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Wilmes D, Coche E, Rodriguez-Villalobos H, Kanaan N. Fungal pneumonia in kidney transplant recipients. Respir Med 2021; 185:106492. [PMID: 34139578 DOI: 10.1016/j.rmed.2021.106492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
Fungal pneumonia is a dreaded complication encountered after kidney transplantation, complicated by increased mortality and often associated with graft failure. Diagnosis can be challenging because the clinical presentation is non-specific and diagnostic tools have limited sensitivity and specificity in kidney transplant recipients and must be interpreted in the context of the clinical setting. Management is difficult due to the increased risk of dissemination and severity, multiple comorbidities, drug interactions and reduced immunosuppression which should be applied as an important adjunct to therapy. This review will focus on the main causes of fungal pneumonia in kidney transplant recipients including Pneumocystis, Aspergillus, Cryptococcus, mucormycetes and Histoplasma. Epidemiology, clinical presentation, laboratory and radiographic features, specific characteristics will be discussed with an update on diagnostic procedures and treatment.
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Affiliation(s)
- D Wilmes
- Division of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - E Coche
- Division of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - H Rodriguez-Villalobos
- Division of Microbiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - N Kanaan
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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Lesouhaitier M, Dudreuilh C, Tamain M, Kanaan N, Bailly E, Legoupil D, Deltombe C, Perrin P, Houot R, Vigneau C. Utilisation des inhibiteurs de checkpoints chez les greffés rénaux. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.371] [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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Wilmes D, Coche E, Rodriguez-Villalobos H, Kanaan N. Bacterial pneumonia in kidney transplant recipients. Respir Med 2018; 137:89-94. [PMID: 29605219 DOI: 10.1016/j.rmed.2018.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/14/2017] [Revised: 02/06/2018] [Accepted: 02/26/2018] [Indexed: 12/16/2022]
Abstract
Bacterial pathogens are the most frequent cause of pneumonia after transplantation. Early after transplantation, recipients are at higher risk for nosocomial infections. The most commonly encountered pathogens during this period are gram-negative bacilli (Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa …), but gram-positive coccus such as Staphylococcus aureus or Streptococcus pneumoniae and anaerobic bacteria can also be found. Empirical antibiotic therapy should be guided by previous colonisation of the recipient and bacterial resistance pattern in the hospital. Six months after transplantation, pneumonias are mostly due to community-acquired bacteria (S. pneumonia, H. influenza, Mycoplasma, Chlamydia and others). Opportunistic pathogens take advantage of the state of immunosuppression which is usually highest from one to six months after transplantation. During this period, but also occurring many years later in the setting of a chronically depressed immune system, bacterial pathogens with low intrinsic virulence can cause pneumonia. The diagnosis of pneumonia caused by opportunistic pathogens can be challenging. The delay in diagnosis preventing the early instauration of adequate treatment in kidney transplant recipients with a depressed immune system, frequently coupled with co-morbid conditions and a state of frailty, will affect prognosis and outcome, increasing morbidity and mortality. This review will focus on the most common opportunistic bacterial pathogens causing pneumonia in kidney transplant recipients: Legionella, Nocardia, Mycobacterium tuberculosis/nontuberculous, and Rhodococcus. Recognition of their specificities in the setting of immunosuppression will allow early diagnosis, crucial for initiation of effective therapy and successful outcome. Interactions with immunosuppressive therapy should be considered as well as reducing immunosuppression if necessary.
