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Salhi S, Congy-Jolivet N, Hebral AL, Esposito L, Vieu G, Milhès J, Kamar N, Del Bello A. Utility of Routine Post Kidney Transplant Anti-HLA Antibody Screening. Kidney Int Rep 2024; 9:1343-1353. [PMID: 38707794 PMCID: PMC11068955 DOI: 10.1016/j.ekir.2024.02.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/28/2024] [Accepted: 02/12/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction De novo donor-specific antibody (dnDSA) is a strong biomarker associated with the development of antibody-mediated rejection (AMR) and graft loss after kidney transplantation. This procedure is expensive; however, systematic annual screening was recommended by some national organ transplant agencies or societies even though its clinical utility was not clearly established. Methods To address this question, we retrospectively assessed the incidence of dnDSA according to the test justification (clinically indicated or systematic) in a cohort of low-immunological risk patients, defined by being nonhuman leukocyte antigen (non-HLA)-sensitized and having no previous kidney transplants. Results A total of 1072 patients, for whom 4611 anti-HLA tests were performed, were included in the study. During the follow-up period of 8 (interquartile range, IQR: 5-11) years, 77 recipients developed dnDSA (prevalence of 7.2%). Thirty-five of these dnDSAs (45.5%) were detected during the first year posttransplantation. In 95% of patients with dnDSA, an immunizing event was identified in their medical records. dnDSA was detected in 46 of 4267 systematic screening tests (1.08%) performed. Active and chronic AMR were frequently observed in biopsies performed after systematic DSA testing (17.9% and 15.4%, respectively). Conclusion Our results suggest that the detection by systematic screening of dnDSA in low-immunological risk kidney transplant patients without sensitizing events is a rare event, especially after 1 year. Moreover, in real life, systematic annual screening for dnDSA, seems having a limited impact to detect AMR at an earlier stage compared to patients in whom dnDSA was detected after a clinically indicated test.
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Affiliation(s)
- Sofiane Salhi
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
- Faculté de santé, Université Paul Sabatier, Toulouse, France
| | - Nicolas Congy-Jolivet
- Faculté de santé, Université Paul Sabatier, Toulouse, France
- Molecular Immunogenetics Laboratory, EA 3034, Faculté de Médecine Purpan, IFR150 (INSERM), France
- Department of Immunology, CHU de Toulouse, Hôpital de Rangueil, CHU de Toulouse, France
| | - Anne-Laure Hebral
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Guillaume Vieu
- Etablissement Francais du Sang, CHU de Purpan, Toulouse, France
| | - Jean Milhès
- Faculté de santé, Université Paul Sabatier, Toulouse, France
- Molecular Immunogenetics Laboratory, EA 3034, Faculté de Médecine Purpan, IFR150 (INSERM), France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
- Faculté de santé, Université Paul Sabatier, Toulouse, France
- INSERM U1043, IFR–BMT, CHU Purpan, Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
- Faculté de santé, Université Paul Sabatier, Toulouse, France
- INSERM U1297, IFR–BMT, CHU Rangueil, Toulouse, France
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Esposito L, Cuellar E, Marion O, Del Bello A, Hebral AL, Sallusto F, Muscari F, Prudhomme T, Kamar N. Belatacept Rescue Therapy in the Early Period After Simultaneous Kidney-Pancreas Transplantation. Transpl Int 2024; 37:12628. [PMID: 38665473 PMCID: PMC11044140 DOI: 10.3389/ti.2024.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Laure Esposito
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Emmanuel Cuellar
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
- INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Anne Laure Hebral
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Federico Sallusto
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - Fabrice Muscari
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Thomas Prudhomme
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
- INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France
- Université Paul Sabatier, Toulouse, France
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Carrillo J, Del Bello A, Sallusto F, Delas A, Colombat M, Mansuy JM, Izopet J, Kamar N, Belliere J. Effect of steroid pulses in severe BK virus allograft nephropathy with extensive interstitial inflammation. Transpl Infect Dis 2024; 26:e14260. [PMID: 38547002 DOI: 10.1111/tid.14260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION As there is no specific antiviral treatment currently available for BK polyomavirus associated nephropathy (BKVAN), its management relies on immunosuppression reduction in kidney transplant patients. Data on efficacy of steroid pulses in this indication are lacking. METHODS We performed a retrospective monocenter study on 64 patients diagnosed with biopsy-proven BKVAN. Patients within the "pulse group" (n = 37) received IV methylprednisolone 10 mg/kg 3 days consecutively. In the "low dose" steroid group (n = 27), patients were continued oral prednisone 5 mg daily. RESULTS Mean follow up was 78 months in the steroid pulse group and 56 months in the low dose group (p = 0.15). Mean eGFR values at diagnosis were comparable, as well as other demographic characteristics. Mean BK plasma viral load was higher in "pulse" than in "low dose" steroid group. Pulse group had higher inflammation and tubulitis (p < 0.05). Graft loss reached 57% in the "pulse" group versus 41% in the "low dose" group, p = 0.20. Rejection events were similar. No major adverse event was statistically associated with steroid pulse, including infections, cancer, and de novo diabetes. CONCLUSION No significant differences were found in the evolution of both groups of patients, despite patients receiving "pulse" steroids were identified as the most severe sharing higher BK viral load and more frequent active lesions on histology.
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Affiliation(s)
- Julien Carrillo
- Department of Nephrology and Organ Transplantation, Referral Centre for Rare Kidney Diseases, French Intensive Care Renal Network, University Hospital of Toulouse, Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Referral Centre for Rare Kidney Diseases, French Intensive Care Renal Network, University Hospital of Toulouse, Toulouse, France
| | - Federico Sallusto
- Department of Urology and Kidney Transplantation, CHU Rangueil, Toulouse, France
| | - Audrey Delas
- Department of Pathology, University Hospital of Toulouse, University Cancer Institute of Toulouse, Toulouse, France
| | - Magali Colombat
- Department of Pathology, University Hospital of Toulouse, University Cancer Institute of Toulouse, Toulouse, France
- Université Toulouse III, Toulouse, France
| | - Jean Michel Mansuy
- Laboratory of Virology, Institut fédératif de Biologie, University Hospital of Toulouse, Toulouse, France
| | - Jacques Izopet
- Laboratory of Virology, Institut fédératif de Biologie, University Hospital of Toulouse, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Referral Centre for Rare Kidney Diseases, French Intensive Care Renal Network, University Hospital of Toulouse, Toulouse, France
- Université Toulouse III, Toulouse, France
- INSERM UMR1291-CNRS UMR5051, Toulouse, France
| | - Julie Belliere
- Department of Nephrology and Organ Transplantation, Referral Centre for Rare Kidney Diseases, French Intensive Care Renal Network, University Hospital of Toulouse, Toulouse, France
- Université Toulouse III, Toulouse, France
- INSERM U1297, Institute of Metabolic and Cardiovascular Diseases, Toulouse, France
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Prudhomme T, Couat C, Bento L, Del Bello A, Sauné K, Izopet J, Soulié M, Sallusto F, Kamar N. BK Viremia and Viruria Does Not Depend on the Type of Double-J Stent Used During Kidney Transplantation. EXP CLIN TRANSPLANT 2024; 22:267-269. [PMID: 38742316 DOI: 10.6002/ect.2024.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVES BK virus is a major cause of chronic renal allograft failure.Transplant ureteral stent use has been reported as a risk factorfor BK virus infection. Recently, the use of a new type of ureteral stent (Magnetic Black Star) was reported in kidney transplant recipients. The aim ofthis preliminary report was to compare BK virus viremia and viruria occurrence depending on the type of double-J stent (standard versus Magnetic Black Star). MATERIALS AND METHODS We included all kidney transplants performed in our center from January to December 2022. Each case had double-J stent placement. Indwelling stents were either a 6- or 7-Fr standard double-J stent or a 6-Fr Magnetic Black Star double-J stent. The type of double-J stent was chosen according to the surgeon's preference. A standard BK virus screening protocol was followed during the study period, which consisted of routine polymerase chain reaction examination of plasma and urine samples during monthly follow-ups. RESULTS We assessed 120 patients without missing data: 92 patients received standard double-J stents and 28 patients received Magnetic Black Star stents. Patients were mostly male in the standard group (70.7%) versus the Magnetic Black Star group (42.9%) (P = .01). ABO- and HLA-incompatible transplant rates were similar in both groups. BK viremia occurrence and BK viruria occurrence were similar between groups at 1 month, 3 months, and 6 months. CONCLUSIONS This preliminary study showed no differences concerning BKvirus infection depending on the type of double-J stents used during kidney transplant.
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Affiliation(s)
- Thomas Prudhomme
- From the Department of Urology, Andrology and Kidney Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
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Bellamy COC, O'Leary JG, Adeyi O, Baddour N, Batal I, Bucuvalas J, Del Bello A, El Hag M, El-Monayeri M, Farris AB, Feng S, Fiel MI, Fischer SE, Fung J, Grzyb K, Guimei M, Haga H, Hart J, Jackson AM, Jaeckel E, Khurram NA, Knechtle SJ, Lesniak D, Levitsky J, McCaughan G, McKenzie C, Mescoli C, Miquel R, Minervini MI, Nasser IA, Neil D, O'Neil MF, Pappo O, Randhawa P, Ruiz P, Fueyo AS, Schady D, Schiano T, Sebagh M, Smith M, Stevenson HL, Taner T, Taubert R, Thung S, Trunecka P, Wang HL, Wood-Trageser M, Yilmaz F, Zen Y, Zeevi A, Demetris AJ. Banff 2022 Liver Group Meeting report: Monitoring long-term allograft health. Am J Transplant 2024:S1600-6135(24)00204-1. [PMID: 38461883 DOI: 10.1016/j.ajt.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
The Banff Working Group on Liver Allograft Pathology met in September 2022. Participants included hepatologists, surgeons, pathologists, immunologists, and histocompatibility specialists. Presentations and discussions focused on the evaluation of long-term allograft health, including noninvasive and tissue monitoring, immunosuppression optimization, and long-term structural changes. Potential revision of the rejection classification scheme to better accommodate and communicate late T cell-mediated rejection patterns and related structural changes, such as nodular regenerative hyperplasia, were discussed. Improved stratification of long-term maintenance immunosuppression to match the heterogeneity of patient settings will be central to improving long-term patient survival. Such personalized therapeutics are in turn contingent on a better understanding and monitoring of allograft status within a rational decision-making approach, likely to be facilitated in implementation with emerging decision-support tools. Proposed revisions to rejection classification emerging from the meeting include the incorporation of interface hepatitis and fibrosis staging. These will be opened to online testing, modified accordingly, and subject to consensus discussion leading up to the next Banff conference.
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Affiliation(s)
- Christopher O C Bellamy
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland and Department of Pathology, Edinburgh Royal Infirmary, Edinburgh, Scotland.
| | - Jacqueline G O'Leary
- Dallas VA Medical Center & University of Texas, Southwestern, Department of Medicine, Dallas Texas, USA
| | - Oyedele Adeyi
- University of Minnesota Medical School, Department of Pathology, Minneapolis, Minnesota, USA
| | - Nahed Baddour
- Faculty of Medicine, University of Alexandria, Egypt
| | - Ibrahim Batal
- Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | | | | | | | | | - Alton B Farris
- Pathology, Emory University Hospital, Atlanta, Georgia, USA
| | - Sandy Feng
- UCSF Health, Department of Surgery, San Francisco, California, USA
| | - Maria Isabel Fiel
- Pathology, Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | | | - John Fung
- Uchicago Medicine, Department of Surgery, Chicago, Illinois, USA
| | | | - Maha Guimei
- Armed Forces College of Medicine, Cairo, Egypt
| | | | - John Hart
- Uchicago Medicine, Department of Pathology, Chicago, Illinois, USA
| | | | | | - Nigar A Khurram
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania, USA
| | | | - Drew Lesniak
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Rosa Miquel
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Marta I Minervini
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania, USA
| | - Imad Ahmad Nasser
- Beth Israel Deaconess Medical Center, Harvard, Boston, Massachusetts, USA
| | - Desley Neil
- University Hospitals Birmingham NHS Foundation Trust, United Kingdom
| | - Maura F O'Neil
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Orit Pappo
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Parmjeet Randhawa
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania, USA
| | - Phillip Ruiz
- University of Miami Hospital, Miami, Florida, USA
| | | | | | - Thomas Schiano
- Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York, USA
| | | | - Maxwell Smith
- Pathology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | | | - Timucin Taner
- Division of Transplantation Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard Taubert
- Dept. of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Swan Thung
- Pathology, Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Pavel Trunecka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Hanlin L Wang
- Pathology, UCLA Health, Los Angeles, California, USA
| | - Michelle Wood-Trageser
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania, USA
| | - Funda Yilmaz
- Pathology, University of Ege, Imir, Bornova, Turkey
| | - Yoh Zen
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Adriana Zeevi
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Guy P, Marion O, Oberic L, Darres A, Cointault O, Del Bello A, Kamar N. CAR T-Cell Therapy for Refractory Posttransplantation Lymphoproliferative Disorder in a Kidney Transplant Patient. Transplant Direct 2024; 10:e1584. [PMID: 38414975 PMCID: PMC10898664 DOI: 10.1097/txd.0000000000001584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 02/29/2024] Open
Affiliation(s)
- Pierre Guy
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Lucie Oberic
- Department of Hematology, IUCT, Toulouse University Hospital, Toulouse, France
| | - Amandine Darres
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Olivier Cointault
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
- INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
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Raynaud M, Al-Awadhi S, Louis K, Zhang H, Su X, Goutaudier V, Wang J, Demir Z, Wei Y, Truchot A, Bouquegneau A, Del Bello A, Bailly É, Lombardi Y, Maanaoui M, Giarraputo A, Naser S, Divard G, Aubert O, Murad MH, Wang C, Liu L, Bestard O, Naesens M, Friedewald JJ, Lefaucheur C, Riella L, Collins G, Ioannidis JP, Loupy A. Prognostic Biomarkers in Kidney Transplantation: A Systematic Review and Critical Appraisal. J Am Soc Nephrol 2024; 35:177-188. [PMID: 38053242 PMCID: PMC10843205 DOI: 10.1681/asn.0000000000000260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/08/2023] [Indexed: 12/07/2023] Open
Abstract
SIGNIFICANCE STATEMENT Why are there so few biomarkers accepted by health authorities and implemented in clinical practice, despite the high and growing number of biomaker studies in medical research ? In this meta-epidemiological study, including 804 studies that were critically appraised by expert reviewers, the authors have identified all prognostic kidney transplant biomarkers and showed overall suboptimal study designs, methods, results, interpretation, reproducible research standards, and transparency. The authors also demonstrated for the first time that the limited number of studies challenged the added value of their candidate biomarkers against standard-of-care routine patient monitoring parameters. Most biomarker studies tended to be single-center, retrospective studies with a small number of patients and clinical events. Less than 5% of the studies performed an external validation. The authors also showed the poor transparency reporting and identified a data beautification phenomenon. These findings suggest that there is much wasted research effort in transplant biomarker medical research and highlight the need to produce more rigorous studies so that more biomarkers may be validated and successfully implemented in clinical practice. BACKGROUND Despite the increasing number of biomarker studies published in the transplant literature over the past 20 years, demonstrations of their clinical benefit and their implementation in routine clinical practice are lacking. We hypothesized that suboptimal design, data, methodology, and reporting might contribute to this phenomenon. METHODS We formed a consortium of experts in systematic reviews, nephrologists, methodologists, and epidemiologists. A systematic literature search was performed in PubMed, Embase, Scopus, Web of Science, and Cochrane Library between January 1, 2005, and November 12, 2022 (PROSPERO ID: CRD42020154747). All English language, original studies investigating the association between a biomarker and kidney allograft outcome were included. The final set of publications was assessed by expert reviewers. After data collection, two independent reviewers randomly evaluated the inconsistencies for 30% of the references for each reviewer. If more than 5% of inconsistencies were observed for one given reviewer, a re-evaluation was conducted for all the references of the reviewer. The biomarkers were categorized according to their type and the biological milieu from which they were measured. The study characteristics related to the design, methods, results, and their interpretation were assessed, as well as reproducible research practices and transparency indicators. RESULTS A total of 7372 publications were screened and 804 studies met the inclusion criteria. A total of 1143 biomarkers were assessed among the included studies from blood ( n =821, 71.8%), intragraft ( n =169, 14.8%), or urine ( n =81, 7.1%) compartments. The number of studies significantly increased, with a median, yearly number of 31.5 studies (interquartile range [IQR], 23.8-35.5) between 2005 and 2012 and 57.5 (IQR, 53.3-59.8) between 2013 and 2022 ( P < 0.001). A total of 655 studies (81.5%) were retrospective, while 595 (74.0%) used data from a single center. The median number of patients included was 232 (IQR, 96-629) with a median follow-up post-transplant of 4.8 years (IQR, 3.0-6.2). Only 4.7% of studies were externally validated. A total of 346 studies (43.0%) did not adjust their biomarker for key prognostic factors, while only 3.1% of studies adjusted the biomarker for standard-of-care patient monitoring factors. Data sharing, code sharing, and registration occurred in 8.8%, 1.1%, and 4.6% of studies, respectively. A total of 158 studies (20.0%) emphasized the clinical relevance of the biomarker, despite the reported nonsignificant association of the biomarker with the outcome measure. A total of 288 studies assessed rejection as an outcome. We showed that these rejection studies shared the same characteristics as other studies. CONCLUSIONS Biomarker studies in kidney transplantation lack validation, rigorous design and methodology, accurate interpretation, and transparency. Higher standards are needed in biomarker research to prove the clinical utility and support clinical use.
