1
|
Lamarque C, Segaux L, Bachellier P, Buchard B, Chermak F, Conti F, Decaens T, Dharancy S, Di Martino V, Dumortier J, Francoz-Caudron C, Gugenheim J, Hardwigsen J, Muscari F, Radenne S, Salamé E, Uguen T, Ursic-Bedoya J, Antoine C, Deshayes A, Jacquelinet C, Natella PA, Leroy V, Cherqui D, Oubaya N, Duvoux C. Evaluation of a delayed liver transplantation strategy for patients with HCC receiving bridging therapy: the DELTA-HCC study. J Hepatol 2024:S0168-8278(24)00202-2. [PMID: 38521171 DOI: 10.1016/j.jhep.2024.03.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/09/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION To maximize utility and prevent premature liver transplantation (LT), a delayed LT strategy (DS) was adopted in France in 2015 in patients listed for any single HCC treated with resection or thermal-ablation during waiting phase, postponing LT until recurrence. The purpose of this study was to evaluate DS to make sure that it did not hamper pre and post-LT outcomes in DS patients. PATIENTS AND METHODS Patients listed for HCC in France between 2015 and 2018 were studied. After data extraction from the national LT database, 2,025 patients were identified and classified according to 6 groups: single tumor entering DS, single tumor not entering DS, multiple tumors, no curative treatment, untreatable HCC or T1 tumors. 18-months Kaplan-Meier estimates of drop-out for death, too sick to be transplanted or tumor progression before LT, 5-year post-LT HCC recurrence and post LT-survival rates were compared. RESULTS Median waiting-time in DS group was 910 days. Pre-LT drop-out probability was significantly lower in DS compare to other groups (13% vs 19%, p=0.0043) and significantly higher in the T1 group (25.4%, p=0.05). Post-LT HCC-recurrence rate in multiples nodules group was significantly higher (19.6%, p= 0.019) and post-LT 5-year survival did not differ among groups with 74% in DS group (p=0.22). CONCLUSION The DELTA HCC study shows that DS does not negatively impact neither pre- nor post-LT patients 'outcomes, and has the potential to redistribute organs to patients in more urgent need of LT. It can reasonably be proposed and pursued. The unexpected high risk of drop out in T1 patients seems related to the MELD-based driving rules underserving this subgroup, calling for revision of allocation rules. IMPACTS AND IMPLICATIONS To maximize utility and prevent premature liver transplantation (LT), a delayed LT strategy (DS) was adopted in France in 2015. It consists in postponing LT until recurrence in patients listed for any single HCC curatively treated by surgical resection or thermal ablation. The DELTA HCC study was conducted to evaluate this nationwide strategy. It shows in a non-US, European LT program that DS:- does not negatively impact pre- nor post-LT patients 'outcome,- concerns up to 20% of LT candidates-has therefore the potential to redistribute organs to patients in more urgent need of LT. Such a delayed strategy can reasonably be pursued and extended to other LT programs. Of note, an unexpected high risk of drop out in T1 patients, seemingly related to MELD-based offering rules which underserve these patients, calls for further scrutinization and revision of allocation rules in this subgroup.
Collapse
|
2
|
Lerosey L, Ksiasek E, Abrahamowicz M, Antoine C, Dharancy S, Dumortier J, Doussot A, Di Martino V, Houssel-Debry P, Conti F, Francoz C, Pageaux GP, Salame E, Faitot F, Coilly A, Hardwigsen J, Decaens T, Chermak F, Muscari F, Anty R, Duvoux C, Abergel A, Minello A, Mouillot T, Binquet C, Latournerie M. Recipient age influences survival after liver transplant: Results of the French national cohort 2007-2017. Liver Int 2024. [PMID: 38451069 DOI: 10.1111/liv.15867] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/11/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND In recent years, age at liver transplantation (LT) has markedly increased. In the context of organ shortage, we investigated the impact of recipient age on post-transplantation mortality. METHODS All adult patients who received a first LT between 2007 and 2017 were included in this cross-sectional study. Recipients' characteristics at the time of listing, donor and surgery data, post-operative complications and follow-up of vital status were retrieved from the national transplantation database. The impact of age on 5-year overall mortality post-LT was estimated using a flexible multivariable parametric model which was also used to estimate the association between age and 10-year net survival, accounting for expected age- and sex-related mortality. RESULTS Among the 7610 patients, 21.4% were aged 60-65 years, and 15.7% over 65. With increasing age, comorbidities increased but severity of liver disease decreased. Older recipient age was associated with decreased observed survival at 5 years after LT (p < .001), with a significant effect particularly during the first 2 years. The linear increase in the risk of death associated with age does not allow any definition of an age's threshold for LT (p = .832). Other covariates associated with an increased risk of 5-year death were dialysis and mechanical ventilation at transplant, transfusion during LT, hepatocellular carcinoma and donor age. Ten-year flexible net survival analysis confirmed these results. CONCLUSION Although there was a selection process for older recipients, increasing age at LT was associated with an increased risk of death, particularly in the first years after LT.
Collapse
Affiliation(s)
- Lea Lerosey
- Service d'Hépato-gastro-entérologie, CHU Dijon-Bourgogne, Dijon, France
| | - Elea Ksiasek
- CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Corinne Antoine
- Agence de Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis, France
| | - Sébastien Dharancy
- Service des maladies de l'appareil digestif, CHRU de Lille, Lille, France
- Université Lille 2 and Inserm U795, Lille, France
| | - Jérôme Dumortier
- Service d'Hépa-gastroentérologie, Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Alexandre Doussot
- Service de Chirurgie Hépato-biliaire, Hôpital Jean Minjoz, Besançon, France
| | | | | | - Filomena Conti
- Service d'Hépatologie, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Claire Francoz
- Service d'hépatologie, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Ephrem Salame
- Service de chirurgie digestive et transplantation hépatique, CHU Tours, Tours, France
| | | | - Audrey Coilly
- Service d'Hépatologie, Hôpital Paul Brousse, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jean Hardwigsen
- Service de chirurgie digestive et transplantation hépatique, CHU Marseille, Marseille, France
| | - Thomas Decaens
- Service d'hépato-gastroentérologie, CHU Grenoble, Grenoble, France
| | - Faiza Chermak
- Service d'Hépato-gastro-entérologie, CHU Bordeaux, Bordeaux, France
| | - Fabrice Muscari
- Service Chirurgie Hépato-Bilio-Pancréatique et Transplantation, CHU Toulouse, Toulouse, France
| | | | | | - Armand Abergel
- Hépatologie, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - Anne Minello
- Service d'Hépato-gastro-entérologie, CHU Dijon-Bourgogne, Dijon, France
| | - Thomas Mouillot
- Service d'Hépato-gastro-entérologie, CHU Dijon-Bourgogne, Dijon, France
| | - Christine Binquet
- CHU Dijon Bourgogne, INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | | |
Collapse
|
3
|
Antoine C, Luc MS, Gross G, Schwitzer T, Hettal L, Conart JB, Angioi-Duprez K. [Aggressiveness and violence in daily ophthalmology practice: Descriptive analysis of a survey sent to residents and assistants in Grand Est and Bourgogne-Franche-Comté]. J Fr Ophtalmol 2024; 47:103994. [PMID: 37903682 DOI: 10.1016/j.jfo.2023.07.015] [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: 03/17/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION The goal of this study was to estimate the prevalence of workplace violence in a population of young ophthalmologists in France and to characterize these situations. METHODS We conducted an epidemiological descriptive, cross-sectional, multi-center study based on an anonymous questionnaire. We submitted a questionnaire to all ophthalmology residents and fellows (n=157) in the Grand Est and Bourgogne-Franche-Comté regions between December 2020 and March 2021. RESULTS The overall response rate was 76.4% (n=120, 55% female and 45% male) of whom 81.6% reported having faced aggression at least once. For 50.9% of participants, aggression had occurred several times per year. These situations occurred during the first year of residency in 64.3% of cases. They mainly consisted of verbal aggression (98.8%) by a patient or their relatives (43.7% and 29.8%). The main complaints voiced by these individuals concerned the wait time (40%) and the feeling of lack of competence or improper medical care (26.8%). Fifty-seven percent of people who faced these situations thought about it for at least a week, and 20.4% of those exposed felt anxiety at work after the incident. CONCLUSION We found high prevalence of verbal aggression in professional ophthalmology practice. Although these situations were mainly verbal aggression without significant consequences, they sometimes lead to anxiety in the aftermath. We should prepare medical students to manage them, through appropriate theoretical and practical training, such as medical simulation described in this article.
Collapse
Affiliation(s)
- C Antoine
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - M-S Luc
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - G Gross
- Centre psychothérapeutique de Nancy, 1, rue Dr-Archambault, 54520 Laxou, France
| | - T Schwitzer
- Centre psychothérapeutique de Nancy, 1, rue Dr-Archambault, 54520 Laxou, France
| | - L Hettal
- CNRS UMR 168, institut Curie, université PSL, Sorbonne Université, 26, rue d'Ulm, 75005 Paris, France
| | - J-B Conart
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - K Angioi-Duprez
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| |
Collapse
|
4
|
Ferrari K, Aarnink A, Ayav C, Frimat L, Couchoud C, Audry B, Antoine C, Girerd S. Evolution of HLA-sensitization according to immunosuppressive therapy management among kidney transplant patients returning to dialysis between 2008 and 2019: A French retrospective study. Clin Transplant 2024; 38:e15160. [PMID: 37823237 DOI: 10.1111/ctr.15160] [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: 08/22/2022] [Revised: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The optimal management of immunosuppressive therapy (IT) after kidney allograft failure (KAF) remains controversial. Although maintaining IT may reduce HLA-sensitization and improve access to retransplantation, it may also increase the rate of immunosuppression-related complications. The overall impact on patient mortality is unknown. The main objective of this study was to compare the evolution of HLA-sensitization 6 months after KAF according to IT management. METHODS Individual clinical and health care data were extracted from the French national end-stage kidney disease registry (Renal Epidemiology and Information Network [REIN]) and the French National Health Data system (SNDS), respectively. Patients aged > 18 years returning to dialysis after KAF between January 2008 and December 2019 in Lorraine were included. Patients were classified into two groups, IT continuation or IT discontinuation. HLA-sensitization was defined as an increase in incompatible graft rate (IGR) between KAF and 6 months post-KAF (change to a higher predefined category (0%-5%), (5%-20%), (20%-50%), (50%-85%), (85%-95%), (95%-98%), (98%-100%)). Secondary outcome was patient survival according to IT management. RESULTS A total of 121 patients were included, 35 (29%) of whom continued IT. HLA-sensitization after KAF tended to be higher in the "IT discontinuation" group (57% vs. 38% in the "IT continuation" group, p = .07). In multivariate analysis, IT continuation was associated with a lower increase in IGR (OR .37, 95% CI [.14; .93]). IT management was not associated with patient mortality. CONCLUSIONS Continuation of IT after KAF was associated with less change in IGR and was not associated with excess mortality.
Collapse
Affiliation(s)
- Kevin Ferrari
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Alice Aarnink
- Histocompatibility Laboratory, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- IMoPA6, UMR7365 CNRS, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Carole Ayav
- Clinical Epidemiology, Inserm CIC-EC, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Luc Frimat
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | | | | | | | - Sophie Girerd
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- Université de Lorraine, Inserm, Centre d'Investigation Clinique-1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| |
Collapse
|
5
|
Kerbaul F, Legeai C, Antoine C. [Towards a revival of organ-tissue harvesting and transplantation in France?]. Rev Prat 2023; 73:957-958. [PMID: 38294442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- François Kerbaul
- Direction du prélèvement et des greffes d'organes et de tissus. Direction médicale et scientifique. Agence de la biomédecine, Saint-Denis La Plaine, France
| | - Camille Legeai
- Direction du prélèvement et des greffes d'organes et de tissus. Direction médicale et scientifique. Agence de la biomédecine, Saint-Denis La Plaine, France
| | - Corinne Antoine
- Direction du prélèvement et des greffes d'organes et de tissus. Direction médicale et scientifique. Agence de la biomédecine, Saint-Denis La Plaine, France
| |
Collapse
|
6
|
Legeai C, Antoine C, Kerbaul F. [French legislation on organ transplantation]. Rev Prat 2023; 73:950-954. [PMID: 38294440] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
EPIDEMIOLOGY OF ORGAN TRANSPLANTATION IN France. The number of transplants has been rising for ten years. Nevertheless, the stabilization of the number of brain-dead people identified as potential organ donors, and the persistently high rate of opposition to organ removal, accentuate the substantial gap between the number of candidates for transplantation and the number of transplants performed each year. Strategies are being used to reduce this imbalance, such as broadening the brain-dead donors selection criteria and increasing procurement from living donors and deceased donors after circulatory death. Unfortunately, the Covid-19 pandemic has further aggravated the difference between the supply of transplants and the need.
