1
|
Duval A, Meuleman M, Chauvet S, Roumenina L, Moulin B, Caillard S, Frémeaux-Bacchi V. Étude de la susceptibilité individuelle à l’activation/régulation du complément à la surface cellulaire endothéliale : validation d’un nouveau modèle ex vivo. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
2
|
Pszczolinski R, Acquaviva C, Bacchetta J, Moulin B. Le retard diagnostique de l’hyperoxalurie primitive reste majeur : résultats de l’étude nationale pheno-hopla [Description phénotypique des hyperoxaluries primaires]. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
3
|
Greuez C, Argemi X, Giorgiutti S, Goichot B, Hannedouche T, Kaltenbach G, Lefebvre N, Lenormand C, Lescuyer S, Moulin B, Rondeau-Lutz M, Schmitt E, Sibilia J, Imperiale A, Andres E. Fièvre et syndrome inflammatoire inexpliqué chez le sujet âgé, impact thérapeutique de la TEP-TDM au 18F-FDG. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
4
|
Perrin P, Collongues N, Baloglu S, Bedo D, Bassand X, Lavaux T, Gautier-Vargas G, Keller N, Kremer S, Fafi-Kremer S, Moulin B, Benotmane I, Caillard S. Cytokine release syndrome-associated encephalopathy in patients with COVID-19. Eur J Neurol 2020; 28:248-258. [PMID: 32853434 PMCID: PMC7461405 DOI: 10.1111/ene.14491] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
Abstract
Background and purpose Neurological manifestations in coronavirus disease (COVID)‐2019 may adversely affect clinical outcomes. Severe COVID‐19 and uremia are risk factors for neurological complications. However, the lack of insight into their pathogenesis, particularly with respect to the role of the cytokine release syndrome (CRS), is currently hampering effective therapeutic interventions. The aims of this study were to describe the neurological manifestations of patients with COVID‐19 and to gain pathophysiological insights with respect to CRS. Methods In this longitudinal study, we performed extensive clinical, laboratory and imaging phenotyping in five patients admitted to our renal unit. Results Neurological presentation included confusion, tremor, cerebellar ataxia, behavioral alterations, aphasia, pyramidal syndrome, coma, cranial nerve palsy, dysautonomia, and central hypothyroidism. Notably, neurological disturbances were accompanied by laboratory evidence of CRS. Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) was undetectable in the cerebrospinal fluid (CSF). Hyperalbuminorrachia and increased levels of the astroglial protein S100B were suggestive of blood−brain barrier (BBB) dysfunction. Brain magnetic resonance imaging findings comprised evidence of acute leukoencephalitis (n = 3, one of whom had a hemorrhagic form), cytotoxic edema mimicking ischaemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted, resulting in rapid recovery from neurological disturbances in two cases. SARS‐CoV2 was undetectable in 88 of the 90 patients with COVID‐19 who underwent Reverse Transcription‐PCR testing of CSF. Conclusions Patients with COVID‐19 can develop neurological manifestations that share clinical, laboratory and imaging similarities with those of chimeric antigen receptor T‐cell‐related encephalopathy. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune‐mediated mechanisms.
Collapse
Affiliation(s)
- P Perrin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - N Collongues
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,Department of Neurology, University Hospital, Strasbourg, France.,Clinical Center for Investigation, INSERM U1434, Strasbourg, France
| | - S Baloglu
- Department of Neuroradiology, University Hospital, Strasbourg, France
| | - D Bedo
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - X Bassand
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - T Lavaux
- Department of Biochemistry and Molecular Biology, University Hospital, Strasbourg, France
| | - G Gautier-Vargas
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - N Keller
- Department of Nephrology and Dialysis, University Hospital, Strasbourg, France
| | - S Kremer
- Department of Neuroradiology, University Hospital, Strasbourg, France
| | - S Fafi-Kremer
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France.,Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - B Moulin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - I Benotmane
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France.,Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - S Caillard
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| |
Collapse
|
5
|
Pszczolinski R, Heitz D, Heibel F, Moulin B, Caillard S. Transplantation rénale après 70 ans : évaluation gériatrique en pré-transplantation et suivi après transplantation. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Benotmane I, Perrin P, Gautier-Vargas G, Bassand X, Bedo D, Baldacini C, Sagnard M, Moulin B, Fafi-Kremer S, Caillard S. Prédiction de la sévérité de la COVID-19 par les biomarqueurs du syndrome de relargage cytokinique au sein d’une population de transplantés rénaux. Nephrol Ther 2020. [PMCID: PMC7494287 DOI: 10.1016/j.nephro.2020.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Les données concernant la coronavirus disease-2019 (COVID-19) dans la population de transplantés rénaux (TR) sont peu nombreuses. Alors que les marqueurs de l’inflammation, d’atteinte myocardique et de coagulopathie sont associés à la gravité et à la mortalité au sein de la population immunocompétente infectée par le severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), aucune étude n’a évalué ces marqueurs chez des TR atteints de la COVID-19. Description Dans cette étude de cohorte portant sur 50 patients TR atteints de la COVID-19, nous avons déterminé les facteurs de risque cliniques et biologiques liés à la gravité et la mortalité de la maladie. Méthodes Selon la sévérité de l’atteinte clinique, la cohorte a été divisée en 3 groupes : – patients avec une atteinte peu sévère ayant bénéficié d’une prise en charge ambulatoire (n = 9) ; – patients hospitalisés avec une atteinte modérée (n = 21) ; – des patients hospitalisés avec une atteinte sévère (n = 20). Résultats La fièvre, les signes respiratoires et digestifs étaient les trois signes les plus fréquents. Le taux de mortalité à 30 jours des patients hospitalisés était de 19,5 %. L’âge supérieur à 60 ans (85 % vs 43 %, p = 0,01), l’obésité (70 % vs 33,3, p = 0,02) et la dyspnée (100 % vs 42,9 %, p < 0,0001) étaient plus fréquents dans le groupe présentant une atteinte sévère. L’élévation des marqueurs de l’inflammation (CRP > 100 mg/L et Interleukin-6 > 65 ng/L), suivis par une élévation de la troponine I hypersensible (> 30 ng/L) et des D-dimères (> 960 ng/mL), était fortement associée à la sévérité et la mortalité de la COVID-19 (Fig. 1). Conclusion Le pronostic de la COVID-19 au sein de la population des TR est lié aux marqueurs du syndrome de relargage cytokinique. Un monitorage de ces marqueurs permettrait de cibler la population à risque de complication et d’améliorer leur prise en charge en utilisant des traitements ciblés.
Collapse
|
7
|
Goussiaume G, Moulin B, Wyplosz B, Fernandes J, Raguideau F, Leboucher C, Moïsi J. Covarisq (estimation de la COuverture VAccinale des adultes à RISQues) : taux de vaccination des personnes en insuffisance rénale chronique terminale ou hospitalisées suite à un syndrome néphrotique à l’échelle nationale en 2017. Nephrol Ther 2020. [DOI: 10.1016/j.nephro.2020.07.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Perrin P, Olagne J, Borni C, Kribs M, Moulin B, Caillard S. Hyperoxalurie primitive compliquée d’oxalose et d’hypercalcémie : mise en évidence d’une réaction granulomateuse exceptionnelle. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
9
|
Solis M, Velay A, Gantner P, Bausson J, Filipputtu A, Freitag R, Moulin B, Caillard S, Fafi-Kremer S. Torquetenovirus viremia for early prediction of graft rejection after kidney transplantation. J Infect 2019; 79:56-60. [PMID: 31100359 DOI: 10.1016/j.jinf.2019.05.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 01/02/2019] [Accepted: 05/10/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES New biomarkers reflecting the degree of immunosuppression in transplant recipients are needed to provide an optimal personalized balance between rejection and infection risks. METHODS For this purpose, we investigated TTV viremia dynamics in 66 kidney transplant recipients followed up for two years after transplantation, in relation to BK virus infection and graft rejection. RESULTS After transplantation, TTV viremia rose by ≥2 log10 copies/mL from baseline to month 3, then declined by ≥1 log10 copies/mL thereafter. Higher TTV viremia was associated with recipients of a deceased donor, a lower count of CD8+ T cells and a higher BKV viremia. Importantly, TTV loads were significantly lower in KTR who would later display graft rejection; indeed, patients with TTV viremia lower than 3.4 log10 copies/mL at transplantation or lower than 4.2 log10 copies/mL at month 1 had a higher risk of developing graft rejection in the two following years (hazard ratio (HR) at D0 = 7.30, p = 0.0007 and HR at M1 = 6.16, p = 0.001). CONCLUSIONS TTV viremia measurement at early times post transplantation predicts graft rejection and would represent a useful tool to improve kidney transplant monitoring.
