101 results on '"Olivier Guillaud"'
Search Results
2. Diagnosis and Outcomes of Late‐Onset Wilson's Disease: A National Registry‐Based Study
- Author
-
Christelle Nilles, Mickael Alexandre Obadia, Rodolphe Sobesky, Jérôme Dumortier, Olivier Guillaud, Chloé Laurencin, Caroline Moreau, Claire Vanlemmens, Fabienne Ory‐Magne, Victor de Ledinghen, Edouard Bardou‐Jacquet, Frederique Fluchère, Corinne Collet, Nouzha Oussedik‐Djebrani, France Woimant, and Aurélia Poujois
- Subjects
Neurology ,Neurology (clinical) - Abstract
Wilson's disease (WD) is usually diagnosed in children and young adults; limited data exist on late-onset forms.The aim was to characterize the clinical and paraclinical presentations, therapeutic management, and outcomes in patients with late-onset WD.Patients diagnosed with WD after age 40 years were identified from the French Wilson's Disease Registry (FWDR). Clinical, laboratory, and imaging findings and treatment were reported at diagnosis and last follow-up.Forty-five patients were identified (median age: 49, range: 40-64) and placed in three groups according to their clinical presentation: neurological (n = 20, median diagnostic delay: 20 months), hepatic (n = 13, diagnostic delay: 12 months), and family screening (n = 12), all confirmed genetically. Six neurological patients had an atypical presentation (1 torticollis, 2 writer's cramps, 2 functional movement disorders, and 1 isolated dysarthria), without T2/fluid-attenuated inversion recovery brain magnetic resonance imaging (MRI) hyperintensities; 5 of 6 had no Kayser-Fleischer ring (KFR); 5 of 6 had liver involvement. In the neurological group, 84% of patients improved clinically, and 1 developed copper deficiency. In the hepatic group, 77% had cirrhosis; 6 patients required liver transplantation. In the screened group, 43% had mild liver involvement; 3 were not treated and remained stable; 24-h urinary copper excretion was normal in 33% of patients at diagnosis.In the FWDR, late-onset forms of WD affect 8% of patients, mostly with neurological presentations. Thirty percent of the neurological forms were atypical (isolated long-lasting symptoms, inconspicuous brain MRI, no KFR). With personalized treatment, prognosis was good. This study emphasized that WD should be suspected at any age and even in cases of atypical presentation. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
- Published
- 2022
3. Antineoplastic chemotherapy and immunosuppression in liver transplant recipients: Squaring the circle?
- Author
-
Antoine Coupier, Yves Gallien, Olivier Boillot, Thomas Walter, Olivier Guillaud, Mélanie Vallin, Elsa Thimonier, Domitille Erard, and Jérôme Dumortier
- Subjects
Transplantation - Abstract
Malignancies are a major cause of late death after liver transplantation (LT). In LT recipients presenting a malignancy, antineoplastic chemotherapy is central part of the therapeutic arsenal, but management of both immunosuppressive and antineoplastic chemotherapy can be very challenging. The aim of the present retrospective study was to describe a recent single center cohort of LT recipients treated with antineoplastic cytotoxic chemotherapy.All LT recipients who received antineoplastic chemotherapy in our center between 2005 and 2021 were included.The study population included 72 antineoplastic chemotherapy courses in 69 patients. There was a majority of men (81.9%); median age at LT was 54.9 (range 1-68) and was 63.0 (18-79) at the diagnosis of malignancy. Lung carcinomas (23.6%), head and neck carcinomas (20.8%), lymphomas (16.7%), and recurrent hepatocellular carcinoma (HCC) (8.3%) were the most frequent malignancies. Neoadjuvant (30.6%), adjuvant (12.5%) or palliative (54.2%) chemotherapy was performed. Immunosuppressive regimen was modified from a calcineurin inhibitor (CNI)-based to an everolimus-based regimen (63.5% of CNI discontinuation). Median survival after diagnosis of malignancy was 22.5 months and 5-year survival was 30.1%. Chemotherapy regimen was considered optimal in 81.9% of the cases. Multivariate analysis disclosed that non-PTLD N+ stage malignancy (HR = 5.52 95%CI [1.40;21.69], p = .014), non-PTLD M+ stage malignancy (HR = 10.55 95%CI [3.20;34.73], p = .0001), and suboptimal chemotherapy (HR = 2.73 95%CI [1.34;5.56], p = .005) were significantly associated with poorer prognosis. No rejection episode occurred during chemotherapy.The present study is the first one focused on antineoplastic chemotherapy in LT recipients. Our results suggest that immunosuppressive drugs and antineoplastic chemotherapy can be managed satisfactorily in most cases but this needs confirmation from larger cohorts.
- Published
- 2022
4. Long-Term Urinary Copper Excretion and Exchangeable Copper in Children With Wilson Disease Under Chelation Therapy
- Author
-
Dany Hermann Ngwanou, Eduardo Couchonnal, François Parant, Abdelouahed Belmalih, Olivier Guillaud, Jérôme Dumortier, Muriel Bost, and Alain Lachaux
- Subjects
Adolescent ,Hepatolenticular Degeneration ,Pediatrics, Perinatology and Child Health ,Gastroenterology ,Ceruloplasmin ,Humans ,Child ,Biomarkers ,Chelation Therapy ,Copper ,Chelating Agents ,Retrospective Studies - Abstract
Determining 24-hour urinary copper excretion (UCE) levels is useful for diagnosing Wilson's disease (WD) and for treatment monitoring. Exchangeable copper (ExC) is a novel potential marker, but its long-term changes have never been described in patients under chelation therapy. Our aim was to describe the long-term changes in ExC levels compared to UCE levels in symptomatic WD pediatric patients under chelation therapy.A retrospective, descriptive, and analytical study including all patients under 18 years of age, diagnosed between 2006 and 2020, and treated with chelation therapy was conducted at the National Reference Center for WD in Lyon. Ceruloplasmin levels, serum copper, 24 h-UCE, ExC, and liver enzymes at diagnosis and during follow-up were analyzed.Our study included 36 patients, predominantly with hepatic form of WD (n = 31). The median [interquartile range (IQR)] age at diagnosis was 10.5 (8.4-13.1) years, and the median (IQR) follow-up duration was 6.3 (3.3-8.8) years. At diagnosis, the median (IQR) ExC value was 1.01 (0.60-1.52) µmol/L. There was a significant decrease during the first year of chelation treatment ( P = 0.0008), then a stabilization. The median (IQR) ExC values was 0.38 (0.22-0.63) µmol/L at 12-18 months and 0.43 (0.31-0.54) µmol/L at 5 years of chelation treatment ( P = 0.4057). Similarly, there was a significant decrease in 24-hour UCE ( Plt; 0.001) during the first year of chelation treatment, then a stabilization.Our study showed a significant decrease in ExC and 24-hour UCE levels during the first year of follow-up; The dynamics of both biomarkers were similar along the follow-up, demonstrating their usefulness in clinical practice for monitoring WD.
