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Le Tilly O, Gatault P, Semlali S, Sberro-Soussan R, Passot C, Bertrand D, Desvignes C, Caillard S, Paintaud G, Halimi JM, Ternant D. Eculizumab dose tapering should take into account the nonlinearity of its pharmacokinetics. Br J Clin Pharmacol 2024; 90:1312-1321. [PMID: 38373846 DOI: 10.1111/bcp.16019] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
AIMS Eculizumab is a monoclonal antibody targeting complement protein C5 used in renal diseases. As recommended dosing regimen leads to unnecessarily high concentrations in some patients, tailored dosing therapeutic drug monitoring was proposed to reduce treatment cost. The objectives of the present work were (i) to investigate the target-mediated elimination of eculizumab and (ii) whether a pharmacokinetic model integrating a nonlinear elimination allows a better prediction of eculizumab concentrations than a linear model. METHODS We analysed 377 eculizumab serum concentrations from 44 patients treated for atypical haemolytic uraemic syndrome and C3 glomerulopathy with a population pharmacokinetic approach. Critical concentrations (below which a non-log-linear decline of concentration over time is evidenced) were computed to estimate the relevance of the target-mediated elimination. Simulations of dosing regimens were then performed to predict probabilities of target attainment (i.e. trough >100 mg/L). RESULTS Pharmacokinetics of eculizumab was nonlinear and followed a mixture of first-order (CL = 1.318 mL/day/kg) and Michaelis-Menten elimination (Vmax = 26.07 mg/day, Km = 24.06 mg/L). Volume of distribution (72.39 mL/kg) and clearance were weight-dependent. Critical concentrations (Vmax/CL) ranged from 144.7 to 759.7 mg/L and were inversely related to body weight (P = .013). Nonlinearity was thus noticeable at therapeutic concentrations. Simulations predicted that 1200 mg of eculizumab every 21 days would allow 85% and 76% of patients to maintain a therapeutic exposure, for 50 or 90 kg body weight, respectively. CONCLUSIONS Our study investigates the nonlinear elimination of eculizumab and discusses the importance of accounting for eculizumab target-mediated elimination in therapeutic drug monitoring.
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Affiliation(s)
- Olivier Le Tilly
- Inserm U1327 ISCHEMIA "Membrane signalling and inflammation in reperfusion injuries", Université de Tours, Tours, France
- Medical Pharmacology, CHRU Tours, Tours, France
| | - Philippe Gatault
- Inserm U1327 ISCHEMIA "Membrane signalling and inflammation in reperfusion injuries", Université de Tours, Tours, France
- Nephrology, Arterial Hypertension, Dialysis and Transplant Department, CHRU Tours, Tours, France
| | | | - Rebecca Sberro-Soussan
- Necker-Enfants Malades Institute, French National Institute of Health and Medical Research, Paris, France
| | | | - Dominique Bertrand
- Nephrology Department and Transplantation Center, Rouen University Hospital, Rouen, France
| | - Céline Desvignes
- Inserm U1327 ISCHEMIA "Membrane signalling and inflammation in reperfusion injuries", Université de Tours, Tours, France
- Pilot Centre for Therapeutic Antibodies Monitoring (PiTAM), CHRU Tours, Tours, France
| | - Sophie Caillard
- Nephrology and Transplantation Department, Strasbourg University Hospital, Strasbourg, France
| | - Gilles Paintaud
- Inserm U1327 ISCHEMIA "Membrane signalling and inflammation in reperfusion injuries", Université de Tours, Tours, France
- Medical Pharmacology, CHRU Tours, Tours, France
- Pilot Centre for Therapeutic Antibodies Monitoring (PiTAM), CHRU Tours, Tours, France
| | - Jean-Michel Halimi
- Inserm U1327 ISCHEMIA "Membrane signalling and inflammation in reperfusion injuries", Université de Tours, Tours, France
- Nephrology, Arterial Hypertension, Dialysis and Transplant Department, CHRU Tours, Tours, France
| | - David Ternant
- Inserm U1327 ISCHEMIA "Membrane signalling and inflammation in reperfusion injuries", Université de Tours, Tours, France
- Medical Pharmacology, CHRU Tours, Tours, France
- Pilot Centre for Therapeutic Antibodies Monitoring (PiTAM), CHRU Tours, Tours, France
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Uro-Coste C, Sberro-Soussan R, Martinez F, Amrouche L, Aubert O, Leruez-Ville M, Delage C, Peraldi MN, Legendre C, Lanternier F, Zuber J, Anglicheau D, Scemla A, Chavarot N. Immunogenicity of Anti-SARS-CoV-2 Vaccination After Kidney Transplantation in Kidney Transplant Recipients Vaccinated Before Transplantation. Transplantation 2023; 107:e213-e214. [PMID: 37211632 PMCID: PMC10358298 DOI: 10.1097/tp.0000000000004654] [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] [Received: 03/23/2023] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Charlotte Uro-Coste
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Frank Martinez
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Lucile Amrouche
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Olivier Aubert
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Marianne Leruez-Ville
- Université Paris Cité, Paris, France
- Virology Laboratory, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claire Delage
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Noëlle Peraldi
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Fanny Lanternier
- Université Paris Cité, Paris, France
- Department of infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Nathalie Chavarot
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
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3
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Bertrand D, Brunel M, Lebourg L, Scemla A, Lemoine M, Amrouche L, Laurent C, Legendre C, Guerrot D, Anglicheau D, Sberro-Soussan R. Conversion From Intravenous In-Hospital Belatacept Injection to Subcutaneous Abatacept Injection in Kidney Transplant Recipients During the First COVID-19 Stay-at-Home Order in France. Transpl Int 2023; 36:11328. [PMID: 37554319 PMCID: PMC10405172 DOI: 10.3389/ti.2023.11328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/02/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023]
Abstract
The first COVID-19 stay-at-home order came into effect in France on 17 March 2020. Immunocompromised patients were asked to isolate themselves, and outpatient clinic visits were dramatically reduced. In order to avoid visits to the hospital by belatacept-treated kidney transplant recipients (KTRs) during the initial period of the pandemic, we promptly converted 176 KTRs at two French transplant centers from once-monthly 5 mg/kg in-hospital belatacept infusion to once-weekly 125 mg subcutaneous abatacept injection. At the end of follow-up (3 months), 171 (97.16%) KTRs survived with a functioning graft, 2 (1.14%) had died, and 3 (1.70%) had experienced graft loss. Two patients (1.1%) experienced acute T cell-mediated rejection. Nineteen patients (10.80%) discontinued abatacept; 47% of the KTRs found the use of abatacept less restrictive than belatacept, and 38% would have preferred to continue abatacept. Mean eGFR remained stable compared to baseline. Seven patients (3.9%) had COVID-19; among these, two developed severe symptoms but survived. Only one patient had a de novo DSA. Side effects of abatacept injection were uncommon and non-severe. Our study reports for the first time in a large cohort that once-weekly injection of abatacept appears to be feasible and safe in KTRs previously treated with belatacept.
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Affiliation(s)
- Dominique Bertrand
- Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France
| | - Mélanie Brunel
- Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Ludivine Lebourg
- Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France
| | - Anne Scemla
- Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Mathilde Lemoine
- Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France
| | - Lucile Amrouche
- Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Charlotte Laurent
- Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France
| | - Christophe Legendre
- Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Dominique Guerrot
- Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France
- INSERM U1096, University of Rouen Normandy, Rouen, France
| | - Dany Anglicheau
- Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, 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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Leon J, LeStang MB, Sberro-Soussan R, Servais A, Anglicheau D, Frémeaux-Bacchi V, Zuber J. Complement-driven hemolytic uremic syndrome. Am J Hematol 2023; 98 Suppl 4:S44-S56. [PMID: 36683290 DOI: 10.1002/ajh.26854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
Overactivation of the complement alternative pathway drives the pathogenesis of primary atypical hemolytic uremic syndrome (aHUS). Genetically-determined or acquired dysregulation of the complement is frequently identified in patients with aHUS, pregnancy-related hemolytic uremic syndrome (HUS) and severe hypertension-associated HUS. In contrast, it is still unclear whether self-limited complement activation, which frequently occurs in other forms of HUS, provides key mechanistic clues or results from endothelium damage. Development of novel biomarkers is underway to firmly establish complement-driven pathogenesis. C5 blockade therapy has revolutionized the management of aHUS patients, resulting in a halving of the subpopulation under chronic dialysis over the course of a few years. On the other hand, the efficacy of C5 blockade in secondary forms of HUS, as assessed by small and uncontrolled case series, is less compelling and should be investigated through properly-designed prospective clinical trials. The increased risk of meningococcal infection, related to C5 inhibition, must be rigorously addressed with suitable prophylaxis. Treatment duration should be determined based on an individualized benefit/risk assessment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Juliette Leon
- Department of Kidney and Metabolic Diseases, Transplantation and Clinical Immunology, Necker Hospital, Paris, AP-HP, France.,Université Paris-Cité, Paris, France.,Inserm UMR_S1163, IHU IMAGINE.,Centre of expertise for the French nationwide TMA network (CNR-MAT), Paris, France
| | - Marie-Bénédicte LeStang
- Department of Kidney and Metabolic Diseases, Transplantation and Clinical Immunology, Necker Hospital, Paris, AP-HP, France.,Centre of expertise for the French nationwide TMA network (CNR-MAT), Paris, France
| | - Rebecca Sberro-Soussan
- Department of Kidney and Metabolic Diseases, Transplantation and Clinical Immunology, Necker Hospital, Paris, AP-HP, France.,Centre of expertise for the French nationwide TMA network (CNR-MAT), Paris, France
| | - Aude Servais
- Department of Kidney and Metabolic Diseases, Transplantation and Clinical Immunology, Necker Hospital, Paris, AP-HP, France.,Centre of expertise for the French nationwide TMA network (CNR-MAT), Paris, France
| | - Dany Anglicheau
- Department of Kidney and Metabolic Diseases, Transplantation and Clinical Immunology, Necker Hospital, Paris, AP-HP, France.,Université Paris-Cité, Paris, France.,Centre of expertise for the French nationwide TMA network (CNR-MAT), Paris, France
| | | | - Julien Zuber
- Department of Kidney and Metabolic Diseases, Transplantation and Clinical Immunology, Necker Hospital, Paris, AP-HP, France.,Université Paris-Cité, Paris, France.,Inserm UMR_S1163, IHU IMAGINE.,Centre of expertise for the French nationwide TMA network (CNR-MAT), Paris, France
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6
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Abbara S, Monfort JB, Savey L, Moguelet P, Saadoun D, Bachmeyer C, Fain O, Terrier B, Amoura Z, Mathian A, Gilardin L, Buob D, Job-Deslandre C, Dufour JF, Sberro-Soussan R, Grateau G, Georgin-Lavialle S. Vasculitis and familial Mediterranean fever: Description of 22 French adults from the juvenile inflammatory rheumatism cohort. Front Med (Lausanne) 2022; 9:1000167. [PMID: 36388918 PMCID: PMC9649929 DOI: 10.3389/fmed.2022.1000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023] Open
Abstract
Objective The frequency of vasculitis may be increased in patients with Familial Mediterranean Fever (FMF), according to several studies. Our aim was to assess the characteristics of French adult patients with both diseases. Methods Patients with vasculitis were selected from patients followed for FMF in the French JIR-cohort. Results Twenty-two patients were included [polyarteritis nodosa (PAN) n = 10, IgA vasculitis n = 8, unclassified vasculitis n = 2, granulomatosis with polyangiitis n = 1, and microscopic polyangiitis n = 1]. Pathogenic mutations in exon 10 were found in all 21 patients (96%) for which MEFV testing results were available, and 18 (82%) had two pathogenic mutations. Histology showed vasculitis in 59% of patients. Most patients with FMF-associated PAN were HBV-negative and had an inactive FMF before PAN onset, and 40% had a peri-renal or central nervous system bleeding. Most patients with FMF-associated IgA vasculitis had an active FMF before vasculitis onset, and 25% had digestive bleeding. Both patients with unclassified vasculitis had ischemic and/or hemorrhagic complications. Conclusion This study confirms the predominance of PAN and IgA vasculitis in patients with FMF and the high frequency of bleeding in FMF-associated PAN. FMF should be considered in case of persistent symptoms and/or inflammatory syndrome despite vasculitis treatment in Mediterranean patients.