Collapse
Affiliation(s)
- Camille Legeai
- Direction du prélèvement et de la greffe d'organes et de tissus, Agence de la biomédecine, Saint-Denis La Plaine, France
| | - Corinne Antoine
- Direction du prélèvement et de la greffe d'organes et de tissus, Agence de la biomédecine, Saint-Denis La Plaine, France
| | - François Kerbaul
- Direction du prélèvement et de la greffe d'organes et de tissus, Agence de la biomédecine, Saint-Denis La Plaine, France
| |
Collapse
|
7
|
Antoine C, Legeai C, Kerbaul F. [French legislation on organ transplantation]. Rev Prat 2023; 73:955-956. [PMID: 38294441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Corinne Antoine
- Direction du prélèvement et des greffes d'organes et de tissus. Direction médicale et scientifique. Agence de la biomédecine, Saint-Denis La Plaine, France
| | - Camille Legeai
- Direction du prélèvement et des greffes d'organes et de tissus. Direction médicale et scientifique. Agence de la biomédecine, Saint-Denis La Plaine, France
| | - François Kerbaul
- Direction du prélèvement et des greffes d'organes et de tissus. Direction médicale et scientifique. Agence de la biomédecine, Saint-Denis La Plaine, France
| |
Collapse
|
8
|
Coilly A, Jasseron C, Legeai C, Conti F, Duvoux C, Kamar N, Dharancy S, Antoine C. Impact of direct antiviral agents for hepatitis C virus -induced liver diseases on registration, waiting list and liver transplant activity in France. Clin Res Hepatol Gastroenterol 2023; 47:102168. [PMID: 37356497 DOI: 10.1016/j.clinre.2023.102168] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
Direct-acting antivirals (DAA) has dramatically improved the prognosis of liver transplantation (LT) candidates for HCV end-stage liver disease (ESLD). We aimed to evaluate the impact of DAA on waiting list (WL) registration and LT activity in France. We evaluated all patients registered to the French WL for HCV ESLD between 2000 and 2018. Timespan was divided into two periods according to DAA availability: 2010-2013 versus 2014-2018. Changes in the indications of LT, outcome on WL were evaluated. Then, we evaluated the activity of LT and outcome for HCV recipients in France. Among 3,173 HCV candidates, registration on WL decreased by 33% between 2013 and 2018. The 1-year waitlist survival increased from 76.9% (95%CI: 74.2%-79.4%) in 2010-2013 to 79.8% (95%CI: 77.2%-82.1%) in 2014-2018 (p < 0.01). Regarding LT activity, the part of HCV ESLD decreased from 26% in 2010 to 16% in 2018. The 1-year graft survival rate in HCV recipients increased from 76.9% (95%CI: 73.7%-79.7%) in 2010-2012 to 84.9% (95%CI: 82.9%-86.7%) in 2013-2018 (p < 0.01). The availability of DAA to treat HCV infection is associated with a significant decrease of registration for LT, death and drop out for worsening condition on the LT. In addition, it has decreased the number of HCV+ LT and improved the 1-year graft survival in France.
Collapse
Affiliation(s)
- Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Université Paris-Saclay, UMR-S 1193, Inserm Unité 1193, FHU Hepatinov, Villejuif 94800, France.
| | - Carine Jasseron
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, 1 avenue du Stade de France, Pôle Évaluation, Saint-Denis La Plaine Cedex, 93212, France
| | - Camille Legeai
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, 1 avenue du Stade de France, Pôle Évaluation, Saint-Denis La Plaine Cedex, 93212, France
| | - Filomena Conti
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Christophe Duvoux
- Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital APHP- Paris Est University, Créteil, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University Paul Sabatier, Toulouse, France
| | - Sébastien Dharancy
- Inserm, Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, UMR995 - LIRIC, Lille, France Univ Lille, UMR995 - LIRIC, Lille, France CHRU Lille, Lille, France
| | - Corinne Antoine
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, 1 avenue du Stade de France, Pôle Évaluation, Saint-Denis La Plaine Cedex, 93212, France.
| |
Collapse
|
9
|
De Wolf J, Fadel G, Olland A, Falcoz PE, Mordant P, Castier Y, Brioude G, Thomas PA, Lacoste P, Issard J, Antoine C, Fadel E, Chapelier A, Mercier O, Sage E. Controlled donation after circulatory death lung transplantation: Results of the French protocol including in situ abdominal normothermic regional perfusion and ex vivo lung perfusion. J Heart Lung Transplant 2023; 42:1093-1100. [PMID: 37019731 DOI: 10.1016/j.healun.2023.03.003] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/30/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The French national protocol for controlled donation after circulatory determination of death (cDCD) includes normothermic regional perfusion (NRP) in case of abdominal organ procurement and additional ex-vivo lung perfusion (EVLP) before considering lung transplantation (LT). METHODS We made a retrospective study of a prospective registry that included all donors considered for cDCD LT from the beginning of the program in May 2016 to November 2021. RESULTS One hundred grafts from 14 donor hospitals were accepted by 6 LT centers. The median duration of the agonal phase was 20 minutes [2-166]. The median duration from circulatory arrest to pulmonary flush was 62 minutes [20-90]. Ten lung grafts were not retrieved due to prolonged agonal phases (n = 3), failure of NRP insertion (n = 5), or poor in situ evaluation (n = 2). The remaining 90 lung grafts were all evaluated on EVLP, with a conversion rate of 84% and a cDCD transplantation rate of 76%. The median total preservation time was 707 minutes [543-1038]. Seventy-one bilateral LTs and 5 single LTs were performed for chronic obstructive pulmonary disease (n = 29), pulmonary fibrosis (n = 21), cystic fibrosis (n = 15), pulmonary hypertension (n = 8), graft-versus-host disease (n = 2), and adenosquamous carcinoma (n = 1). The rate of PGD3 was 9% (n = 5). The 1-year survival rate was 93.4%. CONCLUSION After initial acceptance, cDCD lung grafts led to LT in 76% of cases, with outcomes similar to those already reported in the literature. The relative impacts of NRP and EVLP on the outcome following cDCD LT should be assessed prospectively in the context of comparative studies.
Collapse
Affiliation(s)
- J De Wolf
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France
| | - G Fadel
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France
| | - A Olland
- Department of Thoracic Surgery and Lung Transplantation, Centre Hospitalier Universitaire de Strasbourg Strasbourg, France
| | - P E Falcoz
- Department of Thoracic Surgery and Lung Transplantation, Centre Hospitalier Universitaire de Strasbourg Strasbourg, France
| | - P Mordant
- Department of Vascular Surgery, Thoracic Surgery and Lung Transplantation, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - Y Castier
- Department of Vascular Surgery, Thoracic Surgery and Lung Transplantation, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - G Brioude
- Department of Thoracic Surgery and Lung Transplantation, Hopital Nord de Marseille APHM, Marseille, France
| | - P A Thomas
- Department of Thoracic Surgery and Lung Transplantation, Hopital Nord de Marseille APHM, Marseille, France
| | - P Lacoste
- Department of Thoracic Surgery and Lung Transplantation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - J Issard
- Department of Thoracic Surgery and Lung Transplantation, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - C Antoine
- Agence de la Biomédecine, Saint-Denis, France
| | - E Fadel
- Department of Thoracic Surgery and Lung Transplantation, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - A Chapelier
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France
| | - O Mercier
- Department of Thoracic Surgery and Lung Transplantation, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - E Sage
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France.
| |
Collapse
|
10
|
Hübsch T, Mettler C, Poisnel E, Antoine C, Cambon A, Delarbre D, Dutasta F, Karkowski L, Pangnarind V, Paris JF, Defuentes G, Granel-Rey B. [Autoimmune and inflammatory pathologies associated with systemic scleroderma: Clinical, serological and prognostic profiles. Bi-centric retrospective series in the PACA region]. Rev Med Interne 2023; 44:402-409. [PMID: 37100631 DOI: 10.1016/j.revmed.2023.03.013] [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: 09/27/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Systemic sclerosis (SSc) is a rare auto-immune disease, affecting principally women between 40 and 60 years old. It is caracterised by a cutaneous and visceral fibrosis, an alteration of the microvascular network and the presence of autoantibodies. SSc can be associated with another connectivite tissue disease or to other autoimmune diseases, thus defining the overlap syndrome. The goal of our study is to describe these overlap syndromes. METHODS We have analysed the data of a retrospective and bicentrique cohort, from the internal medicine unit of Hôpital Nord in Marseille and from the internal medicine unit of the Hôpital Sainte-Anne in Toulon, of patients followed for a SSc between January 1st, 2019 and December 1st, 2021. We have collected clinical, imunological features, associated auto-immune and inflammatory diseases with its morbidity and mortality. RESULTS The cohort included 151 patients including 134 limited cutaneous SSc. Fifty-two (34.4%) patients presented at least one associated auto-immune or inflammatory disease. The association of two connectivite tissue diseases including SSc was found in 24 patients (15.9%), a third with Sjögren's syndrome and a third with autoimmune myositis. The principal associated disease to SSc was the autoimmune thyroiditis found in 17 patients (11.3%). The occurrence of complications (hospitalization, long-term oxygene therapy, death) was not significantly different depending on the existence or not of an overlap syndrom. CONCLUSION SSc is often associated with other autoimmune diseases. This interrelation between associated pathologies and SSc, modifying sometimes the evolution of SSc, enhances the need of a personalized follow-up.
Collapse
Affiliation(s)
- T Hübsch
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France.
| | - C Mettler
- Service de médecine interne, hôpital Cochin, Paris, France
| | - E Poisnel
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - C Antoine
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - A Cambon
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - D Delarbre
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - F Dutasta
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - L Karkowski
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - V Pangnarind
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - J-F Paris
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - G Defuentes
- Service de médecine interne, hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - B Granel-Rey
- PU-PH, Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille université, Marseille, France
| |
Collapse
|
11
|
Legeai C, Antoine C, Jasseron C, Kerbaul F, Dumortier J. Impact of the COVID-19 pandemic on liver transplant waitlist outcome in France. Sci Rep 2023; 13:9308. [PMID: 37291177 PMCID: PMC10248328 DOI: 10.1038/s41598-023-32680-8] [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: 10/21/2022] [Accepted: 03/31/2023] [Indexed: 06/10/2023] Open
Abstract
The objective of this study was to investigate the impact of the COVID-19 pandemic on the outcome of patients on the liver transplantation (LT) waitlist in 2020 in France, in particular, the incidence of deaths and delisting for worsening condition, depending on the allocation score component. The 2020 cohort of patients on the waiting list was compared with the 2018/2019 cohorts. 2020 saw fewer LTs than in either 2019 or 2018 (1128, 1356, and 1325, respectively), together with fewer actual brain dead donors (1355, 1729, and 1743). In 2020, deaths or delisting for worsening condition increased significantly versus 2018/2019 (subdistribution hazard ratio 1.4, 95% confidence interval [CI] 1.2-1.7), after adjustment for age, place of care, diabetes, blood type, and score component, although COVID-19-related mortality was low. This increased risk mainly concerned patients with hepatocellular carcinoma (1.52, 95% CI 1.22-1.90), with 650 MELD exception points (2.19, 95% CI 1.08-4.43), and especially those without HCC and MELD scores from 25 to 30 (3.36 [95% CI 1.82-6.18]). In conclusion, by significantly decreasing LT activity in 2020, the COVID-19 pandemic increased the number of waitlist deaths and delisting for worsening condition, and significantly more for particular components of the score, including intermediate severity cirrhosis.
Collapse
Affiliation(s)
- Camille Legeai
- Organ and Tissue Procurement and Transplantation Department, Agence de la Biomédecine, 1, Avenue du Stade de France, 93212, Saint-Denis la Plaine Cedex, France.
| | - Corinne Antoine
- Organ and Tissue Procurement and Transplantation Department, Agence de la Biomédecine, 1, Avenue du Stade de France, 93212, Saint-Denis la Plaine Cedex, France
| | - Carine Jasseron
- Organ and Tissue Procurement and Transplantation Department, Agence de la Biomédecine, 1, Avenue du Stade de France, 93212, Saint-Denis la Plaine Cedex, France
| | - François Kerbaul
- Organ and Tissue Procurement and Transplantation Department, Agence de la Biomédecine, 1, Avenue du Stade de France, 93212, Saint-Denis la Plaine Cedex, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Unité de Transplantation Hépatique et Université Claude Bernard Lyon 1, Lyon, France
| |
Collapse
|
12
|
Marouf A, Molinari N, Sibon D, Cottereau AS, Kanoun S, Antoine C, Debureaux PE, Cavalieri D, Fornecker LM, Casasnovas RO, Herbaux C, Amorim S, Rossi C, Bouscary D, Brice P, Ghesquieres H, Tamburini J, Deau B. Tandem haematopoietic stem cell transplantation versus single cell transplant and BV maintenance in relapsed/refractory Hodgkin lymphoma: A matched cohort analysis from the LYSA. Br J Haematol 2023. [PMID: 37192755 DOI: 10.1111/bjh.18859] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/05/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
Autologous hematopoietic stem cell transplant (ASCT) is the standard curative treatment for patients with high-risk relapsed/refractory Hodgkin lymphoma (R/R HL). The AETHERA study showed survival gain with Brentuximab Vedotin (BV) maintenance after ASCT in BV-naive patients, which was recently confirmed in the retrospective AMAHRELIS cohort, including a majority of BV-exposed patients. However, this approach has not been compared to intensive tandem auto/auto or auto/allo transplant strategies, which were used before BV approval. Here, we matched BV maintenance (AMAHRELIS) and tandem SCT (HR2009) cohorts, and observed that BV maintenance was associated with better survival outcome in patients with HR R/R HL.