Collapse
Affiliation(s)
- M Solis
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France; INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - A Velay
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France; INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - P Gantner
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France; INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - J Bausson
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France
| | - A Filipputtu
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France
| | - R Freitag
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France
| | - B Moulin
- INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France; Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S Caillard
- INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France; Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S Fafi-Kremer
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, 3 rue Koeberlé, F-67000 Strasbourg, France; INSERM UMR S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| |
Collapse
|
10
|
Gaillard F, Courbebaisse M, Kamar N, Couzi L, Gatault P, Dubourg L, Moulin B, Legendre C, Delanaye P, Mariat C. Impact de l’âge sur le niveau de DFG mesuré acceptable pour le don vivant de rein. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Châtelet V, Gatault P, Hazzan M, Anglicheau D, Launoy G, Lobbedez T, Moulin B. Caractéristiques des centres de greffe associées à la greffe rénale avec donneur vivant en France : une analyse hiérarchique avec un modèle multiniveau. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
12
|
Gaillard F, Courbebaisse M, Kamar N, Rostaing L, Girerd S, Flamant M, Moulin B, Legendre C, Delanaye P, Mariat C. Impact de la technique d’évaluation du DFG sur l’éligibilité au don des donneurs vivants de rein. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
13
|
Borocco C, Kone-Paut I, Grateau G, Ulinski T, Belot A, Desjonquères M, Miceli C, Karras A, Moulin B, Boffa J, Buob D, Georgin Lavialle S. Néphropathies non amyloïdes dans les maladies auto-inflammatoires : à propos de 20 cas français. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Ossmane R, Jamme M, Galichon P, Hertig A, Mesnard L, Legendre C, Morelon E, Taupin J, Rostaing L, Moulin B, Rondeau E. Rejet aigu des greffes rénales de donneurs vivants HLA familiaux full match (Radovfull). Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
15
|
Collange O, Jazaerli L, Lejay A, Biermann C, Caillard S, Moulin B, Chakfe N, Severac F, Schaeffer M, Mertes PM, Steib A. Intraoperative Pleth Variability Index Is Linked to Delayed Graft Function After Kidney Transplantation. Transplant Proc 2017; 48:2615-2621. [PMID: 27788791 DOI: 10.1016/j.transproceed.2016.06.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Delayed graft function (DGF) is an early postoperative complication of kidney transplantation (KT) predisposing to acute rejection and lower graft survival. Intraoperative arterial hypotension and hypovolemia are associated with DGF. Central venous pressure (CVP) is used to estimate volemia but its reliability has been criticized. Pleth variability index (PVI) is a hemodynamic parameter predicting fluid responsiveness. The aim of this study was to examine the relationship between intraoperative PVI and CVP values and the occurrence of DGF. METHODS This was a prospective, noninterventional, observational, single-center study. All consecutive patients with KT from deceased donors were included. Recipients received standard, CVP, and PVI monitoring. Intraoperative hemodynamic parameters were recorded from recipients at 5 time points during KT. RESULTS Forty patients were enrolled. There was a poor correlation between PVI and CVP values (r2 = 0.003; P = .44). Immediate graft function and DGF patients had similar hemodynamic values during KT, with the exception of PVI values, which were significantly higher in the DGF group. In particular, a PVI >9% before unclamping of the renal artery was the only predictive parameter of DGF in our multivariate analysis (P = .02). CONCLUSIONS This study suggests that PVI values >9% during KT are associated with the occurrence of DGF.
Collapse
Affiliation(s)
- O Collange
- Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France.
| | - L Jazaerli
- Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - A Lejay
- Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; Service de Chirurgie Vasculaire et de Transplantation Rénale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - C Biermann
- Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S Caillard
- Service de Néphrologie-Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - B Moulin
- Service de Néphrologie-Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - N Chakfe
- Service de Chirurgie Vasculaire et de Transplantation Rénale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - F Severac
- Département de Santé Publique, Secteur Méthodologie et Biostatistique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - M Schaeffer
- Département de Santé Publique, Secteur Méthodologie et Biostatistique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - P-M Mertes
- Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - A Steib
- Pôle d'Anesthésie, Réanimations Chirurgicales, Service d'Aide Médicale Urgente-Service Mobile d'Urgence et de Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| |
Collapse
|
16
|
Gatault P, Kamar N, Büchler M, Colosio C, Bertrand D, Durrbach A, Albano L, Rivalan J, Le Meur Y, Essig M, Bouvier N, Legendre C, Moulin B, Heng AE, Weestel PF, Sayegh J, Charpentier B, Rostaing L, Thervet E, Lebranchu Y. Reduction of Extended-Release Tacrolimus Dose in Low-Immunological-Risk Kidney Transplant Recipients Increases Risk of Rejection and Appearance of Donor-Specific Antibodies: A Randomized Study. Am J Transplant 2017; 17:1370-1379. [PMID: 27862923 DOI: 10.1111/ajt.14109] [Citation(s) in RCA: 77] [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: 08/01/2016] [Revised: 10/05/2016] [Accepted: 10/30/2016] [Indexed: 01/25/2023]
Abstract
The aim of this study (ClinicalTrials.gov, NCT01744470) was to determine the efficacy and safety of two different doses of extended-release tacrolimus (TacER) in kidney transplant recipients (KTRs) between 4 and 12 mo after transplantation. Stable steroid-free KTRs were randomized (1:1) after 4 mo: Group A had a 50% reduction in TacER dose with a targeted TacER trough level (C0 ) >3 μg/L; group B had no change in TacER dose (TacER C0 7-12 μg/L). The primary outcome was estimated GFR at 1 year. Of 300 patients, the intent-to-treat analysis included 186 patients (group A, n = 87; group B, n = 99). TacER C0 was lower in group A than in group B at 6 mo (4.1 ± 2.7 vs. 6.7 ± 3.9 μg/L, p < 0.0001) and 12 mo (5.6 ± 2.0 vs. 7.4 ± 2.1 μg/L, p < 0.0001). Estimated GFR was similar in both groups at 12 mo (group A, 56.0 ± 17.5 mL/min per 1.73 m²; group B, 56.0 ± 22.1 mL/min per 1.73 m²). More rejection episodes occurred in group A than group B (11 vs. 3; p = 0.016). At 1 year, subclinical inflammation occurred more frequently in group A than group B (inflammation score [i] >0: 21.4% vs. 8.8%, p = 0.047; tubulitis score [t] >0: 19.6% vs. 8.7%, p = 0.076; i + t: 1.14 ± 1.21 vs. 0.72 ± 1.01, p = 0.038). Anti-HLA donor-specific antibodies appeared only in group A (6 vs. 0 patients, p = 0.008). TacER C0 should be maintained >7 μg/L during the first year after transplantation in low-immunological-risk, steroid-free KTRs receiving a moderate dose of mycophenolic acid.
