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Duval A, Meuleman M, Chauvet S, Roumenina L, Moulin B, Caillard S, Frémeaux-Bacchi V. Étude de la susceptibilité individuelle à l’activation/régulation du complément à la surface cellulaire endothéliale : validation d’un nouveau modèle ex vivo. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.201] [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: 10/14/2022]
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2
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Bouchet A, Muller B, Olagne J, Rabeyrin M, Dubois V, Parissiadi A, Koenig A, Morelon E, Caillard S, Thaunat O. Après traitement d’un rejet humoral aigu, la réalisation d’une biopsie de contrôle permet de stratifier le risque de perte de greffon rénal. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.323] [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: 10/20/2022]
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3
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Maillard N, Kamar N, Dantal J, Thaunat O, Le Quintrec M, Frimat L, Pouteil Noble C, Caillard S, Ducloux D, Mariat C. Impact de l’induction par anticorps polyclonaux anti-lymphocytes T sur la récidive de la néphropathie à IgA : étude PIRAT. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Perrin P, Collongues N, Baloglu S, Bedo D, Bassand X, Lavaux T, Gautier-Vargas G, Keller N, Kremer S, Fafi-Kremer S, Moulin B, Benotmane I, Caillard S. Cytokine release syndrome-associated encephalopathy in patients with COVID-19. Eur J Neurol 2020; 28:248-258. [PMID: 32853434 PMCID: PMC7461405 DOI: 10.1111/ene.14491] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [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: 06/11/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
Abstract
Background and purpose Neurological manifestations in coronavirus disease (COVID)‐2019 may adversely affect clinical outcomes. Severe COVID‐19 and uremia are risk factors for neurological complications. However, the lack of insight into their pathogenesis, particularly with respect to the role of the cytokine release syndrome (CRS), is currently hampering effective therapeutic interventions. The aims of this study were to describe the neurological manifestations of patients with COVID‐19 and to gain pathophysiological insights with respect to CRS. Methods In this longitudinal study, we performed extensive clinical, laboratory and imaging phenotyping in five patients admitted to our renal unit. Results Neurological presentation included confusion, tremor, cerebellar ataxia, behavioral alterations, aphasia, pyramidal syndrome, coma, cranial nerve palsy, dysautonomia, and central hypothyroidism. Notably, neurological disturbances were accompanied by laboratory evidence of CRS. Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) was undetectable in the cerebrospinal fluid (CSF). Hyperalbuminorrachia and increased levels of the astroglial protein S100B were suggestive of blood−brain barrier (BBB) dysfunction. Brain magnetic resonance imaging findings comprised evidence of acute leukoencephalitis (n = 3, one of whom had a hemorrhagic form), cytotoxic edema mimicking ischaemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted, resulting in rapid recovery from neurological disturbances in two cases. SARS‐CoV2 was undetectable in 88 of the 90 patients with COVID‐19 who underwent Reverse Transcription‐PCR testing of CSF. Conclusions Patients with COVID‐19 can develop neurological manifestations that share clinical, laboratory and imaging similarities with those of chimeric antigen receptor T‐cell‐related encephalopathy. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune‐mediated mechanisms.
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Affiliation(s)
- P Perrin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - N Collongues
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,Department of Neurology, University Hospital, Strasbourg, France.,Clinical Center for Investigation, INSERM U1434, Strasbourg, France
| | - S Baloglu
- Department of Neuroradiology, University Hospital, Strasbourg, France
| | - D Bedo
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - X Bassand
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - T Lavaux
- Department of Biochemistry and Molecular Biology, University Hospital, Strasbourg, France
| | - G Gautier-Vargas
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - N Keller
- Department of Nephrology and Dialysis, University Hospital, Strasbourg, France
| | - S Kremer
- Department of Neuroradiology, University Hospital, Strasbourg, France
| | - S Fafi-Kremer
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France.,Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - B Moulin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - I Benotmane
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France.,Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - S Caillard
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
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Pszczolinski R, Heitz D, Heibel F, Moulin B, Caillard S. Transplantation rénale après 70 ans : évaluation gériatrique en pré-transplantation et suivi après transplantation. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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6
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Lazareth H, Kamar N, Levi C, Caillard S, Frimat L, Chemouny J, Chatelet V, Snanoudj R, Puy H, Pallet N. La transplantation rénale améliore le cours des porphyries aiguës intermittentes. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.032] [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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Chabannes M, Rabant M, Karras A, Dahan K, Caillard S, Crepin T, Ducloux D, Fremeaux Bacchi V, Chauvet S. Caractérisation clinique et immunologique des formes mixtes associant glomérulonéphrite à C3 et SHU atypique : résultats d’une étude rétrospective multicentrique. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.151] [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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8
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Benotmane I, Perrin P, Gautier-Vargas G, Bassand X, Bedo D, Baldacini C, Sagnard M, Moulin B, Fafi-Kremer S, Caillard S. Prédiction de la sévérité de la COVID-19 par les biomarqueurs du syndrome de relargage cytokinique au sein d’une population de transplantés rénaux. Nephrol Ther 2020. [PMCID: PMC7494287 DOI: 10.1016/j.nephro.2020.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Les données concernant la coronavirus disease-2019 (COVID-19) dans la population de transplantés rénaux (TR) sont peu nombreuses. Alors que les marqueurs de l’inflammation, d’atteinte myocardique et de coagulopathie sont associés à la gravité et à la mortalité au sein de la population immunocompétente infectée par le severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), aucune étude n’a évalué ces marqueurs chez des TR atteints de la COVID-19. Description Dans cette étude de cohorte portant sur 50 patients TR atteints de la COVID-19, nous avons déterminé les facteurs de risque cliniques et biologiques liés à la gravité et la mortalité de la maladie. Méthodes Selon la sévérité de l’atteinte clinique, la cohorte a été divisée en 3 groupes : – patients avec une atteinte peu sévère ayant bénéficié d’une prise en charge ambulatoire (n = 9) ; – patients hospitalisés avec une atteinte modérée (n = 21) ; – des patients hospitalisés avec une atteinte sévère (n = 20). Résultats La fièvre, les signes respiratoires et digestifs étaient les trois signes les plus fréquents. Le taux de mortalité à 30 jours des patients hospitalisés était de 19,5 %. L’âge supérieur à 60 ans (85 % vs 43 %, p = 0,01), l’obésité (70 % vs 33,3, p = 0,02) et la dyspnée (100 % vs 42,9 %, p < 0,0001) étaient plus fréquents dans le groupe présentant une atteinte sévère. L’élévation des marqueurs de l’inflammation (CRP > 100 mg/L et Interleukin-6 > 65 ng/L), suivis par une élévation de la troponine I hypersensible (> 30 ng/L) et des D-dimères (> 960 ng/mL), était fortement associée à la sévérité et la mortalité de la COVID-19 (Fig. 1). Conclusion Le pronostic de la COVID-19 au sein de la population des TR est lié aux marqueurs du syndrome de relargage cytokinique. Un monitorage de ces marqueurs permettrait de cibler la population à risque de complication et d’améliorer leur prise en charge en utilisant des traitements ciblés.