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Affiliation(s)
- D Wilmes
- Division of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - E Coche
- Division of Radiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - H Rodriguez-Villalobos
- Division of Microbiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - N Kanaan
- Division of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
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Percy C, Hassoun Z, Mourad M, De Meyer M, Beguin C, Jadoul M, Goffin E, Wallemacq P, Kanaan N. Impact of Acute Infection Requiring Hospitalization on Tacrolimus Blood Levels in Kidney Transplant Recipients. Transplant Proc 2017; 49:2065-2069. [DOI: 10.1016/j.transproceed.2017.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/02/2017] [Indexed: 12/19/2022]
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Kanaan N, Raggi C, Goffin E, De Meyer M, Mourad M, Jadoul M, Beguin C, Kabamba B, Borbath I, Pirson Y, Hassoun Z. Outcome of hepatitis B and C virus-associated hepatocellular carcinoma occurring after renal transplantation. J Viral Hepat 2017; 24:430-435. [PMID: 27917563 DOI: 10.1111/jvh.12655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/23/2016] [Accepted: 11/01/2016] [Indexed: 12/13/2022]
Abstract
Kidney transplant recipients (KTR) are subjected to immunosuppressive therapy that can enhance hepatitis B and C virus replication, leading to cirrhosis and hepatocellular carcinoma (HCC). The aim of this study was to assess the prevalence and outcome of HCC in KTR. Case-control study. Patients with chronic HBV and/or HCV infection who underwent kidney transplantation between 1976 and 2011 and subsequently developed HCC were compared to a control group of patients with chronic HBV and/or HCV infection, matched for gender and age at HCC diagnosis, who did not receive kidney transplantation. Among 2944 KTR, 330 had hepatitis B and/or C. Fourteen developed HCC, a period prevalence of 4.2%. Age at HCC diagnosis was 52.6 ± 6.5 years (53.5 ± 5.7 in controls, P=.76). Time between transplantation and HCC diagnosis was 16.7 ± 2.7 years. Six HCCs were related to HBV, six to HCV and two to co-infection with HBV and HCV. Immunosuppressive therapy was comparable in HBV, HCV and HBV+HCV patients. At diagnosis, 71% of patients met Milan criteria (65% in the control group, P=.4). Alpha-fetoprotein levels, tumour characteristics and treatment modalities were comparable between both groups. Patient survival 2 years after HCC diagnosis was 28% in KTR, compared to 68% in controls (P=.024). Survival after HCC diagnosis is significantly worse in KTR compared to nontransplanted patients with HBV and/or HCV. Prevention is crucial and should be based on viral eradication/suppression before or after transplantation.
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Affiliation(s)
- N Kanaan
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - C Raggi
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - E Goffin
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - M De Meyer
- Division of Surgery and Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - M Mourad
- Division of Surgery and Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - M Jadoul
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - C Beguin
- Division of Medical Information and Statistics, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - B Kabamba
- Division of Microbiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - I Borbath
- Division of Gastroenterology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Y Pirson
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Z Hassoun
- Division of Gastroenterology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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Ponlot E, Aydin S, Demoulin N, Kanaan N, Dahan K, Stordeur P, Pirson Y, Morelle J. Glomérulonéphrite à C3 et variant c.463A>C dans le gène C3 : implications pour le clinicien. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Evenepoel P, Goffin E, Meijers B, Kanaan N, Bammens B, Coche E, Claes K, Jadoul M. Sclerostin Serum Levels and Vascular Calcification Progression in Prevalent Renal Transplant Recipients. J Clin Endocrinol Metab 2015; 100:4669-76. [PMID: 26505822 DOI: 10.1210/jc.2015-3056] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 02/13/2023]
Abstract
CONTEXT Vascular calcification (VC) is prevalent and progressive in renal transplant recipients (RTRs). Recent cross-sectional data suggest that activated Wnt signaling contributes to VC. OBJECTIVE The objective was to investigate whether circulating levels of the Wnt antagonist sclerostin associate with progression of VC. DESIGN This was a post hoc analysis of the longitudinal observational Brussels Renal Transplant Cohort study. SETTING The setting was a tertiary care academic hospital. PATIENTS Coronary artery calcification and aorta calcification were measured by multislice spiral computerized tomography in 268 prevalent RTRs (age, 53 ± 13 y; 61% male) at baseline and remeasured in 189 patients after a median follow-up of 4.4 years. Baseline serum sclerostin levels were assessed on stored blood samples. Regression analysis was performed to identify determinants of baseline VC and progression. MAIN OUTCOME MEASURE The main outcome measure was progression of VC. RESULTS VC was present in up to 84% of participants at baseline. Almost half of the patients showed progression of VC, according to Hokanson criteria. The cross-sectional analysis at baseline demonstrated a direct association between sclerostin levels and VC score in univariate analysis, which became inverse after adjustment for age, gender and PTH level. Remarkably, a lower sclerostin level was identified as an independent determinant of a higher baseline aorta calcification score in the final regression model. Moreover, baseline sclerostin levels showed an inverse association with VC progression, at least after adjustment for traditional risk factors. CONCLUSIONS Serum sclerostin levels inversely associated with VC burden and progression in prevalent RTRs after adjustment for traditional risk factors. Our data corroborate previous findings in nontransplanted chronic kidney disease patients and support the notion that sclerostin may be up-regulated in the vascular wall during the VC process as part of a local counterregulatory mechanism directed to suppress VC. Additional clinical and experimental data are required for confirmation.
