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Bourguiba R, Bachmeyer C, Moguelet P, Kaaki S, Ory C, Touchard G, Cattan E, Georgin-Lavialle S, Colombat M, Valleix S. LC-MS/MS and immuno-electron subtyping combined with genetics show that OSMR mutations cause amyloid deposition of keratins 5/14 in familial primary localized cutaneous amyloidosis. J Eur Acad Dermatol Venereol 2021; 36:e66-e68. [PMID: 34459039 DOI: 10.1111/jdv.17630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- R Bourguiba
- Service de Médecine Interne, Hôpital Tenon, AP-HP, Paris, France
| | - C Bachmeyer
- Service de Médecine Interne, Hôpital Tenon, AP-HP, Paris, France
| | - P Moguelet
- Service d'Anatomo-Pathologie, Hôpital Tenon, AP-HP, Paris, France
| | - S Kaaki
- Service d'Anatomie et Cytologie Pathologique, Unité de Pathologie Ultrastructurale, CHU Poitiers and Centre de Référence Amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Poitiers, France
| | - C Ory
- Service d'Anatomie et Cytologie Pathologique, Unité de Pathologie Ultrastructurale, CHU Poitiers and Centre de Référence Amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Poitiers, France
| | - G Touchard
- Service d'Anatomie et Cytologie Pathologique, Unité de Pathologie Ultrastructurale, CHU Poitiers and Centre de Référence Amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Poitiers, France
| | - E Cattan
- Cabinet de Dermatologie, Pantin, France
| | | | - M Colombat
- Service d'Anatomie et Cytologie Pathologique, Institut Universitaire du Cancer, CHU Toulouse, Université Paul Sabatier, Toulouse, France
| | - S Valleix
- Laboratoire de Biologie et Génétique Moléculaires, Hôpital Cochin, AP-HP.CUP, Université de Paris, Paris, France
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Bender S, Ayala M, Javaugue V, Bonaud A, Cogné M, Touchard G, Jaccard A, Bridoux F, Sirac C. Caractérisation moléculaire complète d’un cas de maladie de dépôts de chaînes lourdes monoclonales. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Javaugue V, Ecotière L, Domenger C, Rinsant A, Kaaki S, Goujon J, Jaccard A, Fermand J, Touchard G, Bridoux F. Glomérulonéphrites à dépôts non organisés non Randall d’immunoglobuline monoclonale (PGNMID) : étude d’une série de 70 cas. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Javaugue V, Domenger C, Bender S, Cohen C, Frémeaux-Bacchi V, Quellard N, Goujon J, Touchard G, Sirac C, Bridoux F. Glomérulonéphrites à dépôts non organisés non Randall de chaîne légère d’immunoglobuline monoclonale : une série de sept cas. Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.015] [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: 10/18/2022]
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Bender S, Ayala V, Bonaud A, Javaugue V, Touchard G, Cogné M, Bridoux F, Sirac C. Glomérulosclérose et insuffisance rénale dans un modèle de maladie de dépôts des chaînes légères d’immunoglobulines monoclonales. Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.078] [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: 10/18/2022]
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Javaugue V, Bouteau I, Sirac C, Quellard N, Diolez J, Colombo A, Desport E, Ecotière L, Goujon JM, Fermand JP, Touchard G, Jaccard A, Bridoux F. [Classification and therapeutic management of monoclonal gammopathies of renal significance]. Rev Med Interne 2017; 39:161-170. [PMID: 28457684 DOI: 10.1016/j.revmed.2017.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
Two categories of renal disorders associated with monoclonal gammopathies are to be distinguished, according to the characteristics of the underlying B-cell clone. The first group of renal diseases always occurs in the setting of high tumor mass with production of large amounts of monoclonal immunoglobulins. The main complication is the so-called myeloma cast nephropathy, which almost invariably complicates high tumor mass myeloma. The second group includes all renal disorders caused by a monoclonal immunoglobulin secreted by a nonmalignant B-cell clone, and currently referred as a "monoclonal gammopathy of renal significance (MGRS)". This term was introduced to distinguish monoclonal gammopathies that are responsible for the development of kidney damage from those that are truly benign. The spectrum of renal diseases in MGRS is wide and its classification relies on the localization of renal lesions, either glomerular or tubular, and on the pattern of ultrastructural organization of immunoglobulin deposits. Physicochemical characteristics of the pathogenic monoclonal immunoglobulin are probably involved in their propensity to deposit or precipitate in the kidney, as illustrated by the high rate of recurrence of each specific type after kidney transplantation. Early diagnosis and efficient chemotherapy targeting the causal B-cell clone are mandatory to improve renal prognosis and patient survival.
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Affiliation(s)
- V Javaugue
- Service de néphrologie, hémodialyse et transplantation rénale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; CNRS-UMR 7276, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, université de Limoges, 87000 Limoges, France.
| | - I Bouteau
- Service de néphrologie, hémodialyse et transplantation rénale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - C Sirac
- CNRS-UMR 7276, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, université de Limoges, 87000 Limoges, France
| | - N Quellard
- Service de pathologie ultrastructurale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 86021 Poitiers, France
| | - J Diolez
- Service de néphrologie, hémodialyse et transplantation rénale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - A Colombo
- Service de néphrologie, hémodialyse et transplantation rénale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - E Desport
- Service de néphrologie, hémodialyse et transplantation rénale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - L Ecotière
- Service de néphrologie, hémodialyse et transplantation rénale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - J-M Goujon
- Service de pathologie ultrastructurale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 86021 Poitiers, France; Laboratoire d'anatomopathologie, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 86021 Poitiers, France
| | - J-P Fermand
- Service d'immunologie et d'hématologie, hôpital Saint-Louis, 75010 Paris, France
| | - G Touchard
- Service de néphrologie, hémodialyse et transplantation rénale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Service de pathologie ultrastructurale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 86021 Poitiers, France
| | - A Jaccard
- Service d'hématologie, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Limoges, 87000 Limoges, France
| | - F Bridoux
- Service de néphrologie, hémodialyse et transplantation rénale, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; CNRS-UMR 7276, centre national de référence maladies rares : amylose AL et autres maladies par dépôts d'immunoglobulines monoclonales, université de Limoges, 87000 Limoges, France
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Ghisdal L, Baron C, Lebranchu Y, Viklický O, Konarikova A, Naesens M, Kuypers D, Dinic M, Alamartine E, Touchard G, Antoine T, Essig M, Rerolle JP, Merville P, Taupin JL, Le Meur Y, Grall‐Jezequel A, Glowacki F, Noël C, Legendre C, Anglicheau D, Broeders N, Coppieters W, Docampo E, Georges M, Ajarchouh Z, Massart A, Racapé J, Abramowicz D, Abramowicz M. Genome-Wide Association Study of Acute Renal Graft Rejection. Am J Transplant 2017; 17:201-209. [PMID: 27272414 PMCID: PMC5215306 DOI: 10.1111/ajt.13912] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 01/25/2023]
Abstract
Acute renal rejection is a major risk factor for chronic allograft dysfunction and long-term graft loss. We performed a genome-wide association study to detect loci associated with biopsy-proven acute T cell-mediated rejection occurring in the first year after renal transplantation. In a discovery cohort of 4127 European renal allograft recipients transplanted in eight European centers, we used a DNA pooling approach to compare 275 cases and 503 controls. In an independent replication cohort of 2765 patients transplanted in two European countries, we identified 313 cases and 531 controls, in whom we genotyped individually the most significant single nucleotide polymorphisms (SNPs) from the discovery cohort. In the discovery cohort, we found five candidate loci tagged by a number of contiguous SNPs (more than five) that was never reached in iterative in silico permutations of our experimental data. In the replication cohort, two loci remained significantly associated with acute rejection in both univariate and multivariate analysis. One locus encompasses PTPRO, coding for a receptor-type tyrosine kinase essential for B cell receptor signaling. The other locus involves ciliary gene CCDC67, in line with the emerging concept of a shared building design between the immune synapse and the primary cilium.