Collapse
Affiliation(s)
- P Gatault
- EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France.,Department of Nephrology and Clinical Immunology, CHRU Tours, Tours, France
| | - N Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - M Büchler
- EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France.,Department of Nephrology and Clinical Immunology, CHRU Tours, Tours, France
| | - C Colosio
- Department of Kidney Transplantation, CHU Reims, Reims, France
| | - D Bertrand
- Department of Kidney Transplantation, CHU Rouen, Rouen, France
| | - A Durrbach
- Department of Kidney Transplantation, Kremlin-Bicêtre Hospital, Villejuif, France
| | - L Albano
- Department of Kidney Transplantation, CHU Nice, Nice, France
| | - J Rivalan
- Department of Kidney Transplantation, CHU Rennes, Rennes, France
| | - Y Le Meur
- Department of Kidney Transplantation, CHU Brest, Brest, France
| | - M Essig
- Department of Kidney Transplantation, CHU Limoges, Limoges, France
| | - N Bouvier
- Department of Kidney Transplantation, CHU Caen, Caen, France
| | - C Legendre
- Department of Kidney Transplantation, Necker Hospital, Paris, France.,INSERM Unité 845, Paris, France
| | - B Moulin
- Department of Kidney Transplantation, CHRU Strasbourg, Strasbourg, France
| | - A-E Heng
- Department of Kidney Transplantation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - P-F Weestel
- Department of Kidney Transplantation, CHU Amiens, Amiens, France
| | - J Sayegh
- Department of Kidney Transplantation, CHU Angers, Angers, France
| | - B Charpentier
- Department of Kidney Transplantation, Kremlin-Bicêtre Hospital, Villejuif, France
| | - L Rostaing
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France
| | - E Thervet
- Department of Kidney Transplantation, Georges-Pompidou Hospital, Paris, France
| | - Y Lebranchu
- EA4245 Dendritic Cells, Immunomodulation and Grafts, François-Rabelais University, Tours, France.,Department of Nephrology and Clinical Immunology, CHRU Tours, Tours, France
| |
Collapse
|
17
|
Damon C, Luck M, Toullec L, Etienne I, Buchler M, Hurault de Ligny B, Choukroun G, Thierry A, Vigneau C, Moulin B, Heng AE, Subra JF, Legendre C, Monnot A, Yartseva A, Bateson M, Laurent-Puig P, Anglicheau D, Beaune P, Loriot MA, Thervet E, Pallet N. Predictive Modeling of Tacrolimus Dose Requirement Based on High-Throughput Genetic Screening. Am J Transplant 2017; 17:1008-1019. [PMID: 27597269 DOI: 10.1111/ajt.14040] [Citation(s) in RCA: 12] [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: 06/29/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 01/25/2023]
Abstract
Any biochemical reaction underlying drug metabolism depends on individual gene-drug interactions and on groups of genes interacting together. Based on a high-throughput genetic approach, we sought to identify a set of covariant single-nucleotide polymorphisms predictive of interindividual tacrolimus (Tac) dose requirement variability. Tac blood concentrations (Tac C0 ) of 229 kidney transplant recipients were repeatedly monitored after transplantation over 3 mo. Given the high dimension of the genomic data in comparison to the low number of observations and the high multicolinearity among the variables (gene variants), we developed an original predictive approach that integrates an ensemble variable-selection strategy to reinforce the stability of the variable-selection process and multivariate modeling. Our predictive models explained up to 70% of total variability in Tac C0 per dose with a maximum of 44 gene variants (p-value <0.001 with a permutation test). These models included molecular networks of drug metabolism with oxidoreductase activities and the multidrug-resistant ABCC8 transporter, which was found in the most stringent model. Finally, we identified an intronic variant of the gene encoding SLC28A3, a drug transporter, as a key gene involved in Tac metabolism, and we confirmed it in an independent validation cohort.
Collapse
Affiliation(s)
- C Damon
- Hypercube Institute, Paris, France
| | - M Luck
- Hypercube Institute, Paris, France.,Paris Descartes University, Paris, France
| | - L Toullec
- Department of Clinical Chemistry, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - I Etienne
- Department of Nephrology, Rouen University Hospital, Rouen, France
| | - M Buchler
- Department of Nephrology, Tours University Hospital, Tours, France
| | | | - G Choukroun
- Department of Nephrology, Amiens University Hospital, Amiens, France
| | - A Thierry
- Department of Nephrology, Poitiers University Hospital, Poitiers, France
| | - C Vigneau
- Department of Nephrology, Rennes University Hospital, Rennes, France
| | - B Moulin
- Department of Nephrology, Strasbourg University Hospital, Strasbourg, France
| | - A-E Heng
- Department of Nephrology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - J-F Subra
- Department of Nephrology, Angers University Hospital, Angers, France
| | - C Legendre
- Department of Nephrology, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - A Monnot
- Hypercube Institute, Paris, France
| | | | | | - P Laurent-Puig
- Paris Descartes University, Paris, France.,Department of Clinical Chemistry, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Institut National pour la Santé et la Recherche Médicale (INSERM) U1147, Paris, France
| | - D Anglicheau
- Department of Nephrology, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - P Beaune
- Paris Descartes University, Paris, France.,Department of Clinical Chemistry, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Institut National pour la Santé et la Recherche Médicale (INSERM) U1147, Paris, France
| | - M A Loriot
- Paris Descartes University, Paris, France.,Department of Clinical Chemistry, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Institut National pour la Santé et la Recherche Médicale (INSERM) U1147, Paris, France
| | - E Thervet
- Paris Descartes University, Paris, France.,Department of Nephrology, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - N Pallet
- Paris Descartes University, Paris, France.,Department of Clinical Chemistry, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Institut National pour la Santé et la Recherche Médicale (INSERM) U1147, Paris, France.,Department of Nephrology, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
18
|
Kleinmann J, Tubach F, Le Guern V, Mathian A, Richez C, Saadoun D, Sacré K, Sellam J, Seror R, Amoura Z, Andres E, Audia S, Bader-Meunier B, Blaison G, Bonnotte B, Cacoub P, Caillard S, Chiche L, Chosidow O, Costedoat-Chalumeau N, Daien C, Daugas E, Derdèche N, Doria A, Fain O, Fakhouri F, Farge D, Gabay C, Guillo S, Hachulla E, Hajjaj-Hassouni N, Hamidou M, Houssiau F, Jourde-Chiche N, Kone-Paut I, Ladjouz-Rezig A, Lambotte O, Lipsker D, Mariette X, Martin Silva N, Martin T, Maurier F, Meckenstock R, Mekinian A, Meyer O, Mohamed S, Morel J, Moulin B, Mulleman D, Papo T, Poindron V, Puéchal X, Punzi L, Quartier P, Sailler L, Smail A, Soubrier M, Sparsa A, Tazi Mezalek Z, Zakraoui L, Zuily S, Sibilia J, Gottenberg J. Recommandations francophones, internationales et multidisciplinaires d’experts pour l’utilisation de biomédicaments dans le lupus érythémateux systémique : le groupe de travail du CRI-IMIDIATE. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
19
|
Solis M, Velay A, Porcher R, Domingo-Calap P, Soulier E, Joly M, Meddeb M, Kack-Kack W, Moulin B, Bahram S, Stoll-Keller F, Barth H, Caillard S, Fafi-Kremer S. Anti-BK virus neutralizing antibody titers before transplantation predict BK virus replication in kidney transplant recipients after transplantation. J Clin Virol 2016. [DOI: 10.1016/j.jcv.2016.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
20
|
Pallet N, Etienne I, Buchler M, Bailly E, Hurault de Ligny B, Choukroun G, Colosio C, Thierry A, Vigneau C, Moulin B, Le Meur Y, Heng AE, Legendre C, Beaune P, Loriot MA, Thervet E. Long-Term Clinical Impact of Adaptation of Initial Tacrolimus Dosing to CYP3A5 Genotype. Am J Transplant 2016; 16:2670-5. [PMID: 26990694 DOI: 10.1111/ajt.13788] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/12/2016] [Accepted: 03/03/2016] [Indexed: 01/25/2023]
Abstract
Pretransplantation adaptation of the daily dose of tacrolimus to CYP3A5 genotype is associated with improved achievement of target trough concentration (C0 ), but whether this improvement affects clinical outcomes is unknown. In the present study, we have evaluated the long-term clinical impact of the adaptation of initial tacrolimus dosing according to CYP3A5 genotype: The transplantation outcomes of the 236 kidney transplant recipients included in the Tactique study were retrospectively investigated over a period of more than 5 years. In the Tactique study, patients were randomly assigned to receive tacrolimus at either a fixed dosage or a dosage determined by their genotype, and the primary efficacy end point was the proportion of patients for whom tacrolimus C0 was within target range (10-15 ng/mL) at day 10. Our results indicate that the incidence of biopsy-proven acute rejection and graft survival were similar between the control and the adapted tacrolimus dose groups, as well as between the patients who achieve the tacrolimus C0 target ranges earlier. Patients' death, cancer, cardiovascular events, and infections were also similar, and renal function did not change. We conclude that optimization of initial tacrolimus dose using pharmacogenetic testing does not improve clinical outcomes.