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Affiliation(s)
- P Evenepoel
- Laboratory of Nephrology (P.E., B.M., B.B., K.C.), Department of Immunology and Microbiology, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium; and Divisions of Nephrology (E.G., N.K., M.J.) and Medical Imaging (E.C.), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium
| | - E Goffin
- Laboratory of Nephrology (P.E., B.M., B.B., K.C.), Department of Immunology and Microbiology, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium; and Divisions of Nephrology (E.G., N.K., M.J.) and Medical Imaging (E.C.), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium
| | - B Meijers
- Laboratory of Nephrology (P.E., B.M., B.B., K.C.), Department of Immunology and Microbiology, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium; and Divisions of Nephrology (E.G., N.K., M.J.) and Medical Imaging (E.C.), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium
| | - N Kanaan
- Laboratory of Nephrology (P.E., B.M., B.B., K.C.), Department of Immunology and Microbiology, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium; and Divisions of Nephrology (E.G., N.K., M.J.) and Medical Imaging (E.C.), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium
| | - B Bammens
- Laboratory of Nephrology (P.E., B.M., B.B., K.C.), Department of Immunology and Microbiology, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium; and Divisions of Nephrology (E.G., N.K., M.J.) and Medical Imaging (E.C.), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium
| | - E Coche
- Laboratory of Nephrology (P.E., B.M., B.B., K.C.), Department of Immunology and Microbiology, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium; and Divisions of Nephrology (E.G., N.K., M.J.) and Medical Imaging (E.C.), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium
| | - K Claes
- Laboratory of Nephrology (P.E., B.M., B.B., K.C.), Department of Immunology and Microbiology, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium; and Divisions of Nephrology (E.G., N.K., M.J.) and Medical Imaging (E.C.), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium
| | - M Jadoul
- Laboratory of Nephrology (P.E., B.M., B.B., K.C.), Department of Immunology and Microbiology, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium; and Divisions of Nephrology (E.G., N.K., M.J.) and Medical Imaging (E.C.), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, B-1200 Brussels, Belgium
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Biller P, Michaux L, Pauw LD, Camboni A, Mourad M, Kanaan N. Post-transplant lymphoproliferative disorder after kidney transplantation: time to adopt monitoring of Epstein-Barr virus? Acta Clin Belg 2015; 70:218-22. [PMID: 25541210 DOI: 10.1179/2295333714y.0000000112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Although post-transplant lymphoproliferative disorder is a classical complication encountered after kidney transplantation, its diagnosis can still be challenging and its outcome life-threatening. Most cases are related to Epstein-Barr virus (EBV) infection and occur mainly in the first year post-transplant, favoured by the seronegative EBV status of the recipient transplanted with a kidney from a seropositive donor, and strong immunosuppression. We report the case of a young kidney-pancreas transplant recipient who developed post-transplant lymphoproliferative disorder (PTLD) early after transplantation, with a rapid fatal issue. We review the pathogenesis, clinical presentation, and management of PTLD with a focus on prevention.