- Published
- 2022
5. Endoscopic resection of Barrett's adenocarcinoma: Intramucosal and low‐risk tumours are not associated with lymph node metastases
- Author
-
Aurélie Charissoux, J Rivory, Maximilien Barret, Mathieu Pioche, Jean Marc O'Brien, Guillaume Perrod, Thierry Ponchon, Olivier Guillaud, Alexandre Jaouen, Gabriel Rahmi, Frédéric Prat, Nicolas Benech, Thomas Walter, Jérémie Jacques, Jean-Christophe Saurin, Romain Legros, Vincent Lepilliez, and Valérie Hervieu
- Subjects
Male ,Risk ,medicine.medical_specialty ,Esophageal Mucosa ,Esophageal Neoplasms ,Oesophageal adenocarcinoma ,Lymph node metastasis ,Adenocarcinoma ,Barrett Esophagus ,03 medical and health sciences ,0302 clinical medicine ,Barrett's Adenocarcinoma ,Humans ,Medicine ,Neoplasm Invasiveness ,Endoscopic resection ,Lymph node ,Aged ,Retrospective Studies ,lymph node metastasis ,business.industry ,fungi ,Gastroenterology ,food and beverages ,Endoscopy ,Middle Aged ,Barrett's oesophagus ,medicine.anatomical_structure ,Oncology ,histological features ,Lymphatic Metastasis ,Positron-Emission Tomography ,030220 oncology & carcinogenesis ,submucosal invasion ,oesophageal adenocarcinoma ,Original Article ,Female ,030211 gastroenterology & hepatology ,Esophagoscopy ,France ,Radiology ,Lymph ,business ,Follow-Up Studies - Abstract
Background Superficial oesophageal adenocarcinoma can be resected endoscopically, but data to define a curative endoscopic resection are scarce. Objective Our study aimed to assess the risk of lymph node metastasis depending on the depth of invasion and histological features of oesophageal adenocarcinoma. Methods We retrospectively included all patients undergoing an endoscopic resection for T1 oesophageal adenocarcinoma among seven expert centres in France in 2004–2016. Mural invasion was defined as either intramucosal or submucosal tumours; the latter were further divided into superficial submucosal (1000 mm). Absence or presence of lymphovascular invasion and/or poorly differentiated cancer (G3) defined a low‐risk or a high‐risk tumour, respectively. For submucosal tumours, invasion depth and histological features were systematically confirmed after a second dedicated histological assessment (new 2‐mm thick slices) performed by a second pathologist. Occurrence of lymph node metastasis was recorded during the follow‐up from histological or PET CT reports when an invasive procedure was not possible. Results In total, 188 superficial oesophageal adenocarcinomas were included with a median follow‐up of 34 months. No lymph node metastases occurred for intramucosal oesophageal adenocarcinomas (n = 135) even with high‐risk histological features. Among submucosal oesophageal adenocarcinomas, only tumours with lymphovascular invasion or poorly differentiated cancer or with a depth of invasion >1000 μm developed lymph node metastasis tumours (n = 10/53%; 18.9%; hazard ratio 12.04). No metastatic evolution occurred under a 1000‐mm threshold for all low‐risk tumours (0/25), nor under 1200 mm (0/1) and three over this threshold (3/13%, 23.1%). Conclusion Intramucosal and low‐risk tumours with shallow submucosal invasion up to 1200 mm were not associated with lymph node metastasis during follow‐up. In case of high‐risk features and/or deep submucosal invasion, endoscopic resections are not sufficient to eliminate the risk of lymph node metastasis, and surgical oesophagectomy should be carried out. These results must be confirmed by larger prospective series., Key Summary Superficial oesophageal adenocarcinoma (OAC) can be resected endoscopically.Data to define a curative endoscopic resection with a low lymph node metastasis (LNM) risk are scarce especially for tumours invading the submucosa.Curative endoscopic resections have been reported in selected OAC invading the first 500 mm of the submucosa, but surgical series showed an LNM risk ranging from 0% to 50%, making endoscopic resection a questionable curative treatment.High‐risk histological features were not associated with LNM in intramucosal tumours.LNM occurred only for tumours invading the submucosa with a depth ≥1200 mm or with high‐risk histological features regardless of the depth of invasion.Endoscopic resection may be a valid and curative therapeutic option for all intramucosal tumours and for submucosal oesophageal adenocarcinoma with an invasion depth ≤1000 mm and low‐risk histological features.
- Published
- 2021
6. Which liver transplant patients will become octogenarians? A French single-center study
- Author
-
Jérôme Dumortier, Olivier Guillaud, and Olivier Boillot
- Subjects
Hepatology ,Gastroenterology - Published
- 2023
7. Maladie de Wilson : les 10 essentiels pour optimiser la prise en charge des patients en pédiatrie
- Author
-
A. Lachaux, F. Ory-Magne, F. Woimant, Olivier Guillaud, C. Vanlemmens, R. Sobesky, Groupe d’experts français de la maladie de Wilson, D. Habès, N. Oussedik-Djebrani, and A. Poujois
- Subjects
03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology - Abstract
Resume En France, on estime entre 1000 et 1500 le nombre de patients atteints de maladie de Wilson (MW). C’est une affection monogenique de transmission autosomique recessive dont le gene est localise sur le chromosome 13. La MW est caracterisee par une accumulation excessive de cuivre dans l’organisme initialement dans le foie puis dans d’autres organes (cerveau, cornee, globules rouges), evoluant vers une affection systemique. La plupart des patients pediatriques atteints de MW presentent une maladie du foie alors que les symptomes neuropsychiatriques sont plus frequents chez les adultes. La MW peut se presenter a tout âge. Le screening familial est indispensable. Une fois le diagnostic evoque, le bilan cuprique et, en particulier l’etude du ratio cuivre echangeable/cuivre total (REC) plasmatique (test rapide et sensible), permet en regle generale une confirmation du diagnostic avec en parallele la recherche de mutations du gene ATP7B qui se revele positive dans 98 % des cas. Les nouveaux traitements par sel de trientine permettent d’adapter la prise en charge des enfants intolerants a la D-penicillamine.
- Published
- 2020
8. Liver transplantation as a rescue therapy for severe neurologic forms of Wilson disease
- Author
-
Aurélia Poujois, Rodolphe Sobesky, Wassilios G. Meissner, Anne-Sophie Brunet, Emmanuel Broussolle, Chloé Laurencin, Laurence Lion-François, Olivier Guillaud, Alain Lachaux, François Maillot, Jérémie Belin, Ephrem Salamé, Claire Vanlemmens, Bruno Heyd, Céline Bellesme, Dalila Habes, Christophe Bureau, Fabienne Ory-Magne, Pascal Chaine, Jean-Marc Trocello, Daniel Cherqui, Didier Samuel, Victor de Ledinghen, Jean-Charles Duclos-Vallée, France Woimant, National reference Centre for Wilson's Disease [Paris] (CRMR Wilson), Service de neurologie [Univ. Paris VII], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service d'Electroneuromyographie et Service de Neurologie C [Hôpital Pierre Wertheimer - HCL], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Université de Lyon, Département d'hépatologie, Hospices Civils de Lyon (HCL), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Groupe de Recherche en Economie Théorique et Appliquée (GREThA), Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS), Hôpital Claude Huriez [Lille], CHU Lille, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Badji Mokhtar de Annaba, CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Paul Brousse, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Centre National de la Recherche Scientifique (CNRS)-Université de Bordeaux (UB), Hôpital Purpan [Toulouse], and Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL)
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,Drug Resistance ,Liver transplantation ,Severity of Illness Index ,Disability Evaluation ,Young Adult ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Hepatolenticular Degeneration ,Liver Function Tests ,Modified Rankin Scale ,Internal medicine ,Severity of illness ,Humans ,Medicine ,Survival rate ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Parkinsonism ,Retrospective cohort study ,medicine.disease ,Magnetic Resonance Imaging ,Liver Transplantation ,3. Good health ,Survival Rate ,Female ,030211 gastroenterology & hepatology ,Neurology (clinical) ,business ,Liver function tests ,030217 neurology & neurosurgery - Abstract
ObjectiveTo evaluate the effect of liver transplantation (LT) in patients with Wilson disease (WD) with severe neurologic worsening resistant to active chelation.MethodsFrench patients with WD who underwent LT for pure neurologic indication were retrospectively studied. Before LT and at the last follow-up, neurologic impairment was evaluated with the Unified Wilson's Disease Rating Scale (UWDRS) score, disability with the modified Rankin Scale (mRS) score, and hepatic function with the Model for End-stage Liver Disease score, together with the presence of a Kayser-Fleischer ring (KFR), brain MRI scores, and copper balance. The survival rate and disability at the last follow-up were the coprimary outcomes; evolution of KFR and brain MRI were the secondary outcomes. Prognosis factors were further assessed.ResultsEighteen patients had LT. All were highly dependent before LT (median mRS score 5). Neurologic symptoms were severe (median UWDRS score 105), dominated by dystonia and parkinsonism. The cumulated survival rate was 88.8% at 1 year and 72.2% at 3 and 5 years. At the last follow-up, 14 patients were alive. Their mRS and UWDRS scores improved (p< 0.0001 andp= 0.0003). Eight patients had a major improvement (78% decrease of the UWDRS score), 4 a moderate one (41% decrease), and 2 a stable status. KFR and brain MRI scores improved (p= 0.0007). Severe sepsis (p= 0.011) and intensive care unit admission (p= 0.001) before LT were significantly associated with death.ConclusionsLT is a rescue therapeutic option that should be carefully discussed in selected patients with neurologic WD resistant to anticopper therapies (chelators or zinc salts) as it might allow patients to gain physical independency with a reasonable risk.Classification of evidenceThis study provides Class IV evidence that for patients with WD with severe neurologic worsening resistant to active pharmacologic therapy, LT might decrease neurologic impairment.