Collapse
Affiliation(s)
- A Marouf
- Laboratoire U1163, Institut Imagine, Université Paris Cité, Inserm, Paris, France
- Service Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Groupe Hospitalier privé Ambroise Paré-Hartmann, Département Recherche Innovation, Neuilly-Sur-Seine, France
| | - N Molinari
- IDESP, INSERM, PreMEdical INRIA, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - D Sibon
- Paris Est University, Créteil, France
- Service Hémopathies Lymphoïdes, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - A S Cottereau
- Laboratoire U1163, Institut Imagine, Université Paris Cité, Inserm, Paris, France
- Service de Médecine Nucléaire, AP-HP, Hôpital Cochin, Paris, France
| | - S Kanoun
- Centre de Recherche Clinique de Toulouse, Team 9, Toulouse, France
| | - C Antoine
- Lymphoma Academic Research Organization (LYSARC) Lymphoma Study Association Imaging, Hôpital Henri Mondor, Créteil, France
| | - P E Debureaux
- Saint Louis Research Institute, INSERM U1160, Paris, France
| | - D Cavalieri
- Service Hématologie, CHRU Lille, Lille, France
| | - L M Fornecker
- Université de Strasbourg, INSERM S-1113, Strasbourg, France
- Service Hématologie, Cancéropôle Est, Strasbourg, France
| | - R O Casasnovas
- UFR des Sciences de Santé, INSERM UMR 1231 CHU Dijon, Dijon, France
- Service Hématologie, CHU Dijon, Dijon, France
| | - C Herbaux
- Service Hématologie, CHU Montpellier, Montpellier, France
| | - S Amorim
- Service Hématologie, Hôpital Saint-Louis, Paris, France
| | - C Rossi
- Department of Hematology, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM Unit 1231, University of Burgundy Franche-Comté, Besancon, France
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, California, USA
| | - D Bouscary
- Laboratoire U1163, Institut Imagine, Université Paris Cité, Inserm, Paris, France
- Service Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Centre de Recherche des Cordeliers, INSERM U1016, Université Paris Cité, Inserm, Paris, France
| | - P Brice
- Service Hématologie, Hôpital Saint-Louis, Paris, France
| | - H Ghesquieres
- Service Hématologie, Hôpital Lyon Sud, Pierre-Bénite, France
| | - J Tamburini
- Laboratoire U1163, Institut Imagine, Université Paris Cité, Inserm, Paris, France
- Service Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Translational Research Centre in Onco-Hematology, Faculty of Medicine, University of Geneva, Geneva 4, Switzerland
| | - B Deau
- Laboratoire U1163, Institut Imagine, Université Paris Cité, Inserm, Paris, France
- Service Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Groupe Hospitalier privé Ambroise Paré-Hartmann, Département Recherche Innovation, Neuilly-Sur-Seine, France
| |
Collapse
|
13
|
Lascarrou JB, Dumas F, Bougouin W, Legriel S, Aissaoui N, Deye N, Beganton F, Lamhaut L, Jost D, Vieillard-Baron A, Nichol G, Marijon E, Jouven X, Cariou A, Agostinucci J, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Coulaud J, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Diehl J, Dinanian S, Domanski L, Dreyfuss D, Dubois-Rande J, Dumas F, Duranteau J, Empana J, Extramiana F, Fagon J, Fartoukh M, Fieux F, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Jabre P, Joseph L, Jost D, Jouven X, Karam N, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt C, Mansencal N, Mansouri N, Marijon E, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira J, Monnet X, Narayanan K, Ngoyi N, Perier M, Piot O, Plaisance P, Plaud B, Plu I, Raphalen J, Raux M, Revaux F, Ricard J, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharshar T, Sideris G, Spaulding C, Teboul J, Timsit J, Tourtier J, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets. Chest 2022; 163:1120-1129. [PMID: 36445800 DOI: 10.1016/j.chest.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/05/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated. RESEARCH QUESTION Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score? STUDY DESIGN AND METHODS Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set. RESULTS A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95% CI, 1.15-2.30; P = .006) and high (adjusted OR, 1.94; 95% CI, 1.06-3.54; P = .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 [95% CI, 1.05-1.75; P = .020] and 2.42 [95% CI, 1.38-4.24; P = .002], respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets. INTERPRETATION TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.
Collapse
Affiliation(s)
- Jean Baptiste Lascarrou
- Université Paris Cité, INSERM, PARCC, Paris, France; Médecine Intensive Réanimation, University Hospital Center, Nantes, France; AfterROSC Network Group, Paris, France.
| | - Florence Dumas
- Université Paris Cité, INSERM, PARCC, Paris, France; Emergency Department, Cochin University Hospital, APHP, Paris, France
| | - Wulfran Bougouin
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical-Surgical Intensive Care Unit, Hopital Privé Jacques Cartier, Massy, France
| | - Stephane Legriel
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay, France
| | - Nadia Aissaoui
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
| | - Nicolas Deye
- AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Lariboisière University Hospital, INSERM U942, Paris, France
| | | | - Lionel Lamhaut
- AfterROSC Network Group, Paris, France; SAMU de Paris-DAR Necker University Hospital-Assistance, Paris, France
| | - Daniel Jost
- Brigade des Sapeurs-Pompiers de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Eloi Marijon
- Université Paris Cité, INSERM, PARCC, Paris, France
| | | | - Alain Cariou
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Artzner T, Legeai C, Antoine C, Jasseron C, Michard B, Faitot F, Schneider F, Bachellier P. Liver transplantation for critically ill cirrhotic patients: Results from the French transplant registry. Clin Res Hepatol Gastroenterol 2022; 46:101817. [PMID: 34607069 DOI: 10.1016/j.clinre.2021.101817] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 02/04/2023]
Abstract
This study describes the population of cirrhotic patients who were transplanted from the ICU in France, identifying pre-transplant risk factors of post-transplant mortality and describing geographic variations in ICU transplant activity. Cirrhotic patients transplanted between 2008 and 2018 were included through the national transplant registry. The demographic, clinical and biological characteristics of the patients transplanted from the ICU were compared to cirrhotic patients who were transplanted from home or from the hospital. Risk factors of post-transplant one-year mortality were identified in uni- and multivariable analysis within the population transplanted from the ICU. Funnel plots were used to illustrate center-specific differences in ICU transplant activity. 1,047 cirrhotic patients were transplanted from the ICU during the study period. While the national rate of transplants performed from the ICU was 14.3% the absolute number and the rate of cirrhotic patients transplanted from the ICU varied significantly from one center to another, ranging from 6.6% to 22.8% (p < 0.05). Three recipient-associated independent risk factors one-year post-LT mortality were identified in the population transplanted from the ICU: age > 50 years (HR 1.65, 95%CI 1.16-2.36), p = 0.005), diabetes (HR 1.46, 95%CI 1.07-1.98, p = 0.02) and intubation (HR2.12, 95%CI 1.62-2.78), p < 0.001). Donor age was also independently associated with mortality (HR 1.01, 95%CI 1.01-1.02, p < 0.001). Funnel plots showed significant differences in the proportion of patients transplanted from the ICU and the distribution of risk factors across French transplant centers, especially the inclination to transplant intubated patients. This study underlines the increased post-transplant mortality among cirrhotic patients transplanted from the ICU. It identifies four clinically pertinent independent risk factors associated with post-transplant mortality in this specific sub-group of transplant candidates. Finally, it illustrates how diverse the landscape of liver transplantation for critically ill cirrhotic patients is across a single country, despite a unified allocation algorithm.
Collapse
|
15
|
Essayagh B, Benfari G, Antoine C, Grigioni F, Le Tourneau T, Roussel JC, Ajmone N, Van Wijngaarden A, Delgado V, Bax J, Tribouilloy C, Hochstadt A, Topilsky Y, Michelena H, Enriquez-Sarano M. The MIDA quantitative international registry: prognostic implications of moderately elevated pulmonary artery pressure. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Pulmonary hypertension is a frequent complication of severe degenerative mitral regurgitation (DMR) associated with major outcome implications. However, whether pulmonary hypertension is linked with worse outcome in less that severe MR is uncertain and even more unsubstantiated is the link of elevated systolic pulmonary artery pressure (sPAP) < 50mmHg with clinical presentation and outcome.
Purpose
To assess the outcome implication of sPAP elevation, even moderate, among mitral regurgitation severity subgroups.
Methods
The MIDA-Quantitative (MIDA-Q) unprecedented registries included 7373 consecutive patients (age 64 ± 17 years, 45% women, follow-up 5.5 ± 3.4 years) with isolated DMR diagnosed at tertiary (European/North-American/Middle East) centers in which systolic pulmonary artery pressure (sPAP) was measured prospectively at baseline. Long-term survival overall, under medical management and post-mitral surgery was analyzed.
Results
Elevated pulmonary pressure (sPAP >50mmHg) was observed in 1371 patients (19%, mean 63 ± 13mmHg) and moderate increase in pulmonary pressure (35< sPAP < 50mmHg) in 1874 patients (25%, mean 41 ± 14mmHg), with no/mild MR in 4067 (50%), moderate in 2073 (25%), and severe or above in 2047 (25%), mean ERO 0.24 ± 24cm2, RVol 37 ± 35mL and posterior leaflet prolapse in 34%. sPAP severe but also moderate both strongly and independently linked to more severe clinical presentation, with more dyspnea, more AFib, and impaired renal function (P ≤ 0.0001). <SPAP< >By sPAP categories, 35 < sPAP< 50mmHg (vs. 35mmHg) was independently associated with worse outcome under medical management adjusted-HR 1.62[1.40-1/87], with considerable excess-mortality for sPAP > 50mmHg (vs. <35mmHg) adjusted-HR 2.54[2.17-2.96], all P < 0.0001. As continuous variable, sPAP was associated with worse outcome adjusted-HR 1.25[1.21-1.29], P < 0.0001 per 10mmHg-increase. Mitral valve surgery (performed in 2378 patients, 32%) improved outcome without alleviating completely higher mortality associated with sPAP > 50mmHg (P < 0.0001).
Conclusion
In this very large international cohort of patients with DMR of all range and prospective sPAP grading, higher sPAP is associated at diagnosis with more severe clinical presentation. Long term, sPAP > 50mmHg but also 35-50mmHg is independently of all confounders, associated with worse mortality. Thus careful assessment and consideration for mitral surgery/transcatheter therapy is warranted even in patients with sPAP <50mmHg.</SPAP< > Abstract Figure. Survival stratified by sPAP Categories Abstract Figure. Postop survival by sPAP Categories
Collapse
Affiliation(s)
- B Essayagh
- Mayo Clinic, Division of Cardiovascular Diseases, Rochester, United States of America
| | - G Benfari
- Mayo Clinic, Division of Cardiovascular Diseases, Rochester, United States of America
| | - C Antoine
- Mayo Clinic, Division of Cardiovascular Diseases, Rochester, United States of America
| | - F Grigioni
- Campus Bio-Medico University Of Rome, Division of Cardiovascular Diseases, Rome, Italy
| | - T Le Tourneau
- University Hospital of Nantes, Department of Cardiology, Nantes, France
| | - JC Roussel
- University Hospital of Nantes, Department of Cardiothoracic Surgery, Nantes, France
| | - N Ajmone
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - A Van Wijngaarden
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - J Bax
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - C Tribouilloy
- University Hospital of Amiens, Division of Cardiovascular Diseases, Amiens, France
| | - A Hochstadt
- Tel Aviv University, Division of Cardiovascular Diseases, Tel Aviv, Israel
| | - Y Topilsky
- Tel Aviv University, Division of Cardiovascular Diseases, Tel Aviv, Israel
| | - H Michelena
- Mayo Clinic, Division of Cardiovascular Diseases, Rochester, United States of America
| | - M Enriquez-Sarano
- Mayo Clinic, Division of Cardiovascular Diseases, Rochester, United States of America
| |
Collapse
|
16
|
Le Dorze M, Martin-Lefèvre L, Santin G, Robert R, Audibert G, Megarbane B, Puybasset L, Dorez D, Veber B, Kerbaul F, Antoine C. Critical pathways for controlled donation after circulatory death in France. Anaesth Crit Care Pain Med 2022; 41:101029. [PMID: 35121185 DOI: 10.1016/j.accpm.2022.101029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/12/2021] [Revised: 10/22/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In 2015, France authorised controlled donation after circulatory death (cDCD) according to a nationally approved protocol. The aim of this study is to provide an overview from the perspective of critical care specialists of cDCD. The primary objective is to assess how the organ donation procedure affects the withdrawal of life-sustaining therapies (WLST) process. The secondary objective is to assess the impact of cDCD donors' diagnoses on the whole process. MATERIAL AND METHODS This 2015-2019 prospective observational multicentre study evaluated the WLST process in all potential cDCD donors identified nationwide, comparing 2 different sets of subgroups: 1- those whose WLST began after organ donation was ruled out vs. while it was still under consideration; 2- those with a main diagnosis of post-anoxic brain injury (PABI) vs. primary brain injury (PBI) at the time of the WLST decision. RESULTS The study analysed 908 potential cDCD donors. Organ donation remained under consideration at WLST initiation for 54.5% of them with longer intervals between their WLST decision and its initiation (2 [1-4] vs. 1 [1-2] days, P < 0.01). Overall, 60% had post-anoxic brain injury. Time from ICU admission to WLST decision was longer for primary brain injury donors (10 [4-21] vs. 6 [4-9] days, P < 0.01). Median time to death (agonal phase) was 15 [15-20] minutes. CONCLUSIONS French cDCD donors are mostly related to post-anoxic brain injury. The organ donation process does not accelerate WLST decision but increases the interval between the WLST decision and its initiation.
