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Nous rapportons l'observation d'un patient transplanté rénal ayant présenté un sarcome de Kaposi huit mois après la greffe, avec une double localisation cutanée et palatine. La réduction du traitement immunosuppresseur et l'introduction de la Rapamune® ont permis une bonne évolution clinique initiale, avec régression des lésions cutanées. Il a présenté par la suite une rechute cutanée avec une localisation viscérale. Le traitement a comporté une chimiothérapie à base de perfusions hebdomadaires de paclitaxel, permettant une rémission partielle et le maintien de la fonction du greffon rénal avec une bonne tolérance clinique. We report the observation of a patient who presented with post-transplant Kaposi's sarcoma after a delay of eight months with a dual cutaneous and palatal localisation. The reduction in immunosuppressive treatment and the introduction of Rapamune® allowed good clinical progress initially with regression of the skin lesions. He subsequently presented later a skin relapse with visceral localisation. Chemotherapy was conducted based on weekly paclitaxel infusions allowing partial remission and maintenance of renal graft function with good clinical tolerance. [ABSTRACT FROM AUTHOR]

Th17 cell subset has been implicated in autoimmune diseases, tumor immunity and, transplant rejection. In order to investigate the role of IL‐17/IL‐23 pathway in allograft outcome, intragraft expression of IL‐17 mRNA and single nucleotide polymorphisms (SNPs) of IL‐17A, IL‐17F, IL‐17RC, and IL23R genes were evaluated with a quantification of IL‐17A, IL‐17F, and IL‐23 plasma levels. This study revealed that recipients with acute rejection (AR) had a significant increase in IL‐17A mRNA expression levels after transplantation compared to controls (P = 0.037). Moreover, IL‐17A plasma levels were significantly higher in AR group; pretransplantation (Day–1 [D–1]): P = 0.00022 and posttransplantation (Day 7 [D7]): P < 10–14. IL‐17F and IL‐23 plasma levels were significantly higher in AR at D7 only (47.86 vs. 22.99 pg/ml; and 33.82 vs. 18.811 pg/ml; P = 0.015 and P < 10–17, respectively). Using receiver‐operating characteristic curves, D7 IL‐17A and IL‐23 plasma levels exhibited excellent sensitivities and specificities for predicting AR. Genetic study revealed no association between IL‐17A, IL‐17F, IL‐17RC, and IL23R studied SNPs and AR. Nevertheless, a significant improvement of graft survival was found in kidney transplant recipients carrying IL‐17F‐rs763780*A/A, IL‐17RC*G/G, and *G/A genotypes. Besides, IL‐17A mRNA levels were significantly higher in patients carrying the IL‐23R*G/G genotype comparatively to those with *G/A genotype. Based on these findings, significant increase of IL‐17A mRNA and protein levels in AR recipients that are genetically controlled highlights the role of this cytokine that can be a useful clinical biomarker to predict early acute renal allograft rejection. Study showing significant associations between Day 7 plasma IL‐17A, IL‐17F and IL‐23 and AR with good performances for IL‐17A and IL‐23 in predicting acute rejection (AR) occurrence; significant increase of IL‐17A expression in kidney graft in case of AR; a significant improvement of graft survival in recipients carrying IL‐17F‐rs763780*A/A, IL‐17RC*G/G and *G/A genotypes. [ABSTRACT FROM AUTHOR]

Drug interactions are unavoidable and need to be proactively identified and managed, in particular, the inductive effect of rifampin on tacrolimus whose potency and duration data are limited. We report the case of a renal transplant patient who was prescribed tacrolimus with preserved tough blood levels (C0) of 7.9 +/- 2 ng/mL. He presented ganglionic tuberculosis and started rifampin. One day later, C0 was 2.6 ng/mL with 5 mg/day. The serum creatinin was normal. Nine days later, C0 was 1.6 ng/mL with 7 mg/day. In this case-report, the tacrolimus-rifampin interaction occurred just one day after rifampin introduction necessitating early C0 monitoring.

Introduction: The prevalence of the terminal chronic renal failure treated by hemodialysis is rising steadily especially for the elderly. Its evolution is fraught with complications including protein-energy malnutrition. The aim of this study was to evaluate the predominance of protein-energy malnutrition among elderly hemodialysis patients., Methods: This cross-sectional descriptive study included 40 elderly hemodialysis patients recruited at the M8 nephrology department of Charles Nicolle Hospital in Tunis. All patients went through a clinical examination, a biological assessment, a dietary survey based on food registration for 3 consecutive days and the calculation of nutritional risk scores (MNA and GNRI)., Results: The Average  of hemodialysis was of 7 ± 3.8 years. The average energy intake of the patients was 25.3 ± 12.3 kcal / kg of ideal weight per day. The weight evolution during the last 6 months preceding the study was marked by a weight loss exceeding the 10 % in 12 % of the cases. A BMI less than 21 kg / m² was noted in 73.7 % of the women and 47.6 % of the men. The brachial circumference was less than 22 cm in 36.8 % of the women and 23.6 % of the men. One-third (32.5 %) of the study population had a calf circumference that is less than 31 cm. Most patients (67.5 %) had hypoalbuminaemia. The predominance of malnutrition according to the 2007 HAS criteria was 71% among hemodialysis patients. The majority of women (78.9 %) and 57.1 % of men had GNRI less than or equal to 98., Conclusion: Protein-energy malnutrition is a common and serious pathological situation in elderly hemodialysis patients which can be life-threatening.