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Affiliation(s)
- Salam Abbara
- Département de Médecine Interne, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses d’Origine Inflammatoire (CEREMAIA), Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Jean-Benoit Monfort
- Département de Dermatologie, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Léa Savey
- Département de Médecine Interne, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses d’Origine Inflammatoire (CEREMAIA), Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Philippe Moguelet
- Département d’Anatomo-Pathologie, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - David Saadoun
- Département de Médecine Interne et Immunologie Clinique, Centre National de Référence Maladies Autoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3 and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biothérapie i2B, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Claude Bachmeyer
- Département de Médecine Interne, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses d’Origine Inflammatoire (CEREMAIA), Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Olivier Fain
- Service de Médecine Interne, Hôpital Saint-Antoine, Sorbonne Université, APHP, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Centre de Référence Maladies Systémiques et Autoimmunes Rares d’Ile de France, Hôpital Cochin, Université Paris Cité, AP-HP, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Groupement Hospitalier Pitié–Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Groupement Hospitalier Pitié–Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Laurent Gilardin
- Département de Médecine Interne et Immunologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - David Buob
- Département d’Anatomo-Pathologie, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Chantal Job-Deslandre
- Service de Pédiatrie, Immunologie, Hématologie et Rhumatologie, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE), Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, Paris, France
| | - Jean-François Dufour
- Service Médecine Interne, Hôpital Nord-Ouest, Centre Hospitalier Villefranche sur Saône, Gleize, France
| | - Rebecca Sberro-Soussan
- Service de Transplantation Rénale Adulte, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, Paris, France
| | - Gilles Grateau
- Département de Médecine Interne, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses d’Origine Inflammatoire (CEREMAIA), Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Sophie Georgin-Lavialle
- Département de Médecine Interne, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses d’Origine Inflammatoire (CEREMAIA), Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
- INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
- *Correspondence: Sophie Georgin-Lavialle,
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7
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Levtchenko E, Servais A, Hulton SA, Ariceta G, Emma F, Game DS, Lange K, Lapatto R, Liang H, Sberro-Soussan R, Topaloglu R, Das AM, Webb NJA, Wanner C. Expert guidance on the multidisciplinary management of cystinosis in adolescent and adult patients. Clin Kidney J 2022; 15:1675-1684. [PMID: 36003666 PMCID: PMC9394719 DOI: 10.1093/ckj/sfac099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Indexed: 11/23/2022] Open
Abstract
Cystinosis, a rare autosomal recessive lysosomal storage disorder, results in an abnormal accumulation of the amino acid cystine in multiple organs and tissues of the body. Renal symptoms typically develop in the first few months of life, with extra-renal manifestations becoming apparent over the next 10–20 years, which require coordinated multidisciplinary care. Here, we describe a consensus-based guidance to support the management of adolescents and adults living with cystinosis. The programme was led by a Steering Committee (SC) of six experts in the management of patients with cystinosis, who identified a list of 15 key questions reflecting the multi-organ effects of cystinosis. An Extended Faculty (EF) of eight additional specialists was invited to answer the questions via an online digital platform using a quasi-Delphi approach. The consolidated answers were summarized into recommendations. Where evidence was lacking, recommendations were developed using collective expert consensus. The EF was asked to agree/disagree with the clinical recommendations. The expert-agreed clinical recommendations provide guidance that considers both renal and extra-renal systems. The topics covered are advice on fertility and family planning, consideration of the nervous, muscular, ophthalmic, cardio-respiratory, endocrine, dermatological and gastrointestinal systems, as well as guidance on dental care, diet, lifestyle, and improving quality of life and psychological well-being. In summary, this work outlines recommendations and a checklist for clinicians with a vision for improving and standardizing the multidisciplinary care for patients with cystinosis.
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Affiliation(s)
| | - Aude Servais
- Nephrology and Transplantation Department, Hôpital Necker Enfants Malades APHP, Paris, France
| | - Sally A Hulton
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, B4 6NH, Birmingham, UK
| | - Gema Ariceta
- Paediatric Nephrology Department, University Hospital Vall d'Hebron, Professor of Paediatrics, The Autonomous University of Barcelona, Barcelona, Spain
| | - Francesco Emma
- Division of Nephrology and Dialysis, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | - David S Game
- Department of Renal Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Karin Lange
- Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Risto Lapatto
- Department of Pediatrics, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hong Liang
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU ForeSight, Paris, France; Inserm-DHOS CIC 1423CHNO des Quinze-Vingts, IHU ForeSight, Paris, France; Inserm, U968; UPMC, université Paris 06, UMR_S968, institut de la vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, Inserm-DHOS CIC 503, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, University Hospital Center (CHU) Necker, Paris Descartes University-Sorbonne Paris Cité, Paris, France
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Anibh M Das
- Clinic for Paediatric Kidney-, Liver- and Metabolic Diseases, Hannover, Germany
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8
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Chavarot N, Melenotte C, Amrouche L, Rouzaud C, Sberro-Soussan R, Pavie J, Martinez F, Pouvaret A, Leruez-Ville M, Cantin D, Fourgeaud J, Delage C, Vimpere D, Peraldi MN, Legendre C, Lanternier F, Zuber J, Scemla A, Anglicheau D. Early treatment with sotrovimab monoclonal antibody in kidney transplant recipients with Omicron infection. Kidney Int 2022; 101:1290-1293. [PMID: 35421508 PMCID: PMC9001009 DOI: 10.1016/j.kint.2022.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/16/2022] [Accepted: 04/05/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Nathalie Chavarot
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
| | - Clea Melenotte
- Université de Paris, Paris, France; Department of infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucile Amrouche
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Claire Rouzaud
- Université de Paris, Paris, France; Department of infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Juliette Pavie
- Infectious Disease Department, Hotel Dieu Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris Centre Hôtel-Dieu, Paris, France
| | - Frank Martinez
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Anne Pouvaret
- Université de Paris, Paris, France; Department of infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marianne Leruez-Ville
- Université de Paris, Paris, France; Virology Laboratory, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Delphine Cantin
- COVID-19 screening center, Emergency Department, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, France
| | - Jacques Fourgeaud
- Université de Paris, Paris, France; Virology Laboratory, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claire Delage
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Vimpere
- Adult Intensive Care Unit, Department of Anaesthesiology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Noëlle Peraldi
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Fanny Lanternier
- Université de Paris, Paris, France; Department of infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
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9
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Chavarot N, Morel A, Leruez-Ville M, Vilain E, Divard G, Burger C, Serris A, Sberro-Soussan R, Martinez F, Amrouche L, Bererhi L, Lanternier F, Legendre C, Zuber J, Anglicheau D, Scemla A. Weak antibody response to three doses of mRNA vaccine in kidney transplant recipients treated with belatacept. Am J Transplant 2021; 21:4043-4051. [PMID: 34431207 PMCID: PMC9906354 DOI: 10.1111/ajt.16814] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 01/25/2023]
Abstract
Poor responses to mRNA COVID-19 vaccine have been reported after 2 vaccine injections in kidney transplant recipients (KTRs) treated with belatacept. We analyzed the humoral response in belatacept-treated KTRs without a history of SARS-CoV-2 infection who received three injections of BNT162b2-mRNA COVID-19 vaccine. We also investigated vaccine immunogenicity in belatacept-treated KTRs with prior COVID-19 and characterized symptomatic COVID-19 infections after the vaccine in belatacept-treated KTRs. Among the 62 belatacept-treated KTRs (36 [58%] males), the median age (63.5 years IQR [51-72]), without COVID-19 history, only four patients (6.4%) developed anti-SARS-CoV-2 IgG with low antibody titers (median 209, IQR [20-409] AU/ml). 71% were treated with mycophenolic acid and 100% with steroids in association with belatacept. In contrast, in all the 5 KTRs with prior COVID-19 history, mRNA vaccine induced a strong antibody response with high antibody titers (median 10 769 AU/ml, IQR [6410-20 069]) after two injections. Seroprevalence after three-vaccine doses in 35 non-belatacept-treated KTRs was 37.1%. Twelve KTRs developed symptomatic COVID-19 after vaccination, including severe forms (50% of mortality). Breakthrough COVID-19 occurred in 5% of fully vaccinated patients. Administration of a third dose of BNT162b2 mRNA COVID-19 vaccine did not improve immunogenicity in KTRs treated with belatacept without prior COVID-19. Other strategies aiming to improve patient protection are needed.