- Published
- 2020
9. Safe and effective digestive endoscopic resection in patients with cirrhosis: a single-center experience
- Author
-
Vincent Lepilliez, Olivier Guillaud, Christine Chambon-Augoyard, Jérôme Rivory, Clothilde Miaglia, Thierry Ponchon, Valérie Hervieu, Jérôme Dumortier, and Mathieu Pioche
- Subjects
Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,Population ,Perforation (oil well) ,Esophageal and Gastric Varices ,Single Center ,Severity of Illness Index ,End Stage Liver Disease ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Esophageal varices ,medicine ,Humans ,Esophagus ,Child ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Stomach ,Gastroenterology ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business - Abstract
Background Endoscopic resection has developed over the years. The main complications are perforation and bleeding. This study aimed to evaluate safety and effectiveness of digestive endoscopic resection in patients with cirrhosis. Methods This retrospective, open-label, single-center study included all consecutive patients with cirrhosis who were admitted for endoscopic resection between 2009 and 2016. Safety, efficacy, and risk factors for delayed bleeding were analyzed. Results 126 patients undergoing 164 procedures were included: 65 endoscopic resections (49 patients) in the upper gastrointestinal tract (esophagus 34, stomach 20, duodenum 11) and 99 in the lower gastrointestinal tract (77 patients). Mean Model for End-Stage Liver Disease score was 9.9 (standard deviation 4.5). Esophageal varices were present in 50 patients, and 21 patients had decompensated cirrhosis. The overall curative rate of endoscopic resection was 84.0 %. No patients died during 30-day follow-up. Immediate overall morbidity was 6.1 %, with two postoperative fevers and eight bleeds. Risk factors for delayed bleeding were duodenal location (P Conclusions Endoscopic resection was safe and effective in patients with mild (Child – Pugh class A/B) cirrhosis, and should be proposed as a first option for treatment of superficial neoplasia. Additional data in patients with severe cirrhosis are needed to confirm the safety in this population.
- Published
- 2020
10. Wilson Disease and Alpha1-Antitrypsin Deficiency: A Review of Non-Invasive Diagnostic Tests
- Author
-
Olivier Guillaud, Jérôme Dumortier, Eduardo Couchonnal-Bedoya, and Mathias Ruiz
- Subjects
Clinical Biochemistry - Abstract
Wilson disease and alpha1-antitrypsin deficiency are two rare genetic diseases that may impact predominantly the liver and/or the brain, and the liver and/or the lung, respectively. The early diagnosis of these diseases is important in order to initiate a specific treatment, when available, ideally before irreversible organ damage, but also to initiate family screening. This review focuses on the non-invasive diagnostic tests available for clinicians in both diseases. These tests are crucial at diagnosis to reduce the potential diagnostic delay and assess organ involvement. They also play a pivotal role during follow-up to monitor disease progression and evaluate treatment efficacy of current or emerging therapies.
- Published
- 2023
11. Primary liver malignancies in patients with Wilson’s disease
- Author
-
Rodolphe Sobesky, Olivier Guillaud, Aurelia Poujois, Audrey Coilly, Eric Vibert, René Adam, Daniel Cherqui, Cyrille Feray, Didier Samuel, and Jean-Charles Duclos-Vallée
- Subjects
Hepatology - Published
- 2022
12. Polydipsia: An atypical symptom of Wilson disease
- Author
-
Guillaume Petit, Paul Jaulent, Eduardo Couchonnal-Bedoya, Olivier Guillaud, Stéphane Thobois, and Chloé Laurencin
- Subjects
Neurology ,Hepatolenticular Degeneration ,Humans ,Polydipsia ,Neurology (clinical) ,Antipsychotic Agents - Published
- 2021
13. Intrathoracic Rupture of Hepatocellular Carcinoma
- Author
-
Jerome Dumortier, Luc Henry, Clément Proust, and Olivier Guillaud
- Subjects
Carcinoma, Hepatocellular ,Rupture, Spontaneous ,Liver Neoplasms ,Gastroenterology ,Humans - Published
- 2021
14. Recurrence of Hereditary Hemorrhagic Telangiectasia After Liver Transplantation: Clinical Implications and Physiopathological Insights
- Author
-
Pierre Paliard, Jérôme Dumortier, Pierre-Jean Valette, Alexander Valent, Sophie Dupuis-Girod, Olivier Guillaud, Olivier Boillot, Jean-Yves Scoazec, Valérie Hervieu, Henri Plauchu, Jean-Christophe Saurin, and Philip Robinson
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Transplants ,Disease ,Liver transplantation ,Gastroenterology ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Recurrence ,Internal medicine ,Liver tissue ,medicine ,Recurrent disease ,Humans ,Telangiectasia ,Aged ,Hepatology ,medicine.diagnostic_test ,business.industry ,Microchimerism ,Middle Aged ,Liver Transplantation ,Hepatic Involvement ,030104 developmental biology ,Liver ,Liver biopsy ,Female ,Telangiectasia, Hereditary Hemorrhagic ,030211 gastroenterology & hepatology ,France ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Liver transplantation (LT) has been proposed as a curative treatment in hereditary hemorrhagic telangiectasia (HHT) with severe hepatic involvement. We provide a long-term evaluation of graft status after LT for HHT, with a focus on the risk of recurrence. The present study included all patients prospectively followed up after LT for HHT in the Lyon Liver Transplant Unit from 1993 to 2010, with a survival of more than 1 year. Protocol clinical, radiological, and histological examinations were performed at regular intervals. Fourteen patients were included (13 women and one man). Median age at LT was 52.5 years (range: 33.1-66.7). In eight patients (seven female), disease recurrence was diagnosed by abnormal radiological features, suggestive of microcirculatory disturbances. Typical vascular lesions, including telangiectasia, were demonstrated by liver biopsy in five of these patients. The median interval between LT and diagnosis of recurrence was 127 months (range: 74-184). The risk of recurrence increased over time; estimated cumulative risk was 47.9% at 15 years. Liver tissue analysis found the coexistence of an angiogenic process combined with endothelial microchimerism, as shown by the presence of vascular lining cells of recipient origin. Conclusion: The present data show that disease recurrence occurs, usually after a long delay, in a significant number of patients treated by LT for liver complications of HHT. This strongly supports the necessity of a lifelong follow-up and suggests that therapeutic strategy needs discussion and evaluation, especially of the role of potential adjuvant treatments to LT, such as antiangiogenic medications, when recurrent disease appears.