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Affiliation(s)
- L. Ghisdal
- Department of Nephrology, Dialysis, and TransplantationHôpital Erasme (Université Libre de Bruxelles)BrusselsBelgium,Present address: Department of NephrologyCentre Hospitalier EpiCURABaudourBelgium
| | - C. Baron
- Department of NephrologyCentre Hospitalier Régional Universitaire de ToursToursFrance
| | - Y. Lebranchu
- Department of NephrologyCentre Hospitalier Régional Universitaire de ToursToursFrance
| | - O. Viklický
- Department of NephrologyTransplant CentreInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | - A. Konarikova
- Department of NephrologyTransplant CentreInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | - M. Naesens
- Department of Microbiology and ImmunologyKU LeuvenUniversity of LeuvenLeuvenBelgium,Department of NephrologyUniversity Hospitals LeuvenLeuvenBelgium
| | - D. Kuypers
- Department of Microbiology and ImmunologyKU LeuvenUniversity of LeuvenLeuvenBelgium,Department of NephrologyUniversity Hospitals LeuvenLeuvenBelgium
| | - M. Dinic
- Department of NephrologyCentre Hospitalier Universitaire de Saint‐EtienneSaint‐EtienneFrance
| | - E. Alamartine
- Department of NephrologyCentre Hospitalier Universitaire de Saint‐EtienneSaint‐EtienneFrance
| | - G. Touchard
- Department of NephrologyCentre Hospitalier Universitaire de PoitiersPoitiersFrance
| | - T. Antoine
- Department of NephrologyCentre Hospitalier Universitaire de PoitiersPoitiersFrance
| | - M. Essig
- Department of Nephrology, Dialysis, TransplantationCentre Hospitalier Universitaire de Limoges and INSERM UMR 850 (Université de Limoges)LimogesFrance
| | - J. P. Rerolle
- Department of Nephrology, Dialysis, TransplantationCentre Hospitalier Universitaire de Limoges and INSERM UMR 850 (Université de Limoges)LimogesFrance
| | - P. Merville
- Department of NephrologyCentre Hospitalier Universitaire de BordeauxBordeauxFrance
| | - J. L. Taupin
- Department of Immunology and HistocompatibilityHôpital Saint‐LouisParisFrance
| | - Y. Le Meur
- Department of NephrologyCentre Hospitalier Universitaire la Cavale blancheBrestFrance
| | - A. Grall‐Jezequel
- Department of NephrologyCentre Hospitalier Universitaire la Cavale blancheBrestFrance
| | - F. Glowacki
- Department of NephrologyCentre Régional Hospitalier Universitaire de LilleLilleFrance
| | - C. Noël
- Department of NephrologyCentre Régional Hospitalier Universitaire de LilleLilleFrance
| | - C. Legendre
- Department of Renal TransplantationUniversité Paris Descartes and Hôpital NeckerAssistance Publique‐Hôpitaux de ParisParisFrance
| | - D. Anglicheau
- Department of Renal TransplantationUniversité Paris Descartes and Hôpital NeckerAssistance Publique‐Hôpitaux de ParisParisFrance
| | - N. Broeders
- Department of Nephrology, Dialysis, and TransplantationHôpital Erasme (Université Libre de Bruxelles)BrusselsBelgium
| | - W. Coppieters
- Unit of Animal GenomicsGroupe Interdisciplinaire de Génoprotéomique Appliquée‐Research (GIGA‐R)University of LiègeLiègeBelgium
| | - E. Docampo
- Unit of Animal GenomicsGroupe Interdisciplinaire de Génoprotéomique Appliquée‐Research (GIGA‐R)University of LiègeLiègeBelgium
| | - M. Georges
- Unit of Animal GenomicsGroupe Interdisciplinaire de Génoprotéomique Appliquée‐Research (GIGA‐R)University of LiègeLiègeBelgium
| | - Z. Ajarchouh
- Institute of Interdisciplinary Research in Molecular and Human biology (IRIBHM)Université Libre de BruxellesBrusselsBelgium
| | - A. Massart
- Department of Nephrology, Dialysis, and TransplantationHôpital Erasme (Université Libre de Bruxelles)BrusselsBelgium,Institute of Interdisciplinary Research in Molecular and Human biology (IRIBHM)Université Libre de BruxellesBrusselsBelgium
| | - J. Racapé
- Centre of EpidemiologyBiostatistic and Clinical ResearchSchool of Public Health (Université Libre de Bruxelles)BrusselsBelgium
| | - D. Abramowicz
- Department of Nephrology, Dialysis, and TransplantationHôpital Erasme (Université Libre de Bruxelles)BrusselsBelgium,Department of NephrologyAntwerp University HospitalAntwerpenBelgium
| | - M. Abramowicz
- Institute of Interdisciplinary Research in Molecular and Human biology (IRIBHM)Université Libre de BruxellesBrusselsBelgium,Medical Genetics DepartmentHôpital Erasme (Université Libre de Bruxelles)BrusselsBelgium
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Domenger C, Desport E, Pourrat O, Bridoux F, Touchard G. Indication de biopsie rénale posée au cours d’une grossesse : présentation clinique, modalités, diagnostic histopathologique et pronostic. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Mihoubi W, Javaugue V, Ecotière L, Desport E, Bauwens M, Gombert J, Goujon J, Bridoux F, Touchard G. Hépatite fulminante compliquant une maladie de dépôts de chaînes lourdes d’immunoglobulines monoclonales de type Randall. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Dufour L, Javaugue V, Goujon J, Galinier A, Desport E, Bridoux F, Touchard G. Glomérulonéphrites à dépôts organisés microtubulaires d’immunoglobuline monoclonale : pronostic à long terme d’une série de 25 patients. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.044] [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]
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Hellemans R, Hazzan M, Durand D, Mourad G, Lang P, Kessler M, Charpentier B, Touchard G, Berthoux F, Merville P, Ouali N, Squifflet JP, Bayle F, Wissing KM, Noël C, Abramowicz D. Daclizumab Versus Rabbit Antithymocyte Globulin in High-Risk Renal Transplants: Five-Year Follow-up of a Randomized Study. Am J Transplant 2015; 15:1923-32. [PMID: 25707875 DOI: 10.1111/ajt.13191] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 12/07/2014] [Accepted: 12/24/2014] [Indexed: 01/25/2023]
Abstract
We previously reported a randomized controlled trial in which 227 de novo deceased-donor kidney transplant recipients were randomized to rabbit antithymocyte (rATG, Thymoglobulin) or daclizumab if they were considered to be at high immunological risk, defined as high panel reactive antibodies (PRA), loss of a first kidney graft through rejection within 2 years of transplantation, or third or fourth transplantation. Patients treated with rATG had lower incidences of biopsy-proven acute rejection (BPAR) and steroid-resistant rejection at 1 year. Patients were followed to 5 years posttransplant in an observational study; findings are described here. Treatment with rATG was associated with a lower rate of BPAR at 5 years (14.2% vs. 26.0% with daclizumab; p = 0.035). Only one rATG-treated patient (0.9%) and one daclizumab-treated patient (1.0%) developed BPAR after 1 year. Five-year graft and patient survival rates, and renal function, were similar between the two groups. Overall graft survival at 5 years was significantly higher in patients without BPAR (81.0% vs. 54.8%; p < 0.001). In conclusion, rATG is superior to daclizumab for the prevention of BPAR among high-immunological-risk renal transplant recipients. Overall graft survival at 5 years was approximately 70% with either induction therapy, which compares favorably to low-risk cohorts.