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Barba T, Maarek A, Bachy E, Genestier L, Gaulard P, Morelon E, Dubois V, Salles G, Caillard S, Thaunat O. Caractéristiques des lymphomes à cellules T/NK après transplantation rénale : une étude rétrospective multicentrique nationale française. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.061] [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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10
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Perrin P, Olagne J, Borni C, Kribs M, Moulin B, Caillard S. Hyperoxalurie primitive compliquée d’oxalose et d’hypercalcémie : mise en évidence d’une réaction granulomateuse exceptionnelle. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.035] [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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Solis M, Velay A, Gantner P, Bausson J, Filipputtu A, Freitag R, Moulin B, Caillard S, Fafi-Kremer S. Torquetenovirus viremia for early prediction of graft rejection after kidney transplantation. J Infect 2019; 79:56-60. [PMID: 31100359 DOI: 10.1016/j.jinf.2019.05.010] [Citation(s) in RCA: 34] [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: 06/09/2018] [Revised: 01/02/2019] [Accepted: 05/10/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES New biomarkers reflecting the degree of immunosuppression in transplant recipients are needed to provide an optimal personalized balance between rejection and infection risks. METHODS For this purpose, we investigated TTV viremia dynamics in 66 kidney transplant recipients followed up for two years after transplantation, in relation to BK virus infection and graft rejection. RESULTS After transplantation, TTV viremia rose by ≥2 log10 copies/mL from baseline to month 3, then declined by ≥1 log10 copies/mL thereafter. Higher TTV viremia was associated with recipients of a deceased donor, a lower count of CD8+ T cells and a higher BKV viremia. Importantly, TTV loads were significantly lower in KTR who would later display graft rejection; indeed, patients with TTV viremia lower than 3.4 log10 copies/mL at transplantation or lower than 4.2 log10 copies/mL at month 1 had a higher risk of developing graft rejection in the two following years (hazard ratio (HR) at D0 = 7.30, p = 0.0007 and HR at M1 = 6.16, p = 0.001). CONCLUSIONS TTV viremia measurement at early times post transplantation predicts graft rejection and would represent a useful tool to improve kidney transplant monitoring.
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Affiliation(s)
- M Solis
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France; INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - A Velay
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France; INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - P Gantner
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France; INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - J Bausson
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France
| | - A Filipputtu
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France
| | - R Freitag
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France
| | - B Moulin
- INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France; Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S Caillard
- INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France; Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S Fafi-Kremer
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France; INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
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Pijnenburg L, Caillard S, Boivin G, Rizzo S, Javier RM. Type 1 primary hyperoxaluria: A case report and focus on bone impairment of systemic oxalosis. Morphologie 2017; 102:48-53. [PMID: 29102553 DOI: 10.1016/j.morpho.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/15/2022]
Abstract
Primary hyperoxaluria is a rare genetic disorder characterized by oxalate overproduction, leading to kidney failure due to nephrocalcinosis, and is eventually responsible for systemic oxalosis. Bone impairment, secondary to oxalate deposits, is one of the many complications that may occur. Skeletal involvement can be difficult to diagnose because of lack of clinical symptoms and therefore needs to be confirmed by invasive testing, such as transiliac bone biopsy. If confirmed, bone oxalosis is the proof of disease severity and that combined liver-kidney transplantation should be performed.
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Affiliation(s)
- L Pijnenburg
- Department of rheumatology, Strasbourg university hospital, 1, avenue Molière, 67200 Strasbourg, France.
| | - S Caillard
- Department of nephrology, transplantation unit, Strasbourg university hospital, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France
| | - G Boivin
- Inserm, UMR 1033, Lyon Est university, 11, rue Guillaume-Pradadin, 69008 Lyon, France
| | - S Rizzo
- Inserm, UMR 1033, Lyon Est university, 11, rue Guillaume-Pradadin, 69008 Lyon, France
| | - R M Javier
- Department of rheumatology, Strasbourg university hospital, 1, avenue Molière, 67200 Strasbourg, France.
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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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Collange O, Jazaerli L, Lejay A, Biermann C, Caillard S, Moulin B, Chakfe N, Severac F, Schaeffer M, Mertes PM, Steib A. Intraoperative Pleth Variability Index Is Linked to Delayed Graft Function After Kidney Transplantation. Transplant Proc 2017; 48:2615-2621. [PMID: 27788791 DOI: 10.1016/j.transproceed.2016.06.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Delayed graft function (DGF) is an early postoperative complication of kidney transplantation (KT) predisposing to acute rejection and lower graft survival. Intraoperative arterial hypotension and hypovolemia are associated with DGF. Central venous pressure (CVP) is used to estimate volemia but its reliability has been criticized. Pleth variability index (PVI) is a hemodynamic parameter predicting fluid responsiveness. The aim of this study was to examine the relationship between intraoperative PVI and CVP values and the occurrence of DGF. METHODS This was a prospective, noninterventional, observational, single-center study. All consecutive patients with KT from deceased donors were included. Recipients received standard, CVP, and PVI monitoring. Intraoperative hemodynamic parameters were recorded from recipients at 5 time points during KT. RESULTS Forty patients were enrolled. There was a poor correlation between PVI and CVP values (r2 = 0.003; P = .44). Immediate graft function and DGF patients had similar hemodynamic values during KT, with the exception of PVI values, which were significantly higher in the DGF group. In particular, a PVI >9% before unclamping of the renal artery was the only predictive parameter of DGF in our multivariate analysis (P = .02). CONCLUSIONS This study suggests that PVI values >9% during KT are associated with the occurrence of DGF.
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Affiliation(s)
- O Collange
- Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
| | - L Jazaerli
- Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - A Lejay
- Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Service de Chirurgie Vasculaire et de Transplantation Rénale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - C Biermann
- Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S Caillard
- Service de Néphrologie-Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - B Moulin
- Service de Néphrologie-Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - N Chakfe
- Service de Chirurgie Vasculaire et de Transplantation Rénale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - F Severac
- Département de Santé Publique, Secteur Méthodologie et Biostatistique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - M Schaeffer
- Département de Santé Publique, Secteur Méthodologie et Biostatistique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - P-M Mertes
- Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - A Steib
- Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
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Kleinmann J, Tubach F, Le Guern V, Mathian A, Richez C, Saadoun D, Sacré K, Sellam J, Seror R, Amoura Z, Andres E, Audia S, Bader-Meunier B, Blaison G, Bonnotte B, Cacoub P, Caillard S, Chiche L, Chosidow O, Costedoat-Chalumeau N, Daien C, Daugas E, Derdèche N, Doria A, Fain O, Fakhouri F, Farge D, Gabay C, Guillo S, Hachulla E, Hajjaj-Hassouni N, Hamidou M, Houssiau F, Jourde-Chiche N, Kone-Paut I, Ladjouz-Rezig A, Lambotte O, Lipsker D, Mariette X, Martin Silva N, Martin T, Maurier F, Meckenstock R, Mekinian A, Meyer O, Mohamed S, Morel J, Moulin B, Mulleman D, Papo T, Poindron V, Puéchal X, Punzi L, Quartier P, Sailler L, Smail A, Soubrier M, Sparsa A, Tazi Mezalek Z, Zakraoui L, Zuily S, Sibilia J, Gottenberg J. Recommandations francophones, internationales et multidisciplinaires d’experts pour l’utilisation de biomédicaments dans le lupus érythémateux systémique : le groupe de travail du CRI-IMIDIATE. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Solis M, Velay A, Porcher R, Domingo-Calap P, Soulier E, Joly M, Meddeb M, Kack-Kack W, Moulin B, Bahram S, Stoll-Keller F, Barth H, Caillard S, Fafi-Kremer S. Anti-BK virus neutralizing antibody titers before transplantation predict BK virus replication in kidney transplant recipients after transplantation. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.012] [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: 10/21/2022]
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Brunet J, Lemoine JP, Pesson B, Valot S, Sautour M, Dalle F, Muller C, Borni-Duval C, Caillard S, Moulin B, Pfaff AW, Razakandrainibe R, Abou-Bacar A, Favennec L, Candolfi E. Ruling out nosocomial transmission of Cryptosporidium in a renal transplantation unit: case report. BMC Infect Dis 2016; 16:363. [PMID: 27484187 PMCID: PMC4969980 DOI: 10.1186/s12879-016-1661-5] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 06/08/2016] [Indexed: 01/10/2023] Open
Abstract
Background Cryptosporidium spp. is a ubiquitous parasite affecting humans as well as domestic and wild vertebrates, causing diarrhea in both immunocompetent and immunocompromised hosts worldwide. Its transmission occurs primarily by the fecal-oral route. In humans, C. parvum and C. hominis are the most prevalent species, whereas immunocompetent and immunocompromised individuals can also be infected by other zoonotic species. Renal transplant patients are prone to develop cryptosporidiosis, which can induce severe and life-threatening diarrhea. Case presentation We report here a series of nearly concomitant cases of acute symptomatic cryptosporidiosis in three renal transplant patients attending the Strasbourg University Hospital Nephrology Unit. The clinical presentation was persistent diarrhea and acute renal failure. The diagnosis was confirmed by microscopic stool examination using a modified Ziehl-Neelsen staining method and species identification by molecular tools. All patients were treated with nitazoxanide and recovered from diarrhea after 14 days of therapy. Conclusion Genotypic species identification was not consistent with an epidemic context, thus underlining the need for genotyping to monitor at risk patients.