Collapse
Affiliation(s)
- N Pallet
- Clinical Chemistry Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.,Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France.,Sorbonne Paris Cité, INSERM UMRS 1147, Paris, France
| | - I Etienne
- Department of Nephrology-Clinical Immmunology, CHU Rouen, Rouen, France
| | - M Buchler
- Department of Nephrology, CHU Tours, Tours, France
| | - E Bailly
- Department of Nephrology, CHU Tours, Tours, France
| | | | - G Choukroun
- Department of Nephrology, CHU Amiens, Amiens, France
| | - C Colosio
- Department of Nephrology, CHU Reims, Reims, France
| | - A Thierry
- Department of Nephrology, CHU Poitiers, Poitiers, France
| | - C Vigneau
- Department of Nephrology, CHU Rennes, Rennes, France
| | - B Moulin
- Department of Nephrology, CHU Strasbourg, Strasbourg, France
| | - Y Le Meur
- Department of Nephrology, CHU Brest, Brest, France
| | - A-E Heng
- Department of Nephrology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - C Legendre
- Department of Nephrology, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - P Beaune
- Clinical Chemistry Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France.,Sorbonne Paris Cité, INSERM UMRS 1147, Paris, France
| | - M A Loriot
- Clinical Chemistry Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France.,Sorbonne Paris Cité, INSERM UMRS 1147, Paris, France
| | - E Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.,Paris Descartes University, Paris, France.,Sorbonne Paris Cité, INSERM UMRS 1147, Paris, France
| |
Collapse
|
21
|
Brunet J, Lemoine JP, Pesson B, Valot S, Sautour M, Dalle F, Muller C, Borni-Duval C, Caillard S, Moulin B, Pfaff AW, Razakandrainibe R, Abou-Bacar A, Favennec L, Candolfi E. Ruling out nosocomial transmission of Cryptosporidium in a renal transplantation unit: case report. BMC Infect Dis 2016; 16:363. [PMID: 27484187 PMCID: PMC4969980 DOI: 10.1186/s12879-016-1661-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 06/08/2016] [Indexed: 01/10/2023] Open
Abstract
Background Cryptosporidium spp. is a ubiquitous parasite affecting humans as well as domestic and wild vertebrates, causing diarrhea in both immunocompetent and immunocompromised hosts worldwide. Its transmission occurs primarily by the fecal-oral route. In humans, C. parvum and C. hominis are the most prevalent species, whereas immunocompetent and immunocompromised individuals can also be infected by other zoonotic species. Renal transplant patients are prone to develop cryptosporidiosis, which can induce severe and life-threatening diarrhea. Case presentation We report here a series of nearly concomitant cases of acute symptomatic cryptosporidiosis in three renal transplant patients attending the Strasbourg University Hospital Nephrology Unit. The clinical presentation was persistent diarrhea and acute renal failure. The diagnosis was confirmed by microscopic stool examination using a modified Ziehl-Neelsen staining method and species identification by molecular tools. All patients were treated with nitazoxanide and recovered from diarrhea after 14 days of therapy. Conclusion Genotypic species identification was not consistent with an epidemic context, thus underlining the need for genotyping to monitor at risk patients.
Collapse
Affiliation(s)
- J Brunet
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France. .,Institut de Parasitologie et Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, 3 rue Koeberlé, F-67000, Strasbourg, France.
| | - J P Lemoine
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - B Pesson
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - S Valot
- Laboratoire de Parasitologie et de Mycologie, Plateau Technique de Biologie du CHU Dijon, 2 rue Angélique Ducoudray, BP 37013, F-21070, Dijon cedex, France
| | - M Sautour
- Laboratoire de Parasitologie et de Mycologie, Plateau Technique de Biologie du CHU Dijon, 2 rue Angélique Ducoudray, BP 37013, F-21070, Dijon cedex, France.,UMR 1347, Université de Bourgogne, 17 rue de Sully, F-21000, Dijon, France
| | - F Dalle
- Laboratoire de Parasitologie et de Mycologie, Plateau Technique de Biologie du CHU Dijon, 2 rue Angélique Ducoudray, BP 37013, F-21070, Dijon cedex, France.,UMR 1347, Université de Bourgogne, 17 rue de Sully, F-21000, Dijon, France
| | - C Muller
- Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - C Borni-Duval
- Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - S Caillard
- Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - B Moulin
- Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - A W Pfaff
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.,Institut de Parasitologie et Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, 3 rue Koeberlé, F-67000, Strasbourg, France
| | - R Razakandrainibe
- Laboratoire de Parasitologie-Mycologie, EA 3800, Centre Hospitalier Universitaire, Université de Rouen, 1, rue de Germont, F-76031, Rouen, France
| | - A Abou-Bacar
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France
| | - L Favennec
- Laboratoire de Parasitologie-Mycologie, EA 3800, Centre Hospitalier Universitaire, Université de Rouen, 1, rue de Germont, F-76031, Rouen, France
| | - E Candolfi
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.,Institut de Parasitologie et Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, 3 rue Koeberlé, F-67000, Strasbourg, France
| |
Collapse
|
22
|
Sabou M, Paz M, Kahn P, Denis J, Gschwend A, Degot T, Khouri T, Moulin B, Kessler R, Herbrecht R, Candolfi E, Letscher-Bru V. Comment diagnostiquer des agents pathogènes de classe 3 dans un laboratoire P2. J Mycol Med 2016. [DOI: 10.1016/j.mycmed.2016.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
23
|
Crepin T, Gaiffe E, Courivaud C, Roubiou C, Laheurte C, Moulin B, Frimat L, Rieu P, Mousson C, Durrbach A, Heng AE, Saas P, Bamoulid J, Ducloux D. Pre-transplant end-stage renal disease-related immune risk profile in kidney transplant recipients predicts post-transplant infections. Transpl Infect Dis 2016; 18:415-22. [PMID: 27027787 DOI: 10.1111/tid.12534] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 11/26/2015] [Accepted: 01/31/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND End-stage renal disease (ESRD) is associated with premature aging of the T-cell system. Nevertheless, the clinical significance of pre-transplant ESRD-related immune senescence is unknown. METHODS We studied whether immune risk phenotype (IRP), a typical feature of immune senescence, may affect post-transplant infectious complications. A total of 486 patients were prospectively studied during the first year post transplant. IRP was defined as positive cytomegalovirus serology with at least 1 of the following criteria: CD4/CD8 ratio <1 and/or CD8 T-cell count >90th percentile. RESULTS We found that 47 patients (9.7%) had pre-transplant IRP. IRP+ patients did not differ from IRP- patients for any clinical characteristics, but exhibited more pronounced immune senescence. Both opportunistic infections (43% vs. 6%, P < 0.001) and severe bacterial infection (SBI) (40% vs. 25%, P = 0.028) were more frequent in IRP(+) patients. In multivariate analysis, IRP was predictive of both opportunistic infection (hazard ratio [HR] 2.97 [95% confidence interval {CI} 1.53-5.76], P = 0.001), and SBI (HR 2.33 [95% CI 1.34-3.92], P = 0.008). Acute rejection rates were numerically much lower in IRP+ patients. A total of 418 patients (86%) had biological evaluation 1 year post transplant. Among 41 IRP+ patients, 35 (85%) remained IRP+ 1 year post transplant. CONCLUSION Pre-transplant IRP is associated with an increased risk of post-transplant infection.