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Affiliation(s)
- Nathalie Chavarot
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Antoine Morel
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marianne Leruez-Ville
- Université de Paris, Paris, France
- Virology Laboratory, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Estelle Vilain
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gillian Divard
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carole Burger
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Alexandra Serris
- Université de Paris, Paris, France
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Frank Martinez
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Lucile Amrouche
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Lynda Bererhi
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fanny Lanternier
- Université de Paris, Paris, France
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
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10
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Chavarot N, Ouedrani A, Marion O, Leruez-Ville M, Vilain E, Baaziz M, Del Bello A, Burger C, Sberro-Soussan R, Martinez F, Chatenoud L, Abravanel F, Anglicheau D, Izopet J, Couat C, Zuber J, Legendre C, Lanternier F, Kamar N, Scemla A. Poor Anti-SARS-CoV-2 Humoral and T-cell Responses After 2 Injections of mRNA Vaccine in Kidney Transplant Recipients Treated With Belatacept. Transplantation 2021; 105:e94-e95. [PMID: 33831941 DOI: 10.1097/tp.0000000000003784] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nathalie Chavarot
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Amani Ouedrani
- Université de Paris, Paris, France
- Immunology Laboratory, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- CNRS UMR8253, INSERM UMR1151, Institut Necker-Enfants Malades, Paris, France
| | - Olivier Marion
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
- Toulouse III Paul Sabatier University, Toulouse, France
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Marianne Leruez-Ville
- Université de Paris, Paris, France
- Virology Laboratory, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Estelle Vilain
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maroua Baaziz
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Arnaud Del Bello
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
- Toulouse III Paul Sabatier University, Toulouse, France
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Carole Burger
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Frank Martinez
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Lucienne Chatenoud
- Université de Paris, Paris, France
- Immunology Laboratory, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- CNRS UMR8253, INSERM UMR1151, Institut Necker-Enfants Malades, Paris, France
| | - Florence Abravanel
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
- Toulouse III Paul Sabatier University, Toulouse, France
- Virology Laboratory, Toulouse Purpan University Hospital, Toulouse, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Jacques Izopet
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
- Toulouse III Paul Sabatier University, Toulouse, France
- Virology Laboratory, Toulouse Purpan University Hospital, Toulouse, France
| | - Chloé Couat
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Fanny Lanternier
- Université de Paris, Paris, France
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nassim Kamar
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
- Toulouse III Paul Sabatier University, Toulouse, France
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
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11
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Chavarot N, Parize P, Podglajen I, Sberro-Soussan R, Burger C, Amrouche L, Martinez F, Legendre C, Zuber J, Scemla A, Giura G, Bruneval P, Anglicheau D. The Case | Cardiac tamponade in a kidney transplant recipient with chronic inflammation. Kidney Int 2021; 100:487-488. [PMID: 34294215 DOI: 10.1016/j.kint.2021.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Nathalie Chavarot
- Service de néphrologie et transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
| | - Perrine Parize
- Université de Paris, Paris, France; Service de maladies infectieuses et tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Podglajen
- Université de Paris, Paris, France; Service de microbiologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Service de néphrologie et transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Carole Burger
- Service de néphrologie et transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Lucile Amrouche
- Service de néphrologie et transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Frank Martinez
- Service de néphrologie et transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Christophe Legendre
- Service de néphrologie et transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Julien Zuber
- Service de néphrologie et transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Anne Scemla
- Service de néphrologie et transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Geltrude Giura
- Université de Paris, Paris, France; Service de cardiologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrick Bruneval
- Université de Paris, Paris, France; Service d'anatomie pathologique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dany Anglicheau
- Service de néphrologie et transplantation rénale, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
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12
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Chavarot N, Divard G, Scemla A, Amrouche L, Aubert O, Leruez-Ville M, Timsit MO, Tinel C, Zuber J, Legendre C, Anglicheau D, Sberro-Soussan R. Increased incidence and unusual presentations of CMV disease in kidney transplant recipients after conversion to belatacept. Am J Transplant 2021; 21:2448-2458. [PMID: 33283406 DOI: 10.1111/ajt.16430] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 07/07/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/25/2023]
Abstract
Belatacept may increase cytomegalovirus (CMV) disease risk after conversion from CNI-based therapy. We analyzed CMV disease characteristics after belatacept conversion. Propensity score matching was used to compare CMV disease incidence in belatacept- and CNI-treated kidney transplant recipients (KTRs). CMV disease characteristics and risk factors under belatacept were analyzed. In total, 223 KTRs (median age [IQR] 59.2 years [45.4-68.5]) were converted to belatacept (median of 11.5 months [2.5-37.0] post-transplantation); 40/223 (17.9%) developed CMV disease. Independent risk factors included increased age (p = .0164), D+/R- CMV serostatus (p = .0220), and low eGFR at conversion (p = .0355). Among 181 belatacept-treated patients matched to 181 controls, 32/181 (17.7%) experienced CMV disease (vs. 5/181 controls [2.8%]). CMV disease cumulative incidences were 6.33 and 0.91/100 person-years (p-y) in belatacept and control groups, respectively. CMV disease risk was particularly high in elderly patients (converted >70 years) and those with eGFR <30 ml/min; cumulative incidences were 18.4 and 5.2/100 p-y, respectively. CMV diseases under belatacept were atypical, with late-onset disease (24/40 patients [60%]), high CMV seropositivity (27/40, 67%), increased severe and tissue-invasive disease rates (gastrointestinal involvement in 32/40 [80%]) and life-threatening diseases (4/40 [10%]). These findings should stimulate further research to secure the use of belatacept as a valuable rescue therapy in KTRs.
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Affiliation(s)
- Nathalie Chavarot
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France.,Université de Paris, Paris, France
| | - Gillian Divard
- INSERM, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France.,Université de Paris, Paris, France
| | - Lucile Amrouche
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France.,Université de Paris, Paris, France
| | - Olivier Aubert
- INSERM, Paris Translational Research Centre for Organ Transplantation, Paris, France
| | - Marianne Leruez-Ville
- Département of Virology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc O Timsit
- Université de Paris, Paris, France.,Department of Urology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claire Tinel
- Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France.,Université de Paris, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Necker-Enfants Malades Institute, French National Institute of Health and Medical Research U1151, Paris, France.,Université de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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13
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Chavarot N, Gueguen J, Bonnet G, Jdidou M, Trimaille A, Burger C, Amrouche L, Weizman O, Pommier T, Aubert O, Celier J, Sberro-Soussan R, Geneste L, Panagides V, Delahousse M, Marsou W, Aguilar C, Deney A, Zuber J, Fauvel C, Legendre C, Mika D, Pezel T, Anglicheau D, Sutter W, Zaidan M, Snanoudj R, Cohen A, Scemla A. COVID-19 severity in kidney transplant recipients is similar to nontransplant patients with similar comorbidities. Am J Transplant 2021; 21:1285-1294. [PMID: 33252201 PMCID: PMC7753406 DOI: 10.1111/ajt.16416] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/25/2023]
Abstract
Higher rates of severe COVID-19 have been reported in kidney transplant recipients (KTRs) compared to nontransplant patients. We aimed to determine if poorer outcomes were specifically related to chronic immunosuppression or underlying comorbidities. We used a 1:1 propensity score-matching method to compare survival and severe disease-free survival (defined as death and/or need for intensive care unit [ICU]) incidence in hospitalized KTRs and nontransplant control patients between February 26 and May 22, 2020. Patients were matched for risk factors of severe COVID-19: age, sex, body mass index, diabetes mellitus, preexisting cardiopathy, chronic lung disease, and basal renal function. We included 100 KTRs (median age [interquartile range (IQR)]) 64.7 years (55.3-73.1) in three French transplant centers. After a median follow-up of 13 days (7-30), transfer to ICU was required for 34 patients (34%) and death occurred in 26 patients (26%). Overall, 43 patients (43%) developed a severe disease during a median follow-up of 8.5 days (2-14). Propensity score matching to a large French cohort of 2017 patients hospitalized in 24 centers, revealed that survival was similar between KTRs and matched nontransplant patients with respective 30-day survival of 62.9% and 71% (p = .38) and severe disease-free 30-day survival of 50.6% and 47.5% (p = .91). These findings suggest that severity of COVID-19 in KTRs is related to their associated comorbidities and not to chronic immunosuppression.
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Affiliation(s)
- Nathalie Chavarot
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France,Correspondence Nathalie Chavarot
| | - Juliette Gueguen
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Guillaume Bonnet
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Mariam Jdidou
- Département de Néphrologie et transplantation, Hôpital Foch, Suresnes
| | - Antonin Trimaille
- Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Carole Burger
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Lucile Amrouche
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Orianne Weizman
- Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-Les-Nancy, France
| | | | - Olivier Aubert
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Joffrey Celier
- Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laura Geneste
- Centre Hospitalier Universitaire d’Amiens-Picardie, Amiens, France
| | | | - Michel Delahousse
- Département de Néphrologie et transplantation, Hôpital Foch, Suresnes
| | - Wassima Marsou
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France
| | - Claire Aguilar
- Université de Paris, Paris, France,Départment de maladies infectieuses et tropicales, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Deney
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Julien Zuber
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Charles Fauvel
- Centre Hospitalier Universitaire de Rouen, FHU REMOD-VHF, Rouen, France
| | - Christophe Legendre
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, Chatenay-Malabry, France
| | - Theo Pezel
- Hôpital Lariboisière, APHP, University of Paris, Paris, France
| | - Dany Anglicheau
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Willy Sutter
- Université de Paris, Paris, France,Paris Translational Research Centre for Organ Transplantation, PARCC, INSERM, Paris, France
| | - Mohamad Zaidan
- Département de Néphrologie et transplantation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Renaud Snanoudj
- Département de Néphrologie et transplantation, Hôpital Foch, Suresnes
| | - Ariel Cohen
- Université de Paris, Paris, France,Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Scemla
- Départment de Néphrologie et transplantation rénale, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
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14
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Chavarot N, Leruez-Ville M, Scemla A, Burger C, Amrouche L, Rouzaud C, Lebreton X, Martinez F, Sberro-Soussan R, Legendre C, Zuber J, Anglicheau D. Decline and loss of anti-SARS-CoV-2 antibodies in kidney transplant recipients in the 6 months following SARS-CoV-2 infection. Kidney Int 2021; 99:486-488. [PMID: 33509358 PMCID: PMC7830266 DOI: 10.1016/j.kint.2020.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Nathalie Chavarot
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
| | - Marianne Leruez-Ville
- Université de Paris, Paris, France; Department of Virology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Carole Burger
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Lucile Amrouche
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Claire Rouzaud
- Université de Paris, Paris, France; Department of Infectious Diseases and Tropical Medicine, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Lebreton
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frank Martinez
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
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15
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Chavarot N, Burger C, Aguilar C, Scemla A, Sberro-Soussan R, Amrouche L, Leruez-Ville M, Martinez F, Legendre C, Anglicheau D, Zuber J. Ig-responsive relapsing inflammatory syndrome following COVID-19 in a kidney transplant recipient. Kidney Int 2021; 99:767-768. [PMID: 33518372 PMCID: PMC7826029 DOI: 10.1016/j.kint.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Nathalie Chavarot
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
| | - Carole Burger
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Claire Aguilar
- Université de Paris, Paris, France; Department of Infectious Diseases and Tropical Medicine, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Lucile Amrouche
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Marianne Leruez-Ville
- Université de Paris, Paris, France; Department of Virology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frank Martinez
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
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16
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Isnard P, Bruneau J, Sberro-Soussan R, Wendum D, Legendre C, Molina T, Chatenoud L, Hermine O, Rossignol J. Dissociation of humoral and cellular immune responses in kidney transplant recipients with EBV mucocutaneous ulcer. Transpl Infect Dis 2021; 23:e13552. [PMID: 33352001 DOI: 10.1111/tid.13552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/01/2020] [Revised: 12/03/2020] [Accepted: 12/13/2020] [Indexed: 01/01/2023]
Abstract
EBV-positive mucocutaneous ulcer (EBV-MCU) is a rare EBV-positive B-cell lymphoproliferative disorder occurring in immunocompromised patients such as patients with solid organ or hematopoietic stem cells transplantation. EBV-MCU often consists of an isolated and circumscribed cutaneous or mucosal ulcerative lesion with a self-limited growth potential and a high regression rate upon immunosuppressive treatment withdrawal or rituximab therapy. Nevertheless, the pathophysiology of this latent infection leading to clonal lymphoproliferation is not well established. We report here two cases of EBV-MCU in kidney transplant recipients with a dissociated immune response to EBV with the absence of EBV-related antibodies and a positive T-cell response to EBV suggesting a potential specific oncogenic mechanism in this lymphoproliferative disorder.