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Affiliation(s)
- J Brunet
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France. .,Institut de Parasitologie et Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, 3 rue Koeberlé, F-67000, Strasbourg, France.
| | - J P Lemoine
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - B Pesson
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - S Valot
- Laboratoire de Parasitologie et de Mycologie, Plateau Technique de Biologie du CHU Dijon, 2 rue Angélique Ducoudray, BP 37013, F-21070, Dijon cedex, France
| | - M Sautour
- Laboratoire de Parasitologie et de Mycologie, Plateau Technique de Biologie du CHU Dijon, 2 rue Angélique Ducoudray, BP 37013, F-21070, Dijon cedex, France.,UMR 1347, Université de Bourgogne, 17 rue de Sully, F-21000, Dijon, France
| | - F Dalle
- Laboratoire de Parasitologie et de Mycologie, Plateau Technique de Biologie du CHU Dijon, 2 rue Angélique Ducoudray, BP 37013, F-21070, Dijon cedex, France.,UMR 1347, Université de Bourgogne, 17 rue de Sully, F-21000, Dijon, France
| | - C Muller
- Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - C Borni-Duval
- Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - S Caillard
- Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - B Moulin
- Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - A W Pfaff
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.,Institut de Parasitologie et Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, 3 rue Koeberlé, F-67000, Strasbourg, France
| | - R Razakandrainibe
- Laboratoire de Parasitologie-Mycologie, EA 3800, Centre Hospitalier Universitaire, Université de Rouen, 1, rue de Germont, F-76031, Rouen, France
| | - A Abou-Bacar
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - L Favennec
- Laboratoire de Parasitologie-Mycologie, EA 3800, Centre Hospitalier Universitaire, Université de Rouen, 1, rue de Germont, F-76031, Rouen, France
| | - E Candolfi
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.,Institut de Parasitologie et Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, 3 rue Koeberlé, F-67000, Strasbourg, 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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San-Juan R, Comoli P, Caillard S, Moulin B, Hirsch HH, Meylan P. Epstein-Barr virus-related post-transplant lymphoproliferative disorder in solid organ transplant recipients. Clin Microbiol Infect 2015; 20 Suppl 7:109-18. [PMID: 24475976 DOI: 10.1111/1469-0691.12534] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epstein-Barr virus (EBV) contributes to the pathogenesis of post-transplant lymphoproliferative disease (PTLD) in more than 70% of cases. EBV DNAemia surveillance has been reported to assist in the prevention and treatment of PTLD in hematopoietic stem-cell transplantation (HSCT) recipients. Derived from experience in HSCT and taking into account that PCR-based EBV monitoring techniques are currently available in most solid organ transplant (SOT) centres, there is a great interest in EBV surveillance and prevention of PTLD in SOT recipients. In the present document we have tried to address from a practical perspective different important topics regarding the prevention and management of EBV-related PTLD in SOT. To this end, available information on SOT was analysed and combined with potentially useful data from HSCT and expert observations. The document is therefore structured according to different specific questions, each of them culminating in a consensus opinion of the panel of European experts, grading the answers according to internationally recognized levels of evidence. The addressed issues were grouped under the following topics. (i) Timing and epidemiological data of PTLD. Prophylaxis guided by clinical risk factors of early and late PTLD in SOT. (ii) Relationship of EBV DNAemia load monitoring and the development of PTLD in solid organ transplant recipients. (iii) Monitoring of EBV DNAemia after SOT. Which population should be monitored? What is the optimal timing of the monitoring? (iv) Management of SOT recipients with persistent and/or increasing EBV DNAemia.
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Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
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Solis M, Meddeb M, Sueur C, Domingo-Calap P, Soulier E, Chabaud A, Perrin P, Moulin B, Bahram S, Caillard S, Stoll-Keller F, Fafi-Kremer S. Interlaboratory comparison of BK virus DNA load assays. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.07.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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San-Juan R, Manuel O, Hirsch HH, Fernández-Ruiz M, López-Medrano F, Comoli P, Caillard S, Grossi P, Aguado JM. Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey. Clin Microbiol Infect 2015; 21:604.e1-9. [PMID: 25686696 DOI: 10.1016/j.cmi.2015.02.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 10/19/2014] [Revised: 12/18/2014] [Accepted: 02/01/2015] [Indexed: 11/25/2022]
Abstract
There is limited clinical evidence on the utility of the monitoring of Epstein-Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients.
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Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
| | - O Manuel
- Transplantation Centre and Service of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland
| | - H H Hirsch
- Transplantation & Clinical Virology, Department Biomedicine, Infectious Diseases & Hospital Epidemiology, University of Basel, Basel, Switzerland
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - P Comoli
- Pediatric Haematology-Oncology and Research Laboratories Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Caillard
- Nephrology and Transplantation Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - P Grossi
- National Centre for Transplantation, Infectious and Tropical Diseases Department, University of Insubria, Varese, Italy
| | - J M Aguado
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
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Muller C, Caillard S, Olagne J, Perrin P, Braun Parvez L, Heibel F, Morel O, Moulin B. Réponse inadaptée au clopidogrel chez le patient transplanté rénal. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nussbaumer T, Olagne J, Marcellin L, Dimitrov Y, Imhoff O, Klein A, Bazin D, Muller C, Caillard S, Moulin B. Cohorte rétrospective multicentrique de glomérulonéphrites membrano-prolifératives et glomérulonéphrites à dépôts de C3 : intérêt de la relecture anatomopathologique dans le contexte de la nouvelle classification. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Perrin P, Kiener C, Caillard S, Javier R, Braun L, Gautier-Vargas G, Heibel F, Olagne J, Muller C, Moulin B. Impact de l’évolution de la prise en charge des troubles minéraux et osseux la première année de transplantation rénale. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.366] [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: 10/24/2022]