Collapse
Affiliation(s)
- T Crepin
- INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, Besançon, France.,Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - E Gaiffe
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France.,CIC Biothérapie, INSERM CIC1431, CHU Besançon, Besançon, France
| | - C Courivaud
- INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, Besançon, France.,Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - C Roubiou
- Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, Besançon, France.,Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - C Laheurte
- INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,Plateforme de Biomonitoring, EFS Bourgogne Franche-Comté, CIC 1431/UMR1098, Besançon, France
| | - B Moulin
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Strasbourg, Strasbourg, France
| | - L Frimat
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Nancy, Nancy, France
| | - P Rieu
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Reims, Reims, France
| | - C Mousson
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Dijon, Dijon, France
| | - A Durrbach
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - A-E Heng
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - P Saas
- INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, Besançon, France.,CIC Biothérapie, INSERM CIC1431, CHU Besançon, Besançon, France.,Plateforme de Biomonitoring, EFS Bourgogne Franche-Comté, CIC 1431/UMR1098, Besançon, France
| | - J Bamoulid
- INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, Besançon, France.,Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - D Ducloux
- INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, Besançon, France.,Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France.,CIC Biothérapie, INSERM CIC1431, CHU Besançon, Besançon, France
| |
Collapse
|
24
|
San-Juan R, Comoli P, Caillard S, Moulin B, Hirsch HH, Meylan P. Epstein-Barr virus-related post-transplant lymphoproliferative disorder in solid organ transplant recipients. Clin Microbiol Infect 2015; 20 Suppl 7:109-18. [PMID: 24475976 DOI: 10.1111/1469-0691.12534] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Epstein-Barr virus (EBV) contributes to the pathogenesis of post-transplant lymphoproliferative disease (PTLD) in more than 70% of cases. EBV DNAemia surveillance has been reported to assist in the prevention and treatment of PTLD in hematopoietic stem-cell transplantation (HSCT) recipients. Derived from experience in HSCT and taking into account that PCR-based EBV monitoring techniques are currently available in most solid organ transplant (SOT) centres, there is a great interest in EBV surveillance and prevention of PTLD in SOT recipients. In the present document we have tried to address from a practical perspective different important topics regarding the prevention and management of EBV-related PTLD in SOT. To this end, available information on SOT was analysed and combined with potentially useful data from HSCT and expert observations. The document is therefore structured according to different specific questions, each of them culminating in a consensus opinion of the panel of European experts, grading the answers according to internationally recognized levels of evidence. The addressed issues were grouped under the following topics. (i) Timing and epidemiological data of PTLD. Prophylaxis guided by clinical risk factors of early and late PTLD in SOT. (ii) Relationship of EBV DNAemia load monitoring and the development of PTLD in solid organ transplant recipients. (iii) Monitoring of EBV DNAemia after SOT. Which population should be monitored? What is the optimal timing of the monitoring? (iv) Management of SOT recipients with persistent and/or increasing EBV DNAemia.
Collapse
Affiliation(s)
- R San-Juan
- Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
25
|
Roucher A, Zaoui P, Tartry D, Choukroun G, Mathis C, Moulin B, Fauvel J. Surveillance de la kaliémie et de la créatininémie au cours des essais cliniques par le laboratoire centralisé ou local ? Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
26
|
Solis M, Meddeb M, Sueur C, Domingo-Calap P, Soulier E, Chabaud A, Perrin P, Moulin B, Bahram S, Caillard S, Stoll-Keller F, Fafi-Kremer S. Interlaboratory comparison of BK virus DNA load assays. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.07.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
27
|
Rostaing L, Hertig A, Albano L, Anglicheau D, Durrbach A, Vuiblet V, Moulin B, Merville P, Hazzan M, Lang P, Touchard G, Hurault deLigny B, Quéré S, Di Giambattista F, Dubois YC, Rondeau E. Fibrosis progression according to epithelial-mesenchymal transition profile: a randomized trial of everolimus versus CsA. Am J Transplant 2015; 15:1303-12. [PMID: 25808994 DOI: 10.1111/ajt.13132] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/12/2014] [Accepted: 11/30/2014] [Indexed: 01/25/2023]
Abstract
Markers of epithelial-mesenchymal transition (EMT) may identify patients at high risk of graft fibrogenesis who could benefit from early calcineurin inhibitor (CNI) withdrawal. In a randomized, open-label, 12-month trial, de novo kidney transplant patients received cyclosporine, enteric-coated mycophenolate sodium (EC-MPS) and steroids to month 3. Patients were stratified as EMT+ or EMT- based on month 3 biopsy, then randomized to start everolimus with half-dose EC-MPS (720 mg/day) and cyclosporine withdrawal (CNI-free) or continue cyclosporine with standard EC-MPS (CNI). The primary endpoint was progression of graft fibrosis (interstitial fibrosis/tubular atrophy [IF/TA] grade increase ≥1 between months 3-12) in EMT+ patients. 194 patients were randomized (96 CNI-free, 98 CNI); 153 (69 CNI-free, 84 CNI) were included in histological analyses. Fibrosis progression occurred in 46.2% (12/26) CNI-free EMT+ patients versus 51.6% (16/31) CNI EMT+ patients (p = 0.68). Biopsy-proven acute rejection (BPAR, including subclinical events) occurred in 25.0% and 5.1% of CNI-free and CNI patients, respectively (p < 0.001). In conclusion, early CNI withdrawal with everolimus initiation does not prevent interstitial fibrosis. Using this CNI-free protocol, in which everolimus exposure was relatively low and administered with half-dose EC-MPS, CNI-free patients were overwhelmingly under-immunosuppressed and experienced an increased risk of BPAR.
Collapse
Affiliation(s)
- L Rostaing
- Department of Nephrology, Dialysis and Transplantation, Hôpital de Rangueil, Toulouse, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Crepin T, Carron C, Roubiou C, Gaugler B, Gaiffe E, Simula-Faivre D, Ferrand C, Tiberghien P, Chalopin JM, Moulin B, Frimat L, Rieu P, Saas P, Ducloux D, Bamoulid J. ATG-induced accelerated immune senescence: clinical implications in renal transplant recipients. Am J Transplant 2015; 15:1028-38. [PMID: 25758660 DOI: 10.1111/ajt.13092] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/16/2014] [Accepted: 11/01/2014] [Indexed: 01/25/2023]
Abstract
Persistent ATG-induced CD4(+) T cell lymphopenia is associated with serious clinical complications. We tested the hypothesis that ATG induces accelerated immune senescence in renal transplant recipients (RTR). Immune senescence biomarkers were analyzed at transplant and one-year later in 97 incident RTR -62 patients receiving ATG and 35 receiving anti-CD25 mAb (α-CD25). This consisted in: (i) thymic output; (ii) bone marrow renewal of CD34(+) hematopoietic progenitor cells (CD34(+) HPC) and lymphoid (l-HPC) and myeloid (m-HPC) progenitor ratio; (iii) T cell phenotype; and (iv) measurement of T cell relative telomere length (RTL) and telomerase activity (RTA). Clinical correlates were analyzed with a 3 year follow-up. Thymic output significantly decreased one-year posttransplant in ATG-treated patients. ATG was associated with a significant decrease in l-HPC/m-HPC ratio. Late stage differentiated CD57(+) /CD28(-) T cells increased in ATG-treated patients. One-year posttransplant T cell RTL and RTA were consequently lower in ATG-treated patients. ATG is associated with accelerated immune senescence. Increased frequency of late differentiated CD4(+) T cell frequency at transplantation tended to be predictive of a higher risk of subsequent opportunistic infections and of acute rejection only in ATG-treated patients but this needs confirmation. Considering pretransplant immune profile may help to select those patients who may benefit from ATG to prevent severe infections and acute rejection.