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Affiliation(s)
- Marc Raynaud
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
| | - Solaf Al-Awadhi
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
| | - Kevin Louis
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
| | - Huanxi Zhang
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaojun Su
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Valentin Goutaudier
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
| | - Jiali Wang
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zeynep Demir
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
| | - Yongcheng Wei
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Agathe Truchot
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
| | - Antoine Bouquegneau
- Department of Nephrology-Dialysis-Transplantation, University Hospital of Liège, Liège, Belgium
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, INSERM, CHU Rangueil & Purpan, Université Paul Sabatier, Toulouse, France
| | - Élodie Bailly
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Yannis Lombardi
- Kidney Transplant Department, Tenon Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Mehdi Maanaoui
- Nephrology Department, CHU Lille, Lille University, Lille, France
- INSERM U1190, Translational Research for Diabetes, Lille, France
| | - Alessia Giarraputo
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Sofia Naser
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
| | - Gillian Divard
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
| | - Olivier Aubert
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
| | | | - Changxi Wang
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Longshan Liu
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Oriol Bestard
- Nephrology Department, Hospital de Vall d'Hebron, Barcelona, Spain
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - John J. Friedewald
- Division of Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Carmen Lefaucheur
- Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Leonardo Riella
- Renal Division, Schuster Family Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gary Collins
- Center for Statistics in Medicine, NDORMS, Botnar Research Center, University of Oxford, Oxford, United Kingdom
| | - John P.A. Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
| | - Alexandre Loupy
- INSERM, PARCC, Paris Institute for Transplantation and Organ Regeneration, Université de Paris Cité, Paris, France
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8
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Darres A, Del Bello A, Marion O, de Lamballerie X, Malvy D, Izopet J, Kamar N. Failure of favipiravir to treat chronic norovirus infection in a kidney-transplant patient. Transpl Infect Dis 2024; 26:e14235. [PMID: 38180288 DOI: 10.1111/tid.14235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Amandine Darres
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
- Department of Vascular Biology, Institute of Metabolic and Cardiovascular Diseases (I2MC), Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
- Department of Vascular Biology, Institute of Metabolic and Cardiovascular Diseases (I2MC), Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
- INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France
| | - Xavier de Lamballerie
- Unité des Virus Émergents, INSERM-1207, IRD-190, Aix-Marseille University, Marseille, France
| | - Denis Malvy
- Service des maladies infectieuses et tropicales, CHU de Bordeaux, Bordeaux, France
- Inserm UMR 1219, IRD EMR 271, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - Jacques Izopet
- INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France
- Department of Virology, Toulouse University Hospital, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
- INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
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9
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Demir Z, Raynaud M, Aubert O, Debray D, Sebagh M, Duong Van Huyen JP, Del Bello A, Jolivet NC, Paradis V, Durand F, Muratot S, Lozach C, Chardot C, Francoz C, Kamar N, Sarnacki S, Coilly A, Samuel D, Vibert E, Féray C, Lefaucheur C, Loupy A. Identification of liver transplant biopsy phenotypes associated with distinct liver biological markers and allograft survival. Am J Transplant 2023:S1600-6135(23)00907-3. [PMID: 38097016 DOI: 10.1016/j.ajt.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 01/01/2024]
Abstract
The intricate association between histologic lesions and circulating antihuman leucocyte antigen donor-specific antibodies (DSA) in liver transplantation (LT) requires further clarification. We conducted a probabilistic, unsupervised approach in a comprehensively well-annotated LT cohort to identify clinically relevant archetypes. We evaluated 490 pairs of LT biopsies with DSA testing from 325 recipients transplanted between 2010 and 2020 across 3 French centers and an external cohort of 202 biopsies from 128 recipients. Unsupervised archetypal analysis integrated all clinico-immuno-histologic parameters of each biopsy to identify biopsy archetypes. The median time after LT was 1.17 (interquartile range, 0.38-2.38) years. We identified 7 archetypes distinguished by clinico-immuno-histologic parameters: archetype #1: severe T cell-mediated rejection (15.9%); #2: chronic rejection with ductopenia (1.8%); #3: architectural and microvascular damages (3.5%); #4: (sub)normal (55.9%); #5: mild T cell-mediated rejection (4.9%); #6: acute antibody-mediated rejection (6.5%); and #7: chronic rejection with DSA (11.4%). Cell infiltrates vary in the archetype. These archetypes were associated with distinct liver biological markers and allograft outcomes. These findings remained consistent when stratified using the patient's age or indications for LT, with good performance in the external cohort (mean highest probability assignment = 0.58, standard deviation ± 0.17). In conclusion, we have identified clinically meaningful archetypes, providing valuable insights into the intricate DSA-histology association, which may help standardize liver allograft pathology classification.
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Affiliation(s)
- Zeynep Demir
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France
| | - Marc Raynaud
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France
| | - Olivier Aubert
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France; Kidney Transplantation Department, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dominique Debray
- Pediatric Hepatology and Liver Transplantation Unit, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Mylène Sebagh
- Pathology Department Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Jean-Paul Duong Van Huyen
- Pathology Department, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Nicolas Congy Jolivet
- Department of Immunology, Hôpital de Rangueil, CHU de Toulouse, Molecular Immunogenetics Laboratory, EA 3034, IFR150 (INSERM), Toulouse, France
| | - Valérie Paradis
- Pathology Department, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, Clichy, France
| | - François Durand
- Hepatology Department, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, Clichy, France
| | - Sophie Muratot
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France
| | - Cécile Lozach
- Department of Pediatric Radiology, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christophe Chardot
- Department of Pediatric Surgery, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Claire Francoz
- Hepatology Department, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, Clichy, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Audrey Coilly
- Hepatobiliary Center, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Inserm Paris-Saclay Research Unit 1193, Paris-Saclay University, Villejuif, France
| | - Didier Samuel
- Hepatobiliary Center, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Inserm Paris-Saclay Research Unit 1193, Paris-Saclay University, Villejuif, France
| | - Eric Vibert
- Hepatobiliary Center, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Inserm Paris-Saclay Research Unit 1193, Paris-Saclay University, Villejuif, France
| | - Cyrille Féray
- Hepatobiliary Center, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Inserm Paris-Saclay Research Unit 1193, Paris-Saclay University, Villejuif, France
| | - Carmen Lefaucheur
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France; Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France; Kidney Transplantation Department, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
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10
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Dumortier J, Conti F, Hiriart JB, Dharancy S, Duvoux C, Besch C, Houssel-Debry P, Latournerie M, Chermak F, Meszaros M, Pageaux GP, Radenne S, Boillot O, Hardwigsen J, Kounis I, Kamar N, Saliba F, Erard D, Del Bello A. Treatment of donor-specific anti-HLA antibodies-mediated rejection after liver transplantation: A French nationwide retrospective study. Liver Transpl 2023; 29:1313-1322. [PMID: 37367954 DOI: 10.1097/lvt.0000000000000200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023]
Abstract
The deleterious effect of donor-specific anti-HLA antibodies (DSA) after liver transplantation (LT) has been increasingly recognized during the past decade. Antibody-mediated rejection (AMR) represents a rare but severe complication in the presence of DSA. However, little is known concerning the treatment of AMR after LT. The nationwide French study aimed to describe LT recipients who received specific treatment of AMR. We performed a multicenter retrospective study on 44 patients who were treated with B-cell targeting agents from January 2008 to December 2020. Median patient age at the time of AMR treatment was 51.6 years (range: 17.9-68.0). AMR was classified as acute (n = 19) or chronic (n = 25). The diagnosis of AMR was made after a median time of 16.8 months (range: 0.4-274.2) after LT. The main therapeutic combination was plasma exchange/rituximab/IVIG (n = 25, 56.8%). The median follow-up after the treatment of AMR was 32 months (range: 1-115). After the treatment, 1-, 5- and 10-year patient and graft survivals were 77%, 55.9%, and 55.9%, and 69.5%, 47.0%, and 47.0%, respectively. Initial total bilirubin (Q1-Q3 vs. Q4) was significantly associated with patient survival (log-rank test, p = 0.005) and graft survival (log-rank test, p = 0.002). After a median follow-up of 21 months (range: 12-107), DSA became undetectable in 15/38 patients (39.5%) with available DSA monitoring. In conclusion, specific treatment of AMR in LT recipients has slowly emerged in France during the past decade and has probably been considered in the most severe patients; this explains the global poor outcome, even if the outcome was favorable in some cases.
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Affiliation(s)
- Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités digestives, et Université Claude Bernard Lyon 1, Lyon, France
| | - Filomena Conti
- APHP, Hôpital de la Pitié Salpêtrière, Service d'hépatologie et transplantation hépatique, Paris, France
| | - Jean-Baptiste Hiriart
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service de Chirurgie hépatobiliaire et de transplantation hépatique, Bordeaux, France
| | - Sébastien Dharancy
- CHU Lille, Hôpital Claude Huriez, Service des maladies de l'appareil digestif, Lille, France
| | | | - Camille Besch
- CHRU Hautepierre, Service de chirurgie hépato-bilio-pancréatique et transplantation hépatique, Strasbourg, France
| | - Pauline Houssel-Debry
- Hôpital Universitaire de Pontchaillou, Service d'Hépatologie et Transplantation hépatique, Rennes, France
| | - Marianne Latournerie
- CHU Dijon, Service d'Hépato-gastroentérologie et oncologie digestive, Inserm EPICAD LNC-UMR1231, Université de Bourgogne-Franche Comté, Dijon, France
| | - Faiza Chermak
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service de Chirurgie hépatobiliaire et de transplantation hépatique, Bordeaux, France
| | - Magdalena Meszaros
- CHU Saint Eloi, Département d'hépato-gatroentérologie et transplantation hépatique, et Université de Montpellier, Montpellier, France
| | - Georges-Philippe Pageaux
- CHU Saint Eloi, Département d'hépato-gatroentérologie et transplantation hépatique, et Université de Montpellier, Montpellier, France
| | - Sylvie Radenne
- Hospices civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Olivier Boillot
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités digestives, et Université Claude Bernard Lyon 1, Lyon, France
| | - Jean Hardwigsen
- APHM, Hôpital La Timone, Service chirurgie générale et transplantation hépatique Marseille, France
| | - Ilias Kounis
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, INSERM, Unité 1193, Hepatinov, et Université Paris Saclay, Villejuif, France
| | - Nassim Kamar
- CHU Rangueil, Département de Néphrologie et Transplantation d'Organes, Toulouse, France
| | - Faouzi Saliba
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, INSERM, Unité 1193, Hepatinov, et Université Paris Saclay, Villejuif, France
| | - Domitille Erard
- Hospices civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-Gastroentérologie, Lyon, France
| | - Arnaud Del Bello
- CHU Rangueil, Département de Néphrologie et Transplantation d'Organes, Toulouse, France
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11
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Milhès J, Marion O, Puissant B, Carlé C, Bouthemy C, Del Bello A, Kamar N, Renaudineau Y, Congy-Jolivet N. Impact of imlifidase treatment on immunoglobulins in an HLA-hypersensitized lupus nephritis patient with anti-SSA/SSB antibodies after kidney transplantation: A case report. J Transl Autoimmun 2023; 7:100223. [PMID: 38162455 PMCID: PMC10755536 DOI: 10.1016/j.jtauto.2023.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Bacterial recombinant cysteine protease Ides (imlifidase, Idefirix®, Hansa Biopharma) is used to prevent humoral transplant rejection in highly HLA-sensitized recipients, and to control IgG-mediated autoimmune diseases. We report the case of a 51 years old woman suffering from lupus nephritis with end stage kidney disease, grafted for the second time and pre-treated with imlifidase. The patient was HLA-hypersensitized (calculated Panel Reactive Antibodies [Abs], cPRA>99 %) and has three preformed Donor Specific Antibodies (DSA). Circulating immunoglobulins were monitored at initiation (0, 6, 36, 72 and 96 h), and at Ab recovery one and two months following imlifidase injection. From baseline, the higher depletion was reported after 36h for total IgG (-75 %) and IgG subclasses (-87 % for IgG1, IgG2 and IgG3, -78 % for IgG4), while no significant impact on IgA and IgM was observed. Anti-SSA 60 kDa and anti-SSB auto-Abs quickly decreased after imlifidase injection (-96 % for both after 36 h) as well as post-vaccinal specific IgG (-95 % for tetanus toxoid, -97 % for pneumococcus and -91 % for Haemophilus influenzae Abs after 36 h). At the Ab recovery phase, total IgG and anti-SSA60/SSB Abs reached their initial level at two months. Regarding alloreactive Abs, anti-HLA Abs including the three DSA showed a dramatic decrease after injection with 100 % depletion from baseline after 36 h as assessed by multiplex single bead antigen assay, leading to negative crossmatches using both lymphocytotoxicity (LCT) and flow cell techniques. DSA rebound at recovery was absent and remained under the positivity threshold (MFI = 1000) after 6 months. The findings from this case report are that imlifidase exerts an early depleting effect on all circulating IgG, while IgG recovery may depend in part from imlifidase's capacity to target memory B cells.
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Affiliation(s)
- Jean Milhès
- Immunology Laboratory Department, Institut Fédératif de Biologie, Purpan, Toulouse University Hospital Center, Toulouse, France
| | - Olivier Marion
- Nephrology and Organ Transplantation Department, Rangueil Toulouse University Hospital, Toulouse, France
| | - Benedicte Puissant
- Immunology Laboratory Department, Institut Fédératif de Biologie, Purpan, Toulouse University Hospital Center, Toulouse, France
- INSERM UMR 1291 - CNRS UMR 5051, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), University Toulouse III, Toulouse, France
| | - Caroline Carlé
- Immunology Laboratory Department, Institut Fédératif de Biologie, Purpan, Toulouse University Hospital Center, Toulouse, France
- INSERM UMR 1291 - CNRS UMR 5051, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), University Toulouse III, Toulouse, France
| | - Charlène Bouthemy
- Immunology Laboratory Department, Institut Fédératif de Biologie, Purpan, Toulouse University Hospital Center, Toulouse, France
| | - Arnaud Del Bello
- Nephrology and Organ Transplantation Department, Rangueil Toulouse University Hospital, Toulouse, France
| | - Nassim Kamar
- Nephrology and Organ Transplantation Department, Rangueil Toulouse University Hospital, Toulouse, France
| | - Yves Renaudineau
- Immunology Laboratory Department, Institut Fédératif de Biologie, Purpan, Toulouse University Hospital Center, Toulouse, France
- INSERM UMR 1291 - CNRS UMR 5051, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), University Toulouse III, Toulouse, France
| | - Nicolas Congy-Jolivet
- Immunology Laboratory Department, Institut Fédératif de Biologie, Purpan, Toulouse University Hospital Center, Toulouse, France
- UMR 1037 INSERM Team 20 / Université Toulouse III Paul Sabatier, Toulouse Cancerology Research Center (CRCT), Toulouse, France
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12
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Kamar N, Marion O, Del Bello A. [Infectious risks after solid organ transplantation]. Rev Prat 2023; 73:969-972. [PMID: 38294445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
INFECTION AFTER SOLID-ORGAN-TRANSPLANTATION. Infections is one the most cause for hospitalization after solid-organ-transplantation. We distinguish donor-derived infections, reactivation of latent infection in recipients, nosocomial infections and community infections. The first three types are observed mainly in the early period post-transplantation, while community infections can occur at any time after transplantation. Opportunistic infections and some specific infections should be assessed systematically and rapidly. This often requires invasive diagnostic procedures. Prevention altered the incidence and severity of post-transplant infections. It included vaccination, use of universal prophylaxis, systematic monitoring of some agents after transplantation and safer living.
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Affiliation(s)
- Nassim Kamar
- Département de néphrologie et transplantation d'organes, CHU Toulouse, Toulouse, France. Inserm UMR 1291, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France. Université Paul-Sabatier, Toulouse, France
| | - Olivier Marion
- Département de néphrologie et transplantation d'organes, CHU Toulouse, Toulouse, France . Inserm UMR 1291, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France
| | - Arnaud Del Bello
- Département de néphrologie et transplantation d'organes, CHU Toulouse, Toulouse, France . Inserm UMR 1291, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France
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13
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Del Bello A, Treiner E. Immune Checkpoints in Solid Organ Transplantation. Biology (Basel) 2023; 12:1358. [PMID: 37887068 PMCID: PMC10604300 DOI: 10.3390/biology12101358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
Allogenic graft acceptance is only achieved by life-long immunosuppression, which comes at the cost of significant toxicity. Clinicians face the challenge of adapting the patients' treatments over long periods to lower the risks associated with these toxicities, permanently leveraging the risk of excessive versus insufficient immunosuppression. A major goal and challenge in the field of solid organ transplantation (SOT) is to attain a state of stable immune tolerance specifically towards the grafted organ. The immune system is equipped with a set of inhibitory co-receptors known as immune checkpoints (ICs), which physiologically regulate numerous effector functions. Insufficient regulation through these ICs can lead to autoimmunity and/or immune-mediated toxicity, while excessive expression of ICs induces stable hypo-responsiveness, especially in T cells, a state sometimes referred to as exhaustion. IC blockade has emerged in the last decade as a powerful therapeutic tool against cancer. The opposite action, i.e., subverting IC for the benefit of establishing a state of specific hypo-responsiveness against auto- or allo-antigens, is still in its infancy. In this review, we will summarize the available literature on the role of ICs in SOT and the relevance of ICs with graft acceptance. We will also discuss the possible influence of current immunosuppressive medications on IC functions.