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Affiliation(s)
- Pierre Isnard
- Department of Nephrology-Transplantation, Necker Enfants Malades Hospital, APHP, Paris, France.,INSERM U1151, Necker Institute, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Julie Bruneau
- Department of Pathology, Necker Enfants Malades Hospital, APHP, Paris, France.,INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology-Transplantation, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Dominique Wendum
- Department of Pathology, Saint-Antoine Hospital, APHP, Paris, France
| | - Christophe Legendre
- Department of Nephrology-Transplantation, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Thierry Molina
- Department of Pathology, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Lucienne Chatenoud
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM U1151, CNRS UMR 8253, INEM Hôpital Necker-Enfants Malades, Paris, France.,Department of Pathology, Saint Antoine Hospital, APHP, Paris, France
| | - Olivier Hermine
- INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France.,Department of Hematology, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Julien Rossignol
- INSERM UMR 1163, Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, Paris, France.,Department of Hematology, Necker Enfants Malades Hospital, APHP, Paris, France
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17
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Gouin A, Sberro-Soussan R, Courivaud C, Bertrand D, Del Bello A, Darres A, Ducloux D, Legendre C, Kamar N. Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients. Kidney Int Rep 2020; 5:2195-2201. [PMID: 33305112 PMCID: PMC7710888 DOI: 10.1016/j.ekir.2020.09.036] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/22/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction During the coronavirus disease 2019 (Covid-19) pandemic, several physicians have questioned pursuing belatacept in kidney-transplant patients in order to reduce the risk of nosocomial transmission during the monthly infusion. The effect of the conversion from belatacept to another immunosuppressive regimen is underreported. The aim of the present retrospective study was to assess the effect on kidney function and the clinical outcome of the conversion from belatacept to another regimen. Methods We have identified 44 maintenance kidney transplantation patients from five French kidney transplantation centers who were converted from belatacept to another regimen either because of a complication (n = 28) or another reason (patients’ request or belatacept shortage, n = 13). The follow-up after the conversion from belatacept was 27.5 ± 25.3 months. Results Overall, mean estimated glomerular filtration rate (eGFR) decreased from 44.2 ± 16 ml/min per 1.73 m2 at conversion from belatacept to 35.7 ± 18.4 ml/min per 1.73 m2 at last follow-up (P = 0.0002). eGFR significantly decreased in patients who had been given belatacept at transplantation as well as in those who had been converted to belatacept earlier. The decrease was less significant in patients who had stopped belatacept without having experienced any complications. Finally, eGFR decreased more severely in patients who were converted to calcineurin inhibitors (CNIs), compared to those who received mammalian target of rapamycin inhibitor (mTORi). Few patients also developed diabetes and hypertension. Conclusions Thus, transplantation physicians should avoid stopping belatacept when not clinically required.
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Affiliation(s)
- Anna Gouin
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Rebecca Sberro-Soussan
- Service de néphrologie-Transplantation, Hôpital Necker, AP-HP, Paris et Université Paris Descartes, Paris
| | - Cécile Courivaud
- Service de néphrologie, dialyse et transplantation rénale, FHU INCREASE, CHU de Besançon, Besançon, France
| | - Dominique Bertrand
- Service de néphrologie, dialyse et transplantation rénale, CHU de Rouen, Rouen, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Amandine Darres
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Didier Ducloux
- Service de néphrologie, dialyse et transplantation rénale, FHU INCREASE, CHU de Besançon, Besançon, France
| | - Christophe Legendre
- Service de néphrologie-Transplantation, Hôpital Necker, AP-HP, Paris et Université Paris Descartes, Paris
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France
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18
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Passot C, Sberro-Soussan R, Bertrand D, Caillard S, Schvartz B, Domenger C, Contin-Bordes C, Paintaud G, Halimi JM, Ternant D, Gatault P. Feasibility and safety of tailored dosing schedule for eculizumab based on therapeutic drug monitoring: Lessons from a prospective multicentric study. Br J Clin Pharmacol 2020; 87:2236-2246. [PMID: 33118186 DOI: 10.1111/bcp.14627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/07/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 12/23/2022] Open
Abstract
AIMS Eculizumab is an anti-C5 monoclonal antibody approved for rare diseases including atypical haemolytic-uraemic syndrome. The maintenance phase dosing regimen is identical for all adult patients: 1200 mg every 2 weeks. Recent studies reported an overexposure in many patients when considering a target trough concentration range of 50-100 mg/L. The aim of the present work was to validate the feasibility of therapeutic drug monitoring of eculizumab in atypical haemolytic-uraemic syndrome patients. METHODS We performed a 2-step prospective multicentre study. In the first phase, we developed a pharmacokinetic population model using data from 40 patients and identified patients for whom a 1-week lengthening of interval between infusions would lead to a trough concentration above 100 mg/L. In the second phase, selected patients were allocated a 1-week extension and eculizumab trough concentrations were monitored. RESULTS The model confirmed the previously reported influence of bodyweight on elimination clearance and predicted that 36 (90%) patients would be eligible for interval extension. In the second phase of the study, a 1-week lengthening of interval between infusions was performed in 15 patients whose trough concentration at the next visit was predicted with a Bayesian model to be above 100 mg/L. After interval extension, 10 patients (67%) presented measured trough concentrations over 100 mg/L. No biological or clinical recurrence of disease was observed, even in the 5 patients with concentrations below 100 mg/L in whom the initial dosing regimen was resumed. CONCLUSION Safe eculizumab interval adjustment is feasible with a PK monitoring.
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Affiliation(s)
- Christophe Passot
- EA7501, University of Tours, France.,Laboratory of Pharmacology-Toxicology, CHRU de Tours, France.,Integrated Center for Oncology, Angers, France
| | - Rebecca Sberro-Soussan
- Service de Néphrologie et Transplantation Adulte, Hôpital Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Sophie Caillard
- Nephrology and Transplant Department, Strasbourg University Hospital, Strasbourg, France
| | | | | | | | - Gilles Paintaud
- EA7501, University of Tours, France.,Laboratory of Pharmacology-Toxicology, CHRU de Tours, France
| | - Jean-Michel Halimi
- EA4245 Transplant Immunology and Inflammation, Université de Tours, Tours, France.,Service de Néphrologie-Hypertension artérielle, Dialyses, Transplantation rénale, CHRU Tours, France
| | - David Ternant
- EA7501, University of Tours, France.,Laboratory of Pharmacology-Toxicology, CHRU de Tours, France
| | - Philippe Gatault
- EA4245 Transplant Immunology and Inflammation, Université de Tours, Tours, France.,Service de Néphrologie-Hypertension artérielle, Dialyses, Transplantation rénale, CHRU Tours, France
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19
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Visentin J, Bachelet T, Aubert O, Del Bello A, Martinez C, Jambon F, Guidicelli G, Ralazamahaleo M, Bouthemy C, Cargou M, Congy-Jolivet N, Nong T, Lee JH, Sberro-Soussan R, Couzi L, Kamar N, Legendre C, Merville P, Taupin JL. Reassessment of the clinical impact of preformed donor-specific anti-HLA-Cw antibodies in kidney transplantation. Am J Transplant 2020; 20:1365-1374. [PMID: 31883413 DOI: 10.1111/ajt.15766] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 08/10/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 01/25/2023]
Abstract
Anti-denatured HLA-Cw antibodies are highly prevalent, whereas anti-native HLA-Cw antibodies seem to lead to random flow cytometry crossmatch results. We aimed to reassess crossmatch prediction for anti-HLA-Cw using 2 types of single antigen flow beads (classical beads and beads with diminished expression of denatured HLA), and to compare the pathogenicity of preformed anti-denatured and anti-native HLA-Cw antibodies in kidney transplantation. We performed 135 crossmatches with sera reacting against donor HLA-Cw (classical beads fluorescence ≥500); only 20.6% were positive. Forty-three (31.6%) were anti-denatured HLA antibodies (beads with diminished expression of denatured HLA fluorescence <300); all were crossmatch negative. The correlation between classical beads fluorescence and the crossmatch ratio was low (ρ = 0.178), and slightly higher with beads with diminished expression of denatured HLA (ρ = 0.289). We studied 52 kidney recipients with preformed anti-HLA-Cw donor-specific antibodies. Those with anti-native HLA antibodies experienced more acute and chronic antibody-mediated rejections (P = .006 and .03, respectively), and displayed a lower graft survival (P = .04). Patients with anti-native HLA-Cw antibodies more frequently had previous sensitizing events (P < .000001) or plausibility of their antibody profile according to known anti-native HLA-Cw eplets (P = .0001). Anti-native but not anti-denatured HLA-Cw antibodies are deleterious, which underscores the need for reagents with diminished expression of denatured HLA.
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Affiliation(s)
- Jonathan Visentin
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France
| | - Thomas Bachelet
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France.,CTMR-Clinique Saint Augustin, ELSAN, Bordeaux, France
| | - Olivier Aubert
- Paris Translational Research for Organ Transplant INSERM U970, PARCC, HEGP, Paris, France
| | - Arnaud Del Bello
- Service de Néphrologie et de transplantation d'organes, CHU Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - Charlie Martinez
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Frédéric Jambon
- Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France.,Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Gwendaline Guidicelli
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Mamy Ralazamahaleo
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Charlène Bouthemy
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Marine Cargou
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Nicolas Congy-Jolivet
- Université Paul Sabatier, Toulouse, France.,Laboratoire d'Immunogénétique Moléculaire, EA 3034, Faculté de Médecine Purpan, IFR150 (INSERM), Toulouse, France.,Service d'Immunologie, CHU de Toulouse, Hôpital de Rangueil, Toulouse, France
| | - Thoa Nong
- One Lambda Inc., Canoga Park, California
| | | | - Rebecca Sberro-Soussan
- Service de Néphrologie-Transplantation Adulte, Hôpital Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.,Inserm U845, Centre Recherche et Signalisation, Université Paris René Descartes, Paris, France
| | - Lionel Couzi
- Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France.,Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Nassim Kamar
- Service de Néphrologie et de transplantation d'organes, CHU Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Christophe Legendre
- Service de Néphrologie-Transplantation Adulte, Hôpital Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.,Inserm U845, Centre Recherche et Signalisation, Université Paris René Descartes, Paris, France
| | - Pierre Merville
- Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France.,Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Jean-Luc Taupin
- Laboratoire d'Immunologie et Immunogénétique, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France
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Servais A, Saitovitch A, Hummel A, Boisgontier J, Scemla A, Sberro-Soussan R, Snanoudj R, Lemaitre H, Legendre C, Pontoizeau C, Antignac C, Anglicheau D, Funalot B, Boddaert N. Central nervous system complications in adult cystinosis patients. J Inherit Metab Dis 2020; 43:348-356. [PMID: 31444911 DOI: 10.1002/jimd.12164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 11/06/2022]
Abstract
Little is known about the long-term progression of adult nephropathic cystinosis patients. Our objective was to study central nervous system complications in cystinosis patients in the era of early cysteamine treatment, using advanced neuroimaging techniques. Neurological examination and multimodal brain 3 Tesla MRI were performed in 21 adult cystinosis patients, including 18 infantile cystinosis patients, 20 controls matched for age and renal function, and 12 healthy controls. Differences in gray matter volume and rest cerebral blood flow (CBF) using arterial spin labeling sequence were investigated using whole-brain voxel-based approach. Median age was 33.8 years (18.7-65.8). Seven patients (38.9%) presented with at least one central nervous system clinical abnormality: two (11.1%) with seizures, three (16.7%) with memory defects, five (27.8%) with cognitive defect, and one (5.5%) with stroke-like episode. These patients had a worse compliance to treatment (compliance score 2 vs 1, P = .03) and received a lower median cysteamine dose (0.9 g/day vs 2.1 g/day, P = .02). Among patients with infantile cystinosis, 13 (72.2%) showed cortical atrophy, which was absent in controls, but it was not correlated with symptoms. Cystinosis patients showed a significant gray matter decrease in the middle frontal gyrus compared with healthy controls and a significant negative correlation between the cystine blood level and rest CBF was observed in the right superior frontal gyrus, a region associated with executive function. Compliance to cysteamine treatment is a major concern in these adult patients and could have an impact on the development of neurological and cognitive complications.