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Le Meur Y, Büchler M, Mousson C, Albano L, Merville P, Caillard S, Etienne I, Hazzan M, Anglicheau D, Rerolle J, Heng A, Kamar N. Éude randomisée multicentrique de l’utilisation de l’évérolimus dans la transplantation rénale de type « ld for old » (Everold). Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.362] [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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Van Londen M, Humalda JK, Aarts BM, Sanders JS, Bakker SJL, Navis GJ, De Borst MH, Pazik J, O Dak M, Lewandowski Z, Podgorska M, Sadowska A, Sitarek E, Malejczyk J, Durlik M, Drechsler C, Philstrom H, Meinitzer A, Pilz S, Tomaschitz A, Abedini S, Fellstrom B, Jardine A, Wanner C, Maerz W, Holdaas H, Halleck F, Staeck O, Neumayer HH, Budde K, Khadzhynov D, Rostaing L, Allal A, Congy N, Aarninck A, Del Bello A, Maggioni S, Debiols B, Sallusto F, Kamar N, Stolyarevich E, Artyukhina L, Kim I, Tomilina N, Zaidenov V, Kurenkova L, Keyzer CA, De Borst MH, Van Den Berg E, Jahnen-Dechent W, Navis G, Bakker SJL, Van Goor H, Pasch A, Aulagnon F, Avettand-Fenoel V, Scemla A, Lanternier F, Lortholary O, Anglicheau D, Legendre C, Zuber J, Furic-Cunko V, Basic-Jukic N, Coric M, Kastelan Z, Hudolin T, Kes P, Mikolasevic I, Racki S, Lukenda V, Orlic L, Dobrowolski LC, Verberne HJ, Ten Berge IJM, Bemelman FJ, Krediet CTP, Ferreira AC, Silva C, Remedio F, Pena A, Nolasco F, Heldal K, Lonning K, Leivestad T, Reisaeter AV, Hartmann A, Foss AE, Midtvedt K, Vlachopanos G, Kassimatis T, Zerva A, Kokkona A, Stavroulaki E, Agrafiotis A, Sanchez Sobrino B, Lafuente Covarrubias O, Karsten Alvarez S, Zalamea Jarrin F, Rubio Gonzalez E, Huerta Arroyo A, Portoles Perez J, Basic-Jukic N, Kes P, Baek CH, Kim M, Kim JS, Yang WS, Han DJ, Park SK, Zulkarnaev A, Vatazin A, Cabiddu G, Maxia S, Castellino S, Loi V, Guzzo G, Piccoli GB, Pani A, Bucsa C, Tacu D, Harza M, Sinescu I, Mircescu G, Stefan G, Alfieri CM, Laura F, Danilovic B, Cresseri D, Meneghini M, Riccardo F, Regalia A, Messa P, Panuccio V, Tripepi R, Parlongo G, Quattrone S, Leonardis D, Tripepi G, Zoccali C, Mallamaci F, Amer H, Geerdes PA, Fettes TT, Prieto M, Walker RC, Edwards BS, Cosio FG, Khrabrova M, Nabokov A, Groene HJ, Weithofer P, Kliem V, Smirnov A, Dobronravov V, Sezer S, Gurlek Demirci B, Tutal E, Guliyev O, Say N CB, Ozdemir Acar FN, Haberal M, Albugami MM, Hussein M, Alsaeed S, Almubarak A, Bel'eed-Akkari K, Go biewska JE, Tarasewicz A, D bska- lizie A, Rutkowski B, Albugami MM, Hussein M, Almubarak A, Alsaeed S, Bel'eed-Akkari K, Ailioaie O, Arzouk N, Tourret J, Mercadal L, Szumilak D, Ourahma S, Parra J, Billault C, Barrou B, Alfieri CM, Floreani R, Ulivieri FM, Meneghini M, Regalia A, Zanoni F, Croci D, Rastaldi MP, Messa PG, Keyzer CA, Riphagen IJ, Joosten MM, Navis G, Muller Kobold AC, Kema IP, Bakker SJL, De Borst MH, Santos Lascasas J, Malheiro J, Fonseca I, Martins L, Almeida M, Pedroso S, Dias L, Henriques A, Cabrita A, Vincenti F, Weir M, Von Visger J, Kopyt N, Mannon R, Deng H, Yue S, Wolf M, Halleck F, Khadzhynov, D, Schmidt D, Petereit F, Slowinski T, Neumayer HH, Budde K, Staeck O, Hernandez Vargas H, Artamendi Larranaga M, Gil Catalinas F, Ramalle Gomara E, Bello Ovalle A, Pimentel Guzman G, Coloma Lopez A, Dall Anesse C, Gil Paraiso A, Beired Val I, Sierra Carpio M, Huarte Loza E, Slubowska K, Szmidt J, Chmura A, Durlik M, Staeck O, Khadzhynov D, Schmidt D, Niemann M, Petereit F, Lachmann N, Neumayer HH, Budde K, Halleck F, Alotaibi T, Nampoory N, Gheith O, Halim M, Aboatteya H, Mansour H, Abdulkawey H, Said T, Nair P, WazNa-Jab O Ska E, Durlik M, Elias M, Caillard S, Morelon E, Rivalan J, Moal V, Frimat L, Mourad G, Rerolle JP, Legendre C, Mousson C, Delahousse M, Pouteil-Noble C, Dantal J, Cassuto E, Subra JF, Lang P, Thervet E, Roosweil D, Molnar MZ, Fornadi K, Ronai KZ, Novak M, Mucsi I, Scale TM, Robertson S, Kumwenda M, Jibani M, Griffin S, Williams AJ, Mikhail A, Jeong JC, Koo TY, Jeon HJ, Han M, Oh KH, Ahn C, Yang J, Bancu I, Canas L, Juega J, Malumbres S, Guermah I, Bonet J, Lauzurica R, Basso E, Messina M, Daidola G, Mella A, Lavacca A, Manzione AM, Rossetti M, Ranghino A, Ariaudo C, Segoloni GP, Biancone L, Whang E, Son SH, Kwon H, Kong JJ, Choi WY, Yoon CS, Ferreira AC, Silva C, Aires I, Ferreira A, Remedio F, Nolasco F, Ratkovic M, Basic Jukic N, Gledovic B, Radunovic D, Prelevic V, Stefan G, Garneata L, Bucsa C, Harza M, Sinescu I, Mircescu G, Tacu D, Aniort J, Kaysi S, Mulliez A, Heng AE, Su owicz J, Wojas-Pelc A, Ignacak E, Janda K, Krzanowski M, Miarka P, Su owicz W, Filipov JJ, Zlatkov BK, Dimitrov EP, Svinarov DA, Champion L, Renoux C, Randoux C, Du Halgouet C, Azeroual L, Glotz D, Vrtovsnik F, Daugas E, Musetti C, Battista M, Cena T, Izzo C, Airoldi A, Magnani C, Stratta P, Fiskvik I, Holte H, Bentdal O, Holdaas H, Erkmen Uyar M, Sezer S, Bal Z, Guliyev O, Colak T, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Kara E, Ahbap E, Basturk T, Koc Y, Sakaci T, Sahutoglu T, Akgol C, Sevinc M, Unsal A, Seyahi N, Abdultawab K, Alotaibi T, Gheith O, Mansour H, Halim M, Nair P, Said T, Balaha M, Elsayed A, Awadeen W, Nampoory N, Hwang JC, Jiang MY, Lu YH, Weng SF, Madziarska K, Zmonarski SC, Augustyniak-Bartosik H, Magott-Procelewska M, Krajewska M, Mazanowska O, Banasik M, Penar J, Weyde W, Boraty Ska M, Klinger M, Swarnalatha G, Narendranath L, Shanta Rao G, Sawhney A, Subrahmanyam L, Kumar S, Jeon H, Hakim A, Patel U, Shrivastava S, Banerjee D, Kimura T, Yagisawa T, Nanmoku K, Kurosawa A, Sakuma Y, Miki A, Nukui A, Lee CH, Oh IH, Park JS, Watarai Y, Narumi S, Goto N, Hiramitsu T, Tsujita M, Yamamoto T, Kobayashi T, Muniz Pacios L, Molina M, Cabrera J, Gonzalez E, Garcia Santiago A, Aunon P, Santana S, Polanco N, Gutierrez E, Jimenez C, Andres A, Mohammed M, Hammam M, Housawi A, Goldsmith DJ, Cronin A, Frame S, Smalcelj R, Canoz MB, Yavuz DD, Altunoglu A, Yavuz R, Colak T, Haberal M, Tong A, Hanson CS, Chapman JR, Halleck F, Budde K, Papachristou C, Craig J, Zheng XY, Han S, Wang LM, Zhu YH, Zeng L, Zhou MS, Guliyev O, Erkmen Uyar M, Sezer S, Bal Z, Colak T, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Ranghino A, Diena D, De Rosa FG, Faletti R, Barbui AM, Guarnaccia C, Corcione S, Messina M, Ariaudo C, Segoloni GP, Biancone L, Patel R, Murray PD, Moiseev A, Kalachik A, Harden PN, Norby G, Mjoen G, Holdaas H, Gilboe IM, Shi Y, Luo L, Cai B, Wang T, Tao Y, Wang L, Erkmen Uyar M, Sezer S, Bal Z, Guliyev O, Tutal E, Gurlek Demirci B, Ozdemir Acar N, Haberal M, Di Vico MC, Messina M, Mezza E, Giraudi R, Nappo A, Boaglio E, Ranghino A, Fop F, Segoloni GP, Biancone L, Carta P, Dattolo E, Buti E, Zanazzi M, Villari D, Di Maria L, Santoro G, Li Marzi V, Minetti EE, Nicita G, Carta P, Zanazzi M, Buti E, Antognoli G, Dervishi E, Vignali L, Caroti L, Di Maria L, Minetti EE, Dorje C, Kovacevic G, Hammarstrom C, Strom EH, Holdaas H, Midtvedt K, Reisaeter AV, Alfieri CM, Floreani R, Meneghini M, Regalia A, Zanoni F, Vettoretti S, Croci MD, Rastaldi MP, Messa P, Heldal K, Lonning K, Reisaeter AV, Bernklev T, Midtvedt K, Strakosha A, Pasko N, Nasto F, Cadri V, Dedei A, Thereska N. TRANSPLANTATION CLINICAL 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Perrin P, Caillard S, Javier RM, Braun L, Heibel F, Borni-Duval C, Muller C, Olagne J, Moulin B. Persistent hyperparathyroidism is a major risk factor for fractures in the five years after kidney transplantation. Am J Transplant 2013; 13:2653-63. [PMID: 24034142 DOI: 10.1111/ajt.12425] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 01/25/2023]