- Published
- 2019
15. De Novo Malignancies Screening After Liver Transplantation for Alcoholic Liver Disease: A Comparative Opportunistic Study
- Author
-
Vincent Leroy, Marie-Noëlle Hilleret, Gilbert Ferretti, Elsa Thimonier, Laurence Renaud, Domitille Erard-Poinsot, Jérôme Dumortier, Olivier Guillaud, Thomas Decaens, Olivier Boillot, Christine Chambon-Augoyard, Adrien Jankowski, and F. Arbib
- Subjects
Adult ,Male ,medicine.medical_specialty ,Alcoholic liver disease ,medicine.medical_treatment ,Physical examination ,030230 surgery ,Liver transplantation ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Neoplasms ,Internal medicine ,medicine ,Humans ,Cumulative incidence ,Lung cancer ,Liver Diseases, Alcoholic ,Survival rate ,Early Detection of Cancer ,Neoplasm Staging ,Retrospective Studies ,Transplantation ,Hepatology ,medicine.diagnostic_test ,business.industry ,Incidence ,Smoking ,Cancer ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Liver Transplantation ,Survival Rate ,Female ,030211 gastroenterology & hepatology ,Surgery ,Tomography, X-Ray Computed ,business ,Follow-Up Studies - Abstract
Patients having received a liver transplantation (LT) for alcoholic liver disease (ALD) have a high risk of de novo malignancies, especially in the upper aerodigestive tract and lungs due to their smoking and alcohol history. The aim of this retrospective study was to compare a group of patients transplanted for ALD who continue to smoke and who were included in an intensive screening program for tobacco-related cancers implemented at the Grenoble University Hospital and a group of similar patients followed according to usual practice (chest computed tomography [CT] scan every 5 years) at the Edouard Herriot Hospital in Lyon. The intensive screening program consisted of an annual checkup, including a clinical examination by an otorhinolaryngologist, a chest CT scan, and an upper digestive endoscopy. A total of 147 patients were included: 71 patients in Grenoble and 76 patients in Lyon. The cumulative incidence of a first tobacco-related cancer was 12.3% at 3 years, 20.6% at 5 years, 42.6% at 10 years, and 64.0% at 15 years. A curative treatment was possible in 80.0% of the patients in Grenoble versus 57.9% in Lyon (P = 0.068). The rates of curative treatment were 63.6% versus 26.3% (P = 0.062) for lung cancers, 100.0% versus 87.5% (P = 0.498) for lip-mouth-pharynx and larynx cancers, and 66.7% versus 100.0% (P = 1) for esophageal cancers, respectively. In addition, for lung cancers, regardless of study group, 68.7% received a curative treatment when the diagnosis was made by CT scan screening versus 14.3% when it was made because of symptoms (P = 0.008). In conclusion, our study strongly confirms the high rate of tobacco-related de novo malignancies in LT patients for ALD and suggests that the screening of lung cancer by annual chest CT scan could significantly increase the rate of curative treatment.
- Published
- 2018
16. Corrigendum to 'ATP7B variant spectrum in a French pediatric Wilson disease cohort' [Eur. J. Med. Genet. 64 (10) (October 2021) 104305]
- Author
-
Eduardo Couchonnal, Sophie Bouchard, Thomas Damgaard Sandahl, Cecile Pagan, Laurence Lion-François, Olivier Guillaud, Dalila Habes, Dominique Debray, Thierry Lamireau, Pierre Broué, Alexandre Fabre, Claire Vanlemmens, Rodolphe Sobesky, Frederic Gottrand, Laure Bridoux-Henno, Abdelouahed Belmalih, Aurelia Poujois, Corinne Collet, Bruno Francou, Anne Sophie Brunet, Alain Lachaux, Micheline Misrahi, and Muriel Bost
- Subjects
Genetics ,General Medicine ,Genetics (clinical) - Published
- 2022
17. Determinants of short-term outcomes after pediatric liver transplantation: a single centre experience over 20 years
- Author
-
Olivier Guillaud, Gabriella Pittau, Olivier Boillot, Alain Lachaux, Jérôme Dumortier, Christine Rivet, and Catherine Boucaud
- Subjects
medicine.medical_specialty ,Multivariate analysis ,medicine.medical_treatment ,Liver transplantation ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Biliary atresia ,medicine ,Humans ,Child ,Retrospective Studies ,Hepatology ,business.industry ,Graft Survival ,Gastroenterology ,Immunosuppression ,Retrospective cohort study ,medicine.disease ,Prognosis ,Surgery ,Liver Transplantation ,Treatment Outcome ,030220 oncology & carcinogenesis ,Child, Preschool ,Cohort ,030211 gastroenterology & hepatology ,Hemodialysis ,business - Abstract
Background Liver transplantation (LT) is a standard-of-care therapeutic modality for selected patients with life-threatening liver disease, including children. In addition to specific clinical characteristics of pediatric LT recipients due to initial liver disease (and related comorbidities) and level of liver failure, early postoperative outcome may be dependent on the surgical technique used, related to the type of organ donor and graft. Therefore, the aims of the present retrospective study from a large single centre cohort were to identify the prognostic factors for both 1-year patient and graft survival. Methods Between October 1990 and October 2010, 151 children underwent a first LT in our centre. Results The mean age was 5.3 ± 7.4 years, and the main indication was biliary atresia (BA) (49.0%). Living donor liver transplantation (LDLT) was performed in 39 cases (25.8%). Cadaveric liver graft was a whole liver in 50 cases (33.1%) and a partial liver (reduced or split) in 62 cases (41.1%). One-year patient and graft survival rates were 88.7% and 86.1%, respectively. Multivariate analysis disclosed that initial liver disease, location at time of LT, donor/recipient (D/R) delta age, early post-transplant hemodialysis and initial immunosuppression (induction) were significantly associated with patient survival and that D/R delta age, primary non-function, early post-transplant hemodialysis and initial immunosuppression (induction) were significantly associated with graft survival. Conclusion The results of our single-centre experience of pediatric LT emphasize that early patient and graft survivals depend on pre-operative/operative factors such as initial liver disease, D/R delta age and immunosuppressive regimen. Awareness of these factors can help in the decision making for children requiring LT.
- Published
- 2020
18. Time to Conversion to an Everolimus-Based Regimen: Renal Outcomes in Liver Transplant Recipients From the EVEROLIVER Registry
- Author
-
Christophe Duvoux, Daniel Eyraud, Rodolphe Sobesky, Guillaume Lasailly, Audrey Coilly, Sylvie Tresson, Olivier Boillot, Didier Samuel, Teresa Antonini, Valérie Cailliez, Yvon Calmus, Georges Philippe Pageaux, Martine Neau-Cransac, Faouzi Saliba, Ephrem Salamé, Eléonora Demartin, Sylvie Radenne, Jean Guguenheim, Jérôme Dumortier, Filomena Conti, Olivier Guillaud, Sébastien Dharancy, Centre hépato-biliaire (CHB), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie et traitement des maladies du foie, Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Trousseau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Edouard Herriot [CHU - HCL], Centre Hospitalier Universitaire de Nice (CHU Nice), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), CHU Bordeaux [Bordeaux], Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Nice Sophia Antipolis (1965 - 2019) (UNS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)
- Subjects
Graft Rejection ,MESH: Registries ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,urologic and male genital diseases ,0302 clinical medicine ,Registries ,Graft Survival ,Immunosuppression ,3. Good health ,Liver ,030211 gastroenterology & hepatology ,Female ,MESH: Immunosuppressive Agents ,France ,Immunosuppressive Agents ,medicine.drug ,Glomerular Filtration Rate ,medicine.medical_specialty ,MESH: Liver Transplantation ,MESH: Graft Survival ,MESH: Transplant Recipients ,Calcineurin Inhibitors ,Urology ,Renal function ,MESH: Graft Rejection ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,MESH: Everolimus ,03 medical and health sciences ,medicine ,Humans ,Everolimus ,Transplantation ,MESH: Humans ,Hepatology ,business.industry ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,medicine.disease ,Transplant Recipients ,Liver Transplantation ,Calcineurin ,MESH: France ,Regimen ,MESH: Glomerular Filtration Rate ,MESH: Calcineurin Inhibitors ,Surgery ,business ,MESH: Female ,Kidney disease ,MESH: Liver - Abstract
International audience; Longterm use of a calcineurin inhibitor (CNI)-based regimen is one of the major reasons for chronic renal failure in liver transplantation recipients (LTRs). The Everolimus Liver registry (EVEROLIVER) evaluated renal function in LTRs who were converted to everolimus (EVR). This observational registry included all LTRs receiving EVR across 9 centers from France. Data are being collected in an electronic database over 10 years (12 visits/patient) to evaluate efficacy, renal function (estimated glomerular filtration rate [eGFR]), and safety of EVR use in clinical practice, and the current analysis is reporting up to 60 months of findings. Until September 2017, 1045 patients received EVR after a mean time of 3.6 ± 5.1 years. CNI withdrawal was feasible in 57.7% of patients as of month 60. Mean eGFR improved in patients with baseline eGFR
- Published
- 2020
19. Partial Major Hepatectomy with Cyst Fenestration for Polycystic Liver Disease:Indications, Short and Long-Term Outcomes
- Author
-
Jessica Crozet-chaussin, Jérôme Dumortier, Olivier Boillot, Pierre-Jean Valette, Olivier Guillaud, Valérie Hervieu, and Bénédicte Cayot
- Subjects
medicine.medical_specialty ,Performance status ,business.industry ,Polycystic liver disease ,Mortality rate ,Perioperative ,medicine.disease ,Surgery ,Ascites ,medicine ,Portal hypertension ,Cyst ,Liver function ,medicine.symptom ,business - Abstract
Background and objective: Symptomatic polycystic liver disease (PLD) with massive hepatomegaly represents a challenging surgical issue. In this work, we focused on early and long term outcomes after partial hepatectomy with cyst fenestration (PHCF) in selected patients. Methods: All patients who had PHCF for treatment of PLD between January 2003 and December 2019 in our center were included in this study. PHCF was undertaken if at least one hepatic section was relatively spared from PLD, afferent and efferent hepatic vasculature was patent, and liver function was maintained. Results: Twenty nine patients (25 women) with a mean age of 54.6±9 years underwent PHCF. Major hepatectomy was performed in all cases with 4.3±0.8 resected segments. Overall perioperative morbidity and mortality rates were 58.6% and 13.8% respectively. Significant postoperative liver volume reduction was 56% during the first year and 65% thereafter. From preoperative evaluation, PS normalized or improved in 80% of patients. After a mean follow-up time of 66.6±66.2 months, overall patient survival was 82.7%. Performance status (PS), initial liver volume, operative time and transfusion were associated with post-operative complications and PS, preoperative cyst infection, portal hypertension, transfusion, postoperative sepsis and persistent ascites were associated with mortality. Conclusions: Our study confirms that in spite of significant morbidity rate, PHCF allows a massive reduction of liver volume in selected patients with symptomatic PLD and is highly and durably effective for the reduction of liver volume and improvement of quality of life.