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Affiliation(s)
- R Hellemans
- Dienst Néphrologie, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - M Hazzan
- Service de N, é, phrologie, Hôpital, Lille, France
| | - D Durand
- Service de Néphrologie-HTA-Dialyse-Transplantation, CHU-Toulouse Rangueil, Toulouse, France
| | - G Mourad
- Département de Néphrologie et Transplantation, CHRU-Hôpital Lapeyronie, Montpellier, France
| | - P Lang
- Service de Néphrologie, Hôpital Henri Mondor, Créteil, France
| | - M Kessler
- Département de Néphrologie, Hôpital Universitaire de Nancy, Nancy, France
| | - B Charpentier
- Service de Néphrologie, CHRU de Bicêtre, Bicêtre, France
| | - G Touchard
- Service de Néphrologie-Transplantation, CHU de Poitiers, Hôpital Jean-Bernard, Poitiers, France
| | - F Berthoux
- Service de Néphrologie, CHRU-Hôpital Nord, Saint-Etienne, France
| | - P Merville
- Service de Néphrologie, Hôpital Pellegrin, Bordeaux, France
| | - N Ouali
- Service de Néphrologie A, Hôpital Tenon, Paris, France
| | - J-P Squifflet
- Cliniques Universitaires St Luc, Brussels, and Department of Abdominal Transplantation, CHU Sart Tilman, Liege, Belgium
| | - F Bayle
- Service de Néphrologie, CHU de Grenoble, Grenoble, France
| | - K M Wissing
- Dienst Nefrologie, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - C Noël
- Service de N, é, phrologie, Hôpital, Lille, France
| | - D Abramowicz
- Dienst Néphrologie, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
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Rostaing L, Hertig A, Albano L, Anglicheau D, Durrbach A, Vuiblet V, Moulin B, Merville P, Hazzan M, Lang P, Touchard G, Hurault deLigny B, Quéré S, Di Giambattista F, Dubois YC, Rondeau E. Fibrosis progression according to epithelial-mesenchymal transition profile: a randomized trial of everolimus versus CsA. Am J Transplant 2015; 15:1303-12. [PMID: 25808994 DOI: 10.1111/ajt.13132] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/12/2014] [Accepted: 11/30/2014] [Indexed: 01/25/2023]
Abstract
Markers of epithelial-mesenchymal transition (EMT) may identify patients at high risk of graft fibrogenesis who could benefit from early calcineurin inhibitor (CNI) withdrawal. In a randomized, open-label, 12-month trial, de novo kidney transplant patients received cyclosporine, enteric-coated mycophenolate sodium (EC-MPS) and steroids to month 3. Patients were stratified as EMT+ or EMT- based on month 3 biopsy, then randomized to start everolimus with half-dose EC-MPS (720 mg/day) and cyclosporine withdrawal (CNI-free) or continue cyclosporine with standard EC-MPS (CNI). The primary endpoint was progression of graft fibrosis (interstitial fibrosis/tubular atrophy [IF/TA] grade increase ≥1 between months 3-12) in EMT+ patients. 194 patients were randomized (96 CNI-free, 98 CNI); 153 (69 CNI-free, 84 CNI) were included in histological analyses. Fibrosis progression occurred in 46.2% (12/26) CNI-free EMT+ patients versus 51.6% (16/31) CNI EMT+ patients (p = 0.68). Biopsy-proven acute rejection (BPAR, including subclinical events) occurred in 25.0% and 5.1% of CNI-free and CNI patients, respectively (p < 0.001). In conclusion, early CNI withdrawal with everolimus initiation does not prevent interstitial fibrosis. Using this CNI-free protocol, in which everolimus exposure was relatively low and administered with half-dose EC-MPS, CNI-free patients were overwhelmingly under-immunosuppressed and experienced an increased risk of BPAR.
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Affiliation(s)
- L Rostaing
- Department of Nephrology, Dialysis and Transplantation, Hôpital de Rangueil, Toulouse, France
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13
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Hazzan M, Hellemans R, Durand D, Mourad G, Lang P, Kessler M, Charpentier B, Touchard G, Berthoux F, Wissing K, Noël C, Abramowicz D. Comparaison de l’induction par daclizumab ou thymoglobuline chez les patients à haut risque immunologique : résultats à 5ans de l’étude TAXI. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Sicard A, Karras A, Goujon JM, Sirac C, Bender S, Labatut D, Callard P, Sarkozy C, Essig M, Vanhille P, Provot F, Nony A, Nochy D, Ronco P, Bridoux F, Touchard G. Light chain deposition disease without glomerular proteinuria: a diagnostic challenge for the nephrologist. Nephrol Dial Transplant 2014; 29:1894-902. [DOI: 10.1093/ndt/gfu045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Bouteau I, Barbet C, Joly D, Machet M, Goujon J, Bremont-Weill C, Valleix S, Touchard G, Halimi J, Bridoux F. Une nouvelle forme de néphropathie amyloïde : l’amylose à la calcitonine. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Tisserand B, Doré B, Touchard G, Bridoux F, Irani J. Impact à long terme des complications chirurgicales sur la survie du transplant rénal. Prog Urol 2013; 23:113-20. [DOI: 10.1016/j.purol.2012.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 09/09/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
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17