Collapse
Affiliation(s)
- Matthieu Le Dorze
- Université de Paris, INSERM, U942 MASCOT, F-75006, paris, france, Department of Anaesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.
| | - Laurent Martin-Lefèvre
- Organ Donation Service, Service de Médecine Intensive Réanimation, boulevard Stéphane Moreau, 85000 La Roche-sur-Yon, France
| | - Gaëlle Santin
- Agence de la biomédecine, Medical and Scientific Department, 1, avenue du stade de France, 93212 Saint-Denis, France
| | - René Robert
- University of Poitiers, CHU de Poitiers, Service de Médecine Intensive Réanimation, CIC Inserm 1402, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Gérard Audibert
- University of Lorraine, Department of Anaesthesiology and Critical Care Medicine, Nancy University Hospital, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Bruno Megarbane
- University of Paris, INSERM UMRS-1144, Department of Medical and Toxicological Critical Care, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Louis Puybasset
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Didier Dorez
- Organ Donation Service, Centre Hospitalier Annecy-genevois, 1, avenue de l'Hôpital, 74370 Epagny Metz-Tessy, France
| | - Benoît Veber
- SFAR Ethics Committee, Surgical Intensive Care Unit, Rouen University Hospital, 37, boulevard Gambetta, 76000 Rouen, France
| | - François Kerbaul
- Agence de la biomédecine, Medical and Scientific Department, 1, avenue du stade de France, 93212 Saint-Denis, France
| | - Corinne Antoine
- Agence de la biomédecine, Medical and Scientific Department, 1, avenue du stade de France, 93212 Saint-Denis, France
| |
Collapse
|
17
|
Essayagh B, Benfari B, Antoine C, Grigioni F, Le Tourneau T, Roussel J, Bax J, Delgado V, Ajmone N, Van Wijngaarden A, Tribouilloy C, Hochstadt A, Topilsky Y, Michelena H, Enriquez-Sarano M. The MIDA quantitative mortality risk score: Prognostic model in floppy mitral valves. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.126] [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: 12/01/2022]
|
18
|
Legeai C, Savoye E, Cantrelle C, Jasseron C, Santin G, Brousse G, Duman M, Foubert F, Mahmoudi R, Deshayes A, Antoine C, Kerbaul F. Impact of COVID-19 on 2020 transplant activity and waiting lists in France ✰,✰✰. J Liver Transpl 2022; 5:100051. [PMID: 38620879 PMCID: PMC8844634 DOI: 10.1016/j.liver.2021.100051] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic strongly affected organ procurement and transplantation in France, despite the intense efforts of all participants in this domain. In 2020, the identification and procurement of deceased donors fell by 12% and 21% respectively, compared with the mean of the preceding 2 years. Similarly, the number of new registrations on the national waiting list declined by 12% and the number of transplants by 24%. The 3-month cumulative incidence of death or drop out for worsening condition of patients awaiting a liver transplant was significantly greater in 2020 compared to the previous 2 years. Continuous monitoring at the national level of early post-transplant outcomes showed no deterioration for any organ in 2020. At the end of 2020, less than 1% of transplant candidates and less than 1% of graft recipients - of any organ - had died of COVID-19.
Collapse
Affiliation(s)
- C Legeai
- Organ and Tissue Procurement and Transplantation Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - E Savoye
- Organ and Tissue Procurement and Transplantation Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - C Cantrelle
- Organ and Tissue Procurement and Transplantation Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - C Jasseron
- Organ and Tissue Procurement and Transplantation Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - G Santin
- Organ and Tissue Procurement and Transplantation Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - G Brousse
- Data Quality Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - M Duman
- Data Quality Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - F Foubert
- Data Quality Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - R Mahmoudi
- Data Quality Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - A Deshayes
- Data Quality Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - C Antoine
- Organ and Tissue Procurement and Transplantation Department, Agence de la biomédecine, Saint Denis La Plaine, France
| | - F Kerbaul
- Organ and Tissue Procurement and Transplantation Department, Agence de la biomédecine, Saint Denis La Plaine, France
| |
Collapse
|
19
|
Essayagh B, Sabbag A, Antoine C, Benfari G, Maalouf J, Asirvatham S, Michelena H, Enriquez-Sarano M. The Arrhythmic mitral valve prolapse: Presentation and outcome. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.125] [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]
|
20
|
Essayagh B, Sabbag A, Antoine C, Benfari G, Maalouf J, Thapa P, Asirvatham S, Michelena H, Enriquez-Sarano M. The Mitral Annulus disjunction in mitral valve prolapse: Presentation and outcome. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.138] [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: 12/01/2022]
|
21
|
Essayagh B, Benfari G, Antoine C, Maalouf J, Pislaru S, Thapa P, Michelena H, Enriquez-Sarano M. Incremental prognosis by left atrial functional assessment: The left atrial coupling index in patients with floppy mitral valves. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.141] [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: 11/26/2022]
|
22
|
Mesnard B, Cantarovich D, Martin-Lefevre L, Rigaud J, Blancho G, Karam G, Badet L, Antoine C, Branchereau J. First French combined kidney/pancreas transplantation from controlled donation after circulatory arrest (Maastricht III). Prog Urol 2021; 32:1-2. [PMID: 34772617 DOI: 10.1016/j.purol.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/09/2021] [Indexed: 10/19/2022]
Affiliation(s)
- B Mesnard
- Clinique urologique, hôpital Hôtel-Dieu, CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Université de Nantes, Nantes, France
| | - D Cantarovich
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Université de Nantes, Nantes, France
| | | | - J Rigaud
- Clinique urologique, hôpital Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - G Blancho
- Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Université de Nantes, Nantes, France
| | - G Karam
- Clinique urologique, hôpital Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - L Badet
- Hospices civils de Lyon, hôpital Edouard-Herriot, Lyon, France
| | - C Antoine
- Direction générale médicale et scientifique, agence de la biomédecine (ABM), Saint-Denis, France
| | - J Branchereau
- Clinique urologique, hôpital Hôtel-Dieu, CHU de Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Université de Nantes, Nantes, France.
| |
Collapse
|
23
|
Essayagh B, Benfari G, Antoine C, Grigioni F, Le Tourneau T, Roussel JC, Bax J, Delgado V, Ajmone N, Van Wijngaarden A, Tribouilloy C, Hochstadt A, Topilsky Y, Michelena H, Enriquez-Sarano M. The MIDA quantitative mortality risk score: prognostic model in floppy mitral valves. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1699] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Mitral Regurgitation International Database (MIDA) score is a validated tool for Degenerative Mitral Regurgitation (DMR) management, being able to position a given patient within a continuous spectrum of short and long term mortality. However, whether this score may be applicable and incremental in the entire span of Floppy Mitral Valves (FMV), regardless of DMR severity, remains unsubstantiated.
Methods
The MIDA-Quantitative (MIDA-Q) unprecedented registries include 8187 consecutive patients (age 64±17 years, 45% women, follow-up 5.5±3.4 years) with isolated degenerative mitral valve disease diagnosed at tertiary (European/ North-American/ Middle Eastern) centers in whom DMR severity used both integrative and quantitative grading. The MIDA-Q Score ranged from 0 to 15 depending on accumulating risk factors. Long-term survival overall, under medical management and post-mitral surgery was analysed.
Results
By quantitative grading, MR was no/trivial in 1938 (24%), mild in 1423 (17%), moderate in 2027 (25%) and severe in 2799 (34%), with ERO 0.24±24cm2, RVol 37±35mL, and posterior leaflet prolapse in 49%. MIDA-Q Scores stratified in 8 categories were 0 (score 0, n=851), 1 (score 1–2, n=1301), 2 (score 3–4, n=2043), 3 (score 5–6, n=1581), 4 (score 7–8, n=1273), 5 (score 9–10, n=718), 6 (score 11–12, n=331) and 7 (score 13–15, n=89). In the whole MIDA-Q population (n=8187 patients), 5-year survival under medical management with Scores categories 0–1, 2–4, and 5–7 was 96±1%, 73±1%, and 61±3% respectively (P<0.0001). Five-year mortality ranged from 3% with MIDA Q-score 0 to 95% with MIDA Q-score 13–15 (P<0.0001). After mitral surgery, 1-year mortality with Scores categories 0–1, 2–4, and 5–7 was 0%, 1%, and 6% respectively and 5-year post-operative survival was 99±1%, 94±1%, and 82±2% (all P<0.0001). In models including age, sex and all guideline-provided prognostic markers, the EuroScoreII and the MIDA Score without DMR severity, the MIDA-Q Score provided incremental prognostic information (P<0.001).
Conclusion
This unheard international cohort of patients with FMV and prospective mitral severity quantitative grading, enables for the first time the calculation of a MIDA-Q Score, highly determinant of survival after diagnosis of FMV with any degree of DMR, that may be very useful for mitral valve prolapse management.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Mayo Fundation Figure 1
Collapse
Affiliation(s)
- B Essayagh
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - G Benfari
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - C Antoine
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - F Grigioni
- Campus Bio-Medico University of Rome, Department of Cardiology, Rome, Italy
| | - T Le Tourneau
- University Hospital of Nantes, Department of Cardiology, Nantes, France
| | - J C Roussel
- University Hospital of Nantes, Department of Cardiothoracic Surgery, Nantes, France
| | - J Bax
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - N Ajmone
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - A Van Wijngaarden
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)
| | - C Tribouilloy
- University Hospital of Amiens, Department of Cardiology, Amiens, France
| | - A Hochstadt
- Tel Aviv University, Department of Cardiology, Tel Aviv, Israel
| | - Y Topilsky
- Tel Aviv University, Department of Cardiology, Tel Aviv, Israel
| | - H Michelena
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - M Enriquez-Sarano
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| |
Collapse
|
24
|
Savoye E, Legeai C, Branchereau J, Gay S, Riou B, Gaudez F, Veber B, Bruyere F, Cheisson G, Kerforne T, Badet L, Bastien O, Antoine C. Optimal donation of kidney transplants after controlled circulatory death. Am J Transplant 2021; 21:2424-2436. [PMID: 36576341 DOI: 10.1111/ajt.16425] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/07/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Controlled donation after circulatory death (cDCD) is used for "extended criteria" donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12-1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20-2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31-2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol.
Collapse
Affiliation(s)
- Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Camille Legeai
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Julien Branchereau
- Department of Urology, Nantes University Hospital, University of Nantes, Nantes, France
| | - Samuel Gay
- Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France
| | - Bruno Riou
- Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francois Gaudez
- Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | | | - Gaelle Cheisson
- Department of Surgical Anesthesia and Intensive Care, South Paris University hospital, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thomas Kerforne
- Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lionel Badet
- Groupement Hospitalier Edouard Herriot, Service d'urologie chirurgie de la Transplantation, Lyon, France
| | - Olivier Bastien
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Corinne Antoine
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | | |
Collapse
|
25
|
Delarbre D, Gan L, Antoine C, Poisnel E, Cambon A, Dutasta F, Paris JF, Simon F, Defuentes G. [Diagnostic issues of Whipple's disease during chronic inflammatory rheumatism: About three cases]. Rev Med Interne 2021; 42:801-804. [PMID: 34218934 DOI: 10.1016/j.revmed.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/12/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Whipple's disease (WD) can mimic chronic inflammatory rheumatism leading to incorrect prescription of tumor necrosis factor inhibitors (TNFI). Several complicated cases of WD have been reported during TNFI treatment which is strongly suspected to modify the host-pathogen relationship. Tropheryma whipplei asymptomatic carriage is high in the general population, making the diagnosis of WD more difficult face to unexplained arthritis. OBSERVATIONS We report three observations that illustrate situations for which the detection of T. whipplei might be valuable to investigate the differential diagnosis of inflammatory rheumatism. CONCLUSION The decision to check for T. whipplei infection should rely on individual clinical assessment. It should be considered in the absence of clinical response or in case of worsening of an inflammatory rheumatism under TNFI treatment, especially in front of atypical features. A systematic screening for T. whipplei before anti-TNF treatment seems unjustified since asymptomatic carriers are frequent.
Collapse
Affiliation(s)
- D Delarbre
- Service de médecine interne, Hôpital d'instruction des armées Sainte-Anne, 1, boulevard Sainte Anne, 83000 Toulon, France.
| | - L Gan
- Service de pathologie digestive, Hôpital d'instruction des armées Sainte-Anne, 1 boulevard Sainte-Anne, 83000 Toulon, France
| | - C Antoine
- Service de médecine interne, Hôpital d'instruction des armées Sainte-Anne, 1, boulevard Sainte Anne, 83000 Toulon, France
| | - E Poisnel
- Service de médecine interne, Hôpital d'instruction des armées Sainte-Anne, 1, boulevard Sainte Anne, 83000 Toulon, France
| | - A Cambon
- Service de médecine interne, Hôpital d'instruction des armées Sainte-Anne, 1, boulevard Sainte Anne, 83000 Toulon, France
| | - F Dutasta
- Service de médecine interne, Hôpital d'instruction des armées Sainte-Anne, 1, boulevard Sainte Anne, 83000 Toulon, France
| | - J F Paris
- Service de médecine interne, Hôpital d'instruction des armées Sainte-Anne, 1, boulevard Sainte Anne, 83000 Toulon, France
| | - F Simon
- CEO & directeur scientifique, RISK&VIR, France; Inserm-IRD-Aix Marseille université, unité des virus émergents, France
| | - G Defuentes
- Service de médecine interne, Hôpital d'instruction des armées Sainte-Anne, 1, boulevard Sainte Anne, 83000 Toulon, France
| |
Collapse
|
26
|
Hamroun A, Gibier JB, Maanaoui M, Lionet A, Gnemmi V, Bouyé S, Fantoni JC, Averland B, Antoine C, Lenain R, Hazzan M, Provôt F. Successful Reuse of Kidney Graft After Early Recurrence of Primary Focal and Segmental Glomerulosclerosis. Am J Kidney Dis 2021; 78:897-901. [PMID: 34118304 DOI: 10.1053/j.ajkd.2021.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/07/2020] [Accepted: 03/26/2021] [Indexed: 11/11/2022]
Abstract
Primary focal and segmental glomerulosclerosis (FSGS) frequently recurs after transplantation and is associated with a poor prognosis. We describe here the successful kidney graft reuse in an adult recipient, 8 months after early primary FSGS recurrence resistant to all available therapeutics. Patient 1, a 23-year-old man, followed for kidney failure secondary to primary FSGS, was first transplanted in 2018 with a deceased donor graft. Unfortunately, we observed an immediate recurrence of biopsy-proven primary FSGS. After 4 lines of treatment (intravenous cyclosporine+corticosteroids, plasma exchanges, immunoadsorption, and rituximab), the patient was still highly nephrotic and kidney function was slowly deteriorating. After approval from both the patient and the health authority (Biomedicine Agency), the graft was detransplanted 8 months after transplantation and reimplanted in patient 2, a 78-year-old nonimmunized and anephric recipient (bi-nephrectomy 2 years previously for bilateral renal carcinoma). We observed immediate kidney function and progressive resolution of proteinuria (serum creatinine of 1.2mg/dL and proteinuria of 0.1 g/d 1 year later). Biopsies performed after surgery showed persistent FSGS lesions with a decrease in overall foot-process effacement. To our knowledge, this is the first reported case showing that kidney graft transfer may still be a viable option for refractory primary FSGS several months after transplantation.