- Published
- 2020
20. Immunosuppressive regimen and risk for de novo malignancies after liver transplantation for alcoholic liver disease
- Author
-
Thomas Walter, Olivier Guillaud, Mélanie Vallin, Jérôme Dumortier, Emilie Ducroux, Delphine Maucort-Boulch, Olivier Boillot, Elsa Thimonier, Christine Chambon-Augoyard, Domitille Poinsot, and Philip Robinson
- Subjects
Adult ,Male ,Alcoholic liver disease ,medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,Malignancy ,Risk Assessment ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Cumulative incidence ,Liver Diseases, Alcoholic ,Aged ,Retrospective Studies ,Hepatology ,business.industry ,Incidence (epidemiology) ,Cancer ,Neoplasms, Second Primary ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Liver Transplantation ,Female ,030211 gastroenterology & hepatology ,business ,Complication ,Immunosuppressive Agents ,Follow-Up Studies - Abstract
Summary Background and aims Long-term prognosis after liver transplantation for alcoholic liver disease is impaired because of the occurrence of de novo malignancies and recurrent disease on liver graft. The aim of the present retrospective study was to evaluate the risk of de novo malignancy and to identify the predictive factors in a large cohort of liver-transplanted patients with a long follow-up in the setting of alcoholic liver disease. Methods All patients who underwent a first liver transplantation for alcoholic liver disease in our centre, from December 1985 to October 2010, and who survived more than 6 months were included. Survival, incidence of de novo malignancies and several clinical and biological parameters were studied. Results The study population consisted in 368 patients (284 males, median age 52.6 years). The cumulative incidence of a first solid organ de novo malignancy after LT was 8.7% at 5 years, 22.3% at 10 years, 31.5% at 15 years, and 33.1% at 20 years. Tobacco use (both past and current) was associated with a significant increased risk of de novo solid organ malignancy (HR 3.35 and 4.62, respectively), whereas immunosuppressive regimen including mTOR inhibitors (mTORi) was associated with a decreased risk (post-transplant time under mTORi-including immunosuppressive regimen was significantly longer in patients who did not present de novo malignancy (10.6% vs. 2.3%, P = 1.4 × 10−5)). Conclusions Our study provides additional evidence that de novo malignancies in alcoholic liver disease liver transplant patients is a major long-term complication, and that conversion from to an mTORi-including immunosuppressive regimen could reduce this risk.
- Published
- 2018
21. Prevalence, Risk Factors, and Impact of Donor‐Specific Alloantibodies After Adult Liver Transplantation
- Author
-
Jérôme Dumortier, Olivier Boillot, Domitille Poinsot, Christine Chambon-Augoyard, Stéphanie Ducreux, Patrice Andre, Philip Robinson, Jean-Yves Scoazec, Olivier Guillaud, Valérie Hervieu, Alexie Bosch, Valérie Dubois, and Katia Vandevoorde
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Liver transplantation ,Tacrolimus ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,HLA Antigens ,Isoantibodies ,Liver Cirrhosis, Alcoholic ,Risk Factors ,Internal medicine ,Prevalence ,medicine ,Humans ,Survival analysis ,Retrospective Studies ,Transplantation ,Hepatology ,business.industry ,Incidence ,Incidence (epidemiology) ,Graft Survival ,Hazard ratio ,Retrospective cohort study ,Middle Aged ,Survival Analysis ,Transplant Recipients ,Liver Transplantation ,Cross-Sectional Studies ,Treatment Outcome ,Population study ,Trough level ,Female ,030211 gastroenterology & hepatology ,Surgery ,business ,Immunosuppressive Agents ,Follow-Up Studies - Abstract
The incidence and impact of anti-human leukocyte antigen donor-specific alloantibodies (DSAs) developing after liver transplantation (LT) remains controversial and not extensively studied. The aim of the present study was to assess the incidence of DSAs, to identify risk factors for the development of DSAs, and to understand the impact of DSAs in a large population of adult LT recipients. This single-center retrospective study included all adult patients who underwent a first LT between 2000 and 2010 in our center. The study population mainly consisted of male patients, the mean age was 52.4 years, and the main indication was alcoholic cirrhosis (54.1%). From the 297 patients included in the cross-sectional study, 14 (4.7%) had preformed DSAs, and 59 (19.9%) presented de novo DSAs (12.2% at 1 year, 13.4% at 5 years, and 19.5% at 10 years). Multivariate analysis found that female donor sex (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.12-2.01; P = 0.01) and delay between LT and DSA screening (HR, 1.10; 95% CI, 1.01-1.20; P = 0.03) were associated with occurrence of de novo DSAs. From the 190 patients included in the subgroup longitudinal analysis, exposure to tacrolimus (mean trough level during the periods 0-2 years and 0-3 years) was significantly lower for patients having DSAs at 5 years. Concerning histology, only acute rejection (P = 0.04) and portal fibrosis ≥2 (P = 0.02) were more frequent at 1 year for patients with DSAs. Patient survival and graft survival were not significantly different according to the presence or not of DSAs at 1 year. Among the 44 patients who had de novo or persistent preformed DSAs, the diagnosis of antibody-mediated rejection was made in 4 (9.1%) patients after 1, 47, 61, and 74 months following LT. In conclusion, the results of the present study suggest that DSAs are observed in a minority of LT adult patients, with limited overall impact on graft and patient outcome.
