclear. One hundred and seventy-seven consecutive renal transplantations were investigated to evaluate the impact of UTIs and APN on graft function. The cumulative incidence of UTIs was 75.1% and that of APN was 18.7%. UTIs occurred mainly during the first year after transplantation and Escherichia coli, Pseudomonas aeruginosa and Enteroccocus sp. were the most frequent pathogens identified. The risk of developing APN was higher in female (64%) than in male recipients, and was correlated with the frequency of recurrent UTIs (p < 0.0001) and rejection episodes (p = 0.0003). APN did not alter graft or recipient survival, however, compared to patients with uncomplicated UTIs, patients with APN exhibited both a significant increase in serum creatinine and a decrease in creatinine clearance, already detected after 1 year (aMDRD-GFR: APN: 39.5 +/- 12.5; uncomplicated UTI: 54.6 +/- 21.7 mL/min/1.73 m(2), p < 0.01) and still persistent ( approximately - 50%) 4 years after transplantation. Multivariate analysis revealed that APN represents an independent risk factor associated with the decline of renal function (p = 0.034). Therefore, APN may be associated with an enduring decrease in renal graft function.
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Affiliation(s)
- G Pellé
- Service des Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, Paris, France
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23
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Hertig A, Verine J, Mougenot B, Jouanneau C, Ouali N, Sebe P, Glotz D, Ancel PY, Rondeau E, Xu-Dubois YC. Risk factors for early epithelial to mesenchymal transition in renal grafts. Am J Transplant 2006; 6:2937-46. [PMID: 17061992 DOI: 10.1111/j.1600-6143.2006.01559.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [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: 01/25/2023]
Abstract
Epithelial-to-mesenchymal transition (EMT) of tubular epithelial cells (TECs) may participate in the pathogenesis of renal fibrosis. We performed a prospective study of EMT markers in protocol biopsies obtained 3 months after engraftment from 56 patients who received deceased donor kidneys and who had stable renal function. The presence of EMT was examined, and quantified by immunohistochemical staining for vimentin and translocation of beta-catenin to the cytoplasm. EMT status was defined as the presence of EMT markers in > or = 10% of TECs. EMT features were virtually absent in implantation biopsies, whereas 41% of the grafts were EMT-positive in the absence of advanced chronic allograft nephropathy. Thirteen patients (23%) had borderline changes or acute rejection. EMT features were more frequent in these patients than in those with normal kidney grafts (vimentin expression, p = 0.003; beta-catenin translocation, p = 0.002). EMT in grafts corresponded with elevated serum creatinine of the donor before the recovery of kidney (p = 0.02) and longer cold ischemia time (p = 0.02). In contrast, the donor age had no influence on the expression of EMT markers. These results suggest that EMT is an early and frequent phenomenon in kidney transplants that could be triggered by immunological and/or ischemic tubular injury.
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Affiliation(s)
- A Hertig
- Department of Nephrology, Hopital Tenon, AP-HP; Inserm U702; Université Paris VI, France.
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Ouali N. [Complications in kidney transplantation]. Presse Med 2001; 30:13-5. [PMID: 11577577] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
DE NOVO DIABETES AND CARDIOVASCULAR RISK: Certain kidney transplant recipients who develop de novo diabetes have an unfavorable cardiovascular risk profile, comparable to patients with type 2 diabetes mellitus, with advanced age, dyslipidemia, obesity and high blood pressure. MYOCARDIAL INFARCTION IN THE PERIOPERATIVE PERIOD: Among kidney transplant recipients, those whose risk factors include male gender diabetes, age over 50 years and prior revascularization procedure for coronary artery disease have a higher risk for myocardial infarction in the perioperative period. The usefulness of anticoagulant or beta-blockers as preventive treatment for these high-risk patients remains to be determined. HYPERLIPIDEMIA: A retrospective analysis of 530 kidney transplant recipients demonstrated that a very significant proportion of those with dyslipidemia are not receiving appropriate care although their lipid profile is indicative of a high or very high cardiovascular risk. MASSIVE PROTEINURIA: An angiotensin II inhibitor, losartan, has been found to be effective against massive proteinuria (> 3.5 g/l) occurring after kidney transplantation. CALCINEURIN-INHIBITOR-INDUCED HEMOLYTIC UREMIA SYNDROME: Five to ten percent of patients given calcineurin inhibitors develop a hemolytic uremia syndrome. Sirolimus appears to be a very interesting alternative for immunoprophylaxys against acute rejection.
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Ouali N, Mangion MBM, Perez J. Experimental and theoretical analysis of both the small- and the large-stress mechanical response of poly(methyl methacrylate). ACTA ACUST UNITED AC 1993. [DOI: 10.1080/01418619308213962] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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