Collapse
Affiliation(s)
- Aghilès Hamroun
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France; Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, Villejuif, France.
| | - Jean-Baptiste Gibier
- Department of Pathology, Pathology Institute, Lille University, Regional and University Hospital Center of Lille, Inserm UMR-S1172 Lille, JPARC-Jean-Pierre Aubert Research Center, Team "Mucins, Epithelial Differentiation and Carcinogenesis," F-59037 Lille, France
| | - Mehdi Maanaoui
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France; INSERM U1190, Translational Research for Diabetes, Lille, France
| | - Arnaud Lionet
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - Viviane Gnemmi
- Department of Pathology, Pathology Institute, Lille University, Regional and University Hospital Center of Lille, Inserm UMR-S1172 Lille, JPARC-Jean-Pierre Aubert Research Center, Team "Mucins, Epithelial Differentiation and Carcinogenesis," F-59037 Lille, France
| | - Sébastien Bouyé
- Urology, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | | | | | - Corinne Antoine
- Agence de la Biomédecine, Saint-Denis, France; Nephrology and Kidney Transplantation, Hospital Saint Louis, Paris, France
| | - Rémi Lenain
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France; INSERM UMR1246 - SPHERE, Nantes University, Tours University, Nantes, France
| | - Marc Hazzan
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France
| | - François Provôt
- Departments of Nephrology, Dialysis, Transplantation, and Apheresis, Lille University, Regional and University Hospital Center of Lille, Lille, France
| |
Collapse
|
27
|
Essayagh B, Sabbag A, Antoine C, Benfari G, Batista R, Yang L, Maalouf J, Asirvatham S, Michelena H, Enriquez-Sarano M. The mitral annulus disjunction of mitral valve prolapse: Presentation and outcome. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.022] [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]
|
28
|
Essayagh B, Benfari G, Antoine C, Maalouf J, Enriquez-Sarano M. Atrial coupling index by standard echocardiography in Degenerative Mitral Regurgitation: An incremental determinant of survival. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.023] [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]
|
29
|
Honselmann KC, Antoine C, Frohneberg L, Deichmann S, Bolm L, Braun R, Lapshyn H, Petrova E, Keck T, Wellner U, Bausch D. A simple nomogram for early postoperative risk prediction of clinically relevant pancreatic fistula after pancreatoduodenectomy. Langenbecks Arch Surg 2021; 406:2343-2355. [PMID: 34009458 PMCID: PMC8578094 DOI: 10.1007/s00423-021-02184-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 07/23/2020] [Accepted: 04/28/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Postoperative pancreatic fistulae (POPF) present a serious and life-threatening complication after pancreatic head resections (PD). Therefore, reliable risk stratification to identify those at risk is urgently needed. The aim of this study was to identify postoperative laboratory parameters for the prediction of POPF in the early postoperative period. METHODS One hundred eighty-two patients who underwent PD from 2012 until 2017 were retrospectively analyzed. Multivariate logistic regression was performed using the GLM (general linear model) method for model building. Two nomograms were created based on the GLM models of postoperative day one and postoperative day one to five. A cohort of 48 patients operated between 2018 and 2019 served as internal validation. RESULTS Clinically relevant pancreatic fistulae (CR-POPF) were present in 16% (n = 29) of patients. Patients with CR-POPF experienced significantly more insufficiencies of gastroenterostomies, delayed gastric emptying, and more extraluminal bleeding than patients without CR-POPF. Multivariate analysis revealed multiple postoperative predictive models, the best one including ASA, main pancreatic duct diameter, operation time, and serum lipase as well as leucocytes on day one. This model was able to predict CR-POPF with an accuracy of 90% and an AUC of 0.903. Two nomograms were created for easier use. CONCLUSION Clinically relevant fistula can be predicted using simple laboratory and clinical parameters. Not serum amylase, but serum lipase is an independent predictor of CR-POPF. Our simple nomograms may help in the identification of patients for early postoperative interventions.
Collapse
Affiliation(s)
- K C Honselmann
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - C Antoine
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - L Frohneberg
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - S Deichmann
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - L Bolm
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - R Braun
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - H Lapshyn
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - E Petrova
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - T Keck
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - U Wellner
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - D Bausch
- Department of Surgery, University Cancer Center, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. .,Department of Surgery, Marien Hospital Herne-University Medical Center of the Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| |
Collapse
|
30
|
Essayagh B, Benfari G, Antoine C, Maalouf J, Michelena H, Sarano M. Atrial coupling-index by standard echocardiography in degenerative mitral regurgitation: An incremental determinant of survival. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.186] [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: 11/26/2022]
|
31
|
Essayagh B, Antoine C, Benfari G, Maalouf J, Michelena H, Crestanello J, Thapa P, Avierinos J, Sarano M. Functional tricuspid regurgitation of degenerative mitral valve disease: A crucial determinant of survival. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.181] [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]
|
32
|
Antoine C, Laforêt F, Blasdel B, Glonti T, Kutter E, Pirnay JP, Mainil J, Delcenserie V, Thiry D. Efficacy assessment of PEV2 phage on Galleria mellonella larvae infected with a Pseudomonas aeruginosa dog otitis isolate. Res Vet Sci 2021; 136:598-601. [PMID: 33895568 DOI: 10.1016/j.rvsc.2021.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/29/2020] [Revised: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
Pseudomonas (P.) aeruginosa is the most frequently isolated Gram-negative bacteria in dog otitis. Antimicrobial resistance is particularly prevalent in P. aeruginosa and phage therapy represents a promising alternative therapeutic strategy. The aim of this study was to assess the efficacy of the PEV2 phage against a clinical P. aeruginosa isolate from a canine otitis using a Galleria (G.) mellonella larvae model. The genomic DNA of PAV237 P. aeruginosa isolate was sequenced and analysed. In a first main experiment, the efficacy of PEV2 phage against PAV237 was assessed at different multiplicities of infection (MOI) (50,000, 5000, 500, 50) by analyzing the larvae survival rate during 4 days. In a second experiment, the bacterial and phage titer evolutions were assessed depending on two MOIs (50,000, 5000). No significant survival increase was observed with PEV2 therapy in the infected larvae groups. The generated Kaplan-Meier curves showed that the rate of alive larvae was significantly higher in the non-infected larvae compared to the infected-treated ones irrespective of phage MOIs. An increase of the phage titer was observed at 24 and 48 h post-inoculation (HPI) with both MOIs and the P. aeruginosa titers were lower with MOI 50,000 and 5000 compared to the infectivity control at 24 and 48 HPI. Even if an ineffectiveness of the PEV2 phage was observed on the larvae survival, PEV2 is active against P. aeruginosa in this model and PEV2 replication is correlated with a lower bacterial proliferation in the phage treated larvae.
Collapse
Affiliation(s)
- C Antoine
- Bacteriology, Department of Infectious and Parasitic Diseases, FARAH and Faculty of Veterinary Medicine, ULiège, 4000 Liège, Belgium; Food Science Department, FARAH and Faculty of Veterinary Medicine, ULiège, 4000 Liège, Belgium
| | - F Laforêt
- Bacteriology, Department of Infectious and Parasitic Diseases, FARAH and Faculty of Veterinary Medicine, ULiège, 4000 Liège, Belgium; Food Science Department, FARAH and Faculty of Veterinary Medicine, ULiège, 4000 Liège, Belgium
| | - B Blasdel
- Vésale Bioscience, Vésale Pharmaceutica, 5310, Noville sur Mehaigne, Belgium
| | - T Glonti
- Laboratory for Molecular and Cellular Technology (LabMCT), Queen Astrid Military Hospital, Neder-over-Heembeek, Belgium
| | - E Kutter
- Evergreen Phage Lab, The Evergreen State College, Olympia, WA, USA
| | - J P Pirnay
- Laboratory for Molecular and Cellular Technology (LabMCT), Queen Astrid Military Hospital, Neder-over-Heembeek, Belgium
| | - J Mainil
- Bacteriology, Department of Infectious and Parasitic Diseases, FARAH and Faculty of Veterinary Medicine, ULiège, 4000 Liège, Belgium
| | - V Delcenserie
- Food Science Department, FARAH and Faculty of Veterinary Medicine, ULiège, 4000 Liège, Belgium
| | - D Thiry
- Bacteriology, Department of Infectious and Parasitic Diseases, FARAH and Faculty of Veterinary Medicine, ULiège, 4000 Liège, Belgium.
| |
Collapse
|
33
|
Bayer F, Audry B, Antoine C, Jasseron C, Legeai C, Bastien O, Jacquelinet C. Removing administrative boundaries using a gravity model for a national liver allocation system. Am J Transplant 2021; 21:1080-1091. [PMID: 32659870 DOI: 10.1111/ajt.16214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/25/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 01/25/2023]
Abstract
Geographic disparities emerged as an increasing issue in organ allocation policies. Because of the sequential and discrete geographical models used for allocation scores, artificial regional boundaries may impede the access of candidates with the greatest medical urgency to vital organs. This article describes a continuous geographical allocation model that provides accurate organ access by introducing a multiplicative interaction between the patient's condition and the distance to the graft by using a gravity model. Patients with the most urgent need will thus have access to organs from farther away, while those in less urgent need may only have access to organs geographically closer. Compared to the previous French liver allocation scheme, the gravity model precluded transplantations for candidates with a Model for End-Stage Liver Disease (MELD) ≤ 14 for decompensated cirrhosis from 10.3% to 0.6%. Death and delisting while on the waiting list at 1 year also decreased from 30.1% to 22.4% for MELD ≥ 35. Waiting list (cumulative hazard ratio (CHR) 0.84 after adjustment) and posttransplant survival improved significantly (hazard ratio = 0.83 after adjustment). This new liver allocation system provides more equitable access to liver transplants and an efficient and safe alternative to administrative boundaries for geographical models in organ allocation.
Collapse
Affiliation(s)
- Florian Bayer
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France
| | - Benoît Audry
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France
| | - Corinne Antoine
- Agence de la Biomédecine, Direction générale médicale et scientifique, Direction Prélèvement Greffe Organes - Tissus, Pôle Stratégie Prélèvement Greffe, Saint-Denis-la-Plaine cedex, France
| | - Carine Jasseron
- Agence de la Biomédecine, Direction générale médicale et scientifique, Direction Prélèvement Greffe Organes - Tissus, Pôle Evaluation - Biostatistique, Saint-Denis-la-Plaine cedex, France
| | - Camille Legeai
- Agence de la Biomédecine, Direction générale médicale et scientifique, Direction Prélèvement Greffe Organes - Tissus, Pôle Evaluation - Biostatistique, Saint-Denis-la-Plaine cedex, France
| | - Olivier Bastien
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France
| | - Christian Jacquelinet
- Agence de la Biomédecine, Medical and Scientific Department, Simulation and Health Geography Units, Saint-Denis La Plaine cedex, France.,Inserm U1018, CESP, Villejuif, France
| |
Collapse
|
34
|
Essayagh B, Benfari G, Antoine C, Batista R, Maalouf J, Michelena H, Enriquez-Sarano M. Atrial coupling index by standard echocardiography in degenerative mitral regurgitation: incremental determinant of survival. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.087] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Mayo Clinic Foundation
Background
Left atrial (LA) volume is linked to outcome in degenerative mitral regurgitation (DMR) but does not encompass LA function assessment. Thus, we ought to determine the prognostic role of left atrial coupling-index (LACI), as left atrial volume-index (LAVI) by Tissue-Doppler-Imaging a’ (TDI-a’), in a large cohort of DMR.
Methods
All consecutive 4792 patients (61 ± 16 years, 48% women) with isolated degenerative mitral valve disease diagnosed at Mayo Clinic 2003-2011, comprehensively characterized, in whom LAVI and TDI-a’ in sinus rhythm was prospectively measured in routine practice, was enrolled and their long-term survival analyzed.