- Published
- 2018
22. Hyperammonemic encephalopathy associated with hereditary hemorrhagic telangiectasia
- Author
-
Olivier Guillaud, Jérôme Dumortier, Claire Francoz, François Durand, Sophie Dupuis-Girod, and Domitille Erard-Poinsot
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,medicine.medical_treatment ,Encephalopathy ,Gastroenterology ,Hyperammonemia ,Liver transplantation ,medicine.disease ,Internal medicine ,Medicine ,medicine.symptom ,Hyperammonemic encephalopathy ,business ,Telangiectasia - Published
- 2019
23. Portal Vein Thrombosis and Nephrotic Syndrome After Liver Transplant
- Author
-
Olivier Boillot, Jérôme Dumortier, Olivier Guillaud, Jean-Yves Scoazec, Antoine Sicard, and Pierre-Jean Valette
- Subjects
Male ,medicine.medical_specialty ,Nephrotic Syndrome ,medicine.medical_treatment ,Liver transplantation ,Gastroenterology ,Nephropathy ,Postoperative Complications ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Venous Thrombosis ,Transplantation ,medicine.diagnostic_test ,Portal Vein ,business.industry ,Middle Aged ,medicine.disease ,Liver Transplantation ,Portal vein thrombosis ,Liver biopsy ,Complication ,business ,Nephrotic syndrome ,Kidney disease - Abstract
Despite systemic thromboembolic complications being frequent, portal vein thrombosis is a rare complication of nephrotic syndrome. We report here a liver transplant recipient who presented a late extensive portal vein thrombosis related to nephrotic syndrome. During regular follow-up after liver transplant, the patient presented with diabetes, arterial hypertension, hypercholesterolemia, and progressive renal dysfunction. In addition, urine analysis showed isolated proteinuria, and the diagnosis of nephrotic syndrome was made 36 months after liver transplant. Sixty months after liver transplant, the patient presented with mild acute abdominal pain, and the diagnosis of portal vein thrombosis was made from a computed tomography scan. Other causes for portal vein thrombosis were excluded. Histologic examination of a liver biopsy disclosed only mild steatosis. Histologic examination of a kidney biopsy disclosed severe lesions, suggesting a multifactorial, advanced chronic nephropathy probably caused by nephroangiosclerosis, diabetes, and toxicity of calcineurin inhibitors. Anticoagulation therapy led to complete recanalization of the portal and splenic veins, which was maintained thereafter. In conclusion, the case we report here illustrates that portal vein thrombosis can occur after liver transplant in the context of nephrotic syndrome, complicating chronic kidney disease, which is a very frequent and multifactorial complication after liver transplant.
- Published
- 2019
24. Deleterious impact of C3d-binding donor-specific anti-HLA antibodies after pediatric liver transplantation
- Author
-
Valérie Dubois, Alain Lachaux, Eduardo Couchonnal, Olivier Guillaud, Christine Rivet, Jérôme Dumortier, Stéphanie Ducreux, Patrice Andre, Rémi Dubois, Sophie Collardeau-Frachon, Alexie Bosch, Jean-Yves Scoazec, Valérie Hervieu, and Olivier Boillot
- Subjects
Graft Rejection ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Immunology ,Human leukocyte antigen ,030230 surgery ,Liver transplantation ,Gastroenterology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Antigen ,HLA Antigens ,Isoantibodies ,Biliary atresia ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Hla antibodies ,Child ,Transplantation ,biology ,business.industry ,Histocompatibility Testing ,Infant ,Liver Failure, Acute ,medicine.disease ,Survival Analysis ,Liver Transplantation ,body regions ,Cross-Sectional Studies ,Complement C3d ,Child, Preschool ,Cohort ,biology.protein ,Female ,030211 gastroenterology & hepatology ,Antibody ,business ,Pediatric population - Abstract
The prevalence and clinical impact of anti-HLA donor-specific antibodies (DSA) after liver transplantation (LT) have not been extensively studied, especially in pediatric population.The present cross-sectional study included 100 patients who underwent a first LT in childhood. Anti HLA immunization study was performed at a single time point during routine follow-up using Luminex® single antigen tests with classical anti-IgG conjugate and anti-C3d conjugate.The main indication for LT was biliary atresia (52%) and median age at LT was 4.6years. The median time between LT and DSA assessment was 7.8years (range 1-21years). DSA was identified in twenty-four patients (24%) after LT, with a prevalence of 8%, 28%, 33%, 50%, respectively 0-5years, 5-10years, 10-15years and15years after LT. DSA were mainly class II (23/24) with a mean MFI of 9.731±5.489 and 18 (79.3%) were C3d-binding DSA. Multivariate analysis disclosed that time elapsed since LT (p0.01) and history of fulminant hepatitis (p=0.04) were significantly associated with a higher rate of DSA. Liver function tests (at time of DSA assessment) were not different according to the presence or not of DSA (or C3d-binding DSA). Regarding histology, the DSA group had a higher rate of chronic rejection, cirrhosis and centrilobular fibrosis or cirrhosis. In addition, patients with C3d-binding DSA and high MFI (10,000) had a significant poorer long-term graft survival (p=0.03).In our pediatric cohort of LT, prevalence of DSA was high and increased regularly with time. Presence of C3d positive-DSA with high MFI was associated with a higher rate of graft loss.
- Published
- 2017
25. Partial major hepatectomy with cyst fenestration for polycystic liver disease: Indications, short and long-term outcomes
- Author
-
Valérie Hervieu, Jérôme Dumortier, Jessica Crozet-chaussin, Bénédicte Cayot, Olivier Boillot, Olivier Guillaud, and Pierre-Jean Valette
- Subjects
medicine.medical_specialty ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Ascites ,medicine ,Hepatectomy ,Humans ,Cyst ,Univariate analysis ,Hepatology ,Performance status ,Cysts ,business.industry ,Liver Diseases ,Polycystic liver disease ,Gastroenterology ,Perioperative ,Middle Aged ,medicine.disease ,Surgery ,030220 oncology & carcinogenesis ,Quality of Life ,Portal hypertension ,Female ,030211 gastroenterology & hepatology ,Liver function ,medicine.symptom ,business - Abstract
Background and objective Symptomatic polycystic liver disease (PLD) with massive hepatomegaly represents a challenging surgical issue. In this work, we focused on early and long term outcomes after partial hepatectomy with cyst fenestration (PHCF) in selected patients. Methods All patients who had PHCF for treatment of PLD between January 2003 and December 2019 in our center were included in this study. PHCF was undertaken if at least one hepatic section was relatively spared from PLD, afferent and efferent hepatic vasculature was patent, and liver function was maintained. Results Twenty nine patients (25 women) with a mean age of 54.6 ± 9 years underwent PHCF. Major hepatectomy was performed in all cases with 4.3 ± 0.8 resected segments. Overall perioperative morbidity (Clavien ≥ II) and mortality rates were 41.4.6% and 13.8% respectively. Significant postoperative liver volume reduction was 52.8% within the first year and 55.5% thereafter. From preoperative evaluation, performance status (PS) normalized or improved in 84% of patients. After a mean follow-up time of 70.8 ± 65 months, overall patient survival was 82.7%. In univariate analysis, PS, initial liver volume, operative time and transfusion were associated with post-operative complications and PS, preoperative cyst infection, portal hypertension, transfusion, postoperative sepsis and persistent ascites were associated with mortality. Conclusions Our study confirms that in spite of significant morbidity rate, PHCF allows a massive reduction of liver volume in selected patients with symptomatic PLD and is highly and durably effective for the reduction of liver volume and improvement of quality of life.
- Published
- 2021
26. Methylprednisolone liver toxicity: A new case and a French regional pharmacovigilance survey
- Author
-
Jérôme Dumortier, Thierry Vial, Judith Cottin, Olivier Guillaud, Jean-Yves Scoazec, Valérie Hervieu, Christine Chambon-Augoyard, Caroline Lavie, and Sandra Vukusic
- Subjects
Adult ,Male ,medicine.medical_specialty ,Context (language use) ,Autoimmune hepatitis ,Methylprednisolone ,Culprit ,Pharmacovigilance ,03 medical and health sciences ,Drug withdrawal ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Glucocorticoids ,Hepatitis ,Hepatology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,medicine.disease ,Surgery ,Female ,030211 gastroenterology & hepatology ,France ,Chemical and Drug Induced Liver Injury ,Liver function tests ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Reported hepatotoxicity induced by corticosteroids is very rare, and the diagnosis is highly challenging in the context of auto-immune disease. We report here a case of high-dose methylprednisolone (MP)-induced acute hepatitis confirmed by liver histology in a patient with multiple sclerosis (MS) and a case series (n=4) notified to the French Pharmacovigilance center of Lyon. In all 5 cases, other common causes of hepatitis were excluded. The causal relationship with MP pulse therapy was supported by the fact that MP was the only culprit drug. In addition, 3 of these 5 patients underwent unintended single or multiple positive MP rechallenge. Our 5 patients scored a RUCAM score from 6 (probable) to 10 (highly probable). MP-induced liver injury is probably very rare, since only less than 30 cases have been reported in the literature. Nevertheless, our cases strongly illustrates that many cases could have been unrecognized; final diagnosis in 3 of 5 of our patients was made after the second or third episode of acute hepatitis. In conclusion, these cases we report here strongly illustrates that high-dose MP-induced liver injury can occur in patients treated for MS or auto-immune disorder. Unintended re-challenge can confirm the diagnosis and can help to distinguish it from autoimmune hepatitis. Performing liver function tests routinely both before and after MP administration would be beneficial, as the timely recognition of this complication and early drug withdrawal may prevent progression of severe necrosis hepatic injury.