Collapse
Affiliation(s)
- T Crepin
- INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France; Université de Franche-Comté, Faculté de Médecine et de Pharmacie, Besançon, France; Structure Fédérative de Recherche, SFR FED4234, Besançon, France; CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Pallet N, Jannot AS, El Bahri M, Etienne I, Buchler M, de Ligny BH, Choukroun G, Colosio C, Thierry A, Vigneau C, Moulin B, Le Meur Y, Heng AE, Subra JF, Legendre C, Beaune P, Alberti C, Loriot MA, Thervet E. Kidney transplant recipients carrying the CYP3A4*22 allelic variant have reduced tacrolimus clearance and often reach supratherapeutic tacrolimus concentrations. Am J Transplant 2015; 15:800-5. [PMID: 25588704 DOI: 10.1111/ajt.13059] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 01/25/2023]
Abstract
CYP3A4*22 is an allelic variant of the cytochrome P450 3A4 associated with a decreased activity. Carriers of this polymorphism may require reduced tacrolimus (Tac) doses to reach the target residual concentrations (Co). We tested this hypothesis in a population of kidney transplant recipients extracted from a multicenter, prospective and randomized study. Among the 186 kidney transplant recipients included, 9.3% (18 patients) were heterozygous for the CYP3A4*22 genotype and none were homozygous (allele frequency of 4.8%). Ten days after transplantation (3 days after starting treatment with Tac), 11% of the CYP3A4*22 carriers were within the target range of Tac Co (10-15 ng/mL), whereas among the CYP3A4*1/*1 carriers, 40% were within the target range (p = 0.02, OR = 0.19 [0.03; 0.69]). The mean Tac Co at day 10 in the CYP3A4*1/*22 group was 23.5 ng/mL (16.6-30.9) compared with 15.1 ng/mL (14-16.3) in the CYP3A4*1/*1 group, p < 0.001. The Tac Co/dose significantly depended on the CYP3A4 genotype during the follow-up (random effects model, p < 0.001) with the corresponding equivalent dose for patients heterozygous for CYP3A4*22 being 0.67 [0.54; 0.84] times the dose for CYP3A4*1/*1 carriers. In conclusion, the CYP3A4*22 allelic variant is associated with a significantly altered Tac metabolism and carriers of this polymorphism often reach supratherapeutic concentrations.
Collapse
Affiliation(s)
- N Pallet
- Clinical Chemistry, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France; Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France; Paris Descartes University, Paris, France; Sorbonne Paris Cité, INSERM UMRS, 1147, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Blanc C, Chauvet S, Le Quintrec M, Togarsimalemath S, Roumenina L, Lapeyraque A, Moal V, Moulin B, Fremeaux-Bacchi V, Büchler M, Dragon-Durey M. Auto-anticorps anti-facteur H dans les glomérulopathies à C3. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
31
|
Muller C, Caillard S, Olagne J, Perrin P, Braun Parvez L, Heibel F, Morel O, Moulin B. Réponse inadaptée au clopidogrel chez le patient transplanté rénal. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
32
|
Nussbaumer T, Olagne J, Marcellin L, Dimitrov Y, Imhoff O, Klein A, Bazin D, Muller C, Caillard S, Moulin B. Cohorte rétrospective multicentrique de glomérulonéphrites membrano-prolifératives et glomérulonéphrites à dépôts de C3 : intérêt de la relecture anatomopathologique dans le contexte de la nouvelle classification. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
33
|
Perrin P, Kiener C, Caillard S, Javier R, Braun L, Gautier-Vargas G, Heibel F, Olagne J, Muller C, Moulin B. Impact de l’évolution de la prise en charge des troubles minéraux et osseux la première année de transplantation rénale. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
34
|
Poitou-Verkinder A, François A, Drieux F, Leprêtre S, Moulin B, Legallicier B, Godin M, Guerrot D. Étude clinico-pathologique des néphropathies associées aux leucémies lymphoïdes chroniques/lymphomes lymphocytaires B à petites cellules. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
35
|
Chauvet C, Chauveau P, Hourmant M, Hurault de Ligny B, Kolko A, Lefrançois G, Merville P, Moulin B, Mourad G, Rostaing L, Zins B, Kessler M, Peraldi MN. [20% of living donor kidney transplantation in France? Yes, it's possible!]. Nephrol Ther 2013; 9:459-60. [PMID: 24176652 DOI: 10.1016/j.nephro.2013.08.001] [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: 07/06/2013] [Accepted: 07/06/2013] [Indexed: 11/15/2022]
Affiliation(s)
- C Chauvet
- Service de néphrologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Perrin P, Caillard S, Javier RM, Braun L, Heibel F, Borni-Duval C, Muller C, Olagne J, Moulin B. Persistent hyperparathyroidism is a major risk factor for fractures in the five years after kidney transplantation. Am J Transplant 2013; 13:2653-63. [PMID: 24034142 DOI: 10.1111/ajt.12425] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 01/25/2023]
Abstract
The risk of fractures after kidney transplantation is high. Hyperparathyroidism frequently persists after successful kidney transplantation and contributes to bone loss, but its impact on fracture has not been demonstrated. This longitudinal study was designed to evaluate hyperparathyroidism and its associations with mineral disorders and fractures in the 5 posttransplant years. We retrospectively analyzed 143 consecutive patients who underwent kidney transplantation between August 2004 and April 2006. The biochemical parameters were determined at transplantation and at 3, 12 and 60 months posttransplantation, and fractures were recorded. The median intact parathyroid hormone (PTH) level was 334 ng/L (interquartile 151-642) at the time of transplantation and 123 ng/L (interquartile 75-224) at 3 months. Thirty fractures occurred in 22 patients. The receiver operating characteristic (ROC) curve analysis for PTH at 3 months (area under the ROC curve = 0.711, p = 0.002) showed that a good threshold for predicting fractures was 130 ng/L (sensitivity = 81%, specificity = 57%). In a multivariable analysis, independent risk factors for fracture were PTH >130 ng/L at 3 months (adjusted hazard ratio [AHR] = 7.5, 95% CI 2.18-25.50), and pretransplant osteopenia (AHR = 2.7, 95% CI 1.07-7.26). In summary, this study demonstrates for the first time that persistent hyperparathyroidism is an independent risk factor for fractures after kidney transplantation.