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Pourreau F, Thierry A, Jollet I, Delbes S, Desport E, Bridoux F, Touchard G. Minimisation de l’immunosuppression : impact à long terme sur l’allo-immunisation anti-HLA et la survie du greffon. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sicard A, Bridoux F, Labatut D, Touchard G, Vanhille P, Callard P, Essig M, Provot F, Nony A, Nochy D, Ronco P, Karras A. Néphropathie liée à la maladie des dépôts de chaînes légères sans protéinurie : étude rétrospective de 14 patients. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Valdivia Vega RP, Perez Carlos J, LI X, LI X, Xu X, Zhang W, Ren H, Chen N, Yorioka N, Doi T, Hirashio S, Arita M, Hirabayashi A, Tilkiyan E, Chonova E, Ronchev Y, Kumchev E, Giamalis P, Spartalis M, Stangou M, Tsouchnikas I, Moysiades D, Dimopoulou D, Garyfalos A, Efstratiadis G, Memmos D, Schonermarck U, Eichhorn P, Sitter T, Wendler T, Vielhauer V, Lederer S, Fechner K, Fischereder M, Bantis C, Heering P, Kouri NM, Stangou M, Schwandt C, Kuhr N, Ivens K, Rump LC, Matta V, Melis P, Conti M, Cao R, Binda V, Altieri P, Asunis AM, Catani W, Floris M, Angioi A, Congia M, Cucca F, Minerba L, Peri M, Pani A, Beck LH, Fervenza FC, Fervenza FC, Bomback AS, Ayalon R, Irazabal MV, Eirin A, Cattran DC, Appel GB, Salant DJ, Santoro D, Postorino A, Costantino G, Bellinghieri G, Savica V, Weiner M, Goh SM, Mohammad A, Eriksson P, Westman K, Selga D, Salama A, Segelmark M, Chocova Z, Hruskova Z, Mareckova H, Svobodova B, Jancova E, Bednarova V, Rysava R, Tesar V, Hruskova Z, Jancova E, Hanzal V, Zamboch K, Grussmannova M, Svojanovsky J, Klaboch J, Kubisova M, Sevcik J, Olsanska R, Sobotkova M, Becvar R, Nemec P, Kodeda M, Jilek D, Chocova Z, Tesar V, Hussain M, Dhaygude A, Cartery C, Cartery C, Huart A, Plaisier E, Bongard V, Montastruc F, Ronco P, Pourrat J, Chauveau D, Prasad N, Gurjar D, Bhadauria D, Sharma RK, Gupta A, Kaul A, Jain M, Venning M, Brown N, Bruce I, Noor S, Dhaygude A, Bekker P, Potarca A, Dairaghi D, Miao S, Powers JP, Jaen JC, Schall TJ, Kalavrizioti D, Kalavrizioti D, Gerolymos M, Komninakis D, Rodi M, Mouzaki A, Kalliakmani P, Goumenos D, Choi BS, Choi BS, Park CW, Kim YS, Yang CW, Sun IO, Qin W, Xie L, Tan C, Qin W, Mian W, Fu P, Tan C, Kaminskyy V, Bantis C, Heering P, Kouri NM, Kuhr N, Schwandt C, Ivens K, Rump LC, Hao X, Hao X, Ren H, Wang W, Chen N, Cengiz C, Nur C, Nurdan Y, Selman G, Pinar T, Mehmet T, Lale S, Caliskan S, Shinzawa M, Yamamoto R, Nagasawa Y, Oseto S, Mori D, Niihata K, Fukunaga M, Yamauchi A, Tsubakihara Y, Rakugi H, Isaka Y, Chen JS, Lin YF, Lin WY, Shu KH, Chen HH, Wu CJ, Yang CS, Tseng TL, Zaza G, Bernich P, Lupo A, Panizo N, Rivera F, Lopez Gomez JM, Regn SROG, Ceresini G, Vaglio A, Urban ML, Corradi D, Usberti E, Palmisano A, Buzio C, Vaglio A, Zineb H, Ramdani B, Marques LPJ, Rioja LDS, Rocco R, Nery ACF, Novaes BC, Bridoux F, Sicard A, Labatut D, Touchard G, Sarkozy C, Vanhille P, Callard P, Essig M, Provot F, Nony A, Ronco P, Karras A, Agustin CP, M Belen HR, Carmen CP, Eliana O, Elisa P, Luis P, Alberto MC, Javier N, Isabel F, Cao R, Conti M, Atzeni A, Fois A, Piras D, Maxia S, Angioi A, Binda V, Melis P, Sau G, Pili G, Floris M, Asunis AM, Porcu M, Derudas D, Angelucci E, Ledda A, La Nasa G, Pani A, Ossareh S, Asgari M, Savaj S, Ataipour Y, Abdi E, Malakoutian T, Rajaa R, Berkchi FZ, Haffane L, Squalli Z, Rouass L, Al Hamany Z, Ezzaitouni F, Benamar L, Bayahya R, Ouzeddoun N, Gao-Yuan H, Yao X, Xin C, Zhen C, Yong-Chun G, Qing-Wen W, Hui-Ping C, Da-XI J, De-Hua G, Wei-Xin H, Zhi-Hong L, Rajaa R, Fatima Zahra B, Laila H, Zoubair S, Rouass L, Al Hamany Z, Ezzaitouni F, Benamar L, Bayahya R, Naima O, Smykal-Jankowiak K, Niemir Z, Polcyn-Adamczak M, Szramka-Pawlak B, Zaba R, Zhang C, Zhang C, Ren H, MA Y, Wang W, Zhang W, Shen P, Chen N, Ouyang Y, Ouyang Y, Pan X, Wang Z, Feng X, Shen P, Ren H, Ni L, Zhang W, Chen N. Primary and secondary glomerulonephritis II. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs239] [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: 11/14/2022] Open
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Thierry A, Thervet E, Vuiblet V, Goujon JM, Machet MC, Noel LH, Rioux-Leclercq N, Comoz F, Cordonnier C, François A, Marcellin L, Girardot-Seguin S, Touchard G. Long-term impact of subclinical inflammation diagnosed by protocol biopsy one year after renal transplantation. Am J Transplant 2011; 11:2153-61. [PMID: 21883902 DOI: 10.1111/j.1600-6143.2011.03695.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The long-term impact of subclinical acute rejection (SCAR) on renal graft function remains poorly understood. Furthermore, the interpretation of borderline lesions is difficult and their incidence is variable. The aim of this study was to analyze the characteristics of subclinical inflammation (SCI) in protocol biopsies performed 1-year after renal transplantation. SCI was defined as the presence of borderline lesions or SCAR according to the Banff 2005 classification. The patients included were a subpopulation of the CONCEPT study in which patients were randomized 3 months after transplantation to receive either sirolimus (SRL) or cyclosporine A (CsA) in combination with mycophenolate mofetil. At 1 year, we observed SCI in 37 of the 121 patients observed with an evaluable biopsy. The incidence was more frequent in the SRL group (SRL 45.2% vs. CsA 15.3%). At 30 months , SCI was associated with a significantly lower level of estimated glomerular filtration rate (mean MDRD 50.8 [±13.3] vs. 57.7 [±16.3] mL/min/1.73 m(2) , p = 0.035). In conclusion, SCI at 1-year posttransplantation is associated with worsening renal function and is more frequent in SRL-treated patients. Therefore, evaluation of SCI may be a valuable tool to allow the optimization of immunosuppressive regimens.
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Affiliation(s)
- A Thierry
- Department of Nephrology and Transplantation, University Hospital, Poitiers, France.