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Affiliation(s)
- Aude Servais
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France
| | - Ana Saitovitch
- Department of Pediatric Radiology, Necker hospital, APHP, Inserm U1000, Imagine Institute, Paris Descartes University, Paris, France
| | - Aurélie Hummel
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | - Jennifer Boisgontier
- Department of Pediatric Radiology, Necker hospital, APHP, Inserm U1000, Imagine Institute, Paris Descartes University, Paris, France
| | - Anne Scemla
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | - Renaud Snanoudj
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | - Hervé Lemaitre
- Department of Pediatric Radiology, Necker hospital, APHP, Inserm U1000, Imagine Institute, Paris Descartes University, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | | | - Corinne Antignac
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France
- Department of Genetics, Necker hospital, APHP, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | - Benoît Funalot
- Department of Genetics, Henri Mondor Hospital, APHP, Créteil, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology, Necker hospital, APHP, Inserm U1000, Imagine Institute, Paris Descartes University, Paris, France
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21
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Coussement J, Scemla A, Hougardy JM, Sberro-Soussan R, Amrouche L, Catalano C, Johnson JR, Abramowicz D. Prevalence of asymptomatic bacteriuria among kidney transplant recipients beyond two months post-transplant: A multicenter, prospective, cross-sectional study. PLoS One 2019; 14:e0221820. [PMID: 31490951 PMCID: PMC6730876 DOI: 10.1371/journal.pone.0221820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND During routine post-kidney transplant care, most European transplant physicians screen patients for asymptomatic bacteriuria. The usefulness of this strategy is debated. To make screening cost-effective, asymptomatic bacteriuria should be prevalent enough to justify the expense, and antibiotics should improve patient outcomes significantly if asymptomatic bacteriuria is detected. Regrettably, the prevalence of asymptomatic bacteriuria among kidney transplant recipients is not well defined. METHODS To determine the prevalence of asymptomatic bacteriuria among kidney transplant recipients, we did a cross-sectional study among kidney transplant recipients undergoing routine surveillance in three outpatient transplant clinics in Belgium and France. We excluded patients who were in the first two months post-transplantation and/or had a urinary catheter. Asymptomatic participants who had a urine culture with one organism isolated at ≥ 105 CFU/mL were asked to provide a confirmatory urine specimen. Asymptomatic bacteriuria was defined per Infectious Diseases Society of America guidelines. RESULTS We screened 500 consecutive kidney transplant recipients. Overall, the prevalence of asymptomatic bacteriuria was 3.4% (17/500 patients). It was similarly low among kidney transplant recipients who were between 2 and 12 months after transplantation (1.3%, 1/76 patients) and those who were farther after transplantation (3.8%, 16/424 patients: p = 0.49). Asymptomatic bacteriuria was significantly associated with female gender (risk ratio 3.7, 95% CI 1.3-10.3, p = 0.007) and older age (mean age: 61 ± 12 years [bacteriuric participants], versus 53 ± 15 years [non-bacteriuric participants], p = 0.03). One participant's colistin-resistant Escherichia coli isolate carried the globally disseminated mcr-1 gene. CONCLUSIONS Among kidney transplant recipients who are beyond the second month post-transplant, the prevalence of asymptomatic bacteriuria is low. Further studies are needed to ascertain the cost-effectiveness of a screen-and-treat strategy for asymptomatic bacteriuria in this population.
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Affiliation(s)
- Julien Coussement
- Division of Infectious Diseases, CUB-Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
- * E-mail:
| | - Anne Scemla
- Service de Néphrologie et Transplantation Adulte, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Labex Transplantex, Paris, France
| | - Jean-Michel Hougardy
- Service de Néphrologie, Dialyse et Transplantation Rénale, CUB-Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Rebecca Sberro-Soussan
- Service de Néphrologie et Transplantation Adulte, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Labex Transplantex, Paris, France
| | - Lucile Amrouche
- Service de Néphrologie et Transplantation Adulte, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Labex Transplantex, Paris, France
| | - Concetta Catalano
- Service de Néphrologie, Dialyse et Transplantation Rénale, CUB-Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - James R. Johnson
- Minneapolis Veterans Health Care System, Minneapolis, Minnesota, United States of America
| | - Daniel Abramowicz
- Department of Nephrology-Hypertension, Universitair Ziekenhuis Antwerpen and Antwerp University, Antwerp, Belgium
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Leon J, Zuber J, Amrouche L, Anglicheau D, Divard G, Bertrand D, Olagne J, Delavenne X, Legendre, Sberro-Soussan R. Les nouveaux anticoagulants oraux directs en transplantation rénale : résultats d’une étude pilote. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.056] [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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23
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Gribouval O, Boyer O, Hummel A, Dantal J, Martinez F, Sberro-Soussan R, Etienne I, Chauveau D, Delahousse M, Lionet A, Allard J, Pouteil Noble C, Tête MJ, Heidet L, Antignac C, Servais A. Identification of genetic causes for sporadic steroid-resistant nephrotic syndrome in adults. Kidney Int 2019; 94:1013-1022. [PMID: 30348286 DOI: 10.1016/j.kint.2018.07.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/18/2018] [Accepted: 07/12/2018] [Indexed: 01/15/2023]
Abstract
Monogenic forms of Steroid-Resistant Nephrotic Syndrome (SRNS) have been widely characterized, but genetic screening paradigms preferentially address congenital, infantile onset, and familial cases. Our aim was to characterize the distribution of disease-causing gene mutations in adults with sporadic SRNS or focal segmental glomerulosclerosis (FSGS). We selected adult patients with non-syndromic, biopsy-proven FSGS or SRNS in the absence of known family history. Strict clinical criteria included lack of response to glucocorticoids and cyclosporine, and no recurrence after kidney transplantation. Mutations in SRNS genes were detected using a targeted gene panel. Sixteen of 135 tested participants (11.8%) carried pathogenic mutations in monogenic SRNS genes, and 14 others (10.4%) carried two APOL1 high-risk alleles. Autosomal recessive disease was diagnosed in 5 participants, autosomal dominant disease in 9, and X-linked disease in 2. Four participants carried a de novo heterozygous mutation. Among the 16 participants with identified mutations in monogenic SNRS genes, 7 (43.7%) had type IV collagen mutations. Mutations in monogenic SNRS genes were identified primarily in participants with proteinuria onset before 25 years of age, while the age at disease onset was variable in those with APOL1 high-risk genotype. Mean age at diagnosis was lower and renal survival was worse in participants with identified mutations in SNRS genes than in those without mutations. We found a significant rate of pathogenic mutations in adults with SRNS, with Type IV collagen mutations being the most frequent. These findings may have immediate impact on clinical practice.
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Affiliation(s)
- Olivier Gribouval
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France
| | - Olivia Boyer
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France; Pediatric Nephrology, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, Paris, France
| | - Aurélie Hummel
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France; Adult Nephrology & Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, Paris, France
| | | | - Frank Martinez
- Adult Nephrology & Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, Paris, France
| | - Rebecca Sberro-Soussan
- Adult Nephrology & Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, Paris, France
| | - Isabelle Etienne
- Nephrology Department, Hôpital de Bois-Guillaume, CHU Rouen, Rouen, France
| | - Dominique Chauveau
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | | | - Arnaud Lionet
- Nephrology Department, Hôpital Huriez, CHU Lille, Lille, France
| | | | - Claire Pouteil Noble
- Nephrology-Transplantation Department, Hôpital Edouard Herriot, Lyon I University, Lyon, France
| | - Marie-Josèphe Tête
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France
| | - Laurence Heidet
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France; Pediatric Nephrology, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, Paris, France; Genetic Department, Necker Hospital, APHP, Paris, France
| | - Corinne Antignac
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France; Genetic Department, Necker Hospital, APHP, Paris, France.
| | - Aude Servais
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France; Adult Nephrology & Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, Paris, France.
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Brunel M, Leclerc-Mercier S, Barnier JP, Bille E, Sberro-Soussan R, Legendre C, Scemla A. The Case | Posttransplant upper limb inflammatory nodules. Kidney Int 2019; 95:721-722. [PMID: 30784666 DOI: 10.1016/j.kint.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Mélanie Brunel
- Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, RTRS "Centaure," Paris, France.
| | - Stéphanie Leclerc-Mercier
- Department of Dermatology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France; Department of Anatomopathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Jean-Philippe Barnier
- Department of Microbiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Emmanuelle Bille
- Department of Microbiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, RTRS "Centaure," Paris, France
| | - Christophe Legendre
- Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, RTRS "Centaure," Paris, France
| | - Anne Scemla
- Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, RTRS "Centaure," Paris, France
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25
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Devresse A, Morin L, Aulagnon F, Taupin JL, Scemla A, Lanternier F, Aubert O, Aidoud AA, Lebreton X, Sberro-Soussan R, Snanoudj R, Amrouche L, Tinel C, Martinez F, Bererhi L, Anglicheau D, Lortholary O, Legendre C, Avettand-Fenoel V, Zuber J. Baseline graft status is a critical predictor of kidney graft failure after diarrhoea. Nephrol Dial Transplant 2019; 34:1597-1604. [DOI: 10.1093/ndt/gfy386] [Citation(s) in RCA: 2] [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] [Received: 07/16/2018] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Diarrhoea is one of the most frequent complications after kidney transplantation (KT). Non-infectious diarrhoea has been associated with reduced graft survival in kidney transplant recipients. However, the risk factors for renal allograft loss following diarrhoea remain largely unknown.
Methods
Between January 2010 and August 2011, 195 consecutive KT recipients who underwent standardized microbiological workups for diarrhoea at a single centre were enrolled in this retrospective study.