Collapse
Affiliation(s)
- P Perrin
- Nephrology-Transplantation Department, University Hospital, Strasbourg, France
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Gautier-Vargas G, Caillard S, Parissiadis A, Olagne J, Muller C, Perrin P, Braun L, Heibel F, Hanau D, Moulin B. Caractéristiques des anticorps anti-HLA fixant le C1q et conséquences sur le greffon rénal. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
38
|
Prinz E, Rosner V, Kessler R, Moulin B. Évaluation du risque lithiasique associé à la mucoviscidose. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
39
|
Legendre CM, Licht C, Muus P, Greenbaum LA, Babu S, Bedrosian C, Bingham C, Cohen DJ, Delmas Y, Douglas K, Eitner F, Feldkamp T, Fouque D, Furman RR, Gaber O, Herthelius M, Hourmant M, Karpman D, Lebranchu Y, Mariat C, Menne J, Moulin B, Nürnberger J, Ogawa M, Remuzzi G, Richard T, Sberro-Soussan R, Severino B, Sheerin NS, Trivelli A, Zimmerhackl LB, Goodship T, Loirat C. Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med 2013; 368:2169-81. [PMID: 23738544 DOI: 10.1056/nejmoa1208981] [Citation(s) in RCA: 1024] [Impact Index Per Article: 93.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atypical hemolytic-uremic syndrome is a genetic, life-threatening, chronic disease of complement-mediated thrombotic microangiopathy. Plasma exchange or infusion may transiently maintain normal levels of hematologic measures but does not treat the underlying systemic disease. METHODS We conducted two prospective phase 2 trials in which patients with atypical hemolytic-uremic syndrome who were 12 years of age or older received eculizumab for 26 weeks and during long-term extension phases. Patients with low platelet counts and renal damage (in trial 1) and those with renal damage but no decrease in the platelet count of more than 25% for at least 8 weeks during plasma exchange or infusion (in trial 2) were recruited. The primary end points included a change in the platelet count (in trial 1) and thrombotic microangiopathy event-free status (no decrease in the platelet count of >25%, no plasma exchange or infusion, and no initiation of dialysis) (in trial 2). RESULTS A total of 37 patients (17 in trial 1 and 20 in trial 2) received eculizumab for a median of 64 and 62 weeks, respectively. Eculizumab resulted in increases in the platelet count; in trial 1, the mean increase in the count from baseline to week 26 was 73×10(9) per liter (P<0.001). In trial 2, 80% of the patients had thrombotic microangiopathy event-free status. Eculizumab was associated with significant improvement in all secondary end points, with continuous, time-dependent increases in the estimated glomerular filtration rate (GFR). In trial 1, dialysis was discontinued in 4 of 5 patients. Earlier intervention with eculizumab was associated with significantly greater improvement in the estimated GFR. Eculizumab was also associated with improvement in health-related quality of life. No cumulative toxicity of therapy or serious infection-related adverse events, including meningococcal infections, were observed through the extension period. CONCLUSIONS Eculizumab inhibited complement-mediated thrombotic microangiopathy and was associated with significant time-dependent improvement in renal function in patients with atypical hemolytic-uremic syndrome. (Funded by Alexion Pharmaceuticals; C08-002 ClinicalTrials.gov numbers, NCT00844545 [adults] and NCT00844844 [adolescents]; C08-003 ClinicalTrials.gov numbers, NCT00838513 [adults] and NCT00844428 [adolescents]).
Collapse
Affiliation(s)
- C M Legendre
- Université Paris Descartes and Assistance Publique–Hôpitaux de Paris, Hôpital Necker, INSERM Unité 845, Paris, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Legendre C, Cohen D, Delmas Y, Feldkamp T, Fouque D, Furman R, Gaber O, Greenbaum L, Goodship T, Haller H, Herthelius M, Hourmant M, Licht C, Moulin B, Sheerin N, Trivelli A, Bedrosian CL, Loirat C, Legendre C, Babu S, Cohen D, Delmas Y, Furman R, Gaber O, Greenbaum L, Hourmant M, Jungraithmayr T, Lebranchu Y, Riedl M, Sheerin N, Bedrosian CL, Loirat C, Sheerin N, Legendre C, Greenbaum L, Furman R, Cohen D, Gaber AO, Bedrosian C, Loirat C, Haller H, Licht C, Muus P, Legendre C, Douglas K, Hourmant M, Herthelius M, Trivelli A, Goodship T, Remuzzi G, Bedrosian C, Loirat C, Kourouklaris A, Ioannou K, Athanasiou I, Demetriou K, Panagidou A, Zavros M, Rodriguez C NY, Blasco M, Arcal C, Quintana LF, Rodriguez de Cordoba S, Campistol JM, Bachmann N, Eisenberger T, Decker C, Bolz HJ, Bergmann C, Pesce F, Cox SN, Serino G, De Palma G, Sallustio FP, Schena F, Falchi M, Pieri M, Stefanou C, Zaravinos A, Erguler K, Lapathitis G, Dweep H, Sticht C, Anastasiadou N, Zouvani I, Voskarides K, Gretz N, Deltas CC, Ruiz A, Bonny O, Sallustio F, Serino G, Curci C, Cox S, De Palma G, Schena F, Kemter E, Sklenak S, Aigner B, Wanke R, Kitzler TM, Moskowitz JL, Piret SE, Lhotta K, Tashman A, Velez E, Thakker RV, Kotanko P, Leierer J, Rudnicki M, Perco P, Koppelstaetter C, Mayer G, Sa MJN, Alves S, Storey H, Flinter F, Willems PJ, Carvalho F, Oliveira J, Arsali M, Papazachariou L, Demosthenous P, Lazarou A, Hadjigavriel M, Stavrou C, Yioukkas L, Voskarides K, Deltas C, Zavros M, Pierides A, Arsali M, Demosthenous P, Papazachariou L, Voskarides K, Kkolou M, Hadjigavriel M, Zavros M, Deltas C, Pierides A, Toka HR, Dibartolo S, Lanske B, Brown EM, Pollak MR, Familiari A, Zavan B, Sanna Cherchi S, Fabris A, Cristofaro R, Gambaro G, D'Angelo A, Anglani F, Toka H, Mount D, Pollak M, Curhan G, Sengoge G, Bajari T, Kupczok A, von Haeseler A, Schuster M, Pfaller W, Jennings P, Weltermann A, Blake S, Sunder-Plassmann G, Kerti A, Csohany R, Wagner L, Javorszky E, Maka E, Tulassay T, Tory K, Kingswood J, Nikolskaya N, Mbundi J, Kingswood J, Jozwiak S, Belousova E, Frost M, Kuperman R, Bebin M, Korf B, Flamini R, Kohrman M, Sparagana S, Wu J, Brechenmacher T, Stein K, Bissler J, Franz D, Kingswood J, Zonnenberg B, Frost M, Cheung W, Wang J, Brechenmacher T, Lam D, Bissler J, Budde K, Ivanitskiy L, Sowershaewa E, Krasnova T, Samokhodskaya L, Safarikova M, Jana R, Jitka S, Obeidova L, Kohoutova M, Tesar V, Evrengul H, Ertan P, Serdaroglu E, Yuksel S, Mir S, Yang n Ergon E, Berdeli A, Zawada A, Rogacev K, Rotter B, Winter P, Fliser D, Heine G, Bataille S, Moal V, Berland Y, Daniel L, Rosado C, Bueno E, Fraile P, Lucas C, Garcoa-Cosmes P, Tabernero JM, Gonzalez R, Rosado C, Bueno E, Fraile P, Lucas C, Garcia-Cosmes P, Tabernero JM, Gonzalez R, Silska-Dittmar M, Zaorska K, Malke A, Musielak A, Ostalska-Nowicka D, Zachwieja J, K d r V, Uz E, Yigit A, Altuntas A, Yigit B, Inal S, Uz E, Sezer M, Yilmaz R, Visciano B, Porto C, Acampora E, Russo R, Riccio E, Capuano I, Parenti G, Pisani A, Feriozzi S, Perrin A, West M, Nicholls K, Sunder-Plassmann G, Torras J, Cybulla M, Conti M, Angioi A, Floris M, Melis P, Asunis AM, Piras D, Pani A, Warnock D, Guasch A, Thomas C, Wanner C, Campbell R, Vujkovac B, Okur I, Biberoglu G, Ezgu F, Tumer L, Hasanoglu A, Bicik Z, Akin Y, Mumcuoglu M, Ecder T, Paliouras C, Mattas G, Papagiannis N, Ntetskas G, Lamprianou F, Karvouniaris N, Alivanis P. Genetic diseases and molecular genetics. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
41
|
Le Quintrec M, Zuber J, Moulin B, Kamar N, Jablonski M, Lionet A, Chatelet V, Mousson C, Mourad G, Bridoux F, Cassuto E, Loirat C, Rondeau E, Delahousse M, Frémeaux-Bacchi V. Complement genes strongly predict recurrence and graft outcome in adult renal transplant recipients with atypical hemolytic and uremic syndrome. Am J Transplant 2013; 13:663-75. [PMID: 23356914 DOI: 10.1111/ajt.12077] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/25/2012] [Accepted: 11/27/2012] [Indexed: 01/25/2023]
Abstract
Atypical hemolytic and uremic syndrome (aHUS) is a severe disease strongly associated with genetic abnormalities in the complement alternative pathway. In renal posttransplantation, few data are available on recurrence risk and graft outcome according to genetic background in aHUS patients. The aim of this study was to identify risk factors for recurrence and transplant outcome and, in particular, the role of complement gene abnormalities. We retrospectively studied 57 aHUS patients who had received 71 renal transplants. A mutation in complement gene was identified in 39 (68%), in factor H (CFH), factor I (CFI), membrane cofactor-protein (MCP), C3 and factor B (CFB). At 5 years, death-censored graft survival was 51%. Disease recurrence was associated with graft loss (p = 0.001). Mutations in complement genes were associated with higher risk of recurrence (p = 0.009). Patients with CFH or gain of function (C3, CFB) mutations had a highest risk of recurrence. M-TOR inhibitor was associated with significant risk of recurrence (p = 0.043) but not calcineurin inhibitor immunosuppressive treatment (p = 0.29). Preemptive plasmatherapy was associated with a trend to decrease recurrence (p = 0.07). Our study highlights that characterization of complement genetic abnormalities predicts the risk of recurrence-related graft loss and paves the way for future genetically based individualized prophylactic therapeutic strategies.