Results
LACI (5.8 ± 3.7–T1 < 3.8; T2 3.8-6.3; T3 > 6.3) was significantly higher through different DMR grades (no, mild, moderate, severe DMR: 3.77 ± 2.26, 5.08 ± 2.95, 6.54 ± 3.74 and 7.84 ±4.29 respectively; p < 0.0001). Independent determinants of LA dysfunction assessed by LACI were age, E/e’, left-ventricle (LV) end-systolic-diameter, mitral-regurgitation (MR) grade, and LV ejection-fraction (all P ≤ 0.0001). LACI > 6 was independently associated with dyspnea, edema, more severe functional tricuspid-regurgitation and elevated pulmonary artery pressure, irrespective of age, sex, Charlson-comorbidity-index, ventricular function and MR severity. Total follow-up was 7.03 ± 3.0 years, during which 1146 (24%) underwent mitral-valve surgery (94% repair-6% replacement) and 880 (18%) died, 780 under medical treatment and 100 after surgery. Overall survival throughout follow-up (10-year 76 ± 1%) was strongly associated with LACI (88 ± 1% vs. 78 ± 1% and 62 ± 2% for LACI <3.8, 3.8-6.3 and ≥6.3, P < 0.0001) even adjusting comprehensively, including for DMR severity (adjusted-hazard-ratio 1.23[1.07-1.43] for LACI > 5.79, P = 0.005). Mortality under medical management was profoundly affected by LACI (adjusted-hazard-ratio 1.11[1.05-1.18] per 3 unit increment; 1.35[1.15-1.58] for LACI > 5.79 vs. ≤5.79, both P = 0.0002). Survival improved after mitral surgery (time-dependent adjusted-hazard-ratio 0.40[0.28-0.65], P < 0.0001) but remained humbly linked to LACI (10-year 93 ± 3% vs. 90 ± 2% and 80 ± 3% for LACI tertiles, P = 0.0008). Most importantly, LACI provided incremental prognostic information over LAVI and other conventional determinants of survival (P < 0.0001) with Net-reclassification-improvement vs. LAVI of 0.21 ± 0.02, P < 0.0001.
Conclusion
LA function assessed by LACI in routine practice, by conventional echocardiographic measurements, displays incremental and independent link to excess-mortality, considerable under medical management and partially alleviated by mitral surgery. Thus, LACI is a simple tool of crucial interest in DMR risk-stratification.
Abstract Figure. LACI in DMR
Collapse
Affiliation(s)
- B Essayagh
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - G Benfari
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - C Antoine
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - R Batista
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - J Maalouf
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - H Michelena
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - M Enriquez-Sarano
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| |
Collapse
|
35
|
Lerosey L, Ksiasek E, Abrahamowicz M, Antoine C, Mouillot T, Darhancy S, Minello A, Granconat L, Binquet C, Latournerie M. L’âge du receveur influence la survie à court et à long terme de la transplantation hépatique. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2020.11.009] [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] Open
|
36
|
Legeai C, Malaquin G, Lamotte C, Antoine C, Averland B, Jasseron C, Bayer F, Bastien O, Kerbaul F. Impact of coronavirus disease 2019 on organ donation and transplantation in France. Transpl Int 2020; 34:204-206. [PMID: 33068462 DOI: 10.1111/tri.13769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Camille Legeai
- Direction Prélèvement Greffe Organe - Tissus, Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - Géraldine Malaquin
- Direction Prélèvement Greffe Organe - Tissus, Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - Christian Lamotte
- Direction Prélèvement Greffe Organe - Tissus, Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - Corinne Antoine
- Direction Prélèvement Greffe Organe - Tissus, Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - Benoît Averland
- Direction Prélèvement Greffe Organe - Tissus, Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - Carine Jasseron
- Direction Prélèvement Greffe Organe - Tissus, Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - Florian Bayer
- Direction Prélèvement Greffe Organe - Tissus, Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - Olivier Bastien
- Direction Prélèvement Greffe Organe - Tissus, Agence de la Biomédecine, La Plaine Saint-Denis, France
| | - François Kerbaul
- Direction Prélèvement Greffe Organe - Tissus, Agence de la Biomédecine, La Plaine Saint-Denis, France
| |
Collapse
|
37
|
Essayagh B, Sabbag A, Antoine C, Benfari G, Maalouf J, Michelena H, Sarano M. The mitral annulus disjunction of mitral valve prolapse: presentation and outcome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1999] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mitral-annulus-disjunction (MAD), often described in mitral-valve-prolapse (MVP) patients, remains incompletely defined and its clinical outcome consequences are unknown.
Objectives
To assess MAD prevalence, clinical and echocardiographic characteristics, and independent impact on outcome in patients with isolated-MVP.
Methods
A cohort of 595 (65±16 years, 278 female) consecutive patients with MVP and comprehensive clinical, rhythmic and Doppler-echocardiographic characterization, was identified. Primary-endpoint was overall-survival, or occurrence of ventricular-arrhythmia. To eliminate clinical differences, we matched MAD-patients 1:1 with no-MAD based on propensity score for overall survival analysis using a greedy 5-to-1 digit-matching algorithm.
Results
MAD was frequent, present in 186 (31%) of MVP-patients and independently associated to bileaflet-MVP, leaflet-redundancy, younger-age, female-sex, enlarged left-ventricle-endsystolic-diameter and higher left-ventricle-ejection-fraction (all P≤0.04). Outcome primary-endpoint of survival after MVP diagnosis in matched-cohort (10-year 95±1%) was not associated with MAD presence (10-year 93±2% for no-MAD and 97±1% for MAD, P=0.4). Mortality was comparable for MAD (univariate-hazard-ratio 0.64 [0.25–1.65], P=0.4 vs. no-MAD), even adjusted-comprehensively including for MVP-characteristics (adjusted-hazard-ratio 1.17 [0.39–3.50], P=0.8). However, 220 (51%) MVP-patients were diagnosed ventricular-arrhythmia (161 with ventricular-tachycardia only) and long-term, MAD was associated with lower arrhythmia- and ventricular-tachycardia- overall freedom (adjusted-hazard-ratio for MAD 2.35 [1.75–3.15], P<0.0001 vs. no-MAD and 2.71 [1.93–3.82], P<0.0001 respectively). Hence, 10-year freedom of significant ventricular-arrhythmia in overall-cohort was severely reduced with MAD (41±4% vs. 62±3% for no-MAD).
Conclusion
In this unique MVP cohort, with arrhythmia and MAD comprehensively-characterized, MAD presence was frequent and independently associated to bileaflet-MVP and leaflet-redundancy. Long-term, MAD compared to no-MAD is not independently associated with higher-mortality but to reduced arrhythmia-freedom occurrence.
Survival overall and by V arrhythmia
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Mayo Foundation
Collapse
Affiliation(s)
- B Essayagh
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - A Sabbag
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - C Antoine
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - G Benfari
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - J Maalouf
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - H Michelena
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - M.E Sarano
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| |
Collapse
|
38
|
Antoine C, Jasseron C, Dondero F, Savier E. Liver Transplantation From Controlled Donors After Circulatory Death Using Normothermic Regional Perfusion: An Initial French Experience. Liver Transpl 2020; 26:1516-1521. [PMID: 32531132 DOI: 10.1002/lt.25818] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/30/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023]
Abstract
A national program of controlled donation after circulatory death (cDCD) began in France in 2014 involving the use of a standardized national protocol that involves the systematic use of normothermic regional perfusion (NRP). In this article, we describe in detail the French cDCD program. Between January 1, 2015, and December 31, 2018, 225 livers were offered for donation, resulting in 123 cDCD liver transplantations (LTs). The overall 90-day graft survival rate was 93.1% (95% confidence interval [CI], 85.9%-96.6%). A total of 21 of 123 LTs (17%) did not adhere strictly to the national protocol. The 1-year graft survival was significantly lower in the group deviating from the national protocol compared with those patients following the national protocol: 68.4% (95% CI, 42.8%-84.4%) versus 94.8% (95% CI, 86.5%-98.0%; P < 0.01). There were 14 patients who died, including 2 after primary 2 after primary non function, and 10 related to liver cancer recurrence. Only 1 case of ischemic cholangiopathy was observed at month 18 in this series, and the patient underwent a successful retransplant. During the first 4 years, excellent LT results were observed where the national protocol was followed. Systematic use of NRP limits liver damage induced by warm ischemia and provides excellent cDCD organs for transplant.
Collapse
Affiliation(s)
- Corinne Antoine
- Direction Générale Médicale et Scientifique, Agence de la Biomédecine, Saint Denis, France
| | - Carine Jasseron
- Direction Générale Médicale et Scientifique, Agence de la Biomédecine, Saint Denis, France
| | - Federica Dondero
- Department of Hepatobiliopancreatic Surgery, Beaujon Hospital, Clichy, France
| | - Eric Savier
- Service de Chirurgie Digestive, Hépato-Bilio-Pancréatique et Transplantation Hépatique, Centre Hospitalier Universitaire Pitié-Salpetriere, Paris, France
| | | |
Collapse
|
39
|
Elias M, Pievani D, Randoux C, Louis K, Denis B, Delion A, Le Goff O, Antoine C, Greze C, Pillebout E, Abboud I, Glotz D, Daugas E, Lefaucheur C. COVID-19 Infection in Kidney Transplant Recipients: Disease Incidence and Clinical Outcomes. J Am Soc Nephrol 2020; 31:2413-2423. [PMID: 32847984 DOI: 10.1681/asn.2020050639] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND COVID-19 has been associated with high morbidity and mortality in kidney transplant recipients. However, risk factors for COVID-19 disease in patients with kidney transplants remain poorly defined. METHODS We enrolled patients who underwent kidney transplantation and were actively followed up in two hospitals in Paris on March 1st, 2020. Patients were screened for baseline and transplant characteristics, functional parameters, comorbidities, and immunosuppressive therapies. COVID-19 disease was assessed. Patients were followed up during the pandemic until April 30th, 2020 by the COVID-19 SLS KT survey program, including teleconsulting, at-home monitoring for patients with COVID-19, and a dedicated phone hotline platform. RESULTS Among 1216 patients with kidney transplants enrolled, 66 (5%) patients were identified with COVID-19 disease, which is higher than the incidence observed in the general population in France (0.3%). Their mean age was 56.4±12.5 years, and 37 (56%) patients were men. The following factors were independently associated with COVID-19 disease: non-White ethnicity (adjusted odds ratio [OR], 2.17; 95% confidence interval [95% CI], 1.23 to 3.78; P=0.007), obesity (OR, 2.19; 95% CI, 1.19 to 4.05; P=0.01), asthma and chronic pulmonary disease (OR, 3.09; 95% CI, 1.49 to 6.41; P=0.002), and diabetes (OR, 3.33; 95% CI, 1.92 to 5.77; P<0.001). The mortality rate related to COVID-19 disease was 1% in the overall study population and 24% in COVID-19-positive patients. CONCLUSIONS Patients with kidney transplants display a high risk of mortality. Non-White ethnicity and comorbidities such as obesity, diabetes, asthma, and chronic pulmonary disease were associated with higher risk of developing COVID-19 disease. It is imperative that policy makers urgently ensure the integration of such risk factors on response operations against COVID-19.
Collapse
Affiliation(s)
- Michelle Elias
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Daniele Pievani
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christine Randoux
- Nephrology Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kevin Louis
- Paris Translational Research Center for Organ Transplantation, INSERM (Institut National de la Santé et de la Recherche Médicale), UMR-S970, Paris, France
| | - Blandine Denis
- Infectious Diseases Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandra Delion
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Océane Le Goff
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Corinne Antoine
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Clarisse Greze
- Nephrology Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Evangeline Pillebout
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Imad Abboud
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Denis Glotz
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Translational Research Center for Organ Transplantation, INSERM (Institut National de la Santé et de la Recherche Médicale), UMR-S970, Paris, France
| | - Eric Daugas
- Nephrology Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmen Lefaucheur
- Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Translational Research Center for Organ Transplantation, INSERM (Institut National de la Santé et de la Recherche Médicale), UMR-S970, Paris, France
| |
Collapse
|
40
|
Winter A, Landais P, Azoulay D, Disabato M, Compagnon P, Antoine C, Jacquelinet C, Daurès JP, Féray C. Should we use liver grafts repeatedly refused by other transplant teams? JHEP Rep 2020; 2:100118. [PMID: 32695966 PMCID: PMC7364172 DOI: 10.1016/j.jhepr.2020.100118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/23/2022] Open
Abstract
Background & Aims In France, liver grafts that have been refused at least 5 times can be “rescued” and allocated to a centre which chooses a recipient from its own waiting list, outside the patient-based allocation framework. We explored whether these “rescued” grafts were associated with worse graft/patient survival, as well as assessing their effect on survival benefit. Methods Among 7,895 candidates, 5,218 were transplanted between 2009 and 2014 (336 centre-allocated). We compared recipient/graft survival between patient allocation and centre allocation, considering a selection bias and the distribution of centre-allocation recipients among the transplant teams. We used a propensity score approach and a weighted Cox model using the inverse probability of treatment weighting method. We also explored the survival benefit associated with centre-allocation grafts. Results There was a significantly higher risk of graft loss/death in the centre allocation group compared to the patient allocation group (hazard ratio 1.13; 95% CI 1.05–1.22). However, this difference was no longer significant for teams that performed more than 7% of the centre-allocation transplantations. Moreover, receiving a centre-allocation graft, compared to remaining on the waiting list and possibly later receiving a patient-allocation graft, did not convey a poorer survival benefit (hazard ratio 0.80; 95% CI 0.60–1.08). Conclusions In centres which transplanted most of the centre-allocation grafts, using grafts repeatedly refused for top-listed candidates was not detrimental. Given the organ shortage, our findings should encourage policy makers to restrict centre-allocation grafts to targeted centres. Lay summary “Centre allocation” (CA) made it possible to save 6 out of 100 available liver grafts that had been refused at least 5 times for use in the top-listed candidates on the national waiting list. In this series, the largest on this topic, we showed that, in centres which transplanted most of the CA grafts, using grafts repeatedly refused for top-listed candidates did not appear to be detrimental. In the context of organ shortage, our results, which could be of interest for any country using this CA strategy, should encourage policy makers to reassess some aspects of graft allocation by restricting CA grafts to targeted centres, fostering the “best” matching between grafts and candidates on the waiting list. Centre allocation (CA) made it possible to save 6 out of 100 liver grafts. 13% higher graft loss/death for CA patients. In transplant centres performing most CA transplants, survival was not impacted.