Abstract
The risk of fractures after kidney transplantation is high. Hyperparathyroidism frequently persists after successful kidney transplantation and contributes to bone loss, but its impact on fracture has not been demonstrated. This longitudinal study was designed to evaluate hyperparathyroidism and its associations with mineral disorders and fractures in the 5 posttransplant years. We retrospectively analyzed 143 consecutive patients who underwent kidney transplantation between August 2004 and April 2006. The biochemical parameters were determined at transplantation and at 3, 12 and 60 months posttransplantation, and fractures were recorded. The median intact parathyroid hormone (PTH) level was 334 ng/L (interquartile 151-642) at the time of transplantation and 123 ng/L (interquartile 75-224) at 3 months. Thirty fractures occurred in 22 patients. The receiver operating characteristic (ROC) curve analysis for PTH at 3 months (area under the ROC curve = 0.711, p = 0.002) showed that a good threshold for predicting fractures was 130 ng/L (sensitivity = 81%, specificity = 57%). In a multivariable analysis, independent risk factors for fracture were PTH >130 ng/L at 3 months (adjusted hazard ratio [AHR] = 7.5, 95% CI 2.18-25.50), and pretransplant osteopenia (AHR = 2.7, 95% CI 1.07-7.26). In summary, this study demonstrates for the first time that persistent hyperparathyroidism is an independent risk factor for fractures after kidney transplantation.
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Affiliation(s)
- P Perrin
- Nephrology-Transplantation Department, University Hospital, Strasbourg, France
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Gautier-Vargas G, Caillard S, Parissiadis A, Olagne J, Muller C, Perrin P, Braun L, Heibel F, Hanau D, Moulin B. Caractéristiques des anticorps anti-HLA fixant le C1q et conséquences sur le greffon rénal. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.150] [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: 11/30/2022]
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Caillard S, Lamy FX, Quelen C, Dantal J, Lebranchu Y, Lang P, Velten M, Moulin B. Epidemiology of posttransplant lymphoproliferative disorders in adult kidney and kidney pancreas recipients: report of the French registry and analysis of subgroups of lymphomas. Am J Transplant 2012; 12:682-93. [PMID: 22226336 DOI: 10.1111/j.1600-6143.2011.03896.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [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
A registry of posttransplant lymphoproliferative disorders (PTLD) was set up for the entire population of adult kidney transplant recipients in France. Cases of PTLD were prospectively enrolled between January 1, 1998, and December 31, 2007. Ten-year cumulative incidence was analyzed in patients transplanted after January 1, 1989. PTLD risk factors were analyzed in patients transplanted after January 1, 1998 by Cox analysis. Cumulative incidence was 1% after 5 years, 2.1% after 10 years. Multivariate analysis showed that PTLD was significantly associated with: older age of the recipient 47-60 years and >60 years (vs. 33-46 years, adjusted hazard ratio (AHR) = 1.87, CI = 1.22-2.86 and AHR = 2.80, CI = 1.73-4.55, respectively, p < 0.0001), simultaneous kidney-pancreas transplantation (AHR = 2.52, CI = 1.27-5.01 p = 0.008), year of transplant 1998-1999 and 2000-2001 (vs. 2006-2007, AHR = 3.36, CI = 1.64-6.87 and AHR = 3.08, CI = 1.55-6.15, respectively, p = 0.003), EBV mismatch (HR = 5.31, CI = 3.36-8.39, p < 0.001), 5 or 6 HLA mismatches (vs. 0-4, AHR = 1.54, CI = 1.12-2.12, p = 0.008), and induction therapy (AHR = 1.42, CI = 1-2.02, p = 0.05). Analyses of subgroups of PTLD provided new information about PTLD risk factors for early, late, EBV positive and negative, polymorphic, monomorphic, graft and cerebral lymphomas. This nationwide study highlights the increased risk of PTLD as long as 10 years after transplantation and the role of cofactors in modifying PTLD risk, particularly in specific PTLD subgroups.
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Affiliation(s)
- S Caillard
- Department of Nephrology Transplantation, Strasbourg Universitary Hospital, Strasbourg, France
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Schaefer E, Zaloszyc A, Lauer J, Durand M, Stutzmann F, Perdomo-Trujillo Y, Redin C, Bennouna Greene V, Toutain A, Perrin L, Gérard M, Caillard S, Bei X, Lewis RA, Christmann D, Letsch J, Kribs M, Mutter C, Muller J, Stoetzel C, Fischbach M, Marion V, Katsanis N, Dollfus H. Mutations in SDCCAG8/NPHP10 Cause Bardet-Biedl Syndrome and Are Associated with Penetrant Renal Disease and Absent Polydactyly. Mol Syndromol 2011; 1:273-281. [PMID: 22190896 DOI: 10.1159/000331268] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2011] [Indexed: 11/19/2022] Open
Abstract
The ciliopathies are an expanding group of disorders caused by mutations in genes implicated in the biogenesis and function of primary cilia. Bardet-Biedl syndrome (BBS) is a model ciliopathy characterized by progressive retinal degeneration, obesity, polydactyly, cognitive impairment, kidney anomalies and hypogonadism. Mutations in SDCCAG8(NPHP10) were described recently in patients with nephronophthisis and retinal degeneration (Senior-Loken syndrome; SLS). Given the phenotypic and genetic overlap between known ciliopathy genes, we hypothesized that mutations in SDCCAG8 might also contribute alleles to more severe, multisystemic ciliopathies. We performed genetic and phenotypic analyses of 2 independent BBS cohorts. Subsequent to mutation screening, we made a detailed phenotypic analysis of 5 families mutated for SDCCAG8 (3 homozygous and 2 compound heterozygous mutations) and conducted statistical analyses across both cohorts to examine possible phenotype-genotype correlations with mutations at this locus. All patients with mutations in SDCCAG8 fulfilled the diagnostic criteria for BBS (retinal degeneration, obesity, cognitive defects, renal failure, hypogonadism). Interestingly, none of the patients with primary SDCCAG8 mutations had polydactyly, a frequent but not obligatory BBS feature. In contrast, the same patients displayed early-onset renal failure, obesity, as well as recurrent pulmonary and ENT infections. Comparison of the phenotypes of these families with our entire BBS cohort indicated that renal impairment and absent polydactyly correlated significantly with causal SDCCAG8 mutations. Thus, SDCCAG8 mutations are sufficient to cause BBS in 1-2% of our combined cohorts, and define this gene as the sixteenth BBS locus (BBS16). The absence of polydactyly and the concomitant, apparently fully penetrant association with early kidney failure represents the first significant genotype-phenotype correlation in BBS that potentially represents an indicator for phenotype-driven priority screening and informs specific patient management.