Results
An enteric pathogen was readily identified in 91 patients (47%), while extensive microbiological investigations failed to find any pathogen in the other 104. Norovirus was the leading cause of diarrhoea in these patients, accounting for 30% of the total diarrhoea episodes. The baseline characteristics were remarkably similar between non-infectious and infectious diarrhoea patients, with the exception that the non-infectious group had significantly lower graft function before diarrhoea (P = 0.039). Infectious diarrhoea was associated with a longer duration of symptoms (P = 0.001) and higher rates of acute kidney injury (P = 0.029) and hospitalization (P < 0.001) than non-infectious diarrhoea. However, the non-infectious group had lower death-censored graft survival than the infectious group (Gehan–Wilcoxon test, P = 0.038). Multivariate analysis retained three independent predictors of graft failure after diarrhoea: diarrhoea occurring ≥5 years after KT [hazard ratio (HR) 4.82; P < 0.001], re-transplantation (HR 2.38; P = 0.001) and baseline estimated glomerular filtration rate <30 mL/min/1.73 m2 (HR 11.02; P < 0.001).
Conclusion
Our study shows that pre-existing conditions (re-transplantation, chronic graft dysfunction and late occurrence) determine the primary functional long-term consequences of post-transplant diarrhoea.
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Affiliation(s)
- Arnaud Devresse
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Service de Néphrologie des Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Bruxelles, Belgique
| | - Lise Morin
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Florence Aulagnon
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Jean-Luc Taupin
- Faculté de médecine, Université Paris Diderot, Paris, France
| | - Anne Scemla
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Fanny Lanternier
- Faculté de Médecine, Université Paris Descartes, Paris, France
- Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, AP-HP, Centre d’infectiologie Necker Pasteur, IHU Imagine, Paris, France
| | - Olivier Aubert
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Adel A Aidoud
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Xavier Lebreton
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Rebecca Sberro-Soussan
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Renaud Snanoudj
- Département de Virologie, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Lucile Amrouche
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Claire Tinel
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Frank Martinez
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Lynda Bererhi
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Dany Anglicheau
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Olivier Lortholary
- Faculté de Médecine, Université Paris Descartes, Paris, France
- Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, AP-HP, Centre d’infectiologie Necker Pasteur, IHU Imagine, Paris, France
| | - Christophe Legendre
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Véronique Avettand-Fenoel
- Faculté de Médecine, Université Paris Descartes, Paris, France
- Service de Néphrologie et Transplantation, Hôpital Foch, Suresnes, France
| | - Julien Zuber
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
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26
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Legendre C, Sberro-Soussan R, Zuber J, Frémeaux-Bacchi V. The role of complement inhibition in kidney transplantation. Br Med Bull 2017; 124:5-17. [PMID: 29069327 DOI: 10.1093/bmb/ldx037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/25/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND BACKGROUND The complement system which belongs to the innate immune system acts both as a first line of defence against various pathogens and as a guardian of host homeostasis. The role of complement has been recently highlighted in several aspects of kidney transplantation: ischaemia-reperfusion, antibody-mediated rejection and native kidney disease recurrence. SOURCES OF DATA Experimental data, availability of complement-blocking molecules (mainly the anti-C5 monoclonal antibody, eculizumab) and several trials in human kidney transplant recipients has led to some areas of agreement and some disappointment. AREAS OF AGREEMENT AND CONTROVERSIES So far, eculizumab has shown great efficacy in treatment and prevention of atypical haemolytic and uraemic syndrome, some efficacy in the prevention of antibody-mediated and so far no efficacy in the prevention of delayed graft function. GROWING POINTS Among the numerous potentially available drugs potentially interfering with complement, recent focus has been made on C1 blockers in the setting of antibody-mediated rejection with promising results. AREAS TIMELY FOR DEVELOPING RESEARCH Complement is now recognized as a major player in transplant immunology, several targets are going to be tested to define precisely which ones may be potentially useful in clinical practice.
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Affiliation(s)
- C Legendre
- Service de Néphrologie-Transplantation, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Sorbonne Paris Cité, Paris, France.,Inserm U1151, INEM, Hôpital necker, Paris, France
| | - R Sberro-Soussan
- Service de Néphrologie-Transplantation, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Zuber
- Service de Néphrologie-Transplantation, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Sorbonne Paris Cité, Paris, France.,Inserm UMRS 1163, Imagine Institute, Hôpital Necker, Paris, France
| | - V Frémeaux-Bacchi
- Laboratoire d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de paris, Paris, France.,INSERM UMRS-1138, Cordeliers Research Center, Complement and Diseases Team, Paris, France
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27
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Passot C, Sberro-Soussan R, Bertrand D, Caillard S, Barbet C, Schvart B, Vigneau C, Domenger C, Ternant D, Gatault P. Suivi thérapeutique pharmacologique de l’éculizumab : une étude multicentrique française. Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.064] [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: 11/16/2022]
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28
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Lazareth H, Cohen D, Vasiliu V, Tinel C, Martinez F, Grünfeld JP, Mamzer MF, Legendre C, Sberro-Soussan R. Paraganglioma of the bladder in a kidney transplant recipient: A case report. Mol Clin Oncol 2017; 6:553-555. [PMID: 28413667 DOI: 10.3892/mco.2017.1182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/03/2016] [Accepted: 01/30/2017] [Indexed: 12/30/2022] Open
Abstract
Renal transplantation has been associated with a significantly increased risk of developing cancer, including bladder neoplasia, with urothelial carcinoma being the most frequent type of bladder cancer. Bladder paraganglioma, also referred to as extra-adrenal pheochromocytoma, is a rare but severe condition that may cause a severe hypertensive crisis during handling and mobilization of the tumor. We herein present the case of a 67-year-old kidney transplant recipient with a bladder polyp consistent with paraganglioma of the bladder. During bladder polyp resection, the patient developed severe hypertension, which resolved with appropriate treatment. The histological analysis of the resected bladder polyp was consistent with extra-adrenal pheochromocytoma, or paraganglioma, and the patient finally underwent partial cystectomy, with no reported postoperative recurrence. To the best of our knowledge, this is the first report of a case of paraganglioma of the bladder in a kidney tranplant recipient. Total or partial bladder cystectomy is considered to be an effective treatment for this type of bladder tumor. Screening for mutations of the succinate dehydrogenase subunit B gene may also be recommended.
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Affiliation(s)
- Hélène Lazareth
- Department of Nephrology and Kidney Transplantation, Necker Enfants-Malades Hospital, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Daniel Cohen
- Department of Urology, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Viorel Vasiliu
- Department of Pathology, Necker Enfants-Malades Hospital, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Claire Tinel
- Department of Nephrology and Kidney Transplantation, Necker Enfants-Malades Hospital, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Frank Martinez
- Department of Nephrology and Kidney Transplantation, Necker Enfants-Malades Hospital, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Jean-Pierre Grünfeld
- Department of Nephrology and Kidney Transplantation, Necker Enfants-Malades Hospital, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Marie-France Mamzer
- Department of Medical Ethics and Legal Medicine, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker Enfants-Malades Hospital, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, Necker Enfants-Malades Hospital, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
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Le Meur Y, Aulagnon F, Bertrand D, Heng AE, Lavaud S, Caillard S, Longuet H, Sberro-Soussan R, Doucet L, Grall A, Legendre C. Effect of an Early Switch to Belatacept Among Calcineurin Inhibitor-Intolerant Graft Recipients of Kidneys From Extended-Criteria Donors. Am J Transplant 2016; 16:2181-6. [PMID: 26718625 DOI: 10.1111/ajt.13698] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [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: 09/08/2015] [Revised: 12/14/2015] [Accepted: 12/12/2015] [Indexed: 01/25/2023]
Abstract
Transplant recipients receiving a kidney from an extended-criteria donor (ECD) are exposed to calcineurin inhibitor (CNI) nephrotoxicity, as demonstrated by severe delayed graft function and/or a low GFR. Belatacept is a nonnephrotoxic drug that is indicated as an alternative to CNIs. We reported 25 cases of conversion from a CNI to belatacept due to CNI intolerance within the first 6 mo after transplantation. The mean age of the recipients was 59 years, and 24 of 25 patients received ECD kidneys. At the date of the medication switch, 12 of 25 patients displayed a calculated GFR (cGFR) <15 mL/min, six patients remained on dialysis, and the biopsies showed evidence of acute tubular damage associated with severe vascular or tubulointerstitial chronic lesions. Three patients did not recover renal function, and three patients died during the follow-up period. Among the remaining patients, renal function improved: The cGFR was 18.28 ± 12.3 mL/min before the medication switch compared with 34.9 ± 14.5 mL/min at 1 year after conversion to belatacept (p = 0.002). Tolerance of and compliance with belatacept were good, and only one patient experienced acute rejection. Belatacept is an effective therapy that preserves renal function in kidney transplant patients who are intolerant of CNIs.
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Affiliation(s)
- Y Le Meur
- Department of Nephrology and Transplantation, University Hospital La Cavale Blanche, European University of Brittany, Brest, France
| | - F Aulagnon
- Department of Renal Transplantation, Necker-Enfants Malades University Hospital, AP-HP, Paris, France
| | - D Bertrand
- Department of Nephrology, University Hospital, Rouen, France
| | - A E Heng
- Department of Nephrology, University Hospital, Clermont-Ferrand, France
| | - S Lavaud
- Department of Nephrology and Transplantation, University Hospital, Reims, France
| | - S Caillard
- Department of Nephrology and Renal Transplantation, Hospices Civils, Strasbourg, France
| | - H Longuet
- Department of Nephrology and Clinical Immunology-EA4245, Bretonneau Hospital, University Hospital, Tours, France
| | - R Sberro-Soussan
- Department of Renal Transplantation, Necker-Enfants Malades University Hospital, AP-HP, Paris, France
| | - L Doucet
- Department of Anatomy and Pathology, University Hospital, Brest, France
| | - A Grall
- Department of Nephrology and Transplantation, University Hospital La Cavale Blanche, European University of Brittany, Brest, France
| | - C Legendre
- Department of Renal Transplantation, Necker-Enfants Malades University Hospital, AP-HP, Paris, France
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Mallet V, Sberro-Soussan R, Vallet-Pichard A, Roque-Afonso AM, Pol S. Transmission of Hepatitis E Virus by Plasma Exchange: A Case Report. Ann Intern Med 2016; 164:851-2. [PMID: 26926359 DOI: 10.7326/l15-0502] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Vincent Mallet
- From Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Unité Mixte de Service 020, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Unité Mixte de Service 020, Paris, France
- Université Paris Sud, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale unité 1193, Villejuif, France
| | - Rebecca Sberro-Soussan
- From Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Unité Mixte de Service 020, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Unité Mixte de Service 020, Paris, France
- Université Paris Sud, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale unité 1193, Villejuif, France
| | - Anais Vallet-Pichard
- From Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Unité Mixte de Service 020, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Unité Mixte de Service 020, Paris, France
- Université Paris Sud, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale unité 1193, Villejuif, France
| | - Anne-Marie Roque-Afonso
- From Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Unité Mixte de Service 020, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Unité Mixte de Service 020, Paris, France
- Université Paris Sud, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale unité 1193, Villejuif, France
| | - Stanislas Pol
- From Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Unité Mixte de Service 020, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Unité Mixte de Service 020, Paris, France
- Université Paris Sud, Assistance Publique-Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale unité 1193, Villejuif, France
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Sébille V, Hardouin JB, Giral M, Bonnaud-Antignac A, Tessier P, Papuchon E, Jobert A, Faurel-Paul E, Gentile S, Cassuto E, Morélon E, Rostaing L, Glotz D, Sberro-Soussan R, Foucher Y, Meurette A. Prospective, multicenter, controlled study of quality of life, psychological adjustment process and medical outcomes of patients receiving a preemptive kidney transplant compared to a similar population of recipients after a dialysis period of less than three years--The PreKit-QoL study protocol. BMC Nephrol 2016; 17:11. [PMID: 26785745 PMCID: PMC4719683 DOI: 10.1186/s12882-016-0225-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of end stage renal disease has an impact on patients' physical and psychological health, including quality of life (QoL). Nowadays, it is known that reducing the dialysis period has many advantages regarding QoL and medical outcomes. Although preemptive transplantation is the preferred strategy to prevent patients undergoing dialysis, its psychological impact is unknown. Moreover, transplantation can be experienced in a completely different manner among patients who were on dialysis and those who still had a functioning kidney at the time of surgery. Longitudinal data are often collected to allow analyzing the evolution of patients' QoL over time using questionnaires. Such data are often difficult to interpret due to the patients' changing standards, values, or conceptualization of what the questionnaire is intended to measure (e.g. QoL). This phenomenon is referred to as response shift and is often linked to the way the patients might adapt or cope with their disease experience. Whether response shift is experienced in a different way among patients who were on dialysis and those who still had a functioning kidney at time of surgery is unknown and will be studied in the PreKit-QoL study (trial registration number: NCT02154815). Understanding the psychological impact of pre-emptive transplantation is an important issue since it can be associated with long-term patient and graft survival. METHODS/DESIGN Adult patients with a pre-emptive transplantation (n = 130) will be prospectively included along with a control group of patients with a pre-transplant dialysis period < 36 months (n = 260). Only first and single kidney transplantation will be considered. Endpoints include: comparison of change between groups in QoL, anxiety and depressive disorders, perceived stress, taking into account response shift. These criteria will be evaluated every 6 months prior to surgery, at hospital discharge, at three and six months, one and two years after transplantation. DISCUSSION The PreKit-QoL study assesses and compares the evolution of QoL and other psychological criteria in preemptive and dialyzed patients taking patients' adaptation into account through response shift analyses. Our study might help to conceive specific, adapted educational programs and psychological support to prevent a possible premature loss of the kidney as a consequence of non-compliance in patients that may be insufficiently prepared for transplantation. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02154815 , registered on May 28, 2014.
