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Dans la triglossie luxembourgeoise – allemand, français, luxembourgeois - le français tient une place particulière puisque tant son statut que son expansion ont varié au cours de l’histoire récente du pays. Langue littéraire de l’élite à l’époque de l’indépendance en 1831 dans un pays germanophone le français connait un pic de diffusion sociale durant la deuxième moitié du XXe siècle, suite à un fort besoin de main-d’oeuvre issue de la Belgique et de la France voisines ainsi que de l’immigration principalement portugaise. Cette « démocratisation » du français s’accompagne alors d’une dévalorisation pour les Luxembourgeois remettant en cause son statut de langue officielle du Grand-Duché.

Aim of the study: The previous results achieved in single hand transplantations confirmed the feasibility of this procedure and encouraged us to perform the first human double hand transplantation, which was performed in January 2000. In the present study we reported the results obtained eighteen months after transplantation.Patient and methods: The recipient was a 33-year old man suffering from a traumatic amputation of both hands in 1996. Surgery included procurement of the upper extremities from a 18-year old multiorgan cadaveric donor, preparation of the graft and recipient’s stumps, transplantation of the hands, which included bone fixation, arterial and venous anastomoses, nerve suture, joining of tendons and muscles, and skin closure. Immunosuppressive protocol included tacrolimus, prednisone and mycophenolate mofetil. An intensive rehabilitation program was performed. Follow-up included immunological tests, skin biopsies, arteriography, bone scintigraphy, electromyography and brain functional magnetic resonance imaging.Results: No surgical complications, infectious complications and graft-versus-host-disease occurred. Two episodes of acute skin rejection were demonstrated and they were completely reversed increasing steroid dose . Nerve regeneration and cortical reorganization were shown. Sensorimotor recovery was encouraging and life quality improved.Conclusion: This double hand transplantation showed that conventional immunosuppressive protocol is effective and safe as well as that functional results are at least as good as those achieved in replanted upper extremities. [Copyright &y& Elsevier]

The management of anemia after kidney transplantation remains poorly explored. The Management of Anemia in French Kidney Transplant Patients (MATRIX) study is an observational study conducted in 10 academic hospitals among kidney-transplant patients designed to evaluate the prevalence, associated factors and management of post-transplant anemia. Over two consecutive weeks, 418 recipients (males: 248; age: 50.8+/-12.7 years) were included, all were transplanted for more than six months. Mean serum creatinine (Scr) was 152+/-67 micromol/l and mean hemoglobin (Hb) was 12.4+/-1.8 g/dl (males: 12.8+/-1.9 g/dl; females 11.9+/-1.6 g/dl). Irrespective of the delay following transplantation, 23% of patients (n=95) were severely anemic (Hb < or = 11 g/dl). Eighteen percent of the patients received an antianemic treatment (10% oral iron, 7% erythropoiesis stimulating agents (ESA), 4% folic acid) and only 35% of the severely anemic patients were actually treated (n=33). A significantly-negative correlation was observed between eGFR and Hb levels (R= -0.347, p<0.02). Ninety-six percent of the 193 patients transplanted for more than six months and a Scr greater than 150 micromol/l (n=185) suffered at least one comorbidity (89% hypertension, 32% hypercholesterolemia, 13% diabetes); this group represent the second cohort. Seventy-four percent of them were treated with mycophenolate mofetil, 16% with azathioprine, and 62% with an ACEI or angiotensin II receptor antagonists. Since the transplantation, 127 patients (66%) have been anemic (Hb < or = 11 g/dl) and 58% (n=112) were treated (iron and/or ESA, respectively 81 and 55%). Among the patients not treated for anemia, 74% had an Hb level below 12g/dl. ESA-treated patients received a mean dose of 8500 UI+/-2800 per week. Anemia is under-diagnosed and under-treated in renal-transplant recipients, despite its high prevalence. As expected, a correlation between renal function and Hb levels was observed, as in CKD patients. Prospective studies are underway to assess the consequences of postkidney transplant anemia on quality of life, cardiovascular morbidity and chronic allograft nephropathy and to define the benefit of the treatment.