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Affiliation(s)
- E Schaefer
- Laboratoire de Génétique Médicale EA 3949, Equipe Avenir-Inserm, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg
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Muller C, Caillard S, Hannedouche T, Gachet C, Moulin B, Morel O. Altération majeure de la réponse au clopidogrel chez le patient insuffisant rénal dialysé. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.414] [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: 11/30/2022]
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Borni Duval C, Caillard S, Perrin P, Olagne J, Braun L, Heibel F, Moulin B. Facteurs de risque d’infection à BK virus à l’ère du suivi thérapeutique pharmacologique. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.294] [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: 10/17/2022]
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Caillard S, Lamy F, Quelen C, Moulin B. Épidémiologie des lymphoproliférations survenant après transplantation rénale : incidence, facteurs de risque et analyse de sous-groupes homogènes de lymphomes à partir de Registre français des lymphomes. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.068] [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: 11/28/2022]
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Olagne J, Caillard S, Gaub MP, Chenard MP, Moulin B. Post-transplant lymphoproliferative disorders: determination of donor/recipient origin in a large cohort of kidney recipients. Am J Transplant 2011; 11:1260-9. [PMID: 21564528 DOI: 10.1111/j.1600-6143.2011.03544.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [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
Although in previous studies most post-transplant lymphoproliferative disorders (PTLD) were reported to derive from recipient cells, some cases derived from donor lymphocytes have been reported. To provide a better description of the features and outcome of PTLD according to the origin of the lymphoma, we performed histologic and molecular studies of PTLD in kidney recipients. Forty-three specimens were analyzed by histochemistry, fluorescent hybridization of the Y chromosome and analysis of multiple short tandem repeat microsatellite loci. Sixteen tumors were shown to be of donor origin and 27 of recipient origin. Time to PTLD was shorter in donor-derived PTLDs (20 ± 27 vs. 69 ± 67 months, p = 0.013). Ten-year patient survival was similar among patients with recipient- and donor-derived PTLD, but when PTLD-related mortality was analyzed, there was a trend to better survival in patients with donor lymphomas. Among the 21 PTLDs localized in the allograft, 14 lymphomas were of donor origin and seven of recipient origin. No difference was found between the two groups. Our analysis of the origin of PTLDs in the largest cohort studied to date with a description of the clinical and histological characteristics of donor and recipient PTLDs should lead to a better understanding of lymphomagenesis.
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Affiliation(s)
- J Olagne
- Department of Nephrology Transplantation, Strasbourg University Hospital, France Service of Molecular Biochemistry, Strasbourg University Hospital, France
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Braun-Parvez L, Charlin E, Caillard S, Ducloux D, Wolf P, Rolle F, Golfier F, Flicoteaux H, Bergerat JP, Moulin B. Gestational choriocarcinoma transmission following multiorgan donation. Am J Transplant 2010; 10:2541-6. [PMID: 20977645 DOI: 10.1111/j.1600-6143.2010.03275.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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
An accidental transmission of placental choriocarcinoma (CC) from a multiorgan donor to four recipients is reported. The donor was a 26-year-old pregnant woman, died from a cerebral hemorrhage. Histological examination demonstrated the presence of a placental CC. Diagnosis of CC transmission was established on the basis of an increase of human chorionic gonadotrophin hormone (hCG) level. The recipient of combined pancreas-kidney is still in complete remission 2 years after the beginning of chemotherapy without removal of the grafted organs which show optimal function. The recipient of a single kidney was rapidly transplantectomized and treated with actinomycin. At 2 years, she remains in remission. Liver recipient showed intestinal metastasis and died from digestive hemorrhage after an initial response to chemotherapy. Heart recipient had an initial remission under EMA-CO, but at the last report, he showed diffuse metastasis. Published reports on CC transmission are rare. The long-lasting remission of our pancreas-kidney recipient and her good outcome after 2 years make our observation original. Moreover, the high rate of transmission demonstrates the high malignant potential of CC in immunosuppressed patients. Chemotherapy combined or not with transplantectomy in case of nonvital organ, should be discussed.
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Affiliation(s)
- L Braun-Parvez
- Service de Néphrologie et Transplantation Rénale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Caillard S. [Benefits of proliferation signal inhibitors beyond immunosuppression. Vascular protection and experience in heart transplantation]. Nephrol Ther 2010; 5 Suppl 6:S379-84. [PMID: 20129449 DOI: 10.1016/s1769-7255(09)73429-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Proliferation Signal inhibitors (PSI), sirolimus and everolimus, possess immunosuppressive and antiproliferative properties that have a substantial impact in organ transplantation. Their antiproliferative and pro-apoptotic action on vascular smooth muscle cells and endothelial cells, with positive effects on vascular remodeling, intimal proliferation, and atheroma plaques, has been demonstrated in many experimental studies in cell culture and on animal vascular, cardiac, and renal models. In humans, the PSI show a major advantage in heart transplantation, since they contribute satisfactory immunosuppression while preventing coronary vasculopathy related to intimal proliferation of smooth muscle cells, a factor that limits the long-term success of the graft. Intravascular ultrasound explorations, which measure intima thickness, showed that PIS treatment can inhibit intracoronary intimal proliferation after heart transplantation and thus reduce the morbidity and mortality at the medium term in transplantation patients. In kidney transplantation, even though their impact is less clear for the moment because of the multifactorial aspect of chronic graft dysfunction, the PSI nevertheless contribute undeniable benefits in terms of improving renal function and reducing the histological lesions of chronic allograft nephropathy.
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Affiliation(s)
- S Caillard
- Service de Néphrologie Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, Strasbourg, France.
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Caillard S, Inhoff O, Moulin B. [Transplantation of patients with cardiovascular risk]. Nephrol Ther 2008; 4 Suppl 3:S218-22. [PMID: 19000891 DOI: 10.1016/s1769-7255(08)74239-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transplantation of patients with cardiovascular risk is becoming more frequent because of the recent changes in the characteristics of hemodialysis patients. Improvement in patient survival after transplantation has been reported in the whole cohort and is probably applicable to cardiovascular risk patients. Nevertheless, cardiovascular mortality is the leading cause of death after transplantation. Systematic screening of patients before transplantation and adapted treatment after transplantation are needed. After transplantation, immunosuppressive treatment should be tailored to the patient's profile and cardiovascular risk factors should be managed cautiously.
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Affiliation(s)
- S Caillard
- Service de Néphrologie-Transplantation, Hôpitaux Universitaires de Strasbourg, 1, place de l'Hôpital 67091 Strasbourg, France.
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Abstract
Glomerular filtration rate (GFR), which evaluates the evolution of the renal function, can be directly assessed by the measure of urinary or plasmatic clearance of a specific marker that ideally should be freely filtrated, without haemodynamic or toxic effects and easily dosed. Unfortunately, such a sensible marker of renal function variations does not yet exist. Particularly for GFRs in the range of 60ml/min estimation formulas generally over or under-estimate the true GFR, especially the Cockcroft formula that estimates creatinine clearance. Therefore, it is recommended to use validated markers for the measurement of the true GFR (inulin, iohexol, Cr EDTA...), in particular for the follow-up of cohorts and for studies using GFR as an outcome measure. For daily clinical practice, it is possible to use estimation formulas, preferably the 4-variables MDRD equation. However, to optimize the accuracy of GFR measures estimated from these formulas, it is first necessary to control the homogenous calibration of creatinine measurement devices.