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Affiliation(s)
- Véronique Sébille
- EA 4275 SPHERE, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes University, Nantes, France. .,Biostatistics Unit, CHU Nantes, Nantes, France.
| | - Jean-Benoit Hardouin
- EA 4275 SPHERE, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes University, Nantes, France. .,Biostatistics Unit, CHU Nantes, Nantes, France.
| | - Magali Giral
- ITUN and Inserm U1064, Nantes University, CHU Nantes, Nantes, France.
| | - Angélique Bonnaud-Antignac
- EA 4275 SPHERE, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes University, Nantes, France.
| | - Philippe Tessier
- EA 4275 SPHERE, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes University, Nantes, France.
| | | | - Alexandra Jobert
- Délégation à la recherche clinique et à l'innovation, CHU Nantes, Nantes, France.
| | - Elodie Faurel-Paul
- Délégation à la recherche clinique et à l'innovation, CHU Nantes, Nantes, France.
| | - Stéphanie Gentile
- Laboratoire de santé publique, SPMC EA3279, Aix-Marseille université, 13385, Marseille, France. .,Service de santé publique et information médicale, hôpital de la Conception, 13005, Marseille, France.
| | | | - Emmanuel Morélon
- Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France.
| | - Lionel Rostaing
- Department of Nephrology, Dialysis and Transplantation, Hôpital de Rangueil, Toulouse, France.
| | - Denis Glotz
- Hôpital Saint Louis - Nephrology and Transplantation, Paris, France.
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Transplantation, Hôpital Necker Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France.
| | - Yohann Foucher
- EA 4275 SPHERE, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes University, Nantes, France.
| | - Aurélie Meurette
- ITUN and Inserm U1064, Nantes University, CHU Nantes, Nantes, France.
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Levi C, Frémeaux-Bacchi V, Rabant M, Scemla A, Zuber J, Legendre C, Sberro-Soussan R. Évolution de 11 patients ayant eu une transplantation rénale pour syndrome hémolytique et urémique atypique traités précocement par éculizumab. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.470] [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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Delville M, Sabbah L, Girard D, Elie C, Manceau S, Piketty M, Martinez F, Méjean A, Legendre C, Sberro-Soussan R. Prevalence and predictors of early cardiovascular events after kidney transplantation: evaluation of pre-transplant cardiovascular work-up. PLoS One 2015; 10:e0131237. [PMID: 26107641 PMCID: PMC4481263 DOI: 10.1371/journal.pone.0131237] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/30/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cardiovascular disease is the leading cause of mortality after renal transplantation. The purpose of this study was to analyze cardiovascular risk factors at transplantation, occurrence of cardiovascular events in the first year after transplantation and evaluate pre-transplant work-up. MATERIAL AND METHOD In total, 244 renal transplant recipients older than 50 years were included. The results of pre-transplant work-up, including clinical evaluation, electrocardiogram, echocardiography, myocardial perfusion testing and coronary angiography were analyzed. RESULTS Patients had multiple risk factors at inclusion on renal transplantation waiting list as high blood pressure (94.7%), dyslipidemia (81.1%), smoking (45.3%), diabetes (23.6%), past history of cardiovascular disease (21.3%) and obesity (12.7%). Following transplantation, 15.5% (n = 38) of patients experienced a cardiovascular event, including 2.8% (n = 7) acute coronary syndrome, 5.8% (n = 14) isolated increase in troponin level and 5.3% (n = 13) new onset atrial fibrillation. The pre-transplant parameters associated with a cardiovascular event were a past medical history of cardiovascular disease (HR = 2.06 [1.06-4.03], p = 0.03), echocardiographic left ventricular hypertrophy (HR = 2.04 [1.04-3.98], p = 0.037) and abnormal myocardial perfusion testing (HR = 2.25 [1.09 -5.96], p = 0.03). Pre-transplantation evaluation allowed the diagnosis of unknown coronary artery lesions in 8.9% of patients.
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Affiliation(s)
- Marianne Delville
- Department of Nephrology and Transplantation, Hôpital Necker Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France
- * E-mail:
| | - Laurent Sabbah
- Department of Cardiology, Hôpital Necker, APHP, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France
| | - Delphine Girard
- Department of Biostatistics, Hôpital Necker, APHP, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France
| | - Caroline Elie
- Department of Biostatistics, Hôpital Necker, APHP, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France
| | - Sandra Manceau
- Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France
- Department of Clinical Research, Hôpital Necker, APHP, Paris, France
| | - Marie Piketty
- Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France
- Department of Functional Explorations, Hôpital Necker, APHP, Paris, France
| | - Frank Martinez
- Department of Nephrology and Transplantation, Hôpital Necker Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France
| | - Arnaud Méjean
- Department of Nephrology and Transplantation, Hôpital Necker Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France
| | - Christophe Legendre
- Department of Nephrology and Transplantation, Hôpital Necker Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Transplantation, Hôpital Necker Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, RTRS « Centaure », Labex « Transplantex », Paris, France
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Aubert O, Bories MC, Suberbielle C, Snanoudj R, Anglicheau D, Rabant M, Martinez F, Scemla A, Legendre C, Sberro-Soussan R. Risk of antibody-mediated rejection in kidney transplant recipients with anti-HLA-C donor-specific antibodies. Am J Transplant 2014; 14:1439-45. [PMID: 24804568 DOI: 10.1111/ajt.12709] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 11/12/2013] [Revised: 02/04/2014] [Accepted: 02/04/2014] [Indexed: 01/25/2023]
Abstract
Anti-HLA donor-specific antibodies (DSAs) cause acute and chronic antibody-mediated rejection (AMR). However, the clinical relevance of anti-HLA-C antibodies remains unclear. We evaluated the clinical relevance of the presence of anti-HLA-C DSA at day 0 in renal transplant recipients. In this retrospective, case-controlled study, 608 patients who underwent kidney transplantation between August 2008 and March 2012 were screened for the presence of isolated anti-HLA-C DSA at day 0. A total of 22 renal transplant recipients were selected and followed for a period of 1 year. AMR was classified according to the Banff classification. The 22 patients were compared with 88 immunized patients. Acute AMR was diagnosed in six patients (27.3%). The median level of DSA at day 0 was 1179 (530-17,941). The mean fluorescence intensity in the anti-C group was 4966 (978-17,941) in the AMR group and 981 (530-8012) in the group of patients without AMR. Acute AMR was diagnosed less frequently in the 88 immunized individuals (9.1%) than in the DSA anti-C group (p = 0.033). The level of DSA at day 0 was predictive for AMR (p = 0.017). Patients with a high level of pretransplant anti-HLA-C DSAs are likely to develop acute AMR during the first year after transplantation.
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Affiliation(s)
- O Aubert
- Service de Néphrologie-Transplantation Adulte, Hôpital Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
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Soussan M, Abisror N, Abad S, Nunes H, Terrier B, Pop G, Eder V, Valeyre D, Sberro-Soussan R, Guillevin L, Dhote R, Fain O, Mekinian A. FDG-PET/CT in patients with ANCA-associated vasculitis: Case-series and literature review. Autoimmun Rev 2014; 13:125-31. [DOI: 10.1016/j.autrev.2013.09.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/25/2013] [Indexed: 12/21/2022]
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Canaud G, Dejucq-Rainsford N, Avettand-Fenoël V, Viard JP, Anglicheau D, Bienaimé F, Muorah M, Galmiche L, Gribouval O, Noël LH, Satie AP, Martinez F, Sberro-Soussan R, Scemla A, Gubler MC, Friedlander G, Antignac C, Timsit MO, Onetti Muda A, Terzi F, Rouzioux C, Legendre C. The kidney as a reservoir for HIV-1 after renal transplantation. J Am Soc Nephrol 2013; 25:407-19. [PMID: 24309185 DOI: 10.1681/asn.2013050564] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Since the recent publication of data showing favorable outcomes for patients with HIV-1 and ESRD, kidney transplantation has become a therapeutic option in this population. However, reports have documented unexplained reduced allograft survival in these patients. We hypothesized that the unrecognized infection of the transplanted kidney by HIV-1 can compromise long-term allograft function. Using electron microscopy and molecular biology, we examined protocol renal transplant biopsies from 19 recipients with HIV-1 who did not have detectable levels of plasma HIV-1 RNA at transplantation. We found that HIV-1 infected the kidney allograft in 68% of these patients. Notably, HIV-1 infection was detected in either podocytes predominately (38% of recipients) or tubular cells only (62% of recipients). Podocyte infection associated with podocyte apoptosis and loss of differentiation markers as well as a faster decline in allograft function compared with tubular cell infection. In allografts with tubular cell infection, epithelial cells of the proximal convoluted tubules frequently contained abnormal mitochondria, and both patients who developed features of subclinical acute cellular rejection had allografts with tubular cell infection. Finally, we provide a novel noninvasive test for determining HIV-1 infection of the kidney allograft by measuring HIV-1 DNA and RNA levels in patients' urine. In conclusion, HIV-1 can infect kidney allografts after transplantation despite undetectable viremia, and this infection might influence graft outcome.