Introduction: In the current context of a high incidence end-stage kidney disease and a shortage of organs for kidney transplantation, the increasing use of transplants considered to be "borderline" represents a potential source of transplants. Over the last 10 years, some centers have developed a transplantation strategy, which consists of transplanting two borderline kidneys that cannot be proposed separately in a single recipient. The authors report their experience of dual kidney transplant., Materials and Methods: Since 2001, 15 dual kidney transplants have been performed in a single centre according to a local protocol based on the correspondence between the weight of the donor kidney and the recipient's weight, weighted by the number of fibrotic glomeruli observed on the initial biopsy. In this study, the authors analyze the postoperative complications and functional results observed in patients transplanted according to this protocol., Results: Dual kidney transplants represented less than 5% of all transplants performed during the study period concerned, which remained lower than the objectives initially announced by the ABM. The surgical technique was left to the surgeon's discretion. The mean follow-up was 26.3 months. Fourteen of the 15 recipients were alive with a functional graft. Surgical complications were globally more frequent when kidneys were transplanted on the same side (versus transplanted on both sides). Mean serum creatinine was 119.4 mol/l at six months (creatinine clearance according to MDRD formula: 57.3 ml/min per 1.73 m2), 118.8 mol/l at 12 months (creatinine clearance: 55.8) and 132.4 mol/l at 24 months (creatinine clearance: 44.2). One year post-transplant, mean renal function measured by inulin clearance was 55.5 ml/min per 1.73 m2. Four of the 15 patients had experienced an episode of acute rejection and three patients experienced delayed return of transplant function., Conclusion: In view of the results obtained, the authors consider that dual kidney transplant could be a reasonable and effective option for selected patients. Positioning of the transplants in each iliac fossa limited the surgical complication rate.

Background: The discovery of the Human Herpes virus 8 (HHV8) improved our knowledge of the pathogenesis of Kaposi's sarcoma. After organ transplantation, Kaposi's sarcoma exhibits distinctive features compared with other forms of the disease., Patients and Methods: We report 22 cases of post-transplant Kaposi's sarcoma (12 kidneys, 2 kidney-pancreas, 6 livers and 2 hearts). The aim of this retrospective study was to analyze clinical and virological characteristics in these transplant patients and to specify the frequency of HHV8 seroconversions in this population., Results: Twenty-one patients showed cutaneous lesions and 9 had visceral involvement. HHV8 serology was positive in 16/20 patients at transplantation and in 21/22 cases at the time of Kaposi's sarcoma diagnosis. Most cases corresponded to viral reactivations whereas seroconversions occurred in 2 cases and may have been linked to viral transmission by the graft. Treatment led to recovery in 68p. 100 of the cases. Two heart-transplant patients died from their disease. We included in our series two cases of re-transplanted patients without recurrence of Kaposi's sarcoma and one case of familial Kaposi's sarcoma., Discussion: Seroconversions after transplantation emphasize the interest of systematic screening of HHV8 serology in transplant recipients and their donors.

Lymphocele is a possible postoperative complication of renal transplantation and its treatment is still controversial. Over a 3-year period (January 1992 to December 1993), 7 patients with a complicated lymphocele were treated by various modalities. Puncture-drainage was used in 7 cases, Povidone sclerotherapy was performed in 4 cases and internal drainage was performed by surgical marsupialization in one case and by laparoscopy in 4 cases. The results of external drainage and sclerotherapy were disappointing, with 1 good result out of 7 and 1 moderate result out of 4, respectively. On the other hand, internal drainage was effective in every case, whether it was performed by surgical or laparoscopic marsupialization. The latter technique avoids the disadvantages of open surgery in high-risk patients. Laparoscopy appears to be the treatment of choice for post-renal transplantation lymphoceles, as it is simple, rapid and effective.