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Affiliation(s)
- M Brucker
- Service de Néphrologie et Transplantation Rénale, Hôpital Civil, CHU de Strasbourg, BP 426, 67091 Strasbourg cedex, France
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Abou-Ayache R, Buchler M, Lepogamp P, Westeel PF, Le Meur Y, Etienne I, Lobbedez T, Toupance O, Caillard S, Goujon JM, Bergougnoux L, Touchard G. CMV infections after two doses of daclizumab versus thymoglobulin in renal transplant patients receiving mycophenolate mofetil, steroids and delayed cyclosporine A. Nephrol Dial Transplant 2008; 23:2024-32. [DOI: 10.1093/ndt/gfm873] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Imhoff O, Caillard S, Moulin B. « Le receveur limite » : existe-t-il encore des freins à l’inscription des patients sur liste d’attente de transplantation rénale ? Nephrol Ther 2007. [DOI: 10.1016/s1769-7255(07)78760-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Le Meur Y, Büchler M, Thierry A, Caillard S, Villemain F, Lavaud S, Etienne I, Westeel PF, Hurault de Ligny B, Rostaing L, Thervet E, Szelag JC, Rérolle JP, Rousseau A, Touchard G, Marquet P. Individualized mycophenolate mofetil dosing based on drug exposure significantly improves patient outcomes after renal transplantation. Am J Transplant 2007; 7:2496-503. [PMID: 17908276 DOI: 10.1111/j.1600-6143.2007.01983.x] [Citation(s) in RCA: 316] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Efficacy and safety of mycophenolate mofetil (MMF) may be optimized with individualized doses based on therapeutic monitoring of its active metabolite, mycophenolic acid (MPA). In this 12-month study, 137 renal allograft recipients from 11 French centers receiving basiliximab, cyclosporine A, MMF and corticosteroids were randomized to receive either concentration-controlled doses or fixed-dose MMF. A novel Bayesian estimator of MPA AUC based on three-point sampling was used to individualize doses on posttransplant days 7 and 14 and months 1, 3 and 6. The primary endpoint was treatment failure (death, graft loss, acute rejection and MMF discontinuation). Data from 65 patients/group were analyzed. At month 12, the concentration-controlled group had fewer treatment failures (p = 0.03) and acute rejection episodes (p = 0.01) with no differences in adverse event frequency. The MMF dose was higher in the concentration-controlled group at day 14 (p < 0.0001), month 1 (p < 0.0001) and month 3 (p < 0.01), as were median AUCs on day 14 (33.7 vs. 27.1 mg*h/L; p = 0.0001) and at month 1 (45.0 vs. 30.9 mg*h/L; p < 0.0001). Therapeutic MPA monitoring using a limited sampling strategy can reduce the risk of treatment failure and acute rejection in renal allograft recipients 12 months posttransplant with no increase in adverse events.
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Affiliation(s)
- Y Le Meur
- Department of Nephrology, University Hospital, Limoges, France.
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Büchler M, Caillard S, Barbier S, Thervet E, Toupance O, Mazouz H, Hurault de Ligny B, Le Meur Y, Thierry A, Villemain F, Heng AE, Moulin B, Morin MP, Noël C, Lebranchu Y. Sirolimus versus cyclosporine in kidney recipients receiving thymoglobulin, mycophenolate mofetil and a 6-month course of steroids. Am J Transplant 2007; 7:2522-31. [PMID: 17868057 DOI: 10.1111/j.1600-6143.2007.01976.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To evaluate the efficacy and tolerance of a calcineurin inhibitor (CNI)-free regimen, 145 renal recipients were prospectively randomized to receive either sirolimus (n = 71) or cyclosporine (CsA; n = 74). All patients received polyclonal antilymphocyte antibodies, mycophenolate mofetil (MMF) and steroids (6 months). The primary endpoint, estimated glomerular filtration rate (eGFR) was not significantly different at 12 months comparing sirolimus- and CsA-treated patients (60 +/- 27 vs. 57 +/- 21 mL/min). At 12 months, patient and graft survival, incidence of biopsy-proven rejection and rates of steroid withdrawal were not statistically different (97% vs. 97%; 90% vs. 93%; 14.3% vs. 8.6% and 82.8% vs. 84.1%, respectively). Delayed and slow graft function (SGF) was not significantly different (18.6% vs. 12.3% and 11.4% vs. 13.7%, respectively). In patients who remained on treatment according to protocol at 12 months, eGFR was significantly higher with sirolimus (69 +/- 19 vs. 60 +/- 14 mL/min, p = 0.01). Overall study drug discontinuation rates were 28.2% with sirolimus and 14.9% with CsA. Adverse events (wound complications, mouth ulcers, diarrhea, hypokalemia, bronchopneumonia) and proteinuria >0.5 g/24h (38.8% vs. 5.6%, p < 0.001) were significantly more frequent in sirolimus-treated patients. Cytomegalovirus (CMV) infections were significantly less frequent with sirolimus (6% vs. 23%, p < 0.01). A CNI-free regimen using sirolimus-MMF can achieve excellent renal function, but patients on sirolimus experienced a high rate of adverse events and study drug discontinuation.
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Affiliation(s)
- M Büchler
- Francois Rabelais University, Department of Nephrology and Clinical Immunology, Bretonneau Hospital, CHU Tours, France.
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Büchler M, Caillard S, Barbier S, Thervet E, Toupance O, Mazouz H, Hurault de Ligny B, Le Meur Y, Thierry A, Villemain F, Heng AE, Moulin B, Morin MP, Noël C, Lebranchu Y. Sirolimus versus cyclosporine in kidney recipients receiving thymoglobulin, mycophenolate mofetil and a 6-month course of steroids. Am J Transplant 2007. [PMID: 17868057 DOI: 10.1111/j.1600-6143.2700.01976.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
To evaluate the efficacy and tolerance of a calcineurin inhibitor (CNI)-free regimen, 145 renal recipients were prospectively randomized to receive either sirolimus (n = 71) or cyclosporine (CsA; n = 74). All patients received polyclonal antilymphocyte antibodies, mycophenolate mofetil (MMF) and steroids (6 months). The primary endpoint, estimated glomerular filtration rate (eGFR) was not significantly different at 12 months comparing sirolimus- and CsA-treated patients (60 +/- 27 vs. 57 +/- 21 mL/min). At 12 months, patient and graft survival, incidence of biopsy-proven rejection and rates of steroid withdrawal were not statistically different (97% vs. 97%; 90% vs. 93%; 14.3% vs. 8.6% and 82.8% vs. 84.1%, respectively). Delayed and slow graft function (SGF) was not significantly different (18.6% vs. 12.3% and 11.4% vs. 13.7%, respectively). In patients who remained on treatment according to protocol at 12 months, eGFR was significantly higher with sirolimus (69 +/- 19 vs. 60 +/- 14 mL/min, p = 0.01). Overall study drug discontinuation rates were 28.2% with sirolimus and 14.9% with CsA. Adverse events (wound complications, mouth ulcers, diarrhea, hypokalemia, bronchopneumonia) and proteinuria >0.5 g/24h (38.8% vs. 5.6%, p < 0.001) were significantly more frequent in sirolimus-treated patients. Cytomegalovirus (CMV) infections were significantly less frequent with sirolimus (6% vs. 23%, p < 0.01). A CNI-free regimen using sirolimus-MMF can achieve excellent renal function, but patients on sirolimus experienced a high rate of adverse events and study drug discontinuation.