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Affiliation(s)
- Arnaud Del Bello
- Department of Nephrology, University Hospital of Toulouse, 31400 Toulouse, France
- Metabolic and Cardiovascular Research Institute (I2MC), Inserm UMR1297, CEDEX 4, 31432 Toulouse, France
- Faculty of Medicine, University Toulouse III Paul Sabatier, 31062 Toulouse, France
| | - Emmanuel Treiner
- Faculty of Medicine, University Toulouse III Paul Sabatier, 31062 Toulouse, France
- Laboratory of Immunology, University Hospital of Toulouse, 31300 Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm UMR1291, 31024 Toulouse, France
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14
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Daniel J, Dumortier J, Del Bello A, Gamon L, Molinari N, Faure S, Meszaros M, Ursic-Bedoya J, Meunier L, Monet C, Navarro F, Boillot O, Pageaux GP, Donnadieu-Rigole H. Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse. JHEP Rep 2023; 5:100832. [PMID: 37681206 PMCID: PMC10480527 DOI: 10.1016/j.jhepr.2023.100832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 09/09/2023] Open
Abstract
Background & Aims Liver transplantation (LT) is a last resort treatment for patients at high risk of mortality from end-stage liver disease. Over the past years, alcohol-associated liver disease has become the most frequent indication for LT in the world. The outcomes of LT for alcohol-associated liver disease are good, but return to alcohol use is detrimental for medium-term survival because of cancer development, cardiovascular events, and recurrent alcohol-associated cirrhosis. Several strategies have been developed to prevent return to alcohol use during the pre- or post-LT period, but there are no specific recommendations. Therefore, the main objective of this study was to investigate if the integration of an addiction team in a LT unit affected the rate of severe alcohol relapse after LT. The secondary objectives were to assess the effects of addiction follow up on cardiovascular events, cancer, and overall survival. Methods This study was a retrospective comparison between centres with or without addiction monitoring. Results The study included 611 patients of which 79.4% were male with a mean age of 55.4 years at the time of LT, 190 were managed by an integrated addiction team. The overall alcohol relapse rate was 28.9% and the rate of severe relapse was 13.0%. Patients with addiction follow-up had significantly less frequent severe alcohol relapse than those in the control group (p = 0.0218). Addiction follow up (odds ratio = 0.19; p = 0.001) and age at LT (odds ratio = 1.23; p = 0.02) remained significantly associated with post-LT cardiovascular events. Conclusions Our study confirms the benefits of integrating an addiction team to reduce return to alcohol use after LT. Clinical Trials registration This study is registered at ClinicalTrials.gov (NCT04964687). Impact and implications The main indication for liver transplantation is alcohol-associated cirrhosis. There are currently no specific recommendations on the addiction monitoring of transplant candidates, although severe return to alcohol use after liver transplantation has a negative impact on long-term survival of patients. In this study, we explored the impact of a systematic addiction intervention on the return to alcohol use rates. In our transplantation centre, we demonstrated the interest of an addiction follow up to limit the severe alcohol relapses rate. This information should be further investigated in prospective studies to validate these data.
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Affiliation(s)
- Jules Daniel
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon et Université Claude Bernard, Lyon, France
| | - Arnaud Del Bello
- Nephrology and Organ Transplant Department, CHU de Toulouse, Toulouse, France
| | - Lucie Gamon
- Medical Information Department, La Colombière Hospital, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Molinari
- Medical Information Department, La Colombière Hospital, University Hospital of Montpellier, Montpellier, France
- Medical University of Montpellier (UM1), Montpellier, France
| | - Stéphanie Faure
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Magdalena Meszaros
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - José Ursic-Bedoya
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Lucy Meunier
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Clément Monet
- Department of Anesthesia and Intensive Care Unit, University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, Montpellier, France
| | - Francis Navarro
- Medical University of Montpellier (UM1), Montpellier, France
- Department of Digestive Surgery, University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Olivier Boillot
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon et Université Claude Bernard, Lyon, France
| | - Georges-Philippe Pageaux
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
- Medical University of Montpellier (UM1), Montpellier, France
| | - Hélène Donnadieu-Rigole
- Medical University of Montpellier (UM1), Montpellier, France
- Addictions Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
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15
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Amaya-Garrido A, Brunet M, Buffin-Meyer B, Piedrafita A, Grzesiak L, Agbegbo E, Del Bello A, Ferrandiz I, Ardeleanu S, Bermudez-Lopez M, Fedou C, Camus M, Burlet-Schiltz O, Massines J, Buléon M, Feuillet G, Alves M, Neau E, Casemayou A, Breuil B, Saulnier-Blache JS, Denis C, Voelkl J, Glorieux G, Hobson S, Arefin S, Rahman A, Kublickiene K, Stenvinkel P, Bascands JL, Faguer S, Valdivielso JM, Schanstra JP, Klein J. Calprotectin is a contributor to and potential therapeutic target for vascular calcification in chronic kidney disease. Sci Transl Med 2023; 15:eabn5939. [PMID: 37672568 DOI: 10.1126/scitranslmed.abn5939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
Vascular calcification is an important risk factor for cardiovascular (CV) mortality in patients with chronic kidney disease (CKD). It is also a complex process involving osteochondrogenic differentiation of vascular smooth muscle cells (VSMCs) and abnormal deposition of minerals in the vascular wall. In an observational, multicenter European study, including 112 patients with CKD from Spain and 171 patients on dialysis from France, we used serum proteome analysis and further validation by ELISA to identify calprotectin, a circulating damage-associated molecular pattern protein, as being independently associated with CV outcome and mortality. This was confirmed in an additional cohort of 170 patients with CKD from Sweden, where increased serum calprotectin concentrations correlated with increased vascular calcification. In primary human VSMCs and mouse aortic rings, calprotectin exacerbated calcification. Treatment with paquinimod, a calprotectin inhibitor, as well as pharmacological inhibition of the receptor for advanced glycation end products and Toll-like receptor 4 inhibited the procalcifying effect of calprotectin. Paquinimod also ameliorated calcification induced by the sera of uremic patients in primary human VSMCs. Treatment with paquinimod prevented vascular calcification in mice with chronic renal failure induced by subtotal nephrectomy and in aged apolipoprotein E-deficient mice as well. These observations identified calprotectin as a key contributor of vascular calcification, and increased circulating calprotectin was strongly and independently associated with calcification, CV outcome, and mortality in patients with CKD. Inhibition of calprotectin might therefore be a promising strategy to prevent vascular calcification in patients with CKD.
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Affiliation(s)
- Ana Amaya-Garrido
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Manon Brunet
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Alexis Piedrafita
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Lucile Grzesiak
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Ezechiel Agbegbo
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Arnaud Del Bello
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Centre Hospitalo-Universitaire de Toulouse, 31400 Toulouse, France
| | - Inés Ferrandiz
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Centre Hospitalo-Universitaire de Toulouse, 31400 Toulouse, France
| | - Serban Ardeleanu
- AURAR Saint Louis Dialysis Center, 97421 Saint Louis, La Réunion, France
| | - Marcelino Bermudez-Lopez
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, 25198 Lleida, Spain
| | - Camille Fedou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Mylène Camus
- Institut de Pharmacologie et Biologie Structurale, IPBS, Université de Toulouse, CNRS, UPS, 31400 Toulouse, France
| | - Odile Burlet-Schiltz
- Institut de Pharmacologie et Biologie Structurale, IPBS, Université de Toulouse, CNRS, UPS, 31400 Toulouse, France
| | - Jean Massines
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Marie Buléon
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Guylène Feuillet
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Melinda Alves
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Eric Neau
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Audrey Casemayou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Centre Hospitalo-Universitaire de Toulouse, 31400 Toulouse, France
| | - Benjamin Breuil
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Jean-Sébastien Saulnier-Blache
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Colette Denis
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Jakob Voelkl
- Institute for Physiology and Pathophysiology, Johannes Kepler University Linz, 4040 Linz, Austria
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Gent, Belgium
| | - Sam Hobson
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Samsul Arefin
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Awahan Rahman
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Jean-Loup Bascands
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, 97491 Sainte Clotilde, La Réunion, France
| | - Stanislas Faguer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
- Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Centre Hospitalo-Universitaire de Toulouse, 31400 Toulouse, France
| | - José M Valdivielso
- Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, 25198 Lleida, Spain
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1297, Institute of Cardiovascular and Metabolic Disease, 31432 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
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16
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Dumortier J, Erard D, Villeret F, Faitot F, Duvoux C, Faure S, Francoz C, Gugenheim J, Hardwigsen J, Hiriart JB, Houssel-Debry P, Bello AD, Lassailly G, Vanlemmens C, Saliba F, Altman C, Latournerie M, Dharancy S, Debs T. Bariatric surgery and liver transplantation, here we are now: A French nationwide retrospective study. Clin Res Hepatol Gastroenterol 2023; 47:102164. [PMID: 37352925 DOI: 10.1016/j.clinre.2023.102164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023]
Abstract
At the time of the growing obesity epidemic worldwide, liver transplantation (LT) and metabolic syndrome are closely linked: non-alcohol-related fatty liver disease (NAFLD) is one of the leading indications for liver transplantation, and metabolic syndrome can also appear after liver transplantation, in relation to immunosuppressive medications and weight gain, whatever was the initial liver disease leading to the indication of LT. Therefore, the role of bariatric surgery (BS) is important due to its longer-lasting effect and efficacy. We performed a retrospective review of all 50 adult French liver transplant recipients who had a history of bariatric surgery, including 37 procedures before transplantation, and 14 after. There were three significantly different characteristics when comparing pre-and post-LT BS: patients were older (at the time of BS), presented more frequently arterial hypertension (at the time of LT), and the proportion of NAFLD as initial liver disease leading to LT was lower, in the post-LT group. Regarding pre-LT BS, in one case BS was complicated by liver failure leading to the rapid indication of LT; it was the single patient for whom the delay between BS and LT was less than 1 year; there was no patient who specifically underwent BS for the purpose of LT listing.
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Affiliation(s)
- Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Pavillon L, 69437, Hospices Civils de Lyon, Cedex 03, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
| | - Domitille Erard
- Service d'hépatologie et de transplantation hépatique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Villeret
- Université Claude Bernard Lyon 1, Lyon, France; Service d'hépatologie et de transplantation hépatique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Faitot
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, CHRU Hautepierre, Strasbourg, France
| | | | - Stéphanie Faure
- Département D'hépatologie et Transplantation Hépatique, CHU Saint Eloi, Montpellier, France
| | - Claire Francoz
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Beaujon, AP-HP, Clichy, France
| | - Jean Gugenheim
- Service de Chirurgie Digestive et de Transplantation Hépatique, CHU Archet II, Nice, France
| | - Jean Hardwigsen
- Service Chirurgie Générale et Transplantation Hépatique, Hôpital La Timone, AP-HM, Marseille, France
| | - Jean-Baptiste Hiriart
- Service de Chirurgie Hépatobiliaire et de Transplantation Hépatique, CHU Haut Lévêque, Bordeaux, France
| | - Pauline Houssel-Debry
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Universitaire de Pontchaillou, Rennes, France
| | - Arnaud Del Bello
- Département de Néphrologie et Transplantation d'Organes, CHU Rangueil, Toulouse, France
| | - Guillaume Lassailly
- Service des Maladies de l'Appareil Digestif, Hôpital Claude Huriez, CHRU Lille, Lille, France
| | - Claire Vanlemmens
- Service d'Hépatologie et Soins Intensifs Digestifs, Hôpital Jean Minjoz, Besançon, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris Saclay, Unité Inserm 1193, AP-HP, Villejuif, France
| | - Clara Altman
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris Saclay, Unité Inserm 1193, AP-HP, Villejuif, France
| | - Marianne Latournerie
- Service D'hépatologie et de Gastro-Entérologie, CHU Dijon-Bourgogne, Dijon, France
| | - Sébastien Dharancy
- Service des Maladies de l'Appareil Digestif, Hôpital Claude Huriez, CHRU Lille, Lille, France
| | - Tarek Debs
- Service de Chirurgie Digestive et de Transplantation Hépatique, CHU Archet II, Nice, France
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17
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Danger R, Le Berre L, Cadoux M, Kerleau C, Papuchon E, Mai HL, Nguyen TVH, Guérif P, Morelon E, Thaunat O, Legendre C, Anglicheau D, Lefaucheur C, Couzi L, Del Bello A, Kamar N, Le Quintrec M, Goutaudier V, Renaudin K, Giral M, Brouard S. Subclinical rejection-free diagnostic after kidney transplantation using blood gene expression. Kidney Int 2023; 103:1167-1179. [PMID: 36990211 DOI: 10.1016/j.kint.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/16/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
We previously established a six-gene-based blood score associated with operational tolerance in kidney transplantation which was decreased in patients developing anti-HLA donor-specific antibodies (DSA). Herein, we aimed to confirm that this score is associated with immunological events and risk of rejection. We measured this using quantitative PCR (qPCR) and NanoString methods from an independent multicenter cohort of 588 kidney transplant recipients with paired blood samples and biopsies at one year after transplantation validating its association with pre-existing and de novo DSA. From 441 patients with protocol biopsy, there was a significant decrease of the score of tolerance in 45 patients with biopsy-proven subclinical rejection (SCR), a major threat associated with pejorative allograft outcomes that prompted an SCR score refinement. This refinement used only two genes, AKR1C3 and TCL1A, and four clinical parameters (previous experience of rejection, previous transplantation, sex of recipient and tacrolimus uptake). This refined SCR score was able to identify patients unlikely to develop SCR with a C-statistic of 0.864 and a negative predictive value of 98.3%. The SCR score was validated in an external laboratory, with two methods (qPCR and NanoString), and on 447 patients from an independent and multicenter cohort. Moreover, this score allowed reclassifying patients with discrepancies between the DSA presence and the histological diagnosis of antibody mediated rejection unlike kidney function. Thus, our refined SCR score could improve detection of SCR for closer and noninvasive monitoring, allowing early treatment of SCR lesions notably for patients DSA-positive and during lowering of immunosuppressive treatment.
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Affiliation(s)
- Richard Danger
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France.
| | - Ludmilla Le Berre
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Marion Cadoux
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Clarisse Kerleau
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Emmanuelle Papuchon
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France; Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), CHU Nantes, Nantes, France
| | - Hoa Le Mai
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Thi-Van-Ha Nguyen
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Pierrick Guérif
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France
| | - Emmanuel Morelon
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, INSERM Unit 1111, Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), Lyon, France
| | - Olivier Thaunat
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, INSERM Unit 1111, Lyon-Est Medical Faculty, Claude Bernard University (Lyon 1), Lyon, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Institute, INSERM, Paris University, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Institute, INSERM, Paris University, Paris, France
| | - Carmen Lefaucheur
- Paris Translational Research Center for Organ Transplantation, INSERM UMR S970, Université Paris Cité, Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis, and Apheresis, CHU Bordeaux, Bordeaux, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire de Toulouse, INSERM UMR1291 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire de Toulouse, INSERM UMR1291 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Moglie Le Quintrec
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Lapeyronie, Montpellier, France
| | - Valentin Goutaudier
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Institute, INSERM, Paris University, Paris, France; Université Paris Cité, INSERM U970, Paris Institute for Transplantation and Organ Regeneration, Paris, France
| | - Karine Renaudin
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France; CHU Nantes, Service d'Anatomie et Cytologie Pathologiques, Nantes, France
| | - Magali Giral
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France; Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), CHU Nantes, Nantes, France; LabEx IGO "Immunotherapy, Graft, Oncology", Nantes Université, Nantes, France
| | - Sophie Brouard
- CHU Nantes, Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, ITUN, Nantes, France; Centre d'Investigation Clinique en Biothérapie, Centre de Ressources Biologiques (CRB), CHU Nantes, Nantes, France; LabEx IGO "Immunotherapy, Graft, Oncology", Nantes Université, Nantes, France.
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18
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Boumaza X, Bonneau B, Roos-Weil D, Pinnetti C, Rauer S, Nitsch L, Del Bello A, Jelcic I, Sühs KW, Gasnault J, Goreci Y, Grauer O, Gnanapavan S, Wicklein R, Lambert N, Perpoint T, Beudel M, Clifford D, Sommet A, Cortese I, Martin-Blondel G. Progressive Multifocal Leukoencephalopathy Treated by Immune Checkpoint Inhibitors. Ann Neurol 2023; 93:257-270. [PMID: 36151879 PMCID: PMC10092874 DOI: 10.1002/ana.26512] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Our aim was to assess the real-world effectiveness of immune checkpoint inhibitors for treatment of patients with progressive multifocal leukoencephalopathy (PML). METHODS We conducted a multicenter survey compiling retrospective data from 79 PML patients, including 38 published cases and 41 unpublished cases, who received immune checkpoint inhibitors as add-on to standard of care. One-year follow-up data were analyzed to determine clinical outcomes and safety profile. Logistic regression was used to identify variables associated with 1-year survival. RESULTS Predisposing conditions included hematological malignancy (n = 38, 48.1%), primary immunodeficiency (n = 14, 17.7%), human immunodeficiency virus/acquired immunodeficiency syndrome (n = 12, 15.2%), inflammatory disease (n = 8, 10.1%), neoplasm (n = 5, 6.3%), and transplantation (n = 2, 2.5%). Pembrolizumab was most commonly used (n = 53, 67.1%). One-year survival was 51.9% (41/79). PML-immune reconstitution inflammatory syndrome (IRIS) was reported in 15 of 79 patients (19%). Pretreatment expression of programmed cell death-1 on circulating T cells did not differ between survivors and nonsurvivors. Development of contrast enhancement on follow-up magnetic resonance imaging at least once during follow-up (OR = 3.16, 95% confidence interval = 1.20-8.72, p = 0.02) was associated with 1-year survival. Cerebrospinal fluid JC polyomavirus DNA load decreased significantly by 1-month follow-up in survivors compared to nonsurvivors (p < 0.0001). Thirty-two adverse events occurred among 24 of 79 patients (30.4%), and led to treatment discontinuation in 7 of 24 patients (29.1%). INTERPRETATION In this noncontrolled retrospective study of patients with PML who were treated with immune checkpoint inhibitors, mortality remains high. Development of inflammatory features or overt PML-IRIS was commonly observed. This study highlights that use of immune checkpoint inhibitors should be strictly personalized toward characteristics of the individual PML patient. ANN NEUROL 2023;93:257-270.