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21
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Gatault P, Jollet I, Rabot N, Boulanger MD, Taupin JL, Barbet C, Baron C, Thierry A, Halimi JM, Lebranchu Y, Touchard G, Büchler M. Mothers without HLA antibodies before transplantation have a low risk of alloimmunization post-transplantation. ACTA ACUST UNITED AC 2011; 78:241-8. [DOI: 10.1111/j.1399-0039.2011.01757.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Debiais C, Moumas E, Lacombe C, Baron M, Sechet A, Vérove C, Goujon JM, Gombert JM, Bridoux F, Touchard G. Maladie de dépôts de chaîne lourde alpha : à propos d’une observation. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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Labatut D, Provôt F, Vanhille P, Desport E, Lacombe C, Fernandez B, Goujon JM, Gombert JM, Bridoux F, Touchard G. Atteinte rénale au cours des cryoglobulinémies de type 1. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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24
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Ecotière L, Debiais C, Desport E, Goujon J, Gombert J, Quellard N, Touchard G, Bridoux F. Pronostic de la néphropathie à cylindres myélomateux : étude rétrospective de 69 patients. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.048] [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]
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25
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Affiliation(s)
- C Sirac
- CNRS UMR 6101, 2 rue Dr Marcland, 87025 Limoges, France
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26
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Thervet E, Loriot MA, Barbier S, Buchler M, Ficheux M, Choukroun G, Toupance O, Touchard G, Alberti C, Le Pogamp P, Moulin B, Le Meur Y, Heng AE, Subra JF, Beaune P, Legendre C. Optimization of initial tacrolimus dose using pharmacogenetic testing. Clin Pharmacol Ther 2010; 87:721-6. [PMID: 20393454 DOI: 10.1038/clpt.2010.17] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Retrospective studies have demonstrated that patients who are expressors of cytochrome P4503A5 (CYP3A5) require a higher tacrolimus dose to achieve a therapeutic trough concentration (C(0)). The aim of this study was to evaluate this effect prospectively by pretransplantation adaptation. We randomly assigned 280 renal transplant recipients to receive tacrolimus either according to CYP3A5 genotype or according to the standard daily regimen. The primary end point was the proportion of patients within the targeted C(0). Secondary end points included the number of dose modifications and the delay in achieving the targeted C(0). In the group receiving the adapted dose, a higher proportion of patients had values within the targeted C(0) at day 3 after initiation of tacrolimus (43.2% vs. 29.1%; P = 0.03); they required fewer dose modifications, and the targeted C(0) was achieved by 75% of these patients more rapidly. The clinical end points were similar in the two groups. Pharmacogenetic adaptation of the daily dose of tacrolimus is associated with improved achievement of the target C(0). Whether this improvement will affect clinical outcomes requires further evaluation.
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Affiliation(s)
- E Thervet
- Department of Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France.
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27
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El Hamel C, Thierry A, Trouillas P, Bridoux F, Carrion C, Quellard N, Goujon JM, Aldigier JC, Gombert JM, Cogne M, Touchard G. Crystal-storing histiocytosis with renal Fanconi syndrome: pathological and molecular characteristics compared with classical myeloma-associated Fanconi syndrome. Nephrol Dial Transplant 2010; 25:2982-90. [DOI: 10.1093/ndt/gfq129] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Artana G, Moreau E, Touchard G. Surface corona discharge along an insulating flat plate in air applied to electrohydrodynamically airflow control. ACTA ACUST UNITED AC 2010. [DOI: 10.1201/9781420034387.ch45] [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: 02/15/2023]
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29
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Abou-Ayache R, Buchler M, Lepogamp P, Westeel PF, Le Meur Y, Etienne I, Lobbedez T, Toupance O, Caillard S, Goujon JM, Bergougnoux L, Touchard G. CMV infections after two doses of daclizumab versus thymoglobulin in renal transplant patients receiving mycophenolate mofetil, steroids and delayed cyclosporine A. Nephrol Dial Transplant 2008; 23:2024-32. [DOI: 10.1093/ndt/gfm873] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Mignot A, Bridoux F, Thierry A, Varnous S, Pujo M, Delcourt A, Gombert JM, Goujon JM, Favreau F, Touchard G, Herpin D, Jaccard A. Successful heart transplantation following melphalan plus dexamethasone therapy in systemic AL amyloidosis. Haematologica 2008; 93:e32-5. [DOI: 10.3324/haematol.12108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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31
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Abou Ayache R, Thierry A, Bridoux F, Bauwens M, Belmouaz M, Desport E, Touchard G. Long-term maintenance of calcineurin inhibitor monotherapy reduces the risk for squamous cell carcinomas after kidney transplantation compared with bi- or tritherapy. Transplant Proc 2007; 39:2592-4. [PMID: 17954185 DOI: 10.1016/j.transproceed.2007.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The incidence of skin cancer after organ transplantation is mainly related to type, level, and duration of immunosuppression. The immunosuppressive minimization strategy reduces skin malignancies, but no data are available concerning long-term calcineurin inhibitor (CNI) monotherapy compared with bi- or tritherapy. We studied the benefits of long-term CNI monotherapy (>6 years of exposure) with regard to the incidence of squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) compared with bi- or tritherapy, among first renal allograft adult recipients who were more than 6 years posttransplantation. Among 294 renal transplantations performed between 1986 and 1999, 80 patients received CNI monotherapy (MT) and 86 patients bi- or tritherapy (BTT) with a follow-up of more than 6 years. MT patients were older, had longer follow-up, and fewer biopsy-proven acute rejection episodes. The incidence of SCC was 15.9 SCC/1000 patients/year for MT vs 26.2 for BTT (P = .07). The incidence was significantly lower for patients older than 40 years (22.4 vs 56, respectively; P < .01). The incidence of BCC was 28.3 BCC/1000 patients/year for MT and 10.1 for BTT (P = .05), which failed to show a significant difference in patients older than 40 years (39.7 vs 25, respectively; P = .09). The ratio of SCC/BCC in MT was maintained around 1/2 over time, while it exceeded 2/1 in BTT after 12 years posttransplantation. Patient survival was comparable between the 2 groups. A higher graft survival rate was observed in the MT group. CNI monotherapy should be considered to be a beneficial, safe immunosuppressive minimization strategy for SCC in selected recipients.
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Affiliation(s)
- R Abou Ayache
- Department of Nephrology, Centre Hospitalier Universitaire La Milétrie, 2 Rue de la Milétrie, 86021 Poitiers, France.
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Le Meur Y, Büchler M, Thierry A, Caillard S, Villemain F, Lavaud S, Etienne I, Westeel PF, Hurault de Ligny B, Rostaing L, Thervet E, Szelag JC, Rérolle JP, Rousseau A, Touchard G, Marquet P. Individualized mycophenolate mofetil dosing based on drug exposure significantly improves patient outcomes after renal transplantation. Am J Transplant 2007; 7:2496-503. [PMID: 17908276 DOI: 10.1111/j.1600-6143.2007.01983.x] [Citation(s) in RCA: 316] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Efficacy and safety of mycophenolate mofetil (MMF) may be optimized with individualized doses based on therapeutic monitoring of its active metabolite, mycophenolic acid (MPA). In this 12-month study, 137 renal allograft recipients from 11 French centers receiving basiliximab, cyclosporine A, MMF and corticosteroids were randomized to receive either concentration-controlled doses or fixed-dose MMF. A novel Bayesian estimator of MPA AUC based on three-point sampling was used to individualize doses on posttransplant days 7 and 14 and months 1, 3 and 6. The primary endpoint was treatment failure (death, graft loss, acute rejection and MMF discontinuation). Data from 65 patients/group were analyzed. At month 12, the concentration-controlled group had fewer treatment failures (p = 0.03) and acute rejection episodes (p = 0.01) with no differences in adverse event frequency. The MMF dose was higher in the concentration-controlled group at day 14 (p < 0.0001), month 1 (p < 0.0001) and month 3 (p < 0.01), as were median AUCs on day 14 (33.7 vs. 27.1 mg*h/L; p = 0.0001) and at month 1 (45.0 vs. 30.9 mg*h/L; p < 0.0001). Therapeutic MPA monitoring using a limited sampling strategy can reduce the risk of treatment failure and acute rejection in renal allograft recipients 12 months posttransplant with no increase in adverse events.