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Affiliation(s)
- M Büchler
- Francois Rabelais University, Department of Nephrology and Clinical Immunology, Bretonneau Hospital, CHU Tours, France.
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Al Najjar A, Etienne I, Le Pogamp P, Bridoux F, Le Meur Y, Toupance O, Mousson C, Caillard S, Hurault de Ligny B, Marlière JF, Lebranchu Y. Long-term results of monoclonal anti-Il2-receptor antibody versus polyclonal antilymphocyte antibodies as induction therapy in renal transplantation. Transplant Proc 2006; 38:2298-9. [PMID: 16980070 DOI: 10.1016/j.transproceed.2006.06.133] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We compared the influence of induction therapy on 5-year patient and graft survival as well as on renal function in 100 kidney graft recipients at low immunological risk treated with antilymphocyte globulin (n = 50) versus anti-IL-2R monoclonal antibody (n = 50) in a prospective multicenter study. Long-term immunosuppressive treatment included cyclosporine, mycophenolate mofetil, and a short course of steroids in all patients. Five year graft (86% vs 86%) and patient (94% vs 94%) survivals were identical in both study arms. Moreover, neither serum creatinine or proteinuria were significantly different between the two groups. Our results showed that the choice of the induction therapy seemed to not have a major impact on long-term outcomes among renal recipients at low immunological risk.
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Affiliation(s)
- A Al Najjar
- Departments of Nephrology and Clinical Immunology, CHU Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37044 Tours cedex 9, France.
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Caillard S, Lelong C, Pessione F, Moulin B. Post-transplant lymphoproliferative disorders occurring after renal transplantation in adults: report of 230 cases from the French Registry. Am J Transplant 2006; 6:2735-42. [PMID: 17049061 DOI: 10.1111/j.1600-6143.2006.01540.x] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Post-transplant lymphoproliferative disorders (PTLD) are a rare but serious complication after organ transplantation. A French Registry of PTLD was set up in a nationwide population of kidney transplant recipients. We prospectively enrolled all adult kidney recipients developing PTLD between January 1, 1998, and December 31, 2003. We analyzed the incidence, risk and prognostic factors of PTLD by Kaplan-Meier and Cox analyses. Totally 230 cases of PTLD were referred to the French Registry. Cumulative incidence was 1.18% after 5 years. Older age (per year, AHR = 2.19, CI = 1.22-3.94) and recipient Epstein-Barr virus seronegativity (AHR = 3.01, CI = 1.57-5.08) were associated with an increased risk of PTLD. Patients with PTLD had a reduced survival rate (61% at 5 years). Graft PTLD had the best prognosis with an 81% survival rate after 5 years. Infection with hepatitis C or B virus (HCV or HBV), late-onset PTLD, multiple sites involvement and high Ann Arbor staging were risk factors for patient death. Use of azathioprine was associated with a poorer survival rate. PTLD incidence and risk factors in French recipients are in line with the international or American PTLD series. We highlighted the role of HBV or HCV in patient mortality and described the relevant prognosis factors for patients with post-transplant lymphoproliferations.
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Affiliation(s)
- S Caillard
- Department of Nephrology and Renal Transplantation, Hôpitaux Universitaires de Strasbourg, France.
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Abstract
Sirolimus (SRL) is suspected to induce proteinuria. We retrospectively studied proteinuria in a population of liver (n = 29) and kidney transplant (n = 30) recipients switched to SRL with progressive diminution or withdrawal of calcineurin inhibitors (CNI). We also observed estimated glomerular filtration rate (GFR), modification of treatment with antiproteinuric drugs, and changes in concentration of SRL. Collection of data started 3 months before SRL introduction at a mean follow-up of 21 months. Following SRL introduction, proteinuria was not detected in the 28 liver transplant patients, and was stable in the two others. In the kidney transplant group, proteinuria did not occur in 12 patients, remained stable in three, and was slightly increased in 14 (0.57 +/- 0.93 g/d vs 1.83 +/- 1.26 g/d). For all patients, eGFR remained stable; there was no difference in management of antiproteinuric drugs. As suspected, cyclosporin (CsA) and tacrolimus (FK) serum concentrations were decreased. We observed a significant correlation between the variation of proteinuria and the variation of serum concentration of CsA or FK (respectively, P = .001 and P = .007). On the other hand, we did not find any correlation between variation in proteinuria and concentration of SRL. This retrospective study suggests that in our cohort of liver transplant patients without previous renal damage, SRL did not provoke proteinuria. On the other hand, the slight aggravation of proteinuria in a subgroup of kidney transplant patients seems to be linked to the hemodynamic renal effects due to CNI withdrawal.
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Affiliation(s)
- T Dervaux
- Service de Néphrologie et Transplantation, CHU Strasbourg, France.
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Jeltsch H, Yee J, Aloy E, Marques Pereira P, Schimchowitsch S, Grandbarbe L, Caillard S, Mohier E, Cassel J. Erratum to “Transplantation of neurospheres after granule cell lesions in rats: cognitive improvements despite no long-term immunodetection of grafted cells”. Behav Brain Res 2003. [DOI: 10.1016/j.bbr.2003.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Forestier E, Faure A, Richter S, Caillard S, Lioure B, Hannedouche T, Moulin B. Encéphalite à parvovirus B19 chez un patient greffé de moelle osseuse. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80643-9] [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: 11/28/2022]
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Veillon S, Caillard S, Epailly E, Eisenmann B, Hannedouche T, Moulin B. Chronic renal failure after cardiac transplantation: predictive factors and influence on mortality-results of a monocenter study in 141 patients. Transplant Proc 2002; 34:2819-20. [PMID: 12431620 DOI: 10.1016/s0041-1345(02)03527-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S Veillon
- Department of Nephrology-Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Caillard S, Lachat V, Moulin B. Posttransplant lymphoproliferative disorders in renal allograft recipients: report of 53 cases of a French multicenter study. PTLD French Working Group. Transpl Int 2001; 13 Suppl 1:S388-93. [PMID: 11112039 DOI: 10.1007/s001470050368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
New immunosuppressive therapies are currently being developed in renal transplantation and their relative risk in terms of posttransplant lymphoproliferative disorders (PTLD) must be carefully evaluated. For this purpose, a French registry of PTLD occurring after renal transplantation was set up. Among 10,000 patients presently followed up in 30 French renal transplantation centers, we prospectively identified 53 new PTLD (0.5%) since January 1998. Patients (34 male, 19 female) ranged from 3 to 72 years (mean age: 46 years), and the median time between grafting and diagnosis of PTLD was 63 months (2 months to 14 years). Ninety percent of recipients were Epstein-Barr virus (EBV) positive before transplantation. Most patients received a quadruple sequential therapy with polyclonal anti-lymphocyte globulin. Sites involved in PTLD were isolated lymph nodes in 13 cases, stomach or bowel in 10 cases, allograft in 14 cases, central nervous system in 6 cases, oropharynx in 4 cases, and skin or mucosa in 4 cases. Only three PTLD expressed markers of T lineage. Out of 40 studied tumors, 31 (78%) were EBV positive. Tumors were classified as polymorph in 26 cases and monomorph in 23 cases. Genotype studies in 18 PTLD showed a monoclonal pattern in 13 cases. In most patients, treatment consisted of reduction of immune suppression, 21 patients were given additional anti-viral therapy, 13 patients had anti-CD20, 23 patients underwent chemotherapy, and 4 patients were given cerebral radiotherapy. Five patients underwent transplantectomy. Sixteen patients (30%) died within the 1st year and 7 patients returned to dialysis (13%). The outcome of patients with PTLD remains poor, and the optimal approach to therapy is largely unknown. This ongoing registry is not only a national observatory but also a task force designed to improve the treatment strategy of PTLD.
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Affiliation(s)
- S Caillard
- Department of Nephrology-Transplantation, Hôpitaux Universitaires de Strasbourg, France
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