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Affiliation(s)
- Xavier Boumaza
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France
| | - Baptiste Bonneau
- Department of Medical Pharmacology, CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Damien Roos-Weil
- Department of Hematology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Carmela Pinnetti
- HIV/AIDS Clinical Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy
| | - Sebastian Rauer
- Department of Neurology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Louisa Nitsch
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, Toulouse III University, Toulouse, France
| | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Kurt-Wolfram Sühs
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Jacques Gasnault
- Unit of Rehabilitation of Neuroviral Diseases, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France.,INSERM U1186, Paul Brousse Hospital, Paris Saclay University, Villejuif, France
| | - Yasemin Goreci
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Oliver Grauer
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Sharmilee Gnanapavan
- Department of Neurology, Barts Health NHS Trust and Queen Mary University of London, London, UK
| | - Rebecca Wicklein
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Nicolas Lambert
- Department of Neurology, University Hospital of Liège, Liège, Belgium
| | - Thomas Perpoint
- Department of Infectious and Tropical Diseases, Lyon University Hospital, Lyon, France
| | - Martijn Beudel
- Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Neuroscience, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - David Clifford
- Department of Neurology, Washington University in St Louis, St Louis, MO, USA
| | - Agnès Sommet
- Department of Medical Pharmacology, CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Irene Cortese
- Experimental Immunotherapeutics Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France.,Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, Toulouse III University, Toulouse, France.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
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19
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Guy P, Delas A, Esposito L, Cointault O, Colombat M, Congy-Jolivet N, Raynaud M, Kamar N, Del Bello A. Progression of histological lesions after ABO incompatible kidney transplantation. Front Immunol 2022; 13:969998. [PMID: 36275771 PMCID: PMC9582152 DOI: 10.3389/fimmu.2022.969998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022] Open
Abstract
Recent large meta-analyses suggested a poorer long-term patients’ and grafts’ outcomes after ABO incompatible (ABOi) living-donor kidney transplantation (LDKT) compared to ABO compatible LDKT. However, little is known about the long-term histological pattern after ABOi LDKT. We compared the histological features observed on protocol biopsies from 03/11 to 11/19 in 94 ABOi LDKT (including 14 with preformed Donor Specific Antibodies, pDSAs), 27 LDKT ABO compatible (ABOc) with pDSAs, and 21 ABOc without pDSAs) during the first five years post transplantation. During the first 5 years post-transplantation, a progression of chronic lesions (patients with a ci >0 raised from 11% to 65%, p<0.0001, patients with a ct >0 raised from 29% to 78%, p<0.0001) was observed in ABOi LDKT without pDSAs. Histological patterns of evolution were comparable to those observed in ABOc kidney transplant patients. Microvascular inflammation was lower in ABOi LDKT without pDSAs compared to those with pDSAs (ABOi or ABOc). At last follow-up, 28 months, IQR (15-48) post-transplantation, 29 patients (36%) had a severe graft dysfunction (defined by a CKD-epi eGFR < 30 mL/min/1.73m²). The donor age was a predictive factor for the development of severe kidney allograft dysfunction at last follow-up (HR= 1.05, 95% CI [1.05-1.10], p= 0.03). Hence, long-term histological analysis of ABOi LDKT shows only an increase of chronic interstitial and tubular atrophy changes, without active lesions. These data confirm that ABOi LDKT programs can be securely developed.
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Affiliation(s)
- Pierre Guy
- Department of Nephrology and Organ Transplantation, Centre Hospitalier et Universitaire (CHU), Toulouse, France
| | - Audrey Delas
- Department of Pathology, Toulouse University Hospital, Toulouse, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, Centre Hospitalier et Universitaire (CHU), Toulouse, France
| | - Olivier Cointault
- Department of Nephrology and Organ Transplantation, Centre Hospitalier et Universitaire (CHU), Toulouse, France
| | - Magali Colombat
- Department of Pathology, Toulouse University Hospital, Toulouse, France
- Centre Hospitalier et Universitaire, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Nicolas Congy-Jolivet
- Laboratory of Immunology, Biology Department, Centre Hospitalier et Universitaire (CHU) de Toulouse, Toulouse, France
| | - Marc Raynaud
- Paris Translational Research Epidemiology and Biostatistics Department, Université de Paris, INSERM U970, PARCC, Paris, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Centre Hospitalier et Universitaire (CHU), Toulouse, France
- Centre Hospitalier et Universitaire, Université Paul Sabatier Toulouse III, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1043-CNRS 5282, Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Centre Hospitalier et Universitaire (CHU), Toulouse, France
- Centre Hospitalier et Universitaire, Université Paul Sabatier Toulouse III, Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1043-CNRS 5282, Toulouse, France
- *Correspondence: Arnaud Del Bello,
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Dumortier J, Erard D, Dharancy S, Saliba F, Del Bello A. Current use of T-cell depleting polyclonal antibodies in liver transplant recipients: Results of a nationwide French survey. Transpl Immunol 2022; 75:101724. [PMID: 36183943 DOI: 10.1016/j.trim.2022.101724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
| | - Domitille Erard
- Service d'hépatologie et de Transplantation Hépatique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Dharancy
- Service des Maladies de l'Appareil Digestif, Hôpital Claude Huriez, CHRU Lille, Lille, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - Arnaud Del Bello
- Département de Néphrologie et Transplantation d'Organes, CHU Rangueil, Toulouse, France
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21
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Faguer S, Del Bello A, Danet C, Renaudineau Y, Izopet J, Kamar N. Apolipoprotein-A-I for severe COVID-19-induced hyperinflammatory states: A prospective case study. Front Pharmacol 2022; 13:936659. [PMID: 36225555 PMCID: PMC9550000 DOI: 10.3389/fphar.2022.936659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Viral infections can promote cytokine storm and multiorgan failure in individuals with an underlying immunosuppression or specific genetic background. Hyperinflammatory states, including critical forms of COVID-19, are characterized by a remodeling of the lipid profile including a dramatic decrease of the serum levels of apolipoprotein-A-I (ApoA-I), a protein known for its capacity to reduce systemic and lung inflammation, modulate innate and adaptive immunity, and prevent endothelial dysfunction and blood coagulation. In this study, four immunocompromised patients with severe COVID-19 cytokine storm that progressed despite standard-of-care therapy [Omicron (n = 3) and Delta (n = 1) variants] received 2– 4 infusions (10 mg/kg) of CER-001, an ApoA-I-containing HDL mimetic. Injections were well-tolerated with no serious adverse events. Three patients treated while not on mechanical ventilation had early clinical and biological improvement (oxygen withdrawal and correction of hematological and inflammatory parameters, including serum levels of interleukin-8) and were discharged from the hospital 3–4 days after CER-001 infusions. In the fourth patient who received CER-001 after orotracheal intubation for acute respiratory distress syndrome, infusions were followed by transient respiratory improvement before secondary worsening related to ventilation-associated pneumonia. This pilot uncontrolled exploratory compassionate study provides initial safety and proof-of-concept data from patients with a COVID-19 cytokine storm receiving ApoA-I. Further randomized controlled trial evaluation is now required to ascertain whether ApoA-I has any beneficial effects on patients with a COVID-19 cytokine storm.
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Affiliation(s)
- Stanislas Faguer
- Referral Center for Rare Kidney Diseases, Department of Nephrology and Organ Transplantation, University Hospital of Toulouse, Toulouse, France
- Faculty of Medicine, University Paul Sabatier—Toulouse 3, Toulouse, France
- French National Institute of Health and Medical Research, U1297 (Institute of Metabolic and Cardiovascular Diseases), Toulouse, France
- *Correspondence: Stanislas Faguer,
| | - Arnaud Del Bello
- Referral Center for Rare Kidney Diseases, Department of Nephrology and Organ Transplantation, University Hospital of Toulouse, Toulouse, France
| | - Chloé Danet
- Department of Clinical Pharmacy, University Hospital of Toulouse, Toulouse, France
| | - Yves Renaudineau
- Faculty of Medicine, University Paul Sabatier—Toulouse 3, Toulouse, France
- French National Institute of Health and Medical Research, U1291 (INFINITY), Toulouse, France
- Laboratory of Immunology, University Hospital of Toulouse, Toulouse, France
| | - Jacques Izopet
- Faculty of Medicine, University Paul Sabatier—Toulouse 3, Toulouse, France
- French National Institute of Health and Medical Research, U1291 (INFINITY), Toulouse, France
- Laboratory of Virology, University Hospital of Toulouse, Toulouse, France
| | - Nassim Kamar
- Referral Center for Rare Kidney Diseases, Department of Nephrology and Organ Transplantation, University Hospital of Toulouse, Toulouse, France
- Faculty of Medicine, University Paul Sabatier—Toulouse 3, Toulouse, France
- French National Institute of Health and Medical Research, U1291 (INFINITY), Toulouse, France
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22
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Del Bello A, Marion O, Izopet J, Kamar N. Can the COVID-19 Pandemic Improve the Management of Solid Organ Transplant Recipients? Viruses 2022; 14:v14091860. [PMID: 36146666 PMCID: PMC9500961 DOI: 10.3390/v14091860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022] Open
Abstract
Increased mortality due to SARS-CoV-2 infection was observed among solid organ transplant patients. During the pandemic, in order to prevent and treat COVID-19 infections in this context, several innovative procedures and therapies were initiated within a short period of time. A large number of these innovations can be applied and expanded to improve the management of non-COVID-19 infectious diseases in solid organ transplant patients and in the case of a future pandemic. In this vein, the present paper reviews and discusses medical care system adaptation, modification of immunosuppression, adjuvant innovative therapies, the role of laboratory expertise, and the prevention of infections as examples of such innovations.
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Affiliation(s)
- Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31059 Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR 1291, 31300 Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31059 Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR 1291, 31300 Toulouse, France
| | - Jacques Izopet
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR 1291, 31300 Toulouse, France
- University Toulouse III—Paul Sabatier, 31000 Toulouse, France
- Laboratory of Virology, Toulouse Purpan University Hospital, 31300 Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31059 Toulouse, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR 1291, 31300 Toulouse, France
- University Toulouse III—Paul Sabatier, 31000 Toulouse, France
- Correspondence: ; Tel.: +33-5-61-32-23-35; Fax: +33-5-61-32-39-89
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23
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Pernin V, Meneghini M, Torija A, Jouve T, Del Bello A, Sanz-Muñoz I, Eiros J, Donadeu L, Polo C, Morandeira F, Navarro S, Masuet C, Favà A, LeQuintrec M, Kamar N, Crespo E, Bestard O. Impaired antigen-specific B-cell responses after Influenza vaccination in kidney transplant recipients receiving co-stimulation blockade with Belatacept. Front Immunol 2022; 13:918887. [PMID: 35967428 PMCID: PMC9374104 DOI: 10.3389/fimmu.2022.918887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 01/14/2023] Open
Abstract
Emerging data suggest that costimulation blockade with belatacept effectively controls humoral alloimmune responses. However, whether this effect may be deleterious for protective anti-infectious immunity remains poorly understood. We performed a mechanistic exploratory study in 23 kidney transplant recipients receiving either the calcineurin-inhibitor tacrolimus (Tac, n=14) or belatacept (n=9) evaluating different cellular immune responses after influenza vaccination such as activated T follicular Helper (Tfh), plasmablasts and H1N1 hemagglutinin (HA)-specific memory B cells (HA+mBC) by flow-cytometry, and anti-influenza antibodies by hemagglutination inhibition test (HI), at baseline and days 10, 30 and 90 post-vaccination. The proportion of CD4+CD54RA-CXCR5+ Tfh was lower in belatacept than Tac patients at baseline (1.86%[1.25-3.03] vs 4.88%[2.40-8.27], p=0.01) and remained stable post-vaccination. At M3, HA+mBc were significantly higher in Tac-treated patients (0.56%[0.32-1.49] vs 0.27%[0.13-0.44], p=0.04) and correlated with activated Tfh numbers. When stratifying patients according to baseline HA+mBc frequencies, belatacept patients with low HA+mBC displayed significantly lower HA+mBc increases after vaccination than Tac patients (1.28[0.94-2.4] vs 2.54[1.73-5.70], p=0.04). Also, belatacept patients displayed significantly lower seroprotection rates against H1N1 at baseline than Tac-treated patients (44.4% vs 84.6%) as well as lower seroconversion rates at days 10, 30 and 90 after vaccination (50% vs 0%, 63.6% vs 0%, and 63.6% vs 0%, respectively). We show the efficacy of belatacept inhibiting T-dependent antigen-specific humoral immune responses, active immunization should be highly encouraged before starting belatacept therapy.
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Affiliation(s)
- Vincent Pernin
- Kidney Transplant Unit, Nephrology Department. Montpellier University Hospital, Montpellier, France
| | - Maria Meneghini
- Kidney transplant Unit. Nephrology Department. Vall d’Hebron Hospital Universitari, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Laboratoryof Nephrology and Transplantation. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alba Torija
- Laboratoryof Nephrology and Transplantation. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas Jouve
- Laboratoryof Nephrology and Transplantation. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Kidney transplant Unit, Nephrology Department. Grenoble University Hospital, Grenoble, France
| | - Arnaud Del Bello
- Centro Nacional de Gripe de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Iván Sanz-Muñoz
- Centro Nacional de Gripe, Valladolid Universidad de Valladolid, Valladolid, Spain
| | - Jose Maria Eiros
- Department of Microbiology and Parasitology, Rio Hortega University Hospital, University of Valladolid, Valladolid, Spain
| | - Laura Donadeu
- Laboratoryof Nephrology and Transplantation. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carol Polo
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | | | - Sergio Navarro
- Immunology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Cristina Masuet
- Department of Preventive Medicine, Bellvitge University Hospital, Barcelona, Spain
| | - Alexandre Favà
- Kidney Transplant Unit, Nephrology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Moglie LeQuintrec
- Kidney Transplant Unit, Nephrology Department. Montpellier University Hospital, Montpellier, France
| | - Nassim Kamar
- Kidney transplant Unit, Nephrology Department. Grenoble University Hospital, Grenoble, France
| | - Elena Crespo
- Laboratoryof Nephrology and Transplantation. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Bestard
- Kidney transplant Unit. Nephrology Department. Vall d’Hebron Hospital Universitari, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Laboratoryof Nephrology and Transplantation. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Oriol Bestard,
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Dimeglio C, Del Bello A, Chapuy-Regaud S, Esposito L, Danet C, Couat C, Izopet J, Kamar N. Casirivimab-imdevimab to Prevent SARS-CoV-2 Infections in Solid Organ Transplant Recipients. Transplantation 2022; 106:e275-e276. [PMID: 35283456 PMCID: PMC9038236 DOI: 10.1097/tp.0000000000004087] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Chloé Dimeglio
- Laboratory of Virology, Toulouse Purpan University Hospital, Toulouse, France
- INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Toulouse, France
- Paul Sabatier University, Toulouse, France
| | - Arnaud Del Bello
- INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Toulouse, France
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Sabine Chapuy-Regaud
- Laboratory of Virology, Toulouse Purpan University Hospital, Toulouse, France
- INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Toulouse, France
- Paul Sabatier University, Toulouse, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Chloé Danet
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France
| | - Chloé Couat
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Jacques Izopet
- Laboratory of Virology, Toulouse Purpan University Hospital, Toulouse, France
- INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Toulouse, France
- Paul Sabatier University, Toulouse, France
| | - Nassim Kamar
- INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Toulouse, France
- Paul Sabatier University, Toulouse, France
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
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25
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Meszaros M, Dubois V, Congy-Jolivet N, Hamada S, Thevenin C, Faure S, Boillot O, Kamar N, Pageaux GP, Del Bello A, Dumortier J. Impact of calcineurin inhibitor-free immunosuppression on de novo donor-specific antibody formation in liver transplant recipients. Liver Int 2022; 42:1132-1143. [PMID: 35184373 DOI: 10.1111/liv.15201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Low calcineurin inhibitor (CNI) levels expose liver transplant recipients to rejection episodes and potentially to antibody-mediated rejection. There are little data on the impact of CNI-free immunosuppression on de novo donor-specific HLA antibody (dnDSA) development. Here we evaluated the prevalence of dnDSA in liver transplant recipients on CNI-free maintenance regimens and their associations with histopathological abnormalities of allografts. METHODS Seven hundred and twenty-seven liver transplant recipients underwent a first liver transplant between 2000 and 2018 in three French transplant centres and had protocolized follow-up with dnDSA screening and allograft biopsy 1, 5 and 10 years after transplantation. RESULTS CNIs were withdrawn in 166 (22.8%) patients with or without conversion to mammalian target of rapamycin inhibitors and/or maintenance with mycophenolic acid. DSA were present after withdrawal in 30.1% (50/166) patients on CNI-free immunosuppression compared with 16% (90/561) on CNI maintenance therapy (p < 0.001). The cumulative incidence of dnDSA 10 years after transplant was 20% in the CNI group versus 28% in the CNI-free group (p < 0.01). dnDSAs were associated with histological graft abnormalities (significant allograft fibrosis or rejection) (HR 2.24, 95% CI 1.2-4.1; p = 0.01). In univariate Cox regression analysis, being on a CNI-free regimen did not impact graft histology. CONCLUSIONS Patients on a CNI-free IS regimen have a higher prevalence of dnDSA than patients on a standard IS regimen. dnDSAs but not CNI-free immunosuppression were associated with abnormal allograft histology.