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Diaz-Tocados JM, Herencia C, Martinez-Moreno JM, Montes De Oca A, Rodriguez-Ortiz ME, Gundlach K, Buchel J, Steppan S, Passlick-Deetjen J, Rodriguez M, Almaden Y, Munoz-Castaneda JR, Nakano C, Hamano T, Fujii N, Matusi I, Mikami S, Tomida K, Mori D, Kusunoki Y, Shimomura A, Obi Y, Hayashi T, Rakugi H, Isaka Y, Tsubakihara Y, Jorgensen HS, Winther S, Hauge EM, Rejnmark L, Botker HE, Bottcher M, Svensson M, Ivarsen P, Sagliker Y, Demirhan O, Yildiz I, Paylar N, Inandiklioglu N, Akbal E, Tunc E, Tartaglione L, Rotondi S, Pasquali M, Muci ML, Mandanici G, Leonangeli C, Sotir N, Sales S, Mazzaferro S, Gigante M, Cafiero C, Brunetti G, Simone S, Grano M, Colucci S, Ranieri E, Pertosa G, Gesualdo L, Evenepoel P, Goffin E, Meijers B, Kanaan N, Bammens B, Coche E, Claes K, Jadoul M, Louvet L, Metzinger L, Buchel J, Steppan S, Massy ZA, Prasad B, St.Onge JR, Tentori F, Zepel L, Comment L, Akiba T, Bommer J, Fukagawa M, Goodkin DA, Jacobson SH, Robinson BM, Port FK, Evenepoel P, Viaene L, Poesen R, Bammens B, Meijers B, Naesens M, Sprangers B, Kuypers D, Claes K, Tominaga Y, Hiramitsu T, Yamamoto T, Tsujita M, Makowka A, G Yda M, Rutkowska-Majewska E, Nowicki MP, Takeshima A, Ogata H, Yamamoto M, Ito H, Kinugasa E, Kadokura Y, Dimkovic N, Dellanna F, Spasovski G, Wanner C, Locatelli F, Troib A, Assadi MH, Landau D, Rabkin R, Segev Y, Ciceri P, Elli F, Cappelletti L, Tosi D, Savi F, Bulfamante G, Cozzolino M, Barreto FC, De Oliveira RB, Benchitrit J, Louvet L, Rezg R, Poirot S, Jorgetti V, Drueke TB, Riser BL, Massy ZA, Pasquali M, Tartaglione L, Rotondi S, Muci ML, Mandanici G, Leonangeli C, Massimetti C, Utzeri G, Biondi B, Mazzaferro S, Verkaik M, Eringa EC, Musters RJ, Pulskens WP, Vervloet MG, Ter Wee PM, Schiller A, Onofriescu M, Apetrii M, Schiller O, Bob F, Timar R, Mihaescu A, Florea L, Mititiuc I, Veisa G, Covic A, Krause R, Kaase H, Stange R, Hopfenmuller W, Chen TC, Holick MF, Kawasaki T, Ando R, Maeda Y, Arai Y, Sato H, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, An WS, Jeong E, Son SH, Kim SE, Son YK, Baxmann AC, Menon VB, Moreira SR, Medina-Pestana J, Carvalho AB, Heilberg IP, Bergman A, Qureshi AR, Haarhaus MH, Lindholm B, Barany P, Heimburger O, Stenvinkel P, Anderstam B, Wilson RJ, Copley JB, Keith MS, Preston P, Santos RSS, Moyses RMA, Silva BC, Jorgetti V, Coelho FMS, Elias RM, Wanderley RA, Ferreira LQO, Sena TCM, Valerio TR, Gueiros JEB, Gueiros APS, Awata R, Goto S, Nakai K, Fujii H, Nishi S, Sagliker Y, Dingil M, Paylar N, Kapur S, Kim B, Lee DY, Yang S, Kim HW, Moon KH, Palmer S, Teixeira-Pinto A, Saglimbene V, Macaskill P, Craig J, Strippoli G, Marks A, Nguyen H, Fluck N, Prescott G, Robertson L, Black C. CKD BONE DISEASE. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu166] [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: 11/13/2022] Open
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Affiliation(s)
- L Mazzoleni
- Division of Nephrology, Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - S Aydin
- Division of Pathology, Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - M De Meyer
- Division of Surgery and Abdominal Transplantation, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Y Pirson
- Division of Nephrology, Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - N Kanaan
- Division of Nephrology, Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
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Rommelaere M, Maréchal C, Yombi JC, Goffin E, Kanaan N. Disseminated varicella zoster virus infection in adult renal transplant recipients: outcome and risk factors. Transplant Proc 2013; 44:2814-7. [PMID: 23146530 DOI: 10.1016/j.transproceed.2012.09.090] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Disseminated varicella zoster virus (VZV) infection, whether due to primary infection or reactivation, may be life threatening in renal transplant recipients. The aims of this study were to assess the outcome of disseminated VZV infection in renal transplant recipients and to determine potential risk factors for mortality. METHODS A search of the English literature from 1985 to 2011 using PUBMED was performed. Reports involving renal transplant recipients younger than 16 years of age were excluded. RESULTS A total of 56 adult patients presenting with a disseminated cutaneous or visceral VZV infection was included. Seventy percent of cases occurred within 5 years after transplantation, and 89% within 10 years. Visceral complications including disseminated intravascular coagulation occurred in two thirds of patients. Mortality decreased significantly from 47% in the era before 1995 to 17% after 1995 (P = .04). Risk factors for mortality included visceral involvement, use of azathioprine as immunosuppressant, and longer time between transplantation and VZV infection. VZV seropositivity did not influence fatal outcome. CONCLUSION Disseminated VZV infection can be life threatening in renal transplant recipients with a global mortality rate of 30%. This rate seems to have decreased since 1995. Seropositive VZV patients with disseminated infection are not protected from fatal outcome.