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Affiliation(s)
- Y Le Meur
- Department of Nephrology, University Hospital, Limoges, France.
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Belmouaz S, Desport E, Leroy F, Teynie J, Hannequin J, Ayache RA, Bridoux F, Touchard G. Posterior reversible encephalopathy induced by intravenous immunoglobulin. Nephrol Dial Transplant 2007; 23:417-9. [DOI: 10.1093/ndt/gfm594] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Leroy F, Sechet A, Abou Ayache R, Thierry A, Belmouaz S, Desport E, Bauwens M, Bridoux F, Touchard G. Cytomegalovirus prophylaxis with intravenous polyvalent immunoglobulin in high-risk renal transplant recipients. Transplant Proc 2006; 38:2324-6. [PMID: 16980080 DOI: 10.1016/j.transproceed.2006.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cytomegalovirus (CMV) seronegative renal allograft recipients (R-), particularly those with a graft from a CMV-seropositive donor (D+), are at high risk for primary CMV infection. CMV resistance to antiviral oral therapy is an emerging problem in renal transplantation, prompting development of new prophylactic strategies. We retrospectively studied the 1-year posttransplantation incidence of CMV infection in high-risk renal transplant recipients, in whom polyvalent intravenous immunoglobulins (IVIg) were used as prophylaxis. Forty R- patients received immunoprophylaxis by polyvalent IVIg (0.25 g/kg weekly for 8 weeks, starting on the operative day). CMV serological tests remained negative in eight patients (20%). Eight patients (20%) had asymptomatic CMV infection while 24 (60%) developed CMV syndrome and were treated with gancyclovir (10 mg/kg/day intravenously for 3 weeks). None had CMV disease or opportunistic infection. Six patients (15%) had biopsy-proven acute rejection, which followed CMV syndrome in three cases. One-year renal allograft and patient survivals were 95% and 97.5%, respectively. Mean serum creatinine level was 124 +/- 33 micromol/L at 1 year. Clinical tolerance of IVIg was excellent, without any episode of acute renal failure. Polyvalent IVIg provides effective prophylaxis in renal transplant recipients at high risk for CMV infection and is associated with excellent 1-year allograft survival. Because of their immunomodulatory functions, IVIg may have a beneficial effect on the incidence of acute and chronic rejection and allograft survival. A randomized prospective study is required to evaluate long-term effects of CMV prophylaxis with polyvalent IVIg compared to antiviral agents in renal transplant recipients.
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Affiliation(s)
- F Leroy
- Service de Néphrologie, CHU La Milétrie, 86021 Poitiers Cedex, France
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Belmouaz S, Desport E, Abou Ayache R, Thierry A, Mignot A, Bauwens M, Goujon JM, Bridoux F, Touchard G. Acute immuno-allergic interstitial nephritis caused by fluindione. Clin Nephrol 2006; 66:455-8. [PMID: 17176918 DOI: 10.5414/cnp66455] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fluindione is a vitamin K antagonist that is commonly prescribed for the treatment of cardiovascular disease and venous thromboembolism in France. Bleeding is the most common side effect of fluindione, whereas hypersensitivity reactions are rare. We describe here a patient with acute immuno-allergic interstitial nephritis caused by fluindione. Initial symptoms included fever, eosinophilia, low albuminuria, microscopic hematuria, eosinophiluria and acute renal failure. Kidney biopsy showed severe interstitial nephritis with interstitial edema, inflammatory infiltrates and tubulorrhexis. Fluindione withdrawal and corticosteroid treatment resulted in rapid recovery of renal function. A review of the literature revealed a very low incidence of fluindione-induced interstitial nephritis, with variable renal and extra-renal signs. Early recognition of this rare complication may prevent the development of severe chronic renal injury.
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Affiliation(s)
- S Belmouaz
- Department of Nephrology, Hôpital Jean Bernard, Centre Hospitalier Universitaire, Rue de la Miletrie, BP 577, 86021 Poitiers, France.
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36
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Abstract
Recent studies have clearly demonstrated that preemptive renal transplantation is associated with better graft and patient survival. It improves the quality of life and is a cost-effective option compared to conventional transplantation. We report our experience with this concept and review the literature. We retrospectively analyzed all adult kidney transplantations performed in our center between March 1986 and May 2004: among 463 renal transplantations 44 were preemptive (9.5%). Mean follow-up was 45.7 +/- 6 months in preemptive versus 62.3 +/- 2.6 months in the other group. At the end of the study, graft survivals were 93.2% and 77.1%, respectively (P = .02). Patient survival rates were similar in both groups. In the preemptive group, grafts were more likely to come from living donors (P < .001) and cold ischemia time was shorter (P = .02). A subgroup case-control study showed that cost saving for dialysis in the preemptive group was about 119,000 Euros per patient. More preemptive patients had professional activity before (P = .0002) and after transplantation (P = .02). Our results and data from the literature support the place of preemptive transplantation as the optimal mode of renal replacement therapy for medical and socioeconomic reasons.
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Affiliation(s)
- R Abou Ayache
- Department of Nephrology, Centre Hospitalier Universitaire La Milétrie, Poitiers, France.
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Bridoux F, Kyndt X, Abou-Ayache R, Mougenot B, Baillet S, Bauwens M, Lemaitre V, Goujon JM, Touchard G, Vanhille P. Proximal tubular dysfunction in primary Sjögrens syndrome: a clinicopathological study of 2 cases. Clin Nephrol 2004; 61:434-9. [PMID: 15224808 DOI: 10.5414/cnp61434] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Tubulointerstitial nephritis is the most common renal complication in primary Sjögren's syndrome (SS). It is usually associated with symptoms of distal tubular dysfunction, type I (distal) renal tubular acidosis (RTA) and nephrogenic diabetes insipidus. Proximal tubular abnormalities are considered to be less frequent, and Fanconi's syndrome has been only exceptionally reported in patients with SS. We describe 2 patients with primary SS, characterized by xerostomia, dry eyes, extensive lymphocytic infiltrate on salivary gland biopsy, positive tests for anti-SSA/SSB antibodies and/or antinuclear antibodies, who presented in renal failure with proteinuria, microscopic hematuria and type I RTA. Further studies revealed proximal tubular dysfunction, including renal glucosuria, generalized aminoaciduria, phosphaturia, uricosuria, together with proximal (type II) RTA in 1 case. Neither of these patients had Bence Jones proteinuria or monoclonal gammopathy. Kidney biopsy showed focal proximal tubulitis, associated with proximal tubular cell atrophy and dedifferentiation, and diffuse interstitial nephritis with fibrosis. No significant glomerular or peritubular deposits of immunoglobulin light or heavy chain were observed. These findings demonstrate that diffuse, distal and proximal, tubular dysfunction may occur in patients with SS and interstitial nephritis. Lymphocytic infiltration of proximal tubular cells is probably involved in the pathogenesis of Fanconi's syndrome in SS. However, the mechanisms involved in the alteration of sodium-dependent apical transports remain to be elucidated.