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Affiliation(s)
- Magdalena Meszaros
- Département d'hépatologie et transplantation hépatique, CHU Saint Eloi, Montpellier, France
| | - Valérie Dubois
- Etablissement Français du Sang, Laboratoire d'Histocompatibilité, Lyon, France
| | | | - Sarah Hamada
- Etablissement Français du Sang, Laboratoire d'Histocompatibilité, Lyon, France
| | - Céline Thevenin
- Département d'Immunologie, CHU Montpellier, Montpellier, France
| | - Stephanie Faure
- Département d'hépatologie et transplantation hépatique, CHU Saint Eloi, Montpellier, France
| | - Olivier Boillot
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Unité de Transplantation hépatique, Lyon, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'Organes, CHU, Toulouse, France
| | | | - Arnaud Del Bello
- Département de Néphrologie et Transplantation d'Organes, CHU, Toulouse, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Unité de Transplantation hépatique, Lyon, France
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Kaminski H, Kamar N, Thaunat O, Bouvier N, Caillard S, Garrigue I, Anglicheau D, Rérolle JP, Le Meur Y, Durrbach A, Bachelet T, Savel H, Coueron R, Visentin J, Del Bello A, Pellegrin I, Déchanet-Merville J, Merville P, Thiébaut R, Couzi L. Incidence of cytomegalovirus infection in seropositive kidney transplant recipients treated with everolimus: A randomized, open-label, multicenter phase 4 trial. Am J Transplant 2022; 22:1430-1441. [PMID: 34990047 DOI: 10.1111/ajt.16946] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 12/02/2021] [Accepted: 12/28/2021] [Indexed: 01/25/2023]
Abstract
Cytomegalovirus (CMV) persists as the most frequent opportunistic infection among solid organ transplant recipients. This multicenter trial aimed to test whether treatment with everolimus (EVR) could decrease the incidence of CMV DNAemia and disease. We randomized 186 CMV seropositive kidney transplant recipients in a 1:1 ratio to receive EVR or mycophenolic acid (MPA) in association with basiliximab, cyclosporin, and steroids and 87 in each group were analyzed. No universal prophylaxis was administered to either group. The composite primary endpoint was the presence of CMV DNAemia, CMV treatment, graft loss, death, and discontinuation of the study at 6 months posttransplant. In the modified intent-to-treat analysis, 42 (48.3%) and 70 (80.5%) patients in the EVR and MPA groups reached the primary endpoint (OR = 0.21, 95% CI: 0.11-0.43, p < .0001). Fewer patients of the EVR group received treatment for CMV (21.8% vs. 47.1%, p = .0007). EVR was discontinued in 31 (35.6%) patients. Among the 56 patients with ongoing EVR treatment, only 7.4% received treatment for CMV. In conclusion, EVR prevents CMV DNAemia requiring treatment in seropositive recipients as long as it is tolerated and maintained.
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Affiliation(s)
- Hannah Kaminski
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France.,UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France.,INSERM U1043, IFR-BMT, Toulouse, France
| | - Olivier Thaunat
- Department of Nephrology, Transplantation and Clinical Immunology of Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon-I University UFR Lyon Est, Lyon, France
| | - Nicolas Bouvier
- Department of Nephrology, Transplantation, Dialysis, CHU Caen, Caen, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, CHU Strasbourg, Strasbourg, France
| | | | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Yannick Le Meur
- Department of Nephrology and Transplantation, Brest University Hospital, Brest, France
| | - Antoine Durrbach
- Department of Nephrology and Kidney Transplantation, INSERM 1186, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Paris, France
| | - Thomas Bachelet
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France
| | - Hélène Savel
- CHU Bordeaux, Service d'information médicale, Bordeaux, France
| | - Roxane Coueron
- CHU Bordeaux, Service d'information médicale, Bordeaux, France
| | - Jonathan Visentin
- UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France.,Laboratory of Immunology and Immunogenetics, CHU Bordeaux, Bordeaux, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France.,INSERM U1043, IFR-BMT, Toulouse, France
| | - Isabelle Pellegrin
- UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France.,Laboratory of Immunology and Immunogenetics, CHU Bordeaux, Bordeaux, France
| | | | - Pierre Merville
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France.,UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France
| | - Rodolphe Thiébaut
- CHU Bordeaux, Service d'information médicale, Bordeaux, France.,INSERM U1219 Bordeaux Population Health Research Center, Inria SISTM, Bordeaux University, Bordeaux, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, CHU Bordeaux, Bordeaux, France.,UMR 5164-ImmunoConcEpT, University of Bordeaux, CNRS, Bordeaux University, Bordeaux, France
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Kamar N, Abravanel F, Marion O, Esposito L, Hebral AL, Médrano C, Guitard J, Lavayssière L, Cointault O, Nogier MB, Bellière J, Faguer S, Couat C, Del Bello A, Izopet J. Anti-SARS-CoV-2 spike protein and neutralizing antibodies at 1 and 3 months after three doses of SARS-CoV-2 vaccine in a large cohort of solid organ transplant patients. Am J Transplant 2022; 22:1467-1474. [PMID: 35000296 PMCID: PMC10149234 DOI: 10.1111/ajt.16950] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 01/25/2023]
Abstract
The immunogenicity of the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccine was improved by the administration of a third dose. The aim of our retrospective study was to assess the evolution of binding and neutralizing antibody concentration until 3 months after the third dose in a large cohort of solid organ transplant (SOT) patients (n = 872). At 1 month after the third dose, anti-SARS-CoV-2 antibodies were detected by means of enzyme-linked immunosorbent assay tests in 578 patients (66.3%). In a subgroup of patients, 70% (180 out of 257) had anti-SARS-CoV-2 antibody concentrations ranging from 1.2 to 18 411 binding antibody units (BAU)/ml and 48.5% (115 out of 239) had a neutralizing antibodies titer that can confer clinical protection against SARS-CoV-2. Three-hundred ninety-three patients out of the 416 (94.5%) who were seropositive at month 1 and were tested at 3 months after vaccination remained seropositive. Between months 1 and 3 after vaccination, binding and neutralizing antibodies concentrations decreased significantly. The proportion of protected patients against the SARS-CoV-2 also slightly decreased. In conclusion, this study shows that although two-third of SOT develop anti-SARS-CoV-2 antibodies after three doses, one-third of them remain weak or non-protected. It is important to measure anti-SARS-CoV-2 antibodies to define the strategy that can optimize SOT protection against SARS-CoV-2.
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Affiliation(s)
- Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), INSERM, CNRS, Toulouse, France
| | - Florence Abravanel
- Université Paul Sabatier, Toulouse, France.,Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), INSERM, CNRS, Toulouse, France.,Department of Virology, Toulouse University Hospital, Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), INSERM, CNRS, Toulouse, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Anne Laure Hebral
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Chloé Médrano
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Joelle Guitard
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Laurence Lavayssière
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Olivier Cointault
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Marie Bétriace Nogier
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Julie Bellière
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,UMR 1297, Institut des Maladies Métaboliques et Cardiovasculaires, Institut National de la Santé et de la Recherche Médicale, Hôpital Rangueil, Toulouse, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,UMR 1297, Institut des Maladies Métaboliques et Cardiovasculaires, Institut National de la Santé et de la Recherche Médicale, Hôpital Rangueil, Toulouse, France
| | - Chloé Couat
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France.,Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), INSERM, CNRS, Toulouse, France
| | - Jacques Izopet
- Université Paul Sabatier, Toulouse, France.,Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), INSERM, CNRS, Toulouse, France.,Department of Virology, Toulouse University Hospital, Toulouse, France
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Abravanel F, Marion O, Del Bello A, Beunon T, Romieu-Mourez R, Couat C, Pucelle M, Staes L, Guitard J, Esposito L, Faguer S, Kamar N, Izopet J. Humoral and Cellular Immune Responses of Solid Organ Transplant Patients on Belatacept to Three Doses of mRNA-Based Anti-SARS-CoV-2 Vaccine. Vaccines (Basel) 2022; 10:vaccines10030354. [PMID: 35334985 PMCID: PMC8949272 DOI: 10.3390/vaccines10030354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Two doses of anti-SARS-CoV-2 mRNA-based vaccines are poorly immunogenic in solid organ transplant recipients (SOT). Methods: In total, 68 belatacept-treated SOT recipients followed at the Toulouse University Hospital were investigated. They were given three injections of the BNT162b2 mRNA COVID-19 vaccine. Their humoral response was assessed by determining anti-spike antibodies and neutralizing antibodies. The T-cell responses were assessed using an enzyme-linked immunospot assay that measured the interferon-γ produced by specific SARS-CoV-2 T-cells in a subgroup of 17 patients. Results: Only 23.5% of these patients developed a detectable anti-spike response. Moreover, the cellular and the humoral responses were well correlated. Patients with no humoral response were also without a detectable cellular response. Those belatacept-treated patients who developed an Anti-SARS-CoV-2 humoral response were younger, had been transplanted for longer, and had a higher lymphocyte count and a better glomerular filtration rate than those with no response. Finally, patients on tacrolimus plus belatacept produced a lower immune response. Conclusions: Belatacept-treated SOT recipients have a reduced immune response to anti-SARS-CoV-2 mRNA vaccination. The vaccine should be given quite separately from the belatacept infusion to improve immunogenicity. Studies to assess whether switching to another immunosuppressive regimen can improve the post-vaccination immune response would be useful.
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Affiliation(s)
- Florence Abravanel
- Laboratory of Virology, Toulouse Purpan University Hospital, 31073 Toulouse, France; (T.B.); (R.R.-M.); (M.P.); (L.S.); (J.I.)
- INFINITY—Inserm U1291-CNRS U5051, 31073 Toulouse, France; (O.M.); (N.K.)
- School of Medicine Rangueil, Paul Sabatier University, 31062 Toulouse, France; (A.D.B.); (S.F.)
- Correspondence: ; Tel.: +33-6-76-90-430
| | - Olivier Marion
- INFINITY—Inserm U1291-CNRS U5051, 31073 Toulouse, France; (O.M.); (N.K.)
- School of Medicine Rangueil, Paul Sabatier University, 31062 Toulouse, France; (A.D.B.); (S.F.)
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31073 Toulouse, France; (C.C.); (J.G.); (L.E.)
| | - Arnaud Del Bello
- School of Medicine Rangueil, Paul Sabatier University, 31062 Toulouse, France; (A.D.B.); (S.F.)
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31073 Toulouse, France; (C.C.); (J.G.); (L.E.)
| | - Thomas Beunon
- Laboratory of Virology, Toulouse Purpan University Hospital, 31073 Toulouse, France; (T.B.); (R.R.-M.); (M.P.); (L.S.); (J.I.)
| | - Raphaelle Romieu-Mourez
- Laboratory of Virology, Toulouse Purpan University Hospital, 31073 Toulouse, France; (T.B.); (R.R.-M.); (M.P.); (L.S.); (J.I.)
| | - Chloé Couat
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31073 Toulouse, France; (C.C.); (J.G.); (L.E.)
| | - Mélanie Pucelle
- Laboratory of Virology, Toulouse Purpan University Hospital, 31073 Toulouse, France; (T.B.); (R.R.-M.); (M.P.); (L.S.); (J.I.)
| | - Laetitia Staes
- Laboratory of Virology, Toulouse Purpan University Hospital, 31073 Toulouse, France; (T.B.); (R.R.-M.); (M.P.); (L.S.); (J.I.)
| | - Joelle Guitard
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31073 Toulouse, France; (C.C.); (J.G.); (L.E.)
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31073 Toulouse, France; (C.C.); (J.G.); (L.E.)
| | - Stanislas Faguer
- School of Medicine Rangueil, Paul Sabatier University, 31062 Toulouse, France; (A.D.B.); (S.F.)
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31073 Toulouse, France; (C.C.); (J.G.); (L.E.)
| | - Nassim Kamar
- INFINITY—Inserm U1291-CNRS U5051, 31073 Toulouse, France; (O.M.); (N.K.)
- School of Medicine Rangueil, Paul Sabatier University, 31062 Toulouse, France; (A.D.B.); (S.F.)
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, 31073 Toulouse, France; (C.C.); (J.G.); (L.E.)
| | - Jacques Izopet
- Laboratory of Virology, Toulouse Purpan University Hospital, 31073 Toulouse, France; (T.B.); (R.R.-M.); (M.P.); (L.S.); (J.I.)
- INFINITY—Inserm U1291-CNRS U5051, 31073 Toulouse, France; (O.M.); (N.K.)
- School of Medicine Rangueil, Paul Sabatier University, 31062 Toulouse, France; (A.D.B.); (S.F.)
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Vellas C, Del Bello A, Gaube G, Tremeaux P, Jeanne N, Ranger N, Martin-Blondel G, Delobel P, Kamar N, Izopet J. Impact of Casirivimab-Imdevimab on SARS-CoV-2 delta variant nasopharyngeal virus load and Spike quasispecies. Open Forum Infect Dis 2022; 9:ofac093. [PMID: 35299988 PMCID: PMC8903465 DOI: 10.1093/ofid/ofac093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background The increasing use of monoclonal antibodies (mAbs) to treat coronavirus disease 2019 raises questions about their impact on the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mAb-resistant variants. We assessed the impact of Casirivimab-Imdevimab on SARS-CoV-2 mutations associated with reduced mAb activity in treated patients. Methods We measured the nasopharyngeal (NP) viral load and sequenced the haplotypes of spike gene of 50 patients infected with the SARS-CoV-2 delta variant and treated with Casirivimab-Imdevimab using single-molecule real-time sequencing. Results The NP SARS-CoV-2 viral load of patients treated with Casirivimab-Imdevimab decreased from 8.13 (interquartile range [IQR], 7.06–8.59) log10 copies/mL pretreatment to 3.67 (IQR, 3.07–5.15) log10 copies/mL 7 days later (P < .001). Of the 36 patients for whom follow-up timepoints Spike sequencing were available, none of the Spike mutations that reduced mAb activity were detected. Conclusions Casirivimab-Imdevimab is an effective treatment for patients infected with the SARS-CoV-2 delta variant. Despite selective pressure on SARS-CoV-2 Spike quasispecies, we detected no key mutations that reduced mAb activity in our patients.
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Affiliation(s)
- Camille Vellas
- CHU de Toulouse, Laboratoire de Virologie, Toulouse, F-31300 France
- INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, F-31300 France
- Université Toulouse III Paul Sabatier, Toulouse, F-31300 France
| | - Arnaud Del Bello
- INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, F-31300 France
- Université Toulouse III Paul Sabatier, Toulouse, F-31300 France
- CHU de Toulouse, Département de Néphrologie, Dialyse et Transplantation d'Organes, Toulouse, F-31300 France
| | - Géraldine Gaube
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse, F-31300 France
| | - Pauline Tremeaux
- CHU de Toulouse, Laboratoire de Virologie, Toulouse, F-31300 France
| | - Nicolas Jeanne
- CHU de Toulouse, Laboratoire de Virologie, Toulouse, F-31300 France
| | - Noémie Ranger
- CHU de Toulouse, Laboratoire de Virologie, Toulouse, F-31300 France
| | - Guillaume Martin-Blondel
- INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, F-31300 France
- Université Toulouse III Paul Sabatier, Toulouse, F-31300 France
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse, F-31300 France
| | - Pierre Delobel
- INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, F-31300 France
- Université Toulouse III Paul Sabatier, Toulouse, F-31300 France
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse, F-31300 France
| | - Nassim Kamar
- INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, F-31300 France
- Université Toulouse III Paul Sabatier, Toulouse, F-31300 France
- CHU de Toulouse, Département de Néphrologie, Dialyse et Transplantation d'Organes, Toulouse, F-31300 France
| | - Jacques Izopet
- CHU de Toulouse, Laboratoire de Virologie, Toulouse, F-31300 France
- INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, F-31300 France
- Université Toulouse III Paul Sabatier, Toulouse, F-31300 France
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Piedrafita A, Vergez F, Belliere J, Prades N, Colombat M, Huart A, Rieu JB, Lagarde S, Del Bello A, Kamar N, Chauveau D, Laurent C, Oberic L, Ysebaert L, Ribes D, Faguer S. Spectrum of Kidney Disorders Associated with T-Cell Immunoclones. J Clin Med 2022; 11:jcm11030604. [PMID: 35160055 PMCID: PMC8836922 DOI: 10.3390/jcm11030604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023] Open
Abstract
Large granular T-cell leukemia is a clonal hematological condition often associated with autoimmune disorders. Whether small-sized T-cell clones that are otherwise asymptomatic can promote immune kidney disorders remains elusive. In this monocentric retrospective cohort in a tertiary referral center in France, we reviewed characteristics of 29 patients with T-cell clone proliferation and autoimmune kidney disorders. Next-generation sequencing of the T-cell receptor of circulating T-cells was performed in a subset of patients. The T-cell clones were detected owing to systematic screening (mean count 0.32 × 109/L, range 0.13–3.7). Strikingly, a common phenotype of acute interstitial nephropathy was observed in 22 patients (median estimated glomerular filtration rate at presentation of 22 mL/min/1.73 m2 (range 0–56)). Kidney biopsies showed polymorphic inflammatory cell infiltration (predominantly CD3+ T-cells, most of them demonstrating positive phospho-STAT3 staining) and non-necrotic granuloma in six cases. Immune-mediated glomerulopathy only or in combination with acute interstitial nephropathy was identified in eight patients. Next-generation sequencing (n = 13) identified a major T-cell clone representing more than 1% of the T-cell population in all but two patients. None had a mutation of STAT3. Twenty patients (69%) had two or more extra-kidney autoimmune diseases. Acute interstitial nephropathies were controlled with corticosteroids, cyclosporin A, or tofacitinib. Thus, we showed that small-sized T-cell clones (i.e., without lymphocytosis) undetectable without specific screening are associated with various immune kidney disorders, including a previously unrecognized phenotype characterized by severe inflammatory kidney fibrosis and lymphocytic JAK/STAT activation.