Collapse
Key Words
- CA, centre allocation
- Centre allocation
- DCD, donation after cardiac death
- DQI, donor quality index
- ES, effect size
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- ICU, intensive care unit
- IPTW, inverse probability of treatment weighting
- LT, liver transplantation
- Liver transplantation
- MELD, model for end-stage liver disease
- PA, patient allocation
- Patient allocation
- Patient and graft survival
- Survival benefit
Collapse
Affiliation(s)
- Audrey Winter
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, University of Montpellier, France
- Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
- Medical Imaging & Informatics, Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Corresponding authors. Address: Clinical Research University Institute, EA2415 641, avenue du doyen Gaston GIRAUD, 34093 Montpellier CEDEX 5, France. Tel.: +33 (0)4 11 75 98 42.
| | - Paul Landais
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, University of Montpellier, France
| | - Daniel Azoulay
- Centre Hépato-Biliaire, Hôpital Paul Brousse, APHP, Villejuif, France
| | - Mara Disabato
- Department of Surgery, Henri Mondor University Hospital, Créteil, France
| | - Philippe Compagnon
- Department of Surgery, Henri Mondor University Hospital, Créteil, France
| | | | | | - Jean-Pierre Daurès
- Department of Biostatistics, UPRES EA2415, Clinical Research University Institute, University of Montpellier, France
- Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
| | - Cyrille Féray
- Centre Hépato-Biliaire, Hôpital Paul Brousse, APHP, Villejuif, France
- Corresponding authors. Address: Clinical Research University Institute, EA2415 641, avenue du doyen Gaston GIRAUD, 34093 Montpellier CEDEX 5, France. Tel.: +33 (0)4 11 75 98 42.
| |
Collapse
|
41
|
Sabbag A, Essayagh B, Antoine C, Benfari G, Malouf J, Asirvatham S, Michelena H, Enriquez-Sarano M. 650The arrhythmic mitral valve prolapse: presentation and outcome. Europace 2020. [DOI: 10.1093/europace/euaa162.351] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The majority of patients with of Mitral-valve-prolapse (MVP) have a excellent prognosis. Until recently most cases of mortality were thought to be related to mitral regurgitation and left ventricular dysfunction. The concept of the arrhythmic MVP emerged to describe cases of sudden cardiac death (SCD) in the presence of isolated MVP yet it’s phonotype remains incompletely and inconsistently defined.
Purpose
To analyze the prevalence, severity and characteristics of ventricular-arrhythmia (VA), to determine it’s phenotypical context and independent impact on outcome in patients with MVP.
Methods
A cohort of 595 (65 ± 16 years, 278 female) consecutive patients with MVP and comprehensive clinical, arrhythmia (24hour-Holter) and Doppler-echocardiographic characterization, was identified and long-term outcome analyzed.
Results
VA was frequent, present in 43% of patients with at least ventricular ectopy≥5%, but was most often moderate (ventricular-tachycardia—VT 120-179bpm) in 27% and rarely severe (VT≥180/min) in 8.6%. Presence of VA was associated with older age, male sex, bileaflet-prolapse, marked leaflet redundancy, mitral-annulus-disjunction (MAD), larger left-atrium and left ventricular end-systolic diameter, and T-wave-inversion/ST-depression (all P ≤ 0.001). Severe VA was independently associated with presence of MAD, leaflet-redundancy and T-wave-inversion/ST-depression (all P < 0.0001) but not with mitral regurgitation severity or ejection-fraction. Outcome primary endpoint of overall survival after arrhythmia diagnosis (8-year 87 ± 2%) was strongly associated with arrhythmia-severity (8-year 90 ± 2% for no/trivial arrhythmia, 85 ± 3% for mild/moderate and 76 ± 7% for severe arrhythmia. P = 0.02, Figure). Excess-mortality was substantial for severe-arrhythmia (univariate-hazard-ratio 2.70[1.27-5.77], P = 0.01 vs. no/trivial arrhythmia), even adjusted comprehensively including for MVP-characteristics (adjusted-hazard-ratio 2.94[1.36-6.36], P = 0.006) ).
Conclusions
This large cohort of isolated consecutive MVP characterized with 24-hour-Holter monitoring, clinical and Echocardiographic assessment, demonstrates that VA are frequent with MVP but rarely severe. The arrhythmic MVP was independently and strongly associated with specific ECG and morphologic patterns, particularly ST-T changes, MAD presence and marked leaflet redundancy, suggestive of a specific arrhythmic MVP phenotype, independently of MR-severity. Arrhythmia, particularly severe, is associated with long-term excess-mortality, independently of any other characteristics, including MR severity and LVEF. These findings lay the foundation for novel risk-stratification of MVP for the conduct of prospective controlled studies evaluating the management of MVP high-risk patients.
Figure – Impact on survival of ventricular arrhythmia
Overall survival of MVP stratified by ventricular arrhythmia (Panel A) or ventricular arrhythmia severity (Panel B) throughout follow-up.
Abstract Figure.
Collapse
Affiliation(s)
- A Sabbag
- Sheba Medical Center, Heart Institute, Ramat Gan, Israel
| | - B Essayagh
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - C Antoine
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - G Benfari
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - J Malouf
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - S Asirvatham
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - H Michelena
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - M Enriquez-Sarano
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| |
Collapse
|
42
|
Sanchez C, Hemmer K, Kroemmelbein N, Seilheimer B, Dubuc JE, Antoine C, Henrotin Y. AB0072 A MULTICOMPONENT MEDICATION PROMOTES CHONDROGENESIS AND REDUCES MMP-13 IN PRIMARY ARTICULAR CHONDROCYTES FROM KNEE OSTEOARTHRITIS PATIENTS IN VITRO. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2106] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:HE-1100 is a multicomponent medicinal product. Initial preclinical data potentially suggest a preventive effect on cartilage degradation.Objectives:This study aims to understand the mode of action of HE-1100 on OA chondrocytesin vitro.Methods:Primary chondrocytes were obtained from 10 knee osteoarthritis (OA) patients undergoing knee replacement surgery. The cultures were treated with 20% (v/v) HE-1100 or placebo. Samples were collected for subsequent RNA extraction using standard methods. The reads were generated with Illumina NextSeq5000 sequencer and aligned to the human reference genome (UCSC hg19) to generate the transcriptome. Differential expression analysis between HE-1100 and placebo was made in R using the DESeq2 package to identify the differentially expressed genes in the OA-associated regulatory pathways. The protein production of the selected genes was quantified by ELISA in 10 independent human OA chondrocytes cultures.Results:According to the DESeq2 analysis, HE-1100 significantly modified the expression of 13 genes in OA chondrocytes by at least 10% with an adjusted p-value < 0.05: EGR1 (+93%), FOS (+87%), NR4A1 (+43%), DUSP1 (+18%), ZFP36 (+18%), ZFP36L1 (+14%), NFKBIZ (+16%) and CYR61 (+14%) were upregulated and ATF7IP (-10%), TXNIP (-11%), C10orf10 (-12%), CLEC3A (-12%) and MMP13 (-18%) were downregulated after 24h HE-1100 treatment. HE-1100 significantly increased (2.3 fold +/-1.2 after 24h, p=0.0444 and 2.3-fold +/-1.0 after 72h, p=0.0239) the CYR61 protein production by human OA chondrocytes. After 72h, HE-1100 slightly but not significantly increased aggrecan production by 14 ± 19 % (p=0.1117) and significantly increased type II collagen pro-peptide production by 27 ± 20 % (p=0.0147). For both time points CYR61 production by OA chondrocytes was positively and significantly correlated with aggrecan (r=0.66, p=0.0004) and type II collagen pro-peptide (r=0.64, p=0.0008) production. In alginate beads culture, pro-MMP-13 was significantly decreased by HE-1100 treated cultures from day 7 to day 14 (from -16 to -25 %, p<0.05) and from day 17 to 21 (-22 %, p=0.0331) in comparison to controls.Conclusion:HE-1100 significantly modified the expression of DUSP1, C10orf10, ZFP36/L1 and CLEC3A, which are pathway mediators involved in MMP-13 expression and activation. Further, long-term (28 days) treatment with HE-1100 significantly reduced the production of pro-MMP-13, the inactive precursor of the metalloproteinase MMP-13 involved in type II collagen degradation. HE-1100 also promoted extracellular matrix formation probably through CYR61 production, a growth factor well correlated with type II collagen and aggrecan production.References:/Acknowledgments:We would like to thank the staff of the GIGA ULiège Genomic Next Generation Sequencing platform for performing the RNA sequencing and Benoit Charloteaux for his help in RNAseq data analysis.Disclosure of Interests:christelle sanchez: None declared, Kathrin Hemmer Employee of: Heel, Natascha Kroemmelbein Employee of: Heel, Bernd Seilheimer Employee of: Heel, Jean-Emile Dubuc: None declared, Christophe Antoine Employee of: Artialis, Yves Henrotin Grant/research support from: HEEL, TILMAN
Collapse
|
43
|
Winter A, Féray C, Antoine C, Azoulay D, Daurès JP, Landais P. Matching Graft Quality to Recipient's Disease Severity Based on the Survival Benefit in Liver Transplantation. Sci Rep 2020; 10:4111. [PMID: 32139780 PMCID: PMC7057972 DOI: 10.1038/s41598-020-60973-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/20/2019] [Accepted: 02/14/2020] [Indexed: 01/04/2023] Open
Abstract
Persistent shortage and heterogeneous quality of liver grafts encourages the optimization of donor-recipient matching in liver transplantation (LT). We explored whether or not there was a survival benefit (SB) of LT according to the quality of grafts assessed by the Donor Quality Index (DQI) and recipients' disease severity, using the Model for End-Stage Liver Disease (MELD) in 8387 French patients wait-listed between 2009 and 2014. SB associated with LT was estimated using the sequential stratification method in different categories of MELD and DQI. For each transplantation, a stratum was created that matched one transplanted patient with all eligible control candidates. Strata were thereafter combined, and a stratified Cox model, adjusted for covariates, was fitted in order to estimate hazard ratios that qualified the SB according to each MELD and DQI sub-group. A significant SB was observed for all MELD and DQI sub-groups, with the exception of high MELD patients transplanted with "high-risk" grafts. More specifically, in decompensated-cirrhosis patients, "high-risk" grafts did not appear to be detrimental in medium MELD patients. Interestingly, in hepatocellular-carcinoma (HCC) patients, a significant SB was found for all MELD-DQI combinations. For MELD exceptions no SB was found. In terms of SB, "low-risk" grafts appeared appropriate for most severe patients (MELD > 30). Conversely, low/medium MELD and HCC patients presented an SB while allocated "high-risk" grafts. Thus, SB based matching rules for LT candidates might improve the survival of the LT population as a whole.
Collapse
Affiliation(s)
- Audrey Winter
- University of Montpellier, Department of Biostatistics, UPRES EA2415, Clinical Reasearch University Institute, Montpellier, France. .,Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France. .,Department of Radiological Sciences, Medical Imaging & Informatics, University of California, Los Angeles, CA, USA.
| | - Cyrille Féray
- Centre Hépato-Biliaire, INSERM 1193, Paul Brousse Hospital, Villejuif, France
| | | | - Daniel Azoulay
- Centre Hépato-Biliaire, INSERM 1193, Paul Brousse Hospital, Villejuif, France
| | - Jean-Pierre Daurès
- University of Montpellier, Department of Biostatistics, UPRES EA2415, Clinical Reasearch University Institute, Montpellier, France.,Beau Soleil Clinic, Languedoc Mutualité, Montpellier, France
| | - Paul Landais
- University of Montpellier, Department of Biostatistics, UPRES EA2415, Clinical Reasearch University Institute, Montpellier, France
| |
Collapse
|
44
|
Hoareau D, Rita M, Antoine C, Lhote F. Intoxication aiguë au sulfate de cuivre compliquée de défaillance multiviscérale avec insuffisance rénale chez une patiente de 42 ans : étude de cas. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.300] [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: 12/01/2022]
|
45
|
Bougouin W, Dumas F, Lamhaut L, Marijon E, Carli P, Combes A, Pirracchio R, Aissaoui N, Karam N, Deye N, Sideris G, Beganton F, Jost D, Cariou A, Jouven X, Adnet F, Agostinucci JM, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Benhamou D, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Crahes M, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Dhonneur G, Diehl JL, Dinanian S, Domanski L, Dreyfuss D, Duboc D, Dubois-Rande JL, Dumas F, Empana JP, Extramiana F, Fartoukh M, Fieux F, Gabbas M, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Hidden Lucet F, Jabre P, Jacob L, Joseph L, Jost D, Jouven X, Karam N, Kassim H, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt CE, Maltret A, Mansencal N, Mansouri N, Marijon E, Marty J, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira JP, Monnet X, Narayanan K, Ngoyi N, Perier MC, Piot O, Pirracchio R, Plaisance P, Plu I, Raux M, Revaux F, Ricard JD, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharifzadehgan A, Sideris G, Spaulding C, Teboul JL, Timsit JF, Tourtier JP, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J 2019; 41:1961-1971. [DOI: 10.1093/eurheartj/ehz753] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/26/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes.
Methods and results
We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002).
Conclusions
In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.