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Affiliation(s)
- F Bridoux
- Department of Nephrology, Hôpital Jean Bernard, Centre Hospitalier Universitaire, Poitiers, France.
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38
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Thierry A, Bridoux F, Goodman H, Belmouaz S, Abou Ayache R, Desport E, Jaccard A, Touchard G. [Immunoglobulin light chain amyloidosis: recent molecular, clinical and therapeutic approach]. Nephrologie 2004; 25:111-8. [PMID: 15291138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
AL amyloidosis is a rare disorder characterised by tissue deposition of a fibrillary proteinaceous material, formed from monoclonal immunoglobulin light (or exceptionally heavy) chains. Although it may complicate multiple myeloma or B-cell lymphomas, AL amyloidosis is often associated with a low burden of clonal plasma cells ("primitive" AL amyloidosis). The mechanisms involved in the formation of AL amyloid deposits remain unclear, but are probably related to structural peculiarities of monoclonal immunoglobulin light chains. AL amyloidosis is usually a systemic disease, often revealed by renal involvement, the most common complication of the disease. The longterm prognosis of AL amyloidosis is poor, mainly related to amyloid restrictive cardiomyopathy leading to congestive heart failure. Oral melphalan and prednisone is considered the standard treatment for AL amyloidosis, but with limited increase in the median survival. High-dose intra-venous melphalan with autologous stem cell transplantation is an effective treatment, aimed at eliminating the clonaly expanded plasma cells, which has been shown to induce complete hematologic remissions and to prolong survival. However, the tolerability of such treatment is low, limiting its use to selected patients. The development of new drugs, able to interfere with amyloid fibril deposition, may provide a new therapeutic approach.
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Affiliation(s)
- A Thierry
- Service de néphrologie, Hôpital Jean Bernard, Centre hospitalier universitaire, Poitiers
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39
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Galea HR, Bridoux F, Aldigier JC, Paraf F, Bordessoule D, Touchard G, Cogné M. Molecular study of an IgG1kappa cryoglobulin yielding organized microtubular deposits and glomerulonephritis in the course of chronic lymphocytic leukaemia. Clin Exp Immunol 2002; 129:113-8. [PMID: 12100030 PMCID: PMC1906418 DOI: 10.1046/j.1365-2249.2002.01896.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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] [Indexed: 11/20/2022] Open
Abstract
Glomerulonephritis with organized microtubular monoclonal immunoglobulin deposits (GOMMID) and glomerulonephritis related to type I cryoglobulin are well-known but rare complications of B cell derived chronic lymphocytic leukaemia. In these disorders, monoclonal Ig have never been studied at the molecular level. We conducted a pathological and molecular analysis in a patient with chronic lymphocytic leukaemia, glomerulonephritis and a single circulating monoclonal Ig. Unusual IgG1kappa kidney deposits were observed. The heavy and light chain variable region sequences of that cryoprecipitating monoclonal Ig were characterized. Light microscopy revealed glomerulonephritis typical of cryoglobulinaemia, with neutrophil and macrophage infiltration, endocapillary hyperplasia and few protein thrombi. Electron microscopic study clearly evidenced numerous subepithelial mixed granular and organized deposits with a unique microtubular organization, reminiscent of the GOMMID. The Ig molecule sequence revealed alterations of charge and hydrophobicity potentially promoting a crystal-like aggregation and the aggregation of microtubules. This description suggests that common mechanisms are involved in various forms of precipitation and/or deposition of complete Ig molecules, with a variable extent of organization and with a possible overlap between pathological patterns of either glomerulonephritis with microtubular deposits or type I cryoglobulinic glomerulonephritis.
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Affiliation(s)
- H R Galea
- Department of Immunology (CNRS UMR6101), University Hospital, Limoges, France
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40
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Séchet A, Bridoux F, Bauwens M, Ayache RA, Belmouaz S, Touchard G. Prevention of cytomegalovirus infection and disease in high-risk renal transplant recipients with polyvalent intravenous immunoglobulins. Transplant Proc 2002; 34:812-3. [PMID: 12034192 DOI: 10.1016/s0041-1345(01)02920-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Séchet
- Service Nephrologie, CHU La Pieirre, Poitiers, France
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41
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Amiri O, Aı̈t-Mokhtar A, Dumargue P, Touchard G. Electrochemical modelling of chlorides migration in cement based materials. Part II: Experimental study—calculation of chlorides flux. Electrochim Acta 2001. [DOI: 10.1016/s0013-4686(01)00659-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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Menet E, Petit ML, Bridoux F, Touchard G, Duport G, Levillain P, Babin P. [Mixed type amyloidomas, beta2 microglobulin and AL lambda, in a long term hemodialysis patient]. Nephrologie 2001; 22:115-8. [PMID: 11436666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A frequent complication of hemodialysis is deposition of beta 2-microglobulin amyloid in tendons and joints. Soft tissues involvement is exceptional. A 74 year-old woman on hemodialysis for 21 years developed two bilateral and symmetric tumours in gluteal regions causing discomfort when sitting. Histology, immunohistochemistry and electron microscopy showed that deposit consisted of predominant beta 2-microglobulin and lambda light chain. This is an unusual localisation of amyloidosis developing late in the course of hemodialysis. It may be perhaps initiated by chronic traumatism and be promoted by the light chain lambda of immunoglobulin.
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Affiliation(s)
- E Menet
- Service d'anatomie et de cytologie pathologiques, Hôpital Jean Bernard, Poitiers.