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Affiliation(s)
- Alexis Piedrafita
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- UMR 1297 (Institut des Maladies Métaboliques et Cardiovasculaires-Team 12), Institut National de la Santé et de la Recherche Médicale, F-31000 Toulouse, France
| | - François Vergez
- Laboratoire d’Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (F.V.); (N.P.); (J.-B.R.); (S.L.)
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
| | - Julie Belliere
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- UMR 1297 (Institut des Maladies Métaboliques et Cardiovasculaires-Team 12), Institut National de la Santé et de la Recherche Médicale, F-31000 Toulouse, France
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
| | - Nais Prades
- Laboratoire d’Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (F.V.); (N.P.); (J.-B.R.); (S.L.)
| | - Magali Colombat
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
- Département d’Anatomopathologie, Institut Universitaire du Cancer de Toulouse, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France;
| | - Antoine Huart
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
| | - Jean-Baptiste Rieu
- Laboratoire d’Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (F.V.); (N.P.); (J.-B.R.); (S.L.)
| | - Stéphanie Lagarde
- Laboratoire d’Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (F.V.); (N.P.); (J.-B.R.); (S.L.)
| | - Arnaud Del Bello
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
| | - Nassim Kamar
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
| | - Dominique Chauveau
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- UMR 1297 (Institut des Maladies Métaboliques et Cardiovasculaires-Team 12), Institut National de la Santé et de la Recherche Médicale, F-31000 Toulouse, France
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
| | - Camille Laurent
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
- Département d’Anatomopathologie, Institut Universitaire du Cancer de Toulouse, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France;
| | - Lucie Oberic
- Département d’Anatomopathologie, Institut Universitaire du Cancer de Toulouse, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France;
| | - Loïc Ysebaert
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
- Service d’Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France
| | - David Ribes
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
| | - Stanislas Faguer
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- UMR 1297 (Institut des Maladies Métaboliques et Cardiovasculaires-Team 12), Institut National de la Santé et de la Recherche Médicale, F-31000 Toulouse, France
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
- Correspondence: ; Tel.: +33-561-323-288; Fax: +33-561-322-351
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Del Bello A, Abravanel F, Marion O, Couat C, Esposito L, Lavayssière L, Izopet J, Kamar N. Efficiency of a boost with a third dose of anti-SARS-CoV-2 messenger RNA-based vaccines in solid organ transplant recipients. Am J Transplant 2022; 22:322-323. [PMID: 34331842 PMCID: PMC8441706 DOI: 10.1111/ajt.16775] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Arnaud Del Bello
- Department of Nephrology and Organs TransplantationToulouse Rangueil University HospitalToulouseFrance,Paul Sabatier UniversityToulouseFrance,INSERM UMR 1291Toulouse Institute for Infectious and Inflammatory Disease (Infinity)ToulouseFrance
| | - Florence Abravanel
- Paul Sabatier UniversityToulouseFrance,INSERM UMR 1291Toulouse Institute for Infectious and Inflammatory Disease (Infinity)ToulouseFrance,Laboratory of VirologyToulouse Purpan University HospitalToulouseFrance
| | - Olivier Marion
- Department of Nephrology and Organs TransplantationToulouse Rangueil University HospitalToulouseFrance,Paul Sabatier UniversityToulouseFrance,INSERM UMR 1291Toulouse Institute for Infectious and Inflammatory Disease (Infinity)ToulouseFrance
| | - Chloé Couat
- Department of Nephrology and Organs TransplantationToulouse Rangueil University HospitalToulouseFrance
| | - Laure Esposito
- Department of Nephrology and Organs TransplantationToulouse Rangueil University HospitalToulouseFrance
| | - Laurence Lavayssière
- Department of Nephrology and Organs TransplantationToulouse Rangueil University HospitalToulouseFrance
| | - Jacques Izopet
- Paul Sabatier UniversityToulouseFrance,INSERM UMR 1291Toulouse Institute for Infectious and Inflammatory Disease (Infinity)ToulouseFrance,Laboratory of VirologyToulouse Purpan University HospitalToulouseFrance
| | - Nassim Kamar
- Department of Nephrology and Organs TransplantationToulouse Rangueil University HospitalToulouseFrance,Paul Sabatier UniversityToulouseFrance,INSERM UMR 1291Toulouse Institute for Infectious and Inflammatory Disease (Infinity)ToulouseFrance
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Dumortier J, Besch C, Moga L, Coilly A, Conti F, Corpechot C, Del Bello A, Faitot F, Francoz C, Hilleret MN, Houssel-Debry P, Jezequel C, Lavayssière L, Neau-Cransac M, Erard-Poinsot D, de Lédinghen V, Bourlière M, Bureau C, Ganne-Carrié N. Non-invasive diagnosis and follow-up in liver transplantation. Clin Res Hepatol Gastroenterol 2022; 46:101774. [PMID: 34332131 DOI: 10.1016/j.clinre.2021.101774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/23/2021] [Indexed: 02/04/2023]
Abstract
The field of liver transplantation directly or indirectly embodies all liver diseases, in addition to specific ones related to organ rejection (cellular and humoral). The recommended non-invasive methods for determining the indication for liver transplantation are the Model for End-stage Liver Disease score, and the alpha-foetoprotein score in case of hepatocellular carcinoma. Radiological methods are the cornerstones for the diagnosis of vascular and biliary complications after liver transplantation. The possible diseases of the liver graft after transplantation are multiple and often intertwined. Non-invasive diagnostic methods have been poorly evaluated in this context, apart from the recurrence of hepatitis C. Liver biopsy remains the gold standard for evaluating graft lesions in the majority of cases, especially graft rejection.
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Affiliation(s)
- Jérôme Dumortier
- Service d'hépato-gastroentérologie, Unité de transplantation hépatique, Hôpital Edouard Herriot - HCL, CHU Lyon, Lyon.
| | - Camille Besch
- Service de chirurgie hépato-bilio-pancréatique et transplantation hépatique, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg
| | - Lucile Moga
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Beaujon, APHP, Clichy
| | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul Brousse, APHP, Villejuif
| | - Filomena Conti
- Service d'Hépatologie et Transplantation Hépatique, Hôpital de la Pitié Salpétrière, APHP, Paris
| | | | - Arnaud Del Bello
- Département de néphrologie et transplantation d'organes, Hôpital Rangueil, CHU Toulouse, Toulouse
| | - François Faitot
- Service de chirurgie hépato-bilio-pancréatique et transplantation hépatique, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg
| | - Claire Francoz
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Beaujon, APHP, Clichy
| | | | | | | | - Laurence Lavayssière
- Département de néphrologie et transplantation d'organes, Hôpital Rangueil, CHU Toulouse, Toulouse
| | | | - Domitille Erard-Poinsot
- Service d'hépato-gastroentérologie, Unité de transplantation hépatique, Hôpital Edouard Herriot - HCL, CHU Lyon, Lyon
| | - Victor de Lédinghen
- Unité Transplantation Hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux
| | - Marc Bourlière
- Service d'hépato-gastroentérologie, Hôpital Saint Joseph & INSERM UMR 1252 IRD SESSTIM Aix Marseille Université, Marseille
| | | | - Nathalie Ganne-Carrié
- Service d'hépatologie, Hôpital Avicenne, APHP, Université Sorbonne Paris Nord, Bobigny & INSERM UMR 1138, Centre de Recherche des Cordeliers, Université de Paris
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Kamar N, Abravanel F, Marion O, Romieu-Mourez R, Couat C, Del Bello A, Izopet J. Assessment of 4 Doses of SARS-CoV-2 Messenger RNA-Based Vaccine in Recipients of a Solid Organ Transplant. JAMA Netw Open 2021; 4:e2136030. [PMID: 34817587 PMCID: PMC8613594 DOI: 10.1001/jamanetworkopen.2021.36030] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This case series study assesses whether a fourth dose of a SARS-CoV-2 messenger RNA (mRNA)–based vaccine is associated with improved anti–SARS-CoV-2 antibody response in solid organ transplant recipients in France.
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Affiliation(s)
- Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
- Université Paul Sabatier, Toulouse, France
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, French National Centre for Scientific Research, Toulouse, France
| | - Florence Abravanel
- Université Paul Sabatier, Toulouse, France
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, French National Centre for Scientific Research, Toulouse, France
- Department of Virology, Toulouse University Hospital, Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
- Université Paul Sabatier, Toulouse, France
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, French National Centre for Scientific Research, Toulouse, France
| | | | - Chloé Couat
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, French National Centre for Scientific Research, Toulouse, France
| | - Jacques Izopet
- Université Paul Sabatier, Toulouse, France
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, French National Centre for Scientific Research, Toulouse, France
- Department of Virology, Toulouse University Hospital, Toulouse, France
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Del Bello A, Gaible C, Longlune N, Hebral AL, Esposito L, Gandia P, Kamar N. Tacrolimus Intrapatient Variability After Switching From Immediate or Prolonged-Release to Extended-Release Formulation, After an Organ Transplantation. Front Pharmacol 2021; 12:602764. [PMID: 34690747 PMCID: PMC8529208 DOI: 10.3389/fphar.2021.602764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 07/26/2021] [Indexed: 01/06/2023] Open
Abstract
Background and Purpose: Several formulations of tacrolimus are available, but evidence of the benefit of changing to the most recent formulations is lacking. Tacrolimus intra-patient variability (tacrolimus IPV) is an emerging risk factor associated with poor graft outcomes after solid organ transplantations. Here, we examined the modifications of tacrolimus IPV after switching to a different formulation of tacrolimus. Experimental Approach: We identified 353 solid organ transplant recipients that were switched in our center from immediate-release (IR-tacrolimus) or prolonged-release tacrolimus (PR-tacrolimus) to extended-release, LCP-tacrolimus (LCP-tacrolimus). Among them, 54 patients underwent at least 3 available tacrolimus blood concentrations before and after the switch, allowing us to investigate tacrolimus IPV. Key Results: The switch was considered as a safe procedure since only four of the 353 patients presented a graft rejection after the switch, and no patient was hospitalized for tacrolimus overdose. The tacrolimus IPV estimated by the coefficient of variation (CV-IPV) was stable before and after the switch to LCP-tacrolimus (CV-IPV: 29.0% (IQR 25-75 (15.5; 38.5) before and 24.0% (15.8; 36.5) after the switch, p = 0.65). Conclusion and Implications: Switching from IR- or PR-tacrolimus to LCP-tacrolimus is a safe procedure. However, the CV-tacrolimus IPV was not impacted by the change of formulation.
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Affiliation(s)
- Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - Clotilde Gaible
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Nathalie Longlune
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Anne-Laure Hebral
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Peggy Gandia
- Pharmacokinetics and Toxicology Laboratory, Toulouse University Hospital, Toulouse, France.,INTHERES, INRAE, ENVT, Université de Toulouse, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France
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Del Bello A, Marion O, Vellas C, Faguer S, Izopet J, Kamar N. Anti-SARS-CoV-2 Monoclonal Antibodies in Solid-organ Transplant Patients. Transplantation 2021; 105:e146-e147. [PMID: 34224543 PMCID: PMC8487703 DOI: 10.1097/tp.0000000000003883] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/02/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
- INFINITY- Inserm U1291-CNRS U5051, Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
- INFINITY- Inserm U1291-CNRS U5051, Toulouse, France
- Paul Sabatier University, Toulouse, France
| | - Camille Vellas
- Laboratory of Virology, Toulouse Purpan University Hospital, INSERM, Toulouse, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
- Paul Sabatier University, Toulouse, France
| | - Jacques Izopet
- INFINITY- Inserm U1291-CNRS U5051, Toulouse, France
- Paul Sabatier University, Toulouse, France
- Laboratory of Virology, Toulouse Purpan University Hospital, INSERM, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
- INFINITY- Inserm U1291-CNRS U5051, Toulouse, France
- Paul Sabatier University, Toulouse, France
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Del Bello A, Kamar N, Vergez F, Faguer S, Marion O, Beq A, Lathrache Y, Abravanel F, Izopet J, Treiner E. Adaptive lymphocyte profile analysis discriminates mild and severe forms of COVID-19 after solid organ transplantation. Kidney Int 2021; 100:915-927. [PMID: 34126110 PMCID: PMC8193964 DOI: 10.1016/j.kint.2021.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/06/2021] [Accepted: 05/20/2021] [Indexed: 01/08/2023]
Abstract
Solid organ transplant recipients are at high risk for the development of severe forms of COVID-19. However, the role of immunosuppression in the morbidity and mortality of the immune phenotype during COVID-19 in transplant recipients remains unknown. In this retrospective study, we compared peripheral blood T and B cell functional and surface markers, as well as serum antibody development during 29 cases of mild (World Health Organization 9-point Ordinal Scale (WOS) of 3-4) and 22 cases of severe COVID-19 (WOS 5-8) in solid organ transplant (72% kidney transplant) recipients hospitalized in our center. Patients who developed severe forms of COVID-19 presented significantly lower CD3+ (median 344/mm3 (inter quartile range 197; 564) vs. 643/mm3 (397; 1251)) and CD8+ T cell counts (124/mm3 (76; 229) vs. 240/mm3 (119; 435)). However, activated CD4+ T cells were significantly more frequent in severe forms (2.9% (1.37; 5.72) vs. 1.4% (0.68; 2.35)), counterbalanced by a significantly higher proportion of Tregs (3.9% (2.35; 5.87) vs. 2.7% (1.9; 3.45)). A marked decrease in the proportion of NK cells was noted only in severe forms. In the B cell compartment, transitional B cells were significantly lower in severe forms (1.2% (0.7; 4.2) vs. 3.6% (2.1; 6.2)). Nonetheless, a majority of transplant recipients developed antibodies against SARS-CoV-2 (77% and 83% in mild and severe forms, respectively). Thus, our data revealed immunological differences between mild and severe forms of COVID-19 in solid organ transplant recipients, similar to previous reports in the immunocompetent population.
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Affiliation(s)
- Arnaud Del Bello
- Département de Néphrologie, Dialyse et Transplantation d'Organes, Centre Hospitalier et Universitaire de Toulouse, Toulouse, France; Institut National de la Santé et de la Recherche Médicale - Centre de Physiopathologie Toulouse Purpan, Inserm UMR 1043 - CNRS 5282, Toulouse, France; Université Paul Sabatier Toulouse III, Toulouse, France.