Collapse
Affiliation(s)
- Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Florence Dumas
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Eloi Marijon
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Pierre Carli
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Alain Combes
- Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpétrière Hospital, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Romain Pirracchio
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Surgical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nadia Aissaoui
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicole Karam
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicolas Deye
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Medical ICU, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Georgios Sideris
- Cardiology Department, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Frankie Beganton
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Brigade de Sapeurs Pompiers de Paris (BSPP), 1 Place Jules Renard, 75017 Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical Intensive Care Unit, Cochin Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Tordjman S, Anderson GM, Charrier A, Oriol C, Kermarrec S, Canitano R, Botbol M, Coulon N, Antoine C, Brailly-Tabard S, Cohen D, Haidar H, Trabado S, Carlier M, Bronsard G, Mottron L. Relationships Between Self-Injurious Behaviors, Pain Reactivity, and β-Endorphin in Children and Adolescents With Autism. J Clin Psychiatry 2019; 79. [PMID: 29617065 DOI: 10.4088/jcp.16m10889] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/08/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Autism and certain associated behaviors including self-injurious behaviors (SIB) and atypical pain reactivity have been hypothesized to result from excessive opioid activity. The objective of this study was to examine the relationships between SIB, pain reactivity, and β-endorphin levels in autism. METHODS Study participants were recruited between 2007 and 2012 from day care centers and included 74 children and adolescents diagnosed with autism (according to DSM-IV-TR, ICD-10, and CFTMEA) and intellectual disability. Behavioral pain reactivity and SIB were assessed in 3 observational situations (parents at home, 2 caregivers at day care center, a nurse and child psychiatrist during blood drawing) using validated quantitative and qualitative scales. Plasma β-endorphin concentrations were measured in 57 participants using 2 different immunoassay methods. RESULTS A high proportion of individuals with autism displayed SIB (50.0% and 70.3% according to parental and caregiver observation, respectively). The most frequent types of SIB were head banging and hand biting. An absence or decrease of overall behavioral pain reactivity was observed in 68.6% and 34.2% of individuals with autism according to parental and caregiver observation, respectively. Those individuals with hyporeactivity to daily life accidental painful stimuli displayed higher rates of self-biting (P < .01, parental evaluation). No significant correlations were observed between β-endorphin level and SIB or pain reactivity assessed in any of the 3 observational situations. CONCLUSIONS The absence of any observed relationships between β-endorphin level and SIB or pain reactivity and the conflicting results of prior opioid studies in autism tend to undermine support for the opioid theory of autism. New perspectives are discussed regarding the relationships found in this study between SIB and hyporeactivity to pain.
Collapse
Affiliation(s)
- Sylvie Tordjman
- PHUPEA (Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent), CHGR, Université de Rennes 1, 154 rue de Châtillon, Rennes 35000, France. .,Hospital-University Department of Child and Adolescent Psychiatry, CHGR and University of Rennes 1, Rennes, France.,Laboratory of Psychology of Perception, CNRS UMR 8158, Paris, France
| | - George M Anderson
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Annaëlle Charrier
- Hospital-University Department of Child and Adolescent Psychiatry, CHGR and University of Rennes 1, Rennes, France
| | - Cécile Oriol
- Hospital-University Department of Child and Adolescent Psychiatry, CHGR and University of Rennes 1, Rennes, France
| | - Solenn Kermarrec
- Hospital-University Department of Child and Adolescent Psychiatry, CHGR and University of Rennes 1, Rennes, France.,Laboratory of Psychology of Perception, CNRS UMR 8158, Paris, France
| | - Roberto Canitano
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, Siena, Italy
| | - Michel Botbol
- Hospital-University Department of Child and Adolescent Psychiatry, UBO, Brest, France
| | - Nathalie Coulon
- Laboratory of Psychology of Perception, CNRS UMR 8158, Paris, France
| | | | - Sylvie Brailly-Tabard
- INSERM U 693, University Paris-South, School of Medicine Paris-South; AP-HP, CHU Bicêtre, Department of Molecular Genetics, Pharmacogenetics and Hormonology, Kremlin-Bicêtre, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, AP-HP, GH Pitié-Salpétrière, CNRS FRE 2987, University Pierre and Marie Curie, Paris, France
| | - Hazar Haidar
- INSERM U 693, University Paris-South, School of Medicine Paris-South; AP-HP, CHU Bicêtre, Department of Molecular Genetics, Pharmacogenetics and Hormonology, Kremlin-Bicêtre, France
| | - Séverine Trabado
- INSERM U 693, University Paris-South, School of Medicine Paris-South; AP-HP, CHU Bicêtre, Department of Molecular Genetics, Pharmacogenetics and Hormonology, Kremlin-Bicêtre, France
| | | | - Guillaume Bronsard
- Laboratory of Public Health EA3279, School of Medicine of La Timone, Marseille, France
| | - Laurent Mottron
- Center of Excellence for Pervasive Developmental Disorders of the University of Montreal (CETEDUM), Rivières-des-Prairies Hospital, Montreal, Quebec, Canada.,Research Center of CIUSSS of the North of Montreal and Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
| |
Collapse
|
47
|
Poisnel E, Delarbre D, Antoine C, Pangnarind V, Hübsch T, Joubert C, Quiniou P, Cambon A, Dutasta F, Defuentes G, Paris J. Une hypertension intracrânienne révélatrice d’un syndrome de Gougerot–Sjögren. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.153] [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]
|
48
|
Jasseron C, Francoz C, Antoine C, Legeai C, Durand F, Dharancy S. Impact of the new MELD-based allocation system on waiting list and post-transplant survival - a cohort analysis using the French national CRISTAL database. Transpl Int 2019; 32:1061-1073. [PMID: 31074921 DOI: 10.1111/tri.13448] [Citation(s) in RCA: 10] [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] [Indexed: 02/28/2024]
Abstract
Concerns related to equity and efficacy of our previous center-based allocation system have led us to introduce a patient-based allocation system called the "Liver Score" that incorporates the MELD score. The main objective of this study was to compare waitlist and post-transplant survivals before and after implementation of the "Liver Score" using the French transplant registry (period before: 2004-2006 and period after: 2007-2012). Patients transplanted during the second period were sicker and had a higher MELD. One-year waitlist survival (74% versus 76%; p=0.8) and one-year post-transplant survival (86.3% vs 85.7%; p=0.5) were similar between the 2 periods. Cirrhotic recipients with MELD>35 had lower one-year post-transplant survival compared to those with MELD<35 (74.8% vs 86.3%; p<0.01), mainly explained by their higher intubation and renal failure rates. The MELD showed a poor discriminative capacity. In cirrhotic recipients with MELD>35, patients presenting 2 or 3 risk factors (dialysis, intubation or infection) had a lower 1-year survival compared to those with none of these risk factors (61.2% vs 92%; p<0.01). The implementation of the MELD-based allocation system has led to transplant sicker patients with no impact on waitlist and post-transplant survivals. Nevertheless, selection of patients with MELD>35 should be completed to allow safe transplantation. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Carine Jasseron
- Agence de la biomédecine, direction prélèvement greffe organes-tissus, pôle évaluation, 93212, Saint-Denis La Plaine, cedex, France
| | - Claire Francoz
- Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France; INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3France
| | - Corinne Antoine
- Agence de la biomédecine, direction générale médicale et scientifique, direction prélèvement greffe organes-tissus, pôle stratégie prélèvement greffe, 93212, Saint-Denis-la-Plaine cedex, France
| | - Camille Legeai
- Agence de la biomédecine, direction prélèvement greffe organes-tissus, pôle évaluation, 93212, Saint-Denis La Plaine, cedex, France
| | - François Durand
- Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France; INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3France
| | - Sébastien Dharancy
- Inserm, UMR995 - LIRIC, Lille, France Univ Lille, UMR995 - LIRIC, Lille, France CHRU Lille, Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital HuriezLille, France
| |
Collapse
|
49
|
Abstract
In France, the main indications for liver transplantation are hepatocellular carcinoma (HCC) and alcoholic cirrhosis. The number of candidates for decompensated hepatitis C virus-related cirrhosis has markedly decreased since the advent of direct-acting antiviral agents. Nonalcoholic steatohepatitis represents a lower proportion of candidates as compared with the United States. The main source of donors is donation after brain death, but the program of transplantation using donation after circulatory death is growing with excellent results. The deceased donation rate was 28.8 per million people in 2017, which has increased over the last few years. Adult-to-adult living donor liver transplantation has been almost completely abandoned. Donors are allocated on a national basis, and there is no longer local or regional priority. In patients with decompensated cirrhosis, prioritization is based on the Model for End-Stage Liver Disease (MELD) score. The distance between the donor and the recipient is taken into account according to an original gravity model. In patients with HCC, prioritization depends on the alfa-fetoprotein (AFP) score, the MELD score, and waiting time. Only patients with HCC tumor-node-metastasis ≥2 and AFP score ≤2 are eligible for the HCC score. A list of MELD exceptions, consisting of uncommon complications where mortality risk is not adequately predicted by the MELD score and conditions other than cirrhosis, has been established. MELD exceptions must be individually validated by a college of experts mandated by the French Regulatory Agency of Transplantation (Agence de la Biomédecine). The most common MELD exception is refractory ascites with a low MELD score. A major challenge is to reduce the rate of refusal of donation through information campaigns.
Collapse
Affiliation(s)
- François Durand
- Hepatology and Liver Intensive Care, Hospital Beaujon, Clichy, France.,University Paris Diderot, Paris, France.,INSERM U1149, Paris, France
| | - Corinne Antoine
- Nephrology and Kidney Transplantation, Hospital Saint Louis, Paris, France.,Agence de la Biomédecine, Saint Denis, France
| | - Olivier Soubrane
- Hepato-Biliary, Liver Transplantation, and Pancreatic Surgery, Hospital Beaujon, Clichy, France.,University Paris Diderot, Paris, France.,INSERM U1149, Paris, France
| |
Collapse
|
50
|
Fontaine H, Alric L, Labreuche J, Legendre B, Louvet A, Antoine C, Legendre CM, Hazzan M, Kamar N, Dharancy S, Pol S, Duhamel A, Mathurin P. Control of replication of hepatitis B and C virus improves patient and graft survival in kidney transplantation. J Hepatol 2019; 70:831-838. [PMID: 30879789 DOI: 10.1016/j.jhep.2018.12.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 06/29/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS Before antiviral therapy, kidney transplant recipients infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) had poor outcomes. Since the 90s, nucleos(t)ide analogues have been widely used in HBV-infected patients, while interferon-based therapy was rarely used in HCV-infected patients. The aim of this study was to assess the impact of HBV and HCV on patient and graft survival, according to viral replication status. METHODS Data from January 1993 to December 2010 were extracted from the French national database CRISTAL. A total of 31,433 kidney transplant recipients were included, of whom 575, 1,060 and 29,798 had chronic hepatitis B, C, or were not infected, respectively. RESULTS Ten-year survival was lower in HCV-infected (71.3%) than in HBV-infected (81.2%, p = 0.0004) or non-infected kidney transplant recipients (82.7%, p <0.0001). Ten-year kidney graft survival was lower in HCV-infected (50.6%) than in HBV-infected (62.3%, p <0.0001) or non-infected kidney transplant recipients (64.7%, p <0.0001). A random analysis of the medical records of 184 patients with HBV and 504 patients with HCV showed a control of viral replication in 94% and 35% of cases, respectively. Ten-year patient and graft survival in patients with detectable HCV RNA was lower than in their matching controls. Conversely, patients with HCV and undetectable HCV RNA had higher 10-year survival than their matched controls without significant differences in graft survival. CONCLUSIONS Chronic HBV infection does not impact 10-year patient and kidney graft survival thanks to control of viral replication with nucleos(t)ide analogues. In kidney transplant recipients infected with HCV, patients with detectable RNA had worse outcomes, whereas the outcomes of those with undetectable RNA were at least as good as non-infected patients. Thus, direct-acting antivirals should be systematically offered to HCV-infected patients. LAY SUMMARY Previously, infections with hepatitis B or hepatitis C virus led to poor outcomes in kidney transplant recipients. However, the outcomes of kidney transplants in patients with viral suppression are as good as those for kidney transplants in non-infected patients. Antiviral therapy should be systematically proposed to hepatitis B and/or hepatitis C-infected kidney transplant recipients or candidates to prevent the deleterious hepatic and extrahepatic impact of chronic viral replication. Recent access to direct-acting antivirals in patients with hepatitis C virus and renal dysfunction provides exciting new opportunities.
Collapse
Affiliation(s)
- Hélène Fontaine
- Unité d'hépatologie, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, INSERM U-1223 et USM20, Institut Pasteur Université Paris Descartes, Paris, France
| | - Laurent Alric
- Service de Médecine Interne-Pôle Digestif UMR 152, CHU de Toulouse, France
| | | | - Benjamin Legendre
- CHRU de Lille, France, Service des maladies de l'appareil digestif, Université Lille 2 and Inserm U795, France
| | - Alexandre Louvet
- CHRU de Lille, France, Service des maladies de l'appareil digestif, Université Lille 2 and Inserm U795, France
| | | | | | - Marc Hazzan
- CHRU de Lille, France, Service Néphrologie, Université Lille 2, France
| | - Nassim Kamar
- Service Néphrologie Hôpital Purpan, Toulouse, France
| | - Sebastien Dharancy
- CHRU de Lille, France, Service des maladies de l'appareil digestif, Université Lille 2 and Inserm U795, France
| | - Stanislas Pol
- Unité d'hépatologie, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, INSERM U-1223 et USM20, Institut Pasteur Université Paris Descartes, Paris, France
| | | | - Philippe Mathurin
- CHRU de Lille, France, Service des maladies de l'appareil digestif, Université Lille 2 and Inserm U795, France.
| |
Collapse
|