- Published
- 2017
27. Survival and prognostic factors after adjuvant 131iodine-labeled lipiodol for hepatocellular carcinoma: a retrospective analysis of 106 patients over 20 years
- Author
-
Jean-Philippe Vuillez, Jonathan Olesinski, Catherine Lombard-Bohas, Jean-Yves Scoazec, Françoise Borson-Chazot, Jérôme Dumortier, Pierre Paliard, Olivier Boillot, Pierre-Jean Valette, Luc Henry, François Mithieux, Olivier Guillaud, C. Partensky, Marie-Noëlle Hilleret, and Thomas Walter
- Subjects
Oncology ,medicine.medical_specialty ,Cirrhosis ,business.industry ,medicine.medical_treatment ,Retrospective cohort study ,General Medicine ,medicine.disease ,Predictive factor ,Tumor recurrence ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Internal medicine ,medicine ,Lipiodol ,Retrospective analysis ,030211 gastroenterology & hepatology ,Radiology, Nuclear Medicine and imaging ,business ,Adjuvant ,medicine.drug - Abstract
Hepatocellular carcinoma (HCC) has high recurrence rate after curative treatment. The aim of the present study was to report our experience with adjuvant use of 131I-lipiodol after curative treatment of HCC in terms of recurrence and survival in a large cohort of patients with a long follow-up. All patients treated with 131I-lipiodol after curative treatment of HCC in two French centers from 1991 to 2009 were included in a retrospective cohort study. One hundred and six patients were included. The median (range) follow-up was 6 years (0.3–22). Forty-three patients (41%) had cirrhosis. Recurrence-free survival rates at 1, 2, 5, 10, and 20 years were 73, 57, 40, 30, and 14%, respectively. Cirrhosis was an independent predictive factor of recurrence [RR = 1.18, 95% CI (1.11–3.02), p = 0.019]. Overall, survival rates at 1, 2, 5, 10, and 20 years were 90, 83, 59, 37, and 23%, respectively. Prognostic factors were recurrence [RR = 2.73, 95% CI (1.35–5.54); p = 0.005], age over 60 years (RR = 1.91, 95% CI [1.02–3.61]; p = 0.044), and tumor number over 3 [RR = 3.31, 95% CI (1.25–8.77); p = 0.016]. Our results suggest that the effect of 131I-lipiodol after curative treatment of HCC could be related to a beneficial impact on risk factors of early tumor recurrence. This could be evaluated in further studies using modern radioembolization methods.
- Published
- 2017
28. Résections endoscopiques hautes chez les patients cirrhotiques: profil d'efficacité et de sécurité
- Author
-
Christine Chambon-Augoyard, Jean-Christophe Saurin, Clothilde Miaglia, Olivier Guillaud, T. Ponchon, J Rivory, Jérôme Dumortier, and Mathieu Pioche
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Gastroenterology ,Medicine ,business - Published
- 2017
29. Predictive value of HLAMatchmaker and PIRCHE-II scores for de novo donor-specific antibody formation after adult and pediatric liver transplantation
- Author
-
Dan-Adrian Luscalov, Sarah Hamada, Olivier Guillaud, Stéphanie Faure, Céline Thevenin, Valérie Dubois, Jérôme Dumortier, Georges-Philippe Pageaux, Magdalena Meszaros, Olivier Boillot, Alain Lachaux, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département d'hépatologie, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Microbiologie cellulaire et moléculaire et pathogénicité (MCMP), Université Bordeaux Segalen - Bordeaux 2-Centre National de la Recherche Scientifique (CNRS), and Research and Breeding Institute of Pomology Holovousy (VSUO)
- Subjects
Adult ,Graft Rejection ,Male ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,Immunology ,Human leukocyte antigen ,030230 surgery ,Liver transplantation ,Epitope ,Serology ,03 medical and health sciences ,0302 clinical medicine ,Antigen ,HLA Antigens ,Isoantibodies ,Predictive Value of Tests ,medicine ,Humans ,Immunology and Allergy ,Child ,Transplantation ,biology ,business.industry ,Infant ,Middle Aged ,Prognosis ,Liver Transplantation ,3. Good health ,Log-rank test ,Child, Preschool ,biology.protein ,Female ,Antibody ,business ,Software ,030215 immunology - Abstract
Production of de novo DSA (dnDSA) is associated with an increased risk of antibody mediated rejection after liver transplantation. Antibodies not only recognize the entire antigen but are able to bind specific functional epitopes present on the HLA molecule surface. The HLAMatchmaker and the PIRCHE-II (predicted indirectly recognizable HLA epitopes) algorithms are able to determine predictive epitope mismatches scores and de novo DSA (dnDSA) synthesis based on alloreactive eplets' identification. The aim of the present study was to assess, for the first time in liver transplantation, the complementarity between these two algorithms. We retrospectively analyzed a cohort of 407 adult and 133 pediatric liver transplant patients without preformed DSA, transplanted between 1991 and 2019 in Lyon and Montpellier. HLA antibodies were detected by single antigen bead assay. HLA typing of the donor-recipient pair was achieved by serological and/or DNA-based techniques. PIRCHE-II and HLAMatchmaker algorithms were then applied on both groups. During follow-up, 27.3% of adults and 38.3% of children developed dnDSA. HLA-DRB1 and DQB1-PIRCHE-II and HLAMatchmaker scores were significantly higher in dnDSA group compared to no DSA group for both pediatric and adult patients (except for PIRCHE-II HLA-DRB1 locus score in pediatrics). ROC curves allowed determining score thresholds classifying patients in low- and high-risk of dnDSA synthesis. The two algorithms' Kaplan-Meier curves showed a predicted incidence of dnDSA 20 years after transplantation significantly lower in the low-risk group compare with the high-risk group (log rank \textless0.05), in both cohorts, with a good negative predictive value. In conclusion, HLAMatchmaker and PIRCHE-II algorithms both are effective tools to identify anti-HLA immunization risk and to predict dnDSA formation after liver transplantation.