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Affiliation(s)
- M Rommelaere
- Division of Nephrology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
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Jouret F, Lhommel R, Devuyst O, Annet L, Pirson Y, Hassoun Z, Kanaan N. Diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease: attributes and limitations of the current modalities. Nephrol Dial Transplant 2012; 27:3746-51. [DOI: 10.1093/ndt/gfs352] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [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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Lipman G, Kanaan N, Constance B, Holck P, Grimm E, Jeffrey G, Williams S. 24 Optic Nerve Sheath Diameter Changes on Ascent to High Altitude. Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.049] [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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Halleux D, Kanaan N, Kabamba B, Thomas I, Hassoun Z. Hepatitis E virus: an underdiagnosed cause of chronic hepatitis in renal transplant recipients. Transpl Infect Dis 2011; 14:99-102. [DOI: 10.1111/j.1399-3062.2011.00677.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 07/09/2011] [Accepted: 07/25/2011] [Indexed: 12/01/2022]
Affiliation(s)
- D. Halleux
- Division of Nephrology; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain; Brussels; Belgium
| | - N. Kanaan
- Division of Nephrology; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain; Brussels; Belgium
| | - B. Kabamba
- Division of Clinical Biology; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain; Brussels; Belgium
| | - I. Thomas
- Belgium Scientific Institute of Public Health; Brussels; Belgium
| | - Z. Hassoun
- Division of Gastroenterology; Cliniques Universitaires Saint-Luc; Université Catholique de Louvain; Brussels; Belgium
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Ho T, Rommelaere M, Coche E, Yombi JC, Kanaan N. Nontuberculous mycobacterial pulmonary infection in renal transplant recipients. Transpl Infect Dis 2010; 12:138-42. [DOI: 10.1111/j.1399-3062.2009.00473.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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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Sibai T, Tohme RA, Beydoun HA, Kanaan N, Sibai AM. Violent behavior among adolescents in post-war Lebanon: the role of personal factors and correlation with other problem behaviors. J Public Health (Oxf) 2008; 31:39-46. [DOI: 10.1093/pubmed/fdn100] [Citation(s) in RCA: 7] [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: 11/14/2022] Open
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Abstract
A 57-year-old man presented with nephrotic syndrome associated with active HBV infection. Liver biopsy showed severe portal and moderate lobular inflammation, patchy necrosis, moderate fibrosis and several "ground glass" cells. Immunofluorescence microscopical view of the renal biopsy showed diffuse granular IgG deposits along the glomerular basement membrane, compatible with MN. As symptomatic therapy with ACE inhibitors did not improve the nephrotic syndrome, lamivudine 100 mg o.d. was initiated. HBV-DNA became undetectable after 10 weeks and seroconversion of HBeAg and HBsAg to anti-HBe and anti-HBs occurred after 2 additional months; proteinuria normalized subsequently. This observation documents for the first time in an adult the beneficial effect of lamivudine in glomerulonephritis related to HBV infection with HBV seroconversion and complete remission of the nephrotic syndrome.
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Affiliation(s)
- N Kanaan
- Department of Nephrology, Université catholique de Louvain, Cliniques Universitaires St. Luc, Brussels, Belgium.
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Abstract
Fibroadenomas of the breast have been reported in female renal graft recipients and associated with the use of cyclosporin A (CsA). We report the case of a young patient given CsA who developed multiple bilateral fibroadenomas of the breasts 3 years after renal transplantation, leading to bilateral mastectomy. We discuss the association of CsA with fibroadenomas, the mechanisms by which the drug can act and review the literature. Based on these observations, an early conversion from CsA to tacrolimus should be considered; further observations are needed to assess the reversibility of the breast(s) lesions after such immunosuppressive regimen switch.