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Affiliation(s)
- D Claisse
- Institut Français de Recherche pour l'Exploitation de la Mer, Centre de Nantes, BP 21105, F-44311, Nantes, France
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44
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Hurault de Ligny B, Etienne I, Francois A, Toupance O, Buchler M, Touchard G, Lepogamp P, Comoz F, Lobbedez T, Godin M, Ryckelynck JP, Lebranchu Y. Polyomavirus-induced acute tubulo-interstitial nephritis in renal allograft recipients. Transplant Proc 2000; 32:2760-1. [PMID: 11134789 DOI: 10.1016/s0041-1345(00)01869-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Touchard G, Hurault de Ligny B, Griveau AM, Pujo M, Jollet I, Lobbedez T, Bauwens M, Bridoux F, Alcalay D. Comparative results of a randomized transfusion of HLA-5, -6 mismatched (one unit) versus HLA semi-identical (one unit) blood in first renal allograft recipients. Transplant Proc 2000; 32:2771-2. [PMID: 11134796 DOI: 10.1016/s0041-1345(00)01876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- G Touchard
- Services de Néphorologie CHU Poitiers, Poitiers, France
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48
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Rengers JU, Touchard G, Decourt C, Deret S, Michel H, Cogné M. Heavy and light chain primary structures control IgG3 nephritogenicity in an experimental model for cryocrystalglobulinemia. Blood 2000; 95:3467-72. [PMID: 10828030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Crystal formation by monoclonal immunoglobulins is a well-known but rare complication of B-cell neoplasia. We have designed an in vivo model of cryocrystalglobulinemia by grafting to mice hybridoma clones producing a pathogenic monoclonal immunogloblulin (Ig) G3kappa. One clone, 8A4, secreted a singular IgG3 that formed crystals both in the proliferating plasma cells and as mesangial and subendothelial deposits in the kidney glomeruli. Morphologic analysis of kidneys revealed neutrophil infiltration and endocapillary hyperplasia, while the morphology of deposits was reminiscent of those in cryocrystalglobulinemia patients. A variant clone that only differed from 8A4 by a 3-amino acid deletion in the V(kappa) CDR1 increased its secretion level by 7-fold and produced an abundant bona fide serum monoclonal cryoglobulin in mice, without crystal formation within tumoral cells; it yielded no subendothelial deposits but only amorphous precipitates in capillary lumens of kidney glomeruli, reminiscent of those seen in the human hyperviscosity syndrome, without other glomerular lesions. A limited variation in the V(kappa) domain thus proved able to increase secretion, to abrogate crystallization, and to modify patterns of glomerular lesions and deposits. Both the crystallizing and noncrystallizing IgG3kappa sequences were related to previously reported murine cryoglobulins, all including a gamma3 chain and canonical VH sequences. Two additional variants of 8A4 with identical VH and VL domains but having switched to IgG1 also lost crystal formation, further showing this feature of 8A4 to result from a unique 3-dimensional conformation of the complete immunoglobulin, relying on V and C domain primary structures of both chains.
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Affiliation(s)
- J U Rengers
- Max-Planck-Institute for Biophysics, Frankfurt, Germany
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Messiaen T, Deret S, Mougenot B, Bridoux F, Dequiedt P, Dion JJ, Makdassi R, Meeus F, Pourrat J, Touchard G, Vanhille P, Zaoui P, Aucouturier P, Ronco PM. Adult Fanconi syndrome secondary to light chain gammopathy. Clinicopathologic heterogeneity and unusual features in 11 patients. Medicine (Baltimore) 2000; 79:135-54. [PMID: 10844934 DOI: 10.1097/00005792-200005000-00002] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Fifty-seven cases of Ig light chain-associated Fanconi syndrome (FS) have been reported so far, mostly as isolated reports. The pioneering work by Maldonado and associates (35), who reviewed the first 17 cases in 1975, led to the unifying concept that patients with FS and Bence Jones proteinuria have a special form of plasma cell dyscrasia characterized by slow progression of the tumor and by prominent crystal formation in proximal tubule cells, in the absence of myeloma casts in the distal tubule. We carefully reappraised these characteristics in a series of 11 patients. Ten renal biopsy specimens were available for electron microscopy, adding to the 15 previously reported cases with ultrastructural studies. Moreover, 10 of the kappa light chains could be entirely or partially sequenced and tested for their resistance to cathepsin B, a lysosomal protease present in proximal tubule cells. Our series showed an unexpected clinicopathologic heterogeneity. Seven patients presented with the typical clinical and pathologic features of FS and low-mass myeloma or monoclonal gammopathy of undetermined significance (MGUS), in keeping with Maldonado et al's description. Crystals in bone marrow cells were detected in patients of this group, only. Three patients who presented with full-blown FS exhibited, however, the characteristic features of myeloma cast nephropathy in the setting of high-mass myeloma. One patient of this group also had numerous crystals in proximal tubule cells. The eleventh patient had complete FS with MGUS, but no crystals in proximal tubule cells even after electron microscopy. Contrasting with the clinicopathologic heterogeneity, genetic and biochemical analyses of the light chains showed a striking homogeneity. First, they all were of the kappa type. Second, 8 of 9 belonged to the V kappa I variability subgroup, which indicates that FS light chains are related by the sequence of their variable regions. Third, the 8 V kappa I light chain sequences most likely originated from only 2 germline genes, LCO2/012 and LCO8/018. Fourth, all 5 LCO2/012-derived sequences presented an unusual hydrophobic or nonpolar residue at position 30. These sequence peculiarities may account for unusual physicochemical properties of the light chains including the resistance of their variable domain V kappa to proteolysis by cathepsin B, observed in 7 of 9 patients in our series, while light chains isolated from patients with myeloma cast nephropathy are completely digested. Resistance of V kappa to proteolysis in FS patients can explain the accumulation of the light chain in the endocytotic compartment of the proximal tubule cells, leading to impairment of proximal tubule functions.
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Affiliation(s)
- T Messiaen
- Service de Néphrologie, Hôpital Tenon, Paris, France
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50
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Hurault de Ligny B, Toupance O, Lavaud S, Bauwens M, Peyronnet P, Le Meur Y, Ryckelynck JP, Jolly D, Leroux-Robert C, Touchard G. Factors predicting the long-term success of maintenance cyclosporine monotherapy after kidney transplantation. Transplantation 2000; 69:1327-32. [PMID: 10798748 DOI: 10.1097/00007890-200004150-00019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The theoretical aim of maintenance cyclosporine monotherapy (mCsA) after kidney transplantation is to reduce the incidence of the metabolic complications of corticosteroids and to minimize the adverse effects of excessive long-term immunosuppression. This study was performed in low-immunological-risk cadaveric kidney transplant recipients to evaluate the risks and benefits of mCsA and the long-term graft survival, and to determine the factors predicting success of this policy. METHODS The multicenter retrospective study was conducted in 329 Caucasian patients receiving mCsA out of 728 first cadaveric kidney transplant recipients. The inclusion criteria were: HLA antibodies < or =25%, serum creatinine <200 micromol/L, and no rejection or only one rejection episode. At the end of the study, we compared the group of patients successfully treated with mCsA (successful group) with those requiring additional immunosuppressive agents (unsuccessful mCsA group). RESULTS Overall patient and graft survival rates for the 728 first cadaveric graft were 92% and 64%, respectively, at 8 years. Out of 329 patients enrolled in mCsA, 240 were maintained on this treatment and 89 were withdrawn (3 deaths, 18 graft losses, 68 functional grafts). The 8-year graft survival in the 329 enrolled mCsA patients was 84%, 95% in the successful mCsA group, and 70% in the unsuccessful mCsA group. Multivariate analysis showed that the factors predicting success of mCsA were: donor age <40 years (P = 0.001), serum creatinine at mCsA initiation <125 micromol/L (P = 0.02), no rejection episode before mCsA initiation (P = 0.005), and glomerulopathy as the primary renal disease (P = 0.001). CONCLUSION Numerous kidney transplant recipients with a low immunological risk and good and stable renal function may benefit from discontinuation of prednisone and azathioprine in order to reduce the complications related to these drugs. This therapeutic approach had no adverse impact on the overall long-term graft survival for "low risk" and successful patients.
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