Lymphoceles can be observed after renal transplantation. Sometimes lymphoceles can cause symptoms (renal insufficiency, pain). In these cases they require surgical treatment. From january 92 to december 1993 seven patients with complicated lymphoceles were treated. Simple drainage with injections of polyvidone iodine was used in 4 cases without effect. Surgical drainage was performed in 5 cases with complete disappearance of the pouch (on open surgical procedure, four celioscopic procedures). Celioscopic marsupialization of lymphoceles after transplantation is a method of choice and is preferred to open surgery for lymphoceles which develop internally.

We report 23 cases of lymphoproliferative diseases which occurred among 2,100 patients with kidney or combined kidney+pancreas transplant. Eleven patients developed a severe diffuse disease within the first 3 months post-transplantation; immunoblastic B cells of recipient origin infiltrated the bone-marrow, transplanted organs, liver, spleen, lymph nodes, lungs, and brain; immunoglobulin abnormalities with fever, leuko-thrombocytopenia and liver dysfunction constituted the symptoms; all patients received anti-lymphocyte globulins; 9 patients were also treated with cyclosporin. Three out of 6 tumors analysed were monoclonal. Epstein-Barr virus was present in 3 lesions analysed. Treatment consisted of cessation of immunosuppressive therapy. Nine patients died with lactic acidosis. Five patients had a less severe form. Seven patients had solid tumors involving the tonsils, lungs (2), lymph nodes (2), and bladder, 8 months after transplantation. All patients received cyclosporin; 4 also received anti-lymphocyte globulins and 3 OKT3. Tumor cells were immunoblasts expressing B cells markers at a late stage of B cell differentiation; 4 tumors were monoclonal. C myc was negative. Treatment consisted of cessation of immunosuppressive therapy, antiviral agents, and monoclonal antibodies (mAb): anti-CD21 and anti-CD24 mAb therapy was followed by cure of the lymphoma in 1 patient, by transient remission in a second one and by failure in the third patient. Two patients had a recurrence of the lymphoma and received chemotherapy; 2 patients died of the lymphoma, 1 died of unrelated cause; 4 are alive, 3 of them having a good graft function.

In theory, transplantation of the islets of Langerhans is the method of choice for the treatment of insulin-dependent diabetes. In actual fact, medical teams who have been working on this subject for about two decades have met with the problem of islet isolation, and for the time being this treatment cannot be considered effective. Pancreas transplantation gives satisfactory results in diabetics with renal impairment when it is coupled with kidney transplantation. However, it cannot yet be applied to all diabetics as its results are mediocre when performed alone, and it requires chronic immunosuppression. Pancreas transplantation not only increases the quality of life but also has the advantage of acting on degenerative complications: it may improve diabetic nephropathy, retinopathy and neuropathy. The results obtained are getting better year after year, and they are now close to those observed with other organ transplantations.

The influence of HLA A, B, DR on the incidence and symptoms of cytomegalovirus (CMV) infection was investigated in 143 patients who, between October 1st, 1987 and December 31st, 1989, received kidneys from cadaveric donors. Systematic virological monitoring was carried out weekly during the first hospitalization and thereafter at each new hospitalization or in the presence of clinical signs suggestive of viral infection. The diagnosis of CMV was based on positive isolation in blood or urine, or seroconversion, or 4-dilution rise in the anti-CMV antibodies titre. HLA grouping of all recipients was made in the same histocompatibility laboratory. Immunosuppression was obtained with a quadruple therapy consisting of corticosteroids (15 mg/kg before transplantation, then 1 mg/kg for 10 days, then gradually tapering off dosage), azathioprine (2 to 3 mg/day), cyclosporin A (2 mg/kg i.v. followed by an oral dose adjusted to the residual levels) and a randomized treatment with either monoclonal anti-CD3 antibody or anti-thymocyte globulins administered during the first 10 days. The incidence of CMV infection was 56 percent (80/143), with 25 percent of primary infection (20/80). The number of DR compatibilities was found to have a significant influence on the incidence of CMV infection, which rose from 22 to 50 and 65 percent respectively in the group of patients with 2.1 or 0 DR compatibility (P less than 0.02). The degree of B + DR compatibility was also associated with the occurrence of CMV infection, the incidence of which rose from 0 to 36, 59, 43.5 and 71 percent respectively in the group of patients with 4, 3, 2, 1, 0 B + DR compatibility (P less than 0.03). The incidence of primary CMV infection increased with the number of DR incompatibilities, rising from 0 to 29 and 52 percent respectively in the group of patients with 0, 1 or 2 DR incompatibilities. The symptoms and severity of CMV infection were significantly influenced by the degree of DR and B + DR compatibility. Despite a very strong association between graft rejection and CMV infection (P less than 0.000001), no influence of HLA, and particularly DR or B + DR compatibility on the incidence and number of graft rejections could be demonstrated. It is concluded that, under the above-described quadruple therapy, the HLA DR and B + DR compatibility exerts a predominant influence on the occurrence and severity of CMV infection, and that this effect is independent of any action on graft rejection.(ABSTRACT TRUNCATED AT 400 WORDS)