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Affiliation(s)
- N Kanaan
- Department of Nephrology, Université Catholique de Louvain, Brussels, Belgium
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Kanaan N, Gavage P, Janssens M, Avesani V, Gigi J, Goffin E. Pasteurella multocida in peritoneal dialysis: a rare cause of peritonitis associated with exposure to domestic cats. Acta Clin Belg 2002; 57:254-6. [PMID: 12534132 DOI: 10.1179/acb.2002.050] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Pasteurella multocida is a rare cause of peritonitis in peritoneal dialysis patients with only 10 cases reported in the literature so far. All cases were observed in patients with close contact with cats, usually with a direct puncture of the dialysis tubing. We report a case of Pasteurella multocida peritonitis in a patient maintained under continuous cycling peritoneal dialysis (CCPD), who had frequent and close contact with cats. Patients should be made aware of this potential complication and advised to keep domestic animals away from the location of their peritoneal exchanges.
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Affiliation(s)
- N Kanaan
- Dpt of Nephrology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
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Kanaan N, Sawaya R. Nocturnal leg cramps. Clinically mysterious and painful--but manageable. Geriatrics (Basel) 2001; 56:34, 39-42. [PMID: 11417373] [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: 02/20/2023] Open
Abstract
Nocturnal leg cramps are common occurrences among older, generally healthy adults. Although there are many known causes--endocrinologic, neurologic, and vascular disorders, treatment with certain drugs, and occupational factors--a significant portion of cases are idiopathic. History, physical exam, and laboratory testing can provide clues for distinguishing between cramps with identifiable causes and idiopathic cases. For nonidiopathic cases, management consists of treating the underlying cause whenever possible. A nonpharmacologic approach (massaging and stretching) is the recommended first-line treatment for idiopathic cases. Quinine sulfate also appears to offer safe and effective symptom management of idiopathic cases, although its efficacy has not been definitively established in clinical trials.
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Affiliation(s)
- N Kanaan
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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22
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Kanaan N, Sawaya RA. Carpal tunnel syndrome: modern diagnostic and management techniques. Br J Gen Pract 2001; 51:311-4. [PMID: 11458486 PMCID: PMC1313983] [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: 02/20/2023] Open
Abstract
Carpal tunnel syndrome is a common disorder characterised by the classical symptoms of numbness and paraesthesiae along the distribution of the median nerve. Thenar muscle weakness is a late manifestation of advanced disease. Tinel's and Phalen's signs are helpful in suggesting the diagnosis. The symptoms and signs arise from entrapment of the median nerve. Electrophysiological tests are helpful in confirming the diagnosis and magnetic resonance imaging may be used in the diagnosis of atypical cases. Ergonomic manoeuvers and steroid injections may alleviate symptoms in mild cases. Surgery is reserved for severe cases and those who do not respond to conservative therapy. Open carpal tunnel release is the classical surgery with usually excellent results. Endoscopic carpal tunnel release surgery was introduced to decrease the morbidity of open surgery. This latter technique also has its complications and is still being refined.
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Affiliation(s)
- N Kanaan
- Department of Family Medicine, American University Medical Center, POB 113-6044/B-31, Beirut, Lebanon.
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Abstract
The proteasome is a multicatalytic complex of proteases involved in T lymphocyte proliferation and activation through multiple mechanisms. In this study, we investigated its role in lymphocyte aggregation. We found that blocking proteasome activity by a proteasome-specific inhibitor lactacystin (LAC) prevented clustering of T lymphocytes after stimulation with various mitogens. Expression of adhesion molecules ICAM-1 and LFA-1 at cell surfaces of activated T cells was decreased after treatment with LAC. Mechanisms by which the proteasome intervenes in the expression of these adhesion molecules were different. LAC inhibited ICAM-1 expression at the mRNA level, whereas LFA-1 inhibition was probably at a post-translational level. Downregulation of these molecules after proteasome inhibition likely contributes to the observed repression of T cell aggregation. Our results show that the proteasome plays an important role in cell-cell interaction during T cell activation.