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Affiliation(s)
- Guillaume Canaud
- Institut National de la Santé et de la Recherche Médicale U845, Growth and Signaling Research Center, Paris Descartes University, Necker Hospital, Paris, France
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Canaud G, Kamar N, Anglicheau D, Esposito L, Rabant M, Noël LH, Guilbeau-Frugier C, Sberro-Soussan R, Del Bello A, Martinez F, Zuber J, Rostaing L, Legendre C. Eculizumab improves posttransplant thrombotic microangiopathy due to antiphospholipid syndrome recurrence but fails to prevent chronic vascular changes. Am J Transplant 2013; 13:2179-85. [PMID: 23763583 DOI: 10.1111/ajt.12319] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [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: 03/08/2013] [Revised: 04/02/2013] [Accepted: 04/22/2013] [Indexed: 01/25/2023]
Abstract
Thrombotic microangiopathy (TMA) is one of the hallmark vascular lesions of antiphospholipid syndrome nephropathy (APSN). These lesions are at high risk of recurrence after kidney transplantation. The complement pathway is thought to be active in this process. We used eculizumab to treat three consecutive kidney transplant recipients with posttransplant TMA due to APSN recurrence that was resistant to plasmapheresis and explored the complement deposition and apoptotic and vascular cell markers on the sequential transplant biopsies. Treatment with eculizumab resulted in a rapid and dramatic improvement of the graft function in all three patients and in improvement of the TMA lesions within the graft. None of these patients had TMA flares after eculizumab was withdrawn. At the time of TMA diagnosis, immunofluorescence studies revealed intense C5b-9 and C4d depositions at the endothelial cell surface of the injured vessels. Moreover, C5b-9 colocalized with vessels exhibiting a high rate of apoptotic cells. Examination of sequential biopsies during eculizumab therapy showed that TMA lesions, C4d and apoptotic markers were rapidly cleared but the C5b-9 deposits persisted for several months as a footprint of the TMA. Finally, we noticed that complement inhibition did not prevent the development of the chronic vascular changes associated with APSN. Eculizumab seems to be an efficient method for treating severe forms of posttransplant TMA due to APSN recurrence. Terminal complement inhibition does not prevent the development of chronic APSN.
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Affiliation(s)
- G Canaud
- Service de Transplantation Adulte, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Legendre CM, Licht C, Muus P, Greenbaum LA, Babu S, Bedrosian C, Bingham C, Cohen DJ, Delmas Y, Douglas K, Eitner F, Feldkamp T, Fouque D, Furman RR, Gaber O, Herthelius M, Hourmant M, Karpman D, Lebranchu Y, Mariat C, Menne J, Moulin B, Nürnberger J, Ogawa M, Remuzzi G, Richard T, Sberro-Soussan R, Severino B, Sheerin NS, Trivelli A, Zimmerhackl LB, Goodship T, Loirat C. Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med 2013; 368:2169-81. [PMID: 23738544 DOI: 10.1056/nejmoa1208981] [Citation(s) in RCA: 1017] [Impact Index Per Article: 92.5] [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: 12/11/2022]
Abstract
BACKGROUND Atypical hemolytic-uremic syndrome is a genetic, life-threatening, chronic disease of complement-mediated thrombotic microangiopathy. Plasma exchange or infusion may transiently maintain normal levels of hematologic measures but does not treat the underlying systemic disease. METHODS We conducted two prospective phase 2 trials in which patients with atypical hemolytic-uremic syndrome who were 12 years of age or older received eculizumab for 26 weeks and during long-term extension phases. Patients with low platelet counts and renal damage (in trial 1) and those with renal damage but no decrease in the platelet count of more than 25% for at least 8 weeks during plasma exchange or infusion (in trial 2) were recruited. The primary end points included a change in the platelet count (in trial 1) and thrombotic microangiopathy event-free status (no decrease in the platelet count of >25%, no plasma exchange or infusion, and no initiation of dialysis) (in trial 2). RESULTS A total of 37 patients (17 in trial 1 and 20 in trial 2) received eculizumab for a median of 64 and 62 weeks, respectively. Eculizumab resulted in increases in the platelet count; in trial 1, the mean increase in the count from baseline to week 26 was 73×10(9) per liter (P<0.001). In trial 2, 80% of the patients had thrombotic microangiopathy event-free status. Eculizumab was associated with significant improvement in all secondary end points, with continuous, time-dependent increases in the estimated glomerular filtration rate (GFR). In trial 1, dialysis was discontinued in 4 of 5 patients. Earlier intervention with eculizumab was associated with significantly greater improvement in the estimated GFR. Eculizumab was also associated with improvement in health-related quality of life. No cumulative toxicity of therapy or serious infection-related adverse events, including meningococcal infections, were observed through the extension period. CONCLUSIONS Eculizumab inhibited complement-mediated thrombotic microangiopathy and was associated with significant time-dependent improvement in renal function in patients with atypical hemolytic-uremic syndrome. (Funded by Alexion Pharmaceuticals; C08-002 ClinicalTrials.gov numbers, NCT00844545 [adults] and NCT00844844 [adolescents]; C08-003 ClinicalTrials.gov numbers, NCT00838513 [adults] and NCT00844428 [adolescents]).
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Affiliation(s)
- C M Legendre
- Université Paris Descartes and Assistance Publique–Hôpitaux de Paris, Hôpital Necker, INSERM Unité 845, Paris, France.
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Bertrand D, Desbuissons G, Pallet N, Debure A, Sartorius A, Anglicheau D, Mamzer MF, Legendre C, Sberro-Soussan R. Sirolimus therapy may cause cardiac tamponade. Transpl Int 2012. [DOI: 10.1111/tri.12025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dominique Bertrand
- Service de Transplantation Rénale et Soins Intensifs; Hôpital Necker; Assistance Publique Hôpitaux de Paris; Université Paris Descartes; Paris; France
| | - Geoffroy Desbuissons
- Service de Transplantation Rénale et Soins Intensifs; Hôpital Necker; Assistance Publique Hôpitaux de Paris; Université Paris Descartes; Paris; France
| | - Nicolas Pallet
- Service de Transplantation Rénale et Soins Intensifs; Hôpital Necker; Assistance Publique Hôpitaux de Paris; Université Paris Descartes; Paris; France
| | - Alain Debure
- Service de Transplantation Rénale et Soins Intensifs; Hôpital Necker; Assistance Publique Hôpitaux de Paris; Université Paris Descartes; Paris; France
| | - Albane Sartorius
- Service de Transplantation Rénale et Soins Intensifs; Hôpital Necker; Assistance Publique Hôpitaux de Paris; Université Paris Descartes; Paris; France
| | - Dany Anglicheau
- Service de Transplantation Rénale et Soins Intensifs; Hôpital Necker; Assistance Publique Hôpitaux de Paris; Université Paris Descartes; Paris; France
| | - Marie-France Mamzer
- Service de Transplantation Rénale et Soins Intensifs; Hôpital Necker; Assistance Publique Hôpitaux de Paris; Université Paris Descartes; Paris; France
| | - Christophe Legendre
- Service de Transplantation Rénale et Soins Intensifs; Hôpital Necker; Assistance Publique Hôpitaux de Paris; Université Paris Descartes; Paris; France
| | - Rebecca Sberro-Soussan
- Service de Transplantation Rénale et Soins Intensifs; Hôpital Necker; Assistance Publique Hôpitaux de Paris; Université Paris Descartes; Paris; France
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Jones M, Oro S, Ortonne N, Foulet F, Sberro-Soussan R, Wolkenstein P, Chosidow O. Alternariose cutanée chez un greffé rénal : à maladie locale et limitée, traitement local et limité. Ann Dermatol Venereol 2011. [DOI: 10.1016/j.annder.2011.09.033] [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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Sberro-Soussan R, Zuber J, Suberbielle-Boissel C, Candon S, Martinez F, Snanoudj R, Rabant M, Pallet N, Nochy D, Anglicheau D, Leruez M, Loupy A, Thervet E, Hermine O, Legendre C. Bortezomib as the sole post-renal transplantation desensitization agent does not decrease donor-specific anti-HLA antibodies. Am J Transplant 2010; 10:681-6. [PMID: 20121729 DOI: 10.1111/j.1600-6143.2009.02968.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [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
Persistence of donor-specific anti-HLA antibodies (DSA) associated with antibody-mediated graft injuries following kidney transplantation predicts evolution toward chronic humoral rejection and reduced graft survival. Targeting plasma cells, the main antibody-producing cells, with the proteasome inhibitor bortezomib may be a promising desensitization strategy. We evaluated the in vivo efficacy of one cycle of bortezomib (1.3 mg/m(2)x 4 doses), used as the sole desensitization therapy, in four renal transplant recipients experiencing subacute antibody-mediated rejection with persisting DSA (>2000 [Mean Fluorescence Intensity] MFI). Bortezomib treatment did not significantly decrease DSA MFI within the 150-day posttreatment period in any patient. In addition, antivirus (HBV, VZV and HSV) antibody levels remained stable following treatment suggesting a lack of efficacy on long-lived plasma cells. In conclusion, one cycle of bortezomib alone does not decrease DSA levels in sensitized kidney transplant recipients in the time period studied. These results underscore the need to evaluate this new desensitization agent properly in prospective, randomized and well-controlled studies.
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Sberro-Soussan R, Zuberl J, Suberbielle-Boissel C, Legendre C. Bortezomib alone fails to decrease donor specific anti-HLA antibodies: even after one year post-treatment. Clin Transpl 2010:409-414. [PMID: 21696059] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In a previous study we evaluated the in vivo efficacy of one cycle of Bortezomib (1.3 mg/m2 x 4 doses), used as the sole desensitization therapy, in four renal transplant recipients experiencing sub-acute antibody mediated rejection with persisting DSA. Bortezomib treatment did not significantly decrease DSA MFI within the 270-day posttreatment period in any patient. Here we reevaluate the patients' outcomes and bortezomib efficacy after one year post-treatment. The DSA levels remained stable or increased. In conclusion, one cycle of bortezomib alone does not decrease DSA levels in sensitized kidney transplant recipients.
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Sberro-Soussan R, Zuber J, Suberbielle-Boissel C, Legendre C. Bortezomib alone fails to decrease donor specific anti-HLA antibodies: 4 case reports. Clin Transpl 2009:433-438. [PMID: 20524311] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In renal transplant recipients, the persistence of donor specific anti-HLA antibodies (DSA) associated with antibody-mediated graft injuries predicts evolution toward chronic humoral rejection and lower graft survival. Targeting plasma cells with the proteasome inhibitor bortezomib may be a promising desensitization strategy. We evaluated the in vivo efficacy of one cycle of bortezomib (1.3 mg/m2 x 4 doses), used as the sole desensitization therapy, in four renal transplant recipients experiencing sub-acute antibody-mediated rejection with persisting DSA (>2000 [Mean Fluorescence Intensity] MFI). Bortezomib treatment did not significantly decrease DSA MFI within the 270-day post-treatment period in any patient. In conclusion, one cycle of bortezomib alone does not decrease DSA levels in sensitized kidney transplant recipients.
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