Four cases of Kaposi's sarcoma in recipients of renal transplants are reported. The 4 patients of Italian origin were male. Kaposi's sarcoma, began during pre-transplantation haemodialysis, then extended in one of the patients; in the remaining 3 patients it developed 20 months on average after transplantation. All patients were receiving an immunosuppressive treatment (azathioprine, systemic corticosteroids, anti-lymphocyte serum). Kaposi's sarcoma was located in the skin and mucosae, sometimes in lymph nodes and viscera. In 2 patients the cutaneous and mucosal lesions responded well to vindesine: in the other two patients withdrawal of the immunosuppressive therapy had no effect on the course of the disease. This study highlights the multiple factors involved in the development of Kaposi's sarcoma, notably immunosuppression and the ethnic factor.

Clinical evolution and CsA monitoring of 65 transplanted patients (55 kidneys and 10 kidneys and pancreas) treated with CsA were analysed, retrospectively (45 patients) and prospectively (34 patients). The aim of the study was: To show that nephrotoxicity is not uncommon with low trough plasma levels of CsA, and to indicate the value of CsA pharmacokinetic studies in individual cases. To suggest that the T6 value of a CsA pharmacokinetic plasma curve (6 hours after oral drug administration) is a valid expression of a full pharmacokinetics study. To show the results in a prospective study utilizing the T6 as a monitoring tool and with dose adjustments disregarding concomitant serum creatinine levels, with the aim of maintaining a therapeutic T6 (range 150-250 ng/ml). Patients with permanent Therapeutic T6 during the follow-up period (without dose adjustments) showed a creatinine serum level of 144 +/- 6 mumol/l. Serum creatinine levels decreased when CsA dose adjustments were made related to the presence of Toxic (greater than 350 ng/ml) or under-therapeutic (less than 100 ng/ml) T6 (p less than 0.01). Kidney and pancreas patients showed a tendency to under-therapeutic T6 and required a dose of 14 +/- 0.7 mg/kg to maintain a therapeutic T6. The CsA dose of kidney grafted patients through the T6 therapeutic period was 7.03 +/- 0.5 mg/kg. During the T6 toxic period, kidney patients received 8.85 +/- 0.3 mg/kg of CsA (p less than 0.02). Kidneys and graft survival is 97.6% at 6 months follow up in the prospective study. Current serum creatinine of all patients is 180.2 +/- 8 mumol/l. No patient was switched to conventional treatment. T6 is more useful than trough plasma levels for CsA monitoring. Nephrotoxicity and CsA under-treatment can be avoided. This new monitoring tool may allow the utilization of lower doses of CsA and thus contribute to improved graft function at long term follow-up.

A Raynaud's phenomenon was observed in a 72 year-old man affected by progressive systemic sclerosis. Few months later, the patient was readmitted to the Hospital because of acute renal failure, and a retroperitoneal fibrosis was first suspected on the basis of typical urinary tract alterations, and subsequently confirmed at the post-mortem examination. Such association does not appear fortuitous on histological data, but it has been rarely described. HLA B27 antigen is not always present. Symptomatic therapy includes association between prednisone and percutaneous nephrostomy.