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Affiliation(s)
- N Kanaan
- Research Center, Notre-Dame Hospital, CHUM, University of Montreal, Montreal, Canada
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Marshansky V, Wang X, Bertrand R, Luo H, Duguid W, Chinnadurai G, Kanaan N, Vu MD, Wu J. Proteasomes modulate balance among proapoptotic and antiapoptotic Bcl-2 family members and compromise functioning of the electron transport chain in leukemic cells. J Immunol 2001; 166:3130-42. [PMID: 11207265 DOI: 10.4049/jimmunol.166.5.3130] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The mechanism underlying apoptosis induced by proteasome inhibition in leukemic Jurkat and Namalwa cells was investigated in this study. The proteasome inhibitor lactacystin differentially regulated the protein levels of proapoptotic Bcl-2 family members and Bik was accumulated at the mitochondria. Bik overexpression sufficed to induce apoptosis in these cells. Detailed examination along the respiration chain showed that lactacystin compromised a step after complex III, and exogenous cytochrome c could overcome this compromise. Probably as a result, the succinate-stimulated generation of mitochondrial membrane potential was significantly diminished. Bcl-x(L) interacted with Bik in the cells, and Bcl-x(L) overexpression prevented cytochrome c leakage out of the mitochondria, corrected the mitochondrial membrane potential defect, and protected the cells from apoptosis. These results show that proteasomes can modulate apoptosis of lymphocytes by affecting the half-life of Bcl-2 family members, Bik being one of them.
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Affiliation(s)
- V Marshansky
- Research Center, Notre-Dame Hospital, Center hospitalier universitaire de l'Université de Montréal, University of Montreal, Montreal, Canada.
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Wu Y, Luo H, Kanaan N, Wu J. The proteasome controls the expression of a proliferation-associated nuclear antigen Ki-67. J Cell Biochem 2000; 76:596-604. [PMID: 10653979] [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: 02/15/2023]
Abstract
The proteasome is a protease complex responsible for rapid, selective, and irreversible removal of regulatory proteins, as well as many other cellular proteins. In this study, we have demonstrated that a proliferation-associated nuclear protein Ki-67 depended on the proteasome for its rapid degradation. A proteasome-specific inhibitor lactacystin augmented Ki-67 protein levels in pancreatic cancer BxPC-3 cells while repressed the level of steady-state Ki-67 mRNA. Inhibition of the proteasome also led to accumulation of two CDK inhibitors p27(kip1) and p21(cip1) in the BxPC-3 cells. Failed reduction of Ki-67 protein and enhanced levels of the two CDK inhibitors are likely contributing factors for the suppressed BxPC-3 proliferation after proteasome inhibition.
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Affiliation(s)
- Y Wu
- Department of Surgery, Second Affiliated Hospital of Zhejiang Medical College, Zhejiang University, Hangzhou, China
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Azar ST, Kanaan N. Intensive insulin therapy compared with conventional insulin therapy does not reduce depressive symptoms in parents of children with type 1 diabetes. Diabetes Care 1999; 22:1372-3. [PMID: 10480786 DOI: 10.2337/diacare.22.8.1372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Kanaan N, Pieters T, Jamar F, Goffin E. Hydrothorax complicating continuous ambulatory peritoneal dialysis: successful management with talc pleurodesis under thoracoscopy. Nephrol Dial Transplant 1999; 14:1590-2. [PMID: 10383035 DOI: 10.1093/ndt/14.6.1590] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Kanaan
- Department of Nephrology, Louvain Medical School, Brussels, Belgium
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Kanaan N, Robinson N, Roth SI, Ye D, Goldberger J, Kadish A. Ventricular tachycardia in healing canine myocardial infarction: evidence for multiple reentrant mechanisms. Pacing Clin Electrophysiol 1997; 20:245-60. [PMID: 9058861 DOI: 10.1111/j.1540-8159.1997.tb06168.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prior studies have demonstrated that unimorphic VT, sometimes due to epicardial reentry, can be induced in healing canine MI; however, the characterization of the types of reentry involved has differed among prior studies. The purpose of this study was to further characterize the spectrum of epicardial reentrant circuits during induced VT in experimental canine MI. Experimental MI was created by total occlusion of the LAD in dogs. Five days later, programmed stimulation was used to induce VT, which was mapped on the epicardium using a combination of vector and isochronal techniques. Pathological analysis was used to determine regions of transmural MI. Epicardial reentrant circuits were identified in eight dogs. The mean cycle length of induced VT was 212 +/- 32 ms. In 3 of 8 experiments, a region of transmural MI was present, which formed at least a portion of a central zone of block around which reentrant impulses circulated. In five experiments, reentry was functional in nature, although the characteristics of the region of functional conduction block were variable. Long lines of functional block, short lines of block with slow conduction transverse to fiber orientation, and leading circle reentry were each observed in different experiments. Although a zone of slow conduction was identified in seven of the experiments, slow conduction transverse to fiber orientation appeared crucial in maintaining reentry in only three experiments. Multiple reentrant mechanisms of VT may be present in this single canine infarction model. Although a zone of slow conduction is usually present, the characteristics of the region of block are highly variable. However, epicardial reentry accounted for only a minority of induced arrhythmia episodes.