| | - Nassim Kamar
- Département de Néphrologie, Dialyse et Transplantation d'Organes, Centre Hospitalier et Universitaire de Toulouse, Toulouse, France; Institut National de la Santé et de la Recherche Médicale - Centre de Physiopathologie Toulouse Purpan, Inserm UMR 1043 - CNRS 5282, Toulouse, France; Université Paul Sabatier Toulouse III, Toulouse, France
| | - Francois Vergez
- Université Paul Sabatier Toulouse III, Toulouse, France; Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France; Institut National de la Santé et de la Recherche Médicale - Centre de Recherche en Cancérologie de Toulouse, UMR 1037 - INSERM, ERL5294 CNRS, Toulouse, France
| | - Stanislas Faguer
- Département de Néphrologie, Dialyse et Transplantation d'Organes, Centre Hospitalier et Universitaire de Toulouse, Toulouse, France; Université Paul Sabatier Toulouse III, Toulouse, France; Institut National de la Santé et de la Recherche Médicale - Institut des Maladies Métaboliques et Cardiovasculaire, Inserm UMR 1297, Toulouse, France
| | - Olivier Marion
- Département de Néphrologie, Dialyse et Transplantation d'Organes, Centre Hospitalier et Universitaire de Toulouse, Toulouse, France; Institut National de la Santé et de la Recherche Médicale - Centre de Physiopathologie Toulouse Purpan, Inserm UMR 1043 - CNRS 5282, Toulouse, France; Université Paul Sabatier Toulouse III, Toulouse, France
| | - Audrey Beq
- Département de Néphrologie, Dialyse et Transplantation d'Organes, Centre Hospitalier et Universitaire de Toulouse, Toulouse, France
| | - Yasmine Lathrache
- Laboratory of Immunology, Biology Department, CHU Toulouse, Toulouse, France
| | - Florence Abravanel
- Institut National de la Santé et de la Recherche Médicale - Centre de Physiopathologie Toulouse Purpan, Inserm UMR 1043 - CNRS 5282, Toulouse, France; Université Paul Sabatier Toulouse III, Toulouse, France; Laboratory of Virology, Biology Department, CHU Toulouse, Toulouse, France
| | - Jacques Izopet
- Institut National de la Santé et de la Recherche Médicale - Centre de Physiopathologie Toulouse Purpan, Inserm UMR 1043 - CNRS 5282, Toulouse, France; Université Paul Sabatier Toulouse III, Toulouse, France; Laboratory of Virology, Biology Department, CHU Toulouse, Toulouse, France
| | - Emmanuel Treiner
- Institut National de la Santé et de la Recherche Médicale - Centre de Physiopathologie Toulouse Purpan, Inserm UMR 1043 - CNRS 5282, Toulouse, France; Université Paul Sabatier Toulouse III, Toulouse, France; Laboratory of Immunology, Biology Department, CHU Toulouse, Toulouse, France
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Bourgade K, Thouard A, Abravanel F, Hebral AL, Del Bello A, Viguier A, Gonzalez-Dunia D, Kamar N. Fatal encephalitis and Borna Disease Virus-1 seropositivity in two kidney-transplant patients living in the same nonendemic area. Transpl Infect Dis 2021; 23:e13734. [PMID: 34549497 DOI: 10.1111/tid.13734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Karine Bourgade
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, CNRS, UPS, Université de Toulouse, Toulouse, France
| | - Anne Thouard
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, CNRS, UPS, Université de Toulouse, Toulouse, France
| | - Florence Abravanel
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, CNRS, UPS, Université de Toulouse, Toulouse, France.,CHU Toulouse, Laboratoire de Virologie, Institut Fédératif de Biologie, Hôpital Purpan, Toulouse, France
| | - Anne-Laure Hebral
- CHU Toulouse, Service de Néphrologie et de Transplantation d'organes, Hôpital Rangueil, Toulouse, France
| | - Arnaud Del Bello
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, CNRS, UPS, Université de Toulouse, Toulouse, France.,CHU Toulouse, Service de Néphrologie et de Transplantation d'organes, Hôpital Rangueil, Toulouse, France
| | - Alain Viguier
- CHU Toulouse, Unité Neuro-Vasculaire, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Daniel Gonzalez-Dunia
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, CNRS, UPS, Université de Toulouse, Toulouse, France
| | - Nassim Kamar
- Toulouse Institute for Inflammatory and Infectious Diseases (Infinity), Inserm, CNRS, UPS, Université de Toulouse, Toulouse, France.,CHU Toulouse, Laboratoire de Virologie, Institut Fédératif de Biologie, Hôpital Purpan, Toulouse, France.,CHU Toulouse, Service de Néphrologie et de Transplantation d'organes, Hôpital Rangueil, Toulouse, France
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38
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Vellas C, Del Bello A, Debard A, Steinmeyer Z, Tribaudeau L, Ranger N, Jeanne N, Martin-Blondel G, Delobel P, Kamar N, Izopet J. Influence of treatment with neutralizing monoclonal antibodies on the SARS-CoV-2 nasopharyngeal load and quasispecies. Clin Microbiol Infect 2021; 28:139.e5-139.e8. [PMID: 34537363 PMCID: PMC8444376 DOI: 10.1016/j.cmi.2021.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 01/01/2023]
Abstract
Objectives To evaluate the impact of neutralizing monoclonal antibody (mAb) treatment and to determine whether the selective pressure of mAbs could facilitate the proliferation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with spike protein mutations that might attenuate mAb effectiveness. Patients and methods We evaluated the impact of mAbs on the nasopharyngeal (NP) viral load and virus quasispecies of mAb-treated patients using single-molecule real-time sequencing. The mAbs used were: Bamlanivimab alone (four patients), Bamlanivimab/Etesevimab (23 patients) and Casirivimab/Imdevimab (five patients). Results The NP SARS-CoV-2 viral load of mAb-treated patients decreased from 8.2 log10 copies/mL before administration to 4.3 log10 copies/mL 7 days after administration. Five immunocompromised patients given Bamlanivimab/Etesevimab were found to have mAb activity-reducing spike mutations. Two patients harboured SARS-CoV-2 variants with a Q493R spike mutation 7 days after administration, as did a third patient 14 days after administration. The fourth patient harboured a variant with a Q493K spike mutation 7 days post-treatment, and the fifth patient had a variant with a E484K spike mutation on day 21. The emergence of the spike mutation was accompanied by stabilization or rebound of the NP viral load in three of five patients. Conclusion Two-mAb therapy can drive the selection of resistant SARS-CoV-2 variants in immunocompromised patients. Patients given mAbs should be closely monitored and measures to limit virus spread should be reinforced.
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Affiliation(s)
- Camille Vellas
- CHU de Toulouse, Virology Laboratory, Toulouse, France; INSERM UMR1291-CNRS UMR5051-Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France.
| | - Arnaud Del Bello
- INSERM UMR1291-CNRS UMR5051-Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France; CHU de Toulouse, Département de Néphrologie, Dialyse et Transplantation d'Organes, Toulouse, France
| | - Alexa Debard
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse, France
| | | | - Laure Tribaudeau
- Université Toulouse III Paul Sabatier, Toulouse, France; CHU de Toulouse, C.O.M.E.D.I.M.S, Toulouse, France
| | - Noémie Ranger
- CHU de Toulouse, Virology Laboratory, Toulouse, France
| | | | - Guillaume Martin-Blondel
- INSERM UMR1291-CNRS UMR5051-Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France; CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse, France
| | - Pierre Delobel
- INSERM UMR1291-CNRS UMR5051-Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France; CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, Toulouse, France
| | - Nassim Kamar
- INSERM UMR1291-CNRS UMR5051-Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France; CHU de Toulouse, Département de Néphrologie, Dialyse et Transplantation d'Organes, Toulouse, France
| | - Jacques Izopet
- CHU de Toulouse, Virology Laboratory, Toulouse, France; INSERM UMR1291-CNRS UMR5051-Université Toulouse III, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France
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39
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Lanaret C, Anglicheau D, Audard V, Büchler M, Caillard S, Couzi L, Malvezzi P, Mesnard L, Bertrand D, Martinez F, Pernin V, Ducloux D, Poulain C, Thierry A, Del Bello A, Rerolle JP, Greze C, Uro-Coste C, Aniort J, Lambert C, Bouvier N, Schvartz B, Maillard N, Sayegh J, Oniszczuk J, Morin MP, Legendre C, Kamar N, Heng AE, Garrouste C. Rituximab for recurrence of primary focal segmental glomerulosclerosis after kidney transplantation: Results of a nationwide study. Am J Transplant 2021; 21:3021-3033. [PMID: 33512779 DOI: 10.1111/ajt.16504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 01/25/2023]
Abstract
Rituximab (RTX) therapy for primary focal segmental glomerulosclerosis recurrence after kidney transplantation (KT) has been extensively debated. We aimed to assess the benefit of adding RTX to plasmapheresis (PP), corticosteroids, and calcineurin inhibitors (standard of care, SOC). We identified 148 adult patients who received KT in 12/2004-12/2018 at 21 French centers: 109 received SOC (Group 1, G1), and 39 received immediate RTX along with SOC (Group 2, G2). In G1, RTX was introduced after 28 days of SOC in the event of failure (G1a, n = 19) or PP withdrawal (G1b, n = 12). Complete remission (CR) was achieved in 46.6% of patients, and partial remission (PR) was achieved in 33.1%. The 10-year graft survival rates were 64.7% and 17.9% in responders and nonresponders, respectively. Propensity score analysis showed no difference in CR+PR rates between G1 (82.6%) and G2 (71.8%) (p = .08). Following the addition of RTX (G1a), 26.3% of patients had CR, and 31.6% had PR. The incidence of severe infections was similar between patients treated with and without RTX. In multivariable analysis, infection episodes were associated with hypogammaglobulinemia <5 g/L. RTX could be used in cases of SOC failure or remission for early discontinuation of PP without increasing the risk of infection.
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Affiliation(s)
- Camille Lanaret
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Dany Anglicheau
- Assistance Publique des Hôpitaux de Paris, Service de Néphrologie et Transplantation, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
| | - Vincent Audard
- Assistance Publique des Hôpitaux de Paris (AP-HP, Service de Néphrologie et Transplantation Centre de Référence Maladie Rare «Syndrome Néphrotique Idiopathique», Hôpitaux Universitaires Henri-Mondor, Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Mathias Büchler
- Service de Néphrologie et Immunologie Clinique, CHRU de Tours, Tours, France
| | - Sophie Caillard
- Service de Néphrologie, University Hospital, Strasbourg, France
| | - Lionel Couzi
- Service de Néphrologie, Transplantation, Dialyse et Aphérèses, CHU de Bordeaux, Bordeaux, France
| | - Paolo Malvezzi
- Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Laurent Mesnard
- Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Tenon, Urgences Néphrologiques et Transplantation Rénale, Université de Paris, Paris, France
| | | | - Franck Martinez
- Assistance Publique des Hôpitaux de Paris, Service de Néphrologie et Transplantation, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
| | - Vincent Pernin
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Didier Ducloux
- Service de Néphrologie, Dialyse et Transplantation, CHU Besançon, Besançon, France
| | - Coralie Poulain
- Service de Néphrologie-Médecine Interne-Dialyse-Transplantation, CHU d'Amiens, Amiens, France
| | - Antoine Thierry
- Service de Néphrologie-Hémodialyse-Transplantation Rénale, CHU de Poitiers, Poitiers, France
| | - Arnaud Del Bello
- Département de Néphrologie et Transplantation d'Organes, CHU Toulouse, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France
| | - Jean P Rerolle
- Service de Néphrologie, Dialyse et Transplantation, CHU Limoges, Limoges, France
| | - Clarisse Greze
- Assistance Publique des Hôpitaux de Paris, Service de Néphrologie, Hôpital Universitaire Bichat-Claude-Bernard, Université de Paris, Paris, France
| | - Charlotte Uro-Coste
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Julien Aniort
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Céline Lambert
- Unité de Biostatistiques (DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas Bouvier
- Service de Néphrologie et Transplantation, CHU Caen, Caen, France
| | | | - Nicolas Maillard
- Service de Néphrologie et Transplantation, CHU Saint-Etienne, Saint-Etienne, France
| | - Johnny Sayegh
- Service de Néphrologie-Dialyse-Transplantation, CHU Angers, Angers, France
| | - Julie Oniszczuk
- Assistance Publique des Hôpitaux de Paris (AP-HP, Service de Néphrologie et Transplantation Centre de Référence Maladie Rare «Syndrome Néphrotique Idiopathique», Hôpitaux Universitaires Henri-Mondor, Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
| | | | - Christophe Legendre
- Assistance Publique des Hôpitaux de Paris, Service de Néphrologie et Transplantation, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'Organes, CHU Toulouse, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France
| | - Anne E Heng
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Cyril Garrouste
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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Chavarot N, Ouedrani A, Marion O, Leruez-Ville M, Vilain E, Baaziz M, Del Bello A, Burger C, Sberro-Soussan R, Martinez F, Chatenoud L, Abravanel F, Anglicheau D, Izopet J, Couat C, Zuber J, Legendre C, Lanternier F, Kamar N, Scemla A. Poor Anti-SARS-CoV-2 Humoral and T-cell Responses After 2 Injections of mRNA Vaccine in Kidney Transplant Recipients Treated With Belatacept. Transplantation 2021; 105:e94-e95. [PMID: 33831941 DOI: 10.1097/tp.0000000000003784] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nathalie Chavarot
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Amani Ouedrani
- Université de Paris, Paris, France
- Immunology Laboratory, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- CNRS UMR8253, INSERM UMR1151, Institut Necker-Enfants Malades, Paris, France
| | - Olivier Marion
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
- Toulouse III Paul Sabatier University, Toulouse, France
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Marianne Leruez-Ville
- Université de Paris, Paris, France
- Virology Laboratory, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Estelle Vilain
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maroua Baaziz
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Arnaud Del Bello
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
- Toulouse III Paul Sabatier University, Toulouse, France
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Carole Burger
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Frank Martinez
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Lucienne Chatenoud
- Université de Paris, Paris, France
- Immunology Laboratory, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- CNRS UMR8253, INSERM UMR1151, Institut Necker-Enfants Malades, Paris, France
| | - Florence Abravanel
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
- Toulouse III Paul Sabatier University, Toulouse, France
- Virology Laboratory, Toulouse Purpan University Hospital, Toulouse, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Jacques Izopet
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
- Toulouse III Paul Sabatier University, Toulouse, France
- Virology Laboratory, Toulouse Purpan University Hospital, Toulouse, France
| | - Chloé Couat
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Julien Zuber
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
| | - Fanny Lanternier
- Université de Paris, Paris, France
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nassim Kamar
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
- Toulouse III Paul Sabatier University, Toulouse, France
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
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Marion O, Del Bello A, Abravanel F, Couat C, Faguer S, Esposito L, Hebral AL, Izopet J, Kamar N. Safety and Immunogenicity of Anti-SARS-CoV-2 Messenger RNA Vaccines in Recipients of Solid Organ Transplants. Ann Intern Med 2021; 174:1336-1338. [PMID: 34029487 PMCID: PMC8252830 DOI: 10.7326/m21-1341] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Olivier Marion
- Toulouse Rangueil University Hospital, Paul Sabatier University, and INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Toulouse, France
| | - Arnaud Del Bello
- Toulouse Rangueil University Hospital and Paul Sabatier University, Toulouse, France
| | - Florence Abravanel
- Toulouse Purpan University Hospital, Paul Sabatier University, and INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Toulouse, France
| | - Chloé Couat
- Toulouse Rangueil University Hospital, Toulouse, France
| | - Stanislas Faguer
- Toulouse Rangueil University Hospital and Paul Sabatier University, Toulouse, France
| | | | | | - Jacques Izopet
- Toulouse Purpan University Hospital, Paul Sabatier University, and INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Toulouse, France
| | - Nassim Kamar
- Toulouse Rangueil University Hospital, Paul Sabatier University, and INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Toulouse, France
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Longlune N, Nogier MB, Miedougé M, Gabilan C, Cartou C, Seigneuric B, Del Bello A, Marion O, Faguer S, Izopet J, Kamar N. High immunogenicity of a messenger RNA-based vaccine against SARS-CoV-2 in chronic dialysis patients. Nephrol Dial Transplant 2021; 36:1704-1709. [PMID: 34057463 PMCID: PMC8195197 DOI: 10.1093/ndt/gfab193] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/27/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease, dialysis patients and kidney transplant patients are at high risk of developing severe coronavirus disease 2019 (COVID-19). Data regarding the immunogenicity of anti-severe acute respiratory syndrome coronavirus 2 messenger RNA (anti-SARS-CoV-2 mRNA) vaccines in dialysis patients were published recently. We assessed the immunogenicity of anti-SARS-CoV-2 mRNA vaccine in dialysis patients. PATIENTS AND METHODS One hundred and nine patients on haemodialysis (n = 85) or peritoneal dialysis (n = 24) have received two injections of 30-μg doses of BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) that were administered intramuscularly 28 days apart. Those who were still seronegative after the second dose were given a third dose 1 month later. Anti-SARS-CoV-2 antibodies were tested before and after vaccination. RESULTS Ninety-one out of the 102 patients who had at least a 1-month follow-up after the second (n = 97) or the third (n = 5) vaccine doses had anti-SARS-CoV-2 antibodies. The seroconversion rate was 88.7% (86 out of 97 patients) among SARS-CoV-2 seronegative patients at the initiation of vaccination. Receiving immunosuppressive therapy was an independent predictive factor for non-response to vaccination. CONCLUSION Due to high immunogenicity and safety of mRNA vaccines, we strongly recommend prioritizing a two-dose vaccination of dialysis patients. A third dose can be required in non-responders to two doses. When possible, patients waiting for a kidney transplantation should be offered the vaccine before transplantation.
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Affiliation(s)
- Nathalie Longlune
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Marie Béatrice Nogier
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Marcel Miedougé
- Laboratory of Virology, Toulouse Purpan University Hospital, Toulouse, France
| | - Charlotte Gabilan
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Charles Cartou
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Bruno Seigneuric
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
- Paul Sabatier University, Toulouse, France
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
- Paul Sabatier University, Toulouse, France
| | - Jacques Izopet
- Laboratory of Virology, Toulouse Purpan University Hospital, Toulouse, France
- Paul Sabatier University, Toulouse, France
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
- Paul Sabatier University, Toulouse, France
- INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, Toulouse, France
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Affiliation(s)
| | | | | | - Chloé Couat
- Toulouse University Hospital, Toulouse, France
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Jarlot-Gas C, Muscari F, Mokrane FZ, Del Bello A, Culetto A, Buscail E, Péré G, Fares N, Péron JM, Cuellar E, Barange K, Kamar N, Suc B, Maulat C. Management of anastomotic biliary stricture after liver transplantation and impact on survival. HPB (Oxford) 2021; 23:1259-1268. [PMID: 33423950 DOI: 10.1016/j.hpb.2020.12.008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anastomotic biliary strictures (AS) is the main surgical complication after liver transplantation. The aims of this study are to investigate the risk factors of AS, its management and its impact on overall survival and survival of the graft. METHODS All patients who had received a liver transplantation with duct-to-duct anastomosis at Toulouse University Hospital between 2010 and 2016 were included. RESULTS Of 225 included patients, 56 (24.9%) presented with AS. The median time to discovery of AS was 83 days and 69.6% of the AS appeared within 6 months. Transplantation in critically ill patients, with a liver score >800 points, was an independent predictive factor of survival (P = 0.003). The first-line treatment was endoscopic (87.5%), with a success rate of 79.6% and a median of 4 procedures per patient in 12 months. In cases of failure of endoscopic therapy, percutaneous treatment had a high failure rate (50%). AS had no impact in terms of overall survival or in terms of graft survival. CONCLUSION AS do not have any repercussions on patient or graft survival, requiring long endoscopic treatment with multiple procedures. In the event of failure of this first-line endoscopic treatment, it seems preferable to turn directly towards surgical repair.