Collapse
Affiliation(s)
- M Le Quintrec
- Néphrologie et Transplantation Rénale, Hôpital Foch, Suresnes, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Hochane M, Raison D, Coquard C, Massfelder T, Moulin B, Barthelmebs M. La protéine apparentée à l’hormone parathyroïdienne (PTHrP) est un facteur de survie des cellules mésangiales exposées à des cytokines pro-inflammatoires. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Trivin C, Karras A, Moulin B, Thervet É. Évaluation du risque infectieux après traitement par rituximab en néphrologie. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
44
|
Leon E, Beaume J, Muller C, Daugas E, Moulin B. Évaluation des facteurs prédictifs de récidives des néphropathies lupiques prolifératives. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
45
|
Seitz-Polski B, Payre C, Cassuto E, Bernard G, Albano L, Burtey S, Bataille S, Mariat C, Krummel T, Moulin B, Lambeau G, Esnault V. ELISA spécifique pour le suivi des anticorps anti-PLA2R1 avant et après transplantation rénale. Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
46
|
Wetzstein M, Trivin C, Dussol B, de Precigout V, Le Mao G, Zadgoun E, Kernaonet E, Alamartine E, Chauveau D, Moulin B, Choukroun G. Traitement enzymatique de substitution par agalsidase bêta chez 60 patients français atteints de la maladie de Fabry : quel impact sur l’évolution de la fonction rénale ? Nephrol Ther 2012. [DOI: 10.1016/j.nephro.2012.07.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
47
|
Lebranchu Y, Snanoudj R, Toupance O, Weestel PF, Hurault de Ligny B, Buchler M, Rerolle JP, Thierry A, Moulin B, Subra JF, Deteix P, Le Pogamp P, Finzi L, Etienne I. Five-year results of a randomized trial comparing de novo sirolimus and cyclosporine in renal transplantation: the SPIESSER study. Am J Transplant 2012; 12:1801-10. [PMID: 22486815 DOI: 10.1111/j.1600-6143.2012.04036.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Calcineurin inhibitors improve acute rejection rates and short-term graft survival in renal transplantation, but their continuous use may be deleterious. We evaluated the 5-year outcomes of sirolimus (SRL) versus cyclosporine (CsA) immunosuppressive treatment. This observational study was an extension of the SPIESSER study where deceased donor kidney transplant recipients were randomized before transplantation to a SRL- or CsA-based regimen and followed up 1 year. Data from 131 (63 SRL, 68 CsA) out of 133 patients living with a functional graft at 1 year were collected retrospectively at 5 years posttransplant. Seventy percent of CsA patients versus 54% of SRL patients were still on the allocated treatment at 5 years (p = 0.091), most discontinuations in each group being due to safety issues. In intent-to-treat, mean MDRD eGFR was higher with SRL: 54.2 versus 45.3 mL/min with CsA (p = 0.019); SRL advantage was greater in on-treatment analyses. There were no differences for patient survival (p = 0.873), graft survival (p = 0.121) and acute rejection (p = 0.284). Adverse events were more frequent with SRL (80% vs. 60%, p = 0.015). Results confirmed the high SRL discontinuation rate due to adverse events. Nevertheless, a benefit was evidenced on renal function in patients (more than 50%) still on treatment at 5 years.
Collapse
Affiliation(s)
- Y Lebranchu
- Department of Nephrology and Clinical Immunology, Bretonneau Hospital, University Hospital, Tours, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Caillard S, Lamy FX, Quelen C, Dantal J, Lebranchu Y, Lang P, Velten M, Moulin B. Epidemiology of posttransplant lymphoproliferative disorders in adult kidney and kidney pancreas recipients: report of the French registry and analysis of subgroups of lymphomas. Am J Transplant 2012; 12:682-93. [PMID: 22226336 DOI: 10.1111/j.1600-6143.2011.03896.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A registry of posttransplant lymphoproliferative disorders (PTLD) was set up for the entire population of adult kidney transplant recipients in France. Cases of PTLD were prospectively enrolled between January 1, 1998, and December 31, 2007. Ten-year cumulative incidence was analyzed in patients transplanted after January 1, 1989. PTLD risk factors were analyzed in patients transplanted after January 1, 1998 by Cox analysis. Cumulative incidence was 1% after 5 years, 2.1% after 10 years. Multivariate analysis showed that PTLD was significantly associated with: older age of the recipient 47-60 years and >60 years (vs. 33-46 years, adjusted hazard ratio (AHR) = 1.87, CI = 1.22-2.86 and AHR = 2.80, CI = 1.73-4.55, respectively, p < 0.0001), simultaneous kidney-pancreas transplantation (AHR = 2.52, CI = 1.27-5.01 p = 0.008), year of transplant 1998-1999 and 2000-2001 (vs. 2006-2007, AHR = 3.36, CI = 1.64-6.87 and AHR = 3.08, CI = 1.55-6.15, respectively, p = 0.003), EBV mismatch (HR = 5.31, CI = 3.36-8.39, p < 0.001), 5 or 6 HLA mismatches (vs. 0-4, AHR = 1.54, CI = 1.12-2.12, p = 0.008), and induction therapy (AHR = 1.42, CI = 1-2.02, p = 0.05). Analyses of subgroups of PTLD provided new information about PTLD risk factors for early, late, EBV positive and negative, polymorphic, monomorphic, graft and cerebral lymphomas. This nationwide study highlights the increased risk of PTLD as long as 10 years after transplantation and the role of cofactors in modifying PTLD risk, particularly in specific PTLD subgroups.
Collapse
Affiliation(s)
- S Caillard
- Department of Nephrology Transplantation, Strasbourg Universitary Hospital, Strasbourg, France
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Mavrogenis G, Coumaros D, Bazin D, Renard C, Moulin B, Bellocq JP. Giant colonic ulcer and pseudopolyps in an immunodepressed patient. Endoscopy 2011; 43:926-7; author reply 927. [PMID: 21984325 DOI: 10.1055/s-0030-1256708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
50
|
Muller C, Caillard S, Hannedouche T, Gachet C, Moulin B, Morel O. Altération majeure de la réponse au clopidogrel chez le patient insuffisant rénal dialysé. Nephrol Ther 2011. [DOI: 10.1016/j.nephro.2011.07.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|