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Affiliation(s)
- N Kanaan
- Department of Internal Medicine, Northwestern University, Chicago, Illinois, USA
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Abstract
UNLABELLED To examine changes in monophasic action potential duration (APD) with a pacing protocol similar to that used during electrophysiological testing, action potentials were recorded in vivo from the left ventricular apical endocardium of 12 normal mongrel dogs. The atrioventricular node was ablated and the dogs paced from the anterior right ventricle at a baseline cycle length of 1000 ms between interventions. Mean steady-state APD (APDss) was 266 +/- 7 ms at a pacing cycle length (PCL) of 1000 ms. Two pacing protocols were used. The first consisted of a sudden acceleration in pacing from a cycle length of 1000 ms to one between 300 and 600 ms. The second consisted of an 8-beat train at a cycle length of 400 ms followed by a premature beat at a coupling interval of 280 ms followed by a pause. The inter-train pause varied between 1 second and 32 seconds. With a sudden acceleration in pacing rate, steady-state values for APD at the faster PCLs were significantly smaller than APDss at 1000 ms with a change to cycle lengths of 600 ms (247 +/- 29 ms), 500 ms (229 +/- 21 ms), 400 ms (220 +/- 17 ms), and 300 ms (203 +/- 31 ms; P less than 0.01 for all comparisons). The time constant of the change in APD was shorter at a PCL of 300 ms (14.9 +/- 0.8 s) than 600 ms (20.3 +/- 4.7 s; P less than 0.05). With drive train pacing and incorporating an inter-train pause, the percent drop in steady-state APD compared to APD for the first train ranged from 10.1% with a 1-second inter-train pause to 2.1% with a 32-second pause. The difference in APD between the first drive train and drive trains after at least 3 minutes of pacing when APD had stabilized was not significant for an inter-train pause exceeding 8 seconds. IN CONCLUSION (1) with a sudden acceleration in pacing rate, endocardial APD in vivo decreases exponentially. The faster the new rate, the shorter the new steady-state APD and the shorter the time constant. (2) When pacing using an 8-beat drive train and an inter-train pause, there is a decremental shortening in APD for pause lengths shorter than 16 seconds. Thus, while performing programmed stimulation using a pause, a conditioning period of at least 2 minutes should be used prior to diastole scanning to allow APD to achieve a steady state.
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Affiliation(s)
- N Kanaan
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor
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Abstract
A computer system for rapid measurement and analysis of monophasic action potentials (MAPs) recorded in vivo was developed. MAPs recorded from the epicardium of mongrel dogs using a contact electrode were digitized by analog-to-digital conversion at a sampling rate of 1 kHz per channel for computer data acquisition. Activation time was detected using a sliding 10-point window at the location where the average positive dV/dT exceeds an adjustable threshold value in order to eliminate spurious detection due to baseline variability or motion artifact. Action potential duration (APD) was determined at 50% and 90% (APD50, APD90) repolarization levels at the first sample point below these detection levels. In addition, a tangent algorithm (APDtan) that detects peak negative dV/dT during repolarization was developed. APDtan was determined from the location of onset of activation to the intersection of tangent and baseline. APDtan allowed estimation of APD in the presence of subsequent premature beats when APD90 was not measurable. To validate activation time measurements, 4,600 action potentials were analyzed during fixed rate pacing. Over a range of paced coupling intervals from 200 to 1000 msec, an R2 value of 0.99968 and a slope of 0.9959 were obtained by linear regression between paced and calculated intervals. To validate APD measurements, 5035 action potentials were analyzed in five animals during fixed rate pacing (longer than 3 minutes) when action potential duration should be constant. Average coefficient of variation of 1.25%, 1.65%, and 1.14% were obtained for APD50, APD90, and APDtan, respectively. This algorithm provides a rapid and accurate method to analyze MAP activation and duration for basic physiological studies such as the determination of initiation of arrhythmias.
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Affiliation(s)
- N Kanaan
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor
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Affiliation(s)
- N Kanaan
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor 48109-2122
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