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Affiliation(s)
- Cécile Jarlot-Gas
- The Digestive Surgery and Liver Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Fabrice Muscari
- The Digestive Surgery and Liver Transplantation Department, Toulouse University Hospital, Toulouse, France
| | | | - Arnaud Del Bello
- Department of Nephrology and Transplantation, Toulouse University Hospital, Toulouse, France
| | - Adrian Culetto
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Etienne Buscail
- The Digestive Surgery and Liver Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Guillaume Péré
- The Digestive Surgery and Liver Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Nadim Fares
- Department of Digestive Oncology, Toulouse University Hospital, Toulouse, France
| | - Jean-Marie Péron
- Department of Hepatology, Toulouse University Hospital, Toulouse, France
| | - Emmanuel Cuellar
- The Digestive Surgery and Liver Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Karl Barange
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Transplantation, Toulouse University Hospital, Toulouse, France
| | - Bertrand Suc
- The Digestive Surgery and Liver Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Charlotte Maulat
- The Digestive Surgery and Liver Transplantation Department, Toulouse University Hospital, Toulouse, France.
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Del Bello A, Zakaroff AG, Meyer N, Delas A, Faguer S, Kamar N, Belliere J. Cytokine storm induced by a PD1 inhibitor in a renal transplant patient. Am J Transplant 2021; 21:2616-2618. [PMID: 33797848 DOI: 10.1111/ajt.16589] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, University Hospital of Toulouse, Toulouse, France
| | - Alexia G Zakaroff
- INSERM U1048, Institute of Metabolic and Cardiovascular Diseases, team 12, Rangueil Hospital, Toulouse, France
| | - Nicolas Meyer
- Department of Onco-Dermatology, Toulouse Cancer Institute (IUC) and University Hospital (CHU), Toulouse, France
| | - Audrey Delas
- Department of Pathology, Toulouse CHU, Toulouse - Oncopole IUC, Toulouse, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, University Hospital of Toulouse, Toulouse, France.,INSERM U1048, Institute of Metabolic and Cardiovascular Diseases, team 12, Rangueil Hospital, Toulouse, France.,INSERM U1043, IFR-BMT, Toulouse University Hospital, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, University Hospital of Toulouse, Toulouse, France.,Paul Sabatier University, Toulouse, France.,INSERM U1043, IFR-BMT, Toulouse University Hospital, Toulouse, France
| | - Julie Belliere
- Department of Nephrology and Organ Transplantation, University Hospital of Toulouse, Toulouse, France.,INSERM U1048, Institute of Metabolic and Cardiovascular Diseases, team 12, Rangueil Hospital, Toulouse, France.,INSERM U1043, IFR-BMT, Toulouse University Hospital, Toulouse, France
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Amaya Garrido A, Valdivielso JM, Faguer S, Del Bello A, Buffin-Meyer B, Piedrafita A, Camus M, Schiltz O, Bascands JL, HOBSON SAM, Kublickiene K, Stenvinkel P, Schanstra J, Klein J. MO441CALPROTECTIN IS A NOVEL CONTRIBUTING FACTOR IN VASCULAR CALCIFICATION AND A PREDICTOR OF CARDIOVASCULAR OUTCOME IN CKD PATIENTS*. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab090.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Vascular calcification, leading to aortic stiffening and heart failure, is decisive risk factor for cardiovascular (CV) mortality in patients with chronic kidney disease (CKD). Promoted by bone mineral disorder and systemic inflammation in CKD patients, vascular calcification is a complex mechanism involving osteochondrogenic differentiation of vascular smooth muscle cells (VSMCs) and abnormal deposition of minerals in the vascular wall. Despite intensive research efforts in recent years, available treatments have limited effect and none of them prevent or reverse vascular calcification. The aim of this study was to analyse the serum proteome of CKD stage 3-4 patients in order to unravel new molecular changes associated to CV morbid-mortality and to decipher the role of novel candidates on vascular calcification to provide potential new therapeutic agents.
Method
In this study we used serum samples from two independent cohorts: 112 CKD stage 3-4 patients with a 4 years follow-up for CV events and 222 CKD stage 5 patients exhibiting a broad range of calcification degree determined by histological quantification in the epigastric and/or iliac artery. Serum proteome analysis was performed using tandem mass-spectrometry in a subcohort of 66 CKD3-4 patients and validation of protein candidates was performed using ELISA in the two full cohorts. Human primary vascular smooth muscle cells and mouse aortic rings were used for calcification assays. Calcium content was quantified using QuantiChrom calcium assay kit and calcium deposition was visualized by Alizarin Red and Von Kossa staining.
Results
Among 443 proteins detected in the serum of CKD3-4 patients, 134 displayed significant modified abundance in patients with CV events (n=32) compared to patients without (n=34). One of the most prominent changes was increased level of calprotectin (up to 8.6 fold, P<.0001). Using ELISA, we validated that higher serum calprotectin levels were strongly associated with higher probability of developing CV complications and increased mortality in CKD stage 3-4 patients (Figure A). Moreover, we showed that higher serum calprotectin was associated with increased vascular calcification levels in CKD stage 5 patients (Figure B). In vitro, calprotectin promoted calcification of human VSMCs (p<0.0001) (Figures C-D) and in mouse aortic rings (p<0.0001) (Figure E-F). Interestingly, these effects were significantly attenuated by paquinimod, a calprotectin inhibitor (Figures C-F).
Conclusion
Circulating calprotectin is a novel predictor of CV outcome and mortality in CKD patients. Calprotectin also shows calcification-inducing properties and its blockade by paquinimod alleviates its effects. Future experiments will consist in deciphering the signalling pathways involved in the regulation of calcification by calprotectin and evaluating in vivo the therapeutic potential of paquinimod on the development of medial vascular calcification lesions associated with CKD.
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Massat M, Congy-Jolivet N, Hebral AL, Esposito L, Marion O, Delas A, Colombat M, Faguer S, Kamar N, Del Bello A. Do anti-IL-6R blockers have a beneficial effect in the treatment of antibody-mediated rejection resistant to standard therapy after kidney transplantation? Am J Transplant 2021; 21:1641-1649. [PMID: 33141487 DOI: 10.1111/ajt.16391] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 01/25/2023]
Abstract
Antibody-mediated rejection (AMR) that resists to standard of care (SOC) therapy remains a major challenge after kidney transplantation and leads to graft failure in a majority of cases. The use of anti-IL6 receptor antibodies was suggested to treat chronic antibody-mediated rejection (cAMR) after failure of classical treatments. We treated nine patients with AMR resistant to apheresis, rituximab, and intravenous immunoglobulins, with a monthly infusion of tocilizumab and compared them with a historical cohort of 37 patients with similar clinical, immunological, and histological characteristics. The 1-year graft survival and the decline in renal function did not differ between patients who received tocilizumab and those who did not. Histological follow-up showed that despite a decrease in inflammation and tubulitis scores after tocilizumab, the course of antibody-mediated lesions and chronic glomerulopathy were similar in both groups. In our study, the addition of monthly infusions of tocilizumab did not alter the course of AMR that resist to SOC therapy. Large randomized studies are urgently needed to assess the effect of tocilizumab in this context.
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Affiliation(s)
- Maéva Massat
- Department of Nephrology and Organ Transplant, CHU Toulouse Rangueil, Toulouse, France
| | - Nicolas Congy-Jolivet
- Université Paul Sabatier, Toulouse, France.,Laboratory of Immunology and Immunogenetics, CHU Toulouse Purpan, Toulouse, France.,INSERM U1037, IFR-BMT, Centre de Recherche en Cancérologie de Toulouse (CRCT), Université de Toulouse III-Paul Sabatier, Toulouse, France
| | - Anne-Laure Hebral
- Department of Nephrology and Organ Transplant, CHU Toulouse Rangueil, Toulouse, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplant, CHU Toulouse Rangueil, Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplant, CHU Toulouse Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Audrey Delas
- Department of Pathology, Institut Universitaire du Cancer, Toulouse, France
| | - Magali Colombat
- Université Paul Sabatier, Toulouse, France.,Department of Pathology, Institut Universitaire du Cancer, Toulouse, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplant, CHU Toulouse Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,INSERM U1049, CHU Rangueil, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplant, CHU Toulouse Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplant, CHU Toulouse Rangueil, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
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Préterre J, Visentin J, Saint Cricq M, Kaminski H, Del Bello A, Prezelin-Reydit M, Merville P, Kamar N, Couzi L. Comparison of two strategies based on mammalian target of rapamycin inhibitors in secondary prevention of non-melanoma skin cancer after kidney transplantation, a pilot study. Clin Transplant 2021; 35:e14207. [PMID: 33369772 DOI: 10.1111/ctr.14207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 01/05/2023]
Abstract
After kidney transplantation, withdrawal of calcineurin inhibitors (CNI) and conversion to sirolimus (SRL) may reduce the occurrence of new non-melanoma skin cancer (NMSC). Conversely, a reduced CNI exposure with everolimus (EVR) is an alternative strategy that has not been thoroughly evaluated. We retrospectively compared the occurrence of newly diagnosed NMSCs in two cohorts of kidney transplant recipients (KTR) with at least one NMSC: 35 patients were converted to EVR with reduced CNI exposure (CNI/EVR group), whereas 46 patients were converted to SRL in association with mycophenolic acid (MPA) (SRL/MPA group). Two years after conversion, survival free of new NMSC was similar between the two cohorts (p = .37), with 19 KTR (54.3%) in the CNI/EVR group and 22 (47.8%) in the SRL/MPA group being diagnosed of at least one new NMSC. Half of the KTR from both groups showed adverse events, leading to mTORi discontinuation for 37.1% of KTR in the CNI/EVR group and 21.7% in the SRL/MPA group (p = .09). The incidence of rejections was similar between the two groups. In a retrospective cohort of KTR with at least one post-transplant NMSC, the outcome of the patients converted to a CNI/EVR regimen was not different from those converted to a SRL/MPA regimen.
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Affiliation(s)
- Julie Préterre
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, Bordeaux, France
| | - Jonathan Visentin
- CHU de Bordeaux, Service d'Immunologie et Immunogénétique, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, CNRS "ImmunoConcEpT" UMR 5164, Bordeaux, France
| | - Morgane Saint Cricq
- Department of Nephrology, Dialysis and Organ Transplantation, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Hannah Kaminski
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, CNRS "ImmunoConcEpT" UMR 5164, Bordeaux, France
| | - Arnaud Del Bello
- Department of Nephrology, Dialysis and Organ Transplantation, Hôpital Rangueil, CHU de Toulouse, Toulouse, France.,Centre de Physiopathologie Toulouse Purpan, University Paul Sabatier, INSERM U1043, Toulouse, France
| | - Mathilde Prezelin-Reydit
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, Bordeaux, France
| | - Pierre Merville
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, CNRS "ImmunoConcEpT" UMR 5164, Bordeaux, France
| | - Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, Hôpital Rangueil, CHU de Toulouse, Toulouse, France.,Centre de Physiopathologie Toulouse Purpan, University Paul Sabatier, INSERM U1043, Toulouse, France
| | - Lionel Couzi
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèse, Hôpital Pellegrin, Bordeaux, France.,Université de Bordeaux, CNRS "ImmunoConcEpT" UMR 5164, Bordeaux, France
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Gouin A, Sberro-Soussan R, Courivaud C, Bertrand D, Del Bello A, Darres A, Ducloux D, Legendre C, Kamar N. Conversion From Belatacept to Another Immunosuppressive Regimen in Maintenance Kidney-Transplantation Patients. Kidney Int Rep 2020; 5:2195-2201. [PMID: 33305112 PMCID: PMC7710888 DOI: 10.1016/j.ekir.2020.09.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/22/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction During the coronavirus disease 2019 (Covid-19) pandemic, several physicians have questioned pursuing belatacept in kidney-transplant patients in order to reduce the risk of nosocomial transmission during the monthly infusion. The effect of the conversion from belatacept to another immunosuppressive regimen is underreported. The aim of the present retrospective study was to assess the effect on kidney function and the clinical outcome of the conversion from belatacept to another regimen. Methods We have identified 44 maintenance kidney transplantation patients from five French kidney transplantation centers who were converted from belatacept to another regimen either because of a complication (n = 28) or another reason (patients’ request or belatacept shortage, n = 13). The follow-up after the conversion from belatacept was 27.5 ± 25.3 months. Results Overall, mean estimated glomerular filtration rate (eGFR) decreased from 44.2 ± 16 ml/min per 1.73 m2 at conversion from belatacept to 35.7 ± 18.4 ml/min per 1.73 m2 at last follow-up (P = 0.0002). eGFR significantly decreased in patients who had been given belatacept at transplantation as well as in those who had been converted to belatacept earlier. The decrease was less significant in patients who had stopped belatacept without having experienced any complications. Finally, eGFR decreased more severely in patients who were converted to calcineurin inhibitors (CNIs), compared to those who received mammalian target of rapamycin inhibitor (mTORi). Few patients also developed diabetes and hypertension. Conclusions Thus, transplantation physicians should avoid stopping belatacept when not clinically required.
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Affiliation(s)
- Anna Gouin
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Rebecca Sberro-Soussan
- Service de néphrologie-Transplantation, Hôpital Necker, AP-HP, Paris et Université Paris Descartes, Paris
| | - Cécile Courivaud
- Service de néphrologie, dialyse et transplantation rénale, FHU INCREASE, CHU de Besançon, Besançon, France
| | - Dominique Bertrand
- Service de néphrologie, dialyse et transplantation rénale, CHU de Rouen, Rouen, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Amandine Darres
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Didier Ducloux
- Service de néphrologie, dialyse et transplantation rénale, FHU INCREASE, CHU de Besançon, Besançon, France
| | - Christophe Legendre
- Service de néphrologie-Transplantation, Hôpital Necker, AP-HP, Paris et Université Paris Descartes, Paris
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France
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50
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Kaminski H, Belliere J, Burguet L, Del Bello A, Taton B, Poirot-Mazères S, Accoceberry I, Delhaes L, Visentin J, Gregori M, Iriart X, Charpentier E, Couzi L, Kamar N, Merville P. Identification of Predictive Markers and Outcomes of Late-onset Pneumocystis jirovecii Pneumonia in Kidney Transplant Recipients. Clin Infect Dis 2020; 73:e1456-e1463. [DOI: 10.1093/cid/ciaa1611] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background
In the era of prophylaxis, Pneumocystis pneumonia (PCP) has become a late-onset opportunistic infection requiring indications for prolonged prophylaxis to be defined. The primary objective of our study was therefore to evaluate risk factors associated with late-onset PCP. The secondary objective was to assess the impact of this infection on graft and patient survival.
Methods
We conducted a French case-control study in Bordeaux and Toulouse center by matching 1 case to 1–2 controls from the same center based on the transplant date and the type of induction treatment.
Results
Seventy cases and 134 controls were included. PCP occurred at a median of 3 years after transplantation. The total lymphocyte count and CD4+ and CD8+ T-lymphocyte values were lower in the cases than in their matched controls on the day of infection and annually up to 4 years earlier. The covariables independently associated with PCP were the total lymphocyte count 1 year before Pneumocystis, mTOR inhibitors used as maintenance immunosuppressive drugs, and the administration of corticosteroid boluses used in acute rejection. A total lymphocyte count threshold <1000/µL offered the best predictive value for infection occurrence. PCP was associated with high incidence of graft loss and patient death (30% and 17% respectively, 3 years after PCP).
Conclusions
Pneumocystis pneumonia has dramatic consequences in kidney transplant recipients; a targeted prophylaxis based on simple criteria, such as chronic lymphopenia and/or history of corticosteroid boluses, could be useful to avoid life-threatening complications.
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Affiliation(s)
- Hannah Kaminski
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France
- Centre National de Recherche Scientifique- Unité Mixte de Recherche 5164 ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Julie Belliere
- Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire Toulouse, Toulouse, France
- Paul Sabatier University, Toulouse, France
| | - Laure Burguet
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Benjamin Taton
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France
- Mathematics Modeling for Oncology, Institute of Bordeaux Mathematics, Institut National de Recherche en Informatique et en automatique-Unité Mixte de Recherche 5251, Talence, France
| | - Stéphane Poirot-Mazères
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France
| | - Isabelle Accoceberry
- Laboratory of Parasitology-Mycology, Pellegrin University Hospital, Bordeaux, France
| | - Laurence Delhaes
- Laboratory of Parasitology-Mycology, Pellegrin University Hospital, Bordeaux, France
| | - Jonathan Visentin
- Centre National de Recherche Scientifique- Unité Mixte de Recherche 5164 ImmunoConcEpT, Bordeaux University, Bordeaux, France
- Laboratory of Immunology and Immunogenetics, Pellegrin University Hospital, Bordeaux, France
| | - Marco Gregori
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France
| | - Xavier Iriart
- Department of Parasitology-Mycology, Toulouse University Hospital Toulouse, France
- Institut national de la santé et de la recherche médicale U1043, Institut Fédératif de Recherche Bio-Médicale de Toulouse, Toulouse, France
| | - Elena Charpentier
- Department of Parasitology-Mycology, Toulouse University Hospital Toulouse, France
- Institut national de la santé et de la recherche médicale U1043, Institut Fédératif de Recherche Bio-Médicale de Toulouse, Toulouse, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France
- Centre National de Recherche Scientifique- Unité Mixte de Recherche 5164 ImmunoConcEpT, Bordeaux University, Bordeaux, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire Toulouse, Toulouse, France
- Paul Sabatier University, Toulouse, France
- Institut national de la santé et de la recherche médicale U1043, Institut Fédératif de Recherche Bio-Médicale de Toulouse, Toulouse, France
| | - Pierre Merville
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France
- Centre National de Recherche Scientifique- Unité Mixte de Recherche 5164 ImmunoConcEpT, Bordeaux University, Bordeaux, France
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