- Published
- 2020
30. Simplification of Wilson’s disease maintenance therapy with a single daily dose: safety and efficacy in difficult to treat patients
- Author
-
Olivier Guillaud, Eduardo Couchonnal, Broussole Emmanuel, Chloé Laurencin, Laurence Lion-François, Belmalih Abdelouahed, Muriel Bost, Jérôme Dumortier, and Alain Lachaux
- Subjects
Hepatology - Published
- 2020
31. Assessment of liver fibrosis by transient elastography (Fibroscan
- Author
-
Olivier, Guillaud, Jérôme, Dumortier, Julie, Traclet, Lioara, Restier, Philippe, Joly, Colette, Chapuis-Cellier, Alain, Lachaux, and Jean François, Mornex
- Subjects
Liver Cirrhosis ,Male ,alpha 1-Antitrypsin Deficiency ,Elasticity Imaging Techniques ,Humans ,Female ,Prospective Studies ,Middle Aged - Abstract
Alpha-1-antitrypsin deficiency (A1ATD) is a common genetic condition which predisposes to emphysema and liver disorders. It is estimated that 10-15% of homozygous individuals for the Z allele (PiZZ) may develop liver fibrosis. The optimal modalities to detect liver disease in PiZZ adult patients need to be defined. The aim of this prospective study was to perform a systematic non-invasive evaluation of the liver fibrosis by elastometry using FibroscanPatients followed in our respiratory unit were enrolled in this prospective study and underwent on the same day a physical examination, a biochemical profiling, an abdominal ultrasound (US) and a FibroscanTwenty-nine PiZZ adults (19 male) were included. Median age was 50.4 yrs (21.5-67.2). Median serum A1AT level was 0.20 g/L (0.15-0.33). Liver Function Tests (LFT) were not normal in 2 patients and US was abnormal in 6 patients. Two patients had both abdnormal LFT and US. FibroscanFibroscan
- Published
- 2018
32. ENDOSCOPIC RESECTIONS IN CIRRHOTIC PATIENTS: OUTCOMES AND ADVERSE EVENTS OF 269 PROCEDURES
- Author
-
Mathieu Pioche, J Rivory, Christine Chambon-Augoyard, T. Ponchon, Olivier Guillaud, Jérôme Dumortier, Vincent Lepilliez, and Clothilde Miaglia
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Adverse effect ,business ,Surgery - Published
- 2018
33. Traitement du diverticule de Zenker: comparaison rétrospective de la technique de la fenêtre par endoscopie souple et des approches chirurgicales
- Author
-
Laura Calavas, T. Ponchon, Sabine Roman, Mathieu Pioche, Jean-Christophe Saurin, Olivier Guillaud, and J Rivory
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,business - Published
- 2018
34. Impact of a first study of early transplantation in acute alcoholic hepatitis: Results of a nationwide survey in french liver transplantation programs
- Author
-
Christophe Duvoux, Sébastien Dharancy, Teresa Antonini, Philippe Mathurin, for Groupe de Recherche Français en Greffe de Foie, Jean-Charles Duclos-Vallée, Olivier Guillaud, Faouzi Saliba, and Jérôme Dumortier
- Subjects
medicine.medical_specialty ,Time Factors ,Tissue and Organ Procurement ,medicine.medical_treatment ,Consensus Development Conferences as Topic ,MEDLINE ,Drug Resistance ,Pilot Projects ,Drug resistance ,030230 surgery ,Liver transplantation ,Nationwide survey ,Resource Allocation ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Surveys and Questionnaires ,medicine ,Humans ,Survival rate ,Glucocorticoids ,Hepatitis ,Transplantation ,Hepatology ,business.industry ,Hepatitis, Alcoholic ,Patient Selection ,medicine.disease ,Liver Transplantation ,Survival Rate ,Treatment Outcome ,030211 gastroenterology & hepatology ,Surgery ,France ,business ,Acute Alcoholic Hepatitis - Published
- 2017
35. Treatment of severe refractory de novo auto-immune hepatitis after liver transplantation with plasmapheresis
- Author
-
Jérôme Dumortier, Olivier Guillaud, Olivier Hequet, Olivier Boillot, Jean-Yves Scoazec, and Valérie Hervieu
- Subjects
Hepatology ,Refractory ,business.industry ,medicine.medical_treatment ,Immunology ,Gastroenterology ,Auto immune hepatitis ,Medicine ,Plasmapheresis ,Liver transplantation ,business - Published
- 2015
36. Screening of Wilson’s disease in a psychiatric population: difficulties and pitfalls. A preliminary study
- Author
-
Caroline Demily, François Parant, David Cheillan, Emmanuel Broussolle, Alice Pavec, Olivier Guillaud, Lioara Restier, MOPSY Consortium, Alain Lachaux, and Muriel Bost
- Subjects
0301 basic medicine ,medicine.medical_specialty ,lcsh:RC435-571 ,Copper homeostasis ,Alcohol abuse ,Wilson’s disease ,Population ,Inborn errors of metabolism ,Disease ,Treatable hereditary metabolic disorders ,Copper chelators ,03 medical and health sciences ,Exon ,0302 clinical medicine ,lcsh:Psychiatry ,Etiopathogenesis ,Bipolar disorders ,medicine ,Missense mutation ,Allele ,Psychiatry ,education ,education.field_of_study ,Serum copper ,biology ,business.industry ,Ceruloplasmin ,ATP7B gene ,medicine.disease ,Mental diseases ,Wilson's disease ,Psychiatry and Mental health ,030104 developmental biology ,Schizophrenia ,biology.protein ,Mental health ,Primary Research ,Psychiatric disorders ,business ,030217 neurology & neurosurgery - Abstract
Background Wilson’s disease (WD) is a rare autosomal-recessive, inherited disorder caused by a mutation in the copper-transporting gene ATP7B affecting the liver and nervous system. About 30% of patients with WD may initially present with psychiatric symptoms, and diagnosis can be difficult to establish. The objectives of the present preliminary study were [1] to evaluate the relevance of serum copper (Cu) and ceruloplasmin (Cp) measures in hospitalized patients with psychiatric disorders; and [2] to identify possible mutations in the ATP7B gene in patients with abnormal biological copper profile. Methods All psychiatric patients who participated in this study were hospitalized in Saint-Jean de Dieu Hospital (Lyon, France). Cp was measured by immunoturbidimetry and serum Cu by inductively coupled plasma-optical emission spectrometry. When Cp and serum Cu levels were inferior to, respectively, 0.18 g/L and 0.88 mg/L in combination with atypical psychiatric presentations, complete clinical examinations were performed by multidisciplinary physicians specialized in WD. In addition, mutation detection in the ATP7B gene was performed. Results A total of 269 patients completed the study. (1) 51 cases (19%) showed both decreased Cp and Cu concentrations. (2) Molecular genetic tests were performed in 29 patients, and one ATP7B mutation (heterozygous state) was found in four patients. We identified three different missense mutations: p.His1069Gln, c.3207C>A (exon 14), p.Pro1379Ser, c.4135C>T (exon 21) and p.Thr1434Met, c.4301C>T (exon 21). No pathogenic mutation on either ATP7B allele was detected. Conclusion Results of Cp and/or serum Cu concentrations below the normal limits are common in patients with psychiatric disorders and nonrelevant and/or informative for the WD diagnosis. WD diagnosis is based on a combination of clinical and biological arguments. Psychiatric patients with suspicion of WD should be evaluated in a reference center. Trial registration CPP Lyon Sud-Est IVNo 10/044, CNIL No DR-2011-470, Afssaps No B100832-40 and CCTIRS No 10.612 bis, registered 8 June 2010
- Published
- 2017
37. Conversion to everolimus dramatically improves the prognosis ofde novomalignancies after liver transplantation for alcoholic liver disease
- Author
-
Mélanie Vallin, Jérôme Dumortier, Olivier Guillaud, Elsa Thimonier, Evelyne Decullier, Thomas Walter, and Olivier Boillot
- Subjects
Adult ,Male ,Alcoholic liver disease ,medicine.medical_specialty ,medicine.medical_treatment ,Liver transplantation ,Malignancy ,Gastroenterology ,Postoperative Complications ,Liver Cirrhosis, Alcoholic ,Risk Factors ,Neoplasms ,Internal medicine ,medicine ,Humans ,Everolimus ,Prospective cohort study ,Aged ,Retrospective Studies ,Sirolimus ,Transplantation ,business.industry ,Retrospective cohort study ,Middle Aged ,Prognosis ,medicine.disease ,Liver Transplantation ,Surgery ,Survival Rate ,Relative risk ,Population study ,Female ,business ,Immunosuppressive Agents ,Follow-Up Studies ,medicine.drug - Abstract
De novo malignancies are a main cause for late death after liver transplantation (LT). Everolimus (ERL) is an immunosuppressive agent with antitumoral properties. The aim of the present retrospective study was to identify prognostic factors, including conversion to ERL, for patients presenting non-cutaneous de novo solid organ malignancy after LT for alcoholic cirrhosis. The study population consisted of 83 patients (presenting 100 tumors, including 75% of upper aerodigestive tract cancers), among the 398 patients who underwent LT for alcoholic cirrhosis in our center. After diagnosis, ERL was introduced in 38 patients and calcineurin-inhibitor was discontinued in 64.1% of them. Tumor stage was a significant prognostic factor with a one-yr survival at 82.6% for early stages, 63.4% for intermediate stages (N+) and 27.4% for disseminated diseases (p < 0.001). Associated relative risk factor was 2.202 (95% CI 1.044-4.644) for intermediate stages and 5.743 (95% CI 2.436-13.541) for metastatic stages. One- and five-yr survival was 77.4% and 35.2% in ERL group vs. 47.2% and 19.4% in the non-ERL group, respectively (p = 0.003). The relative risk factor for ERL was 0.447 (95%CI 0.257-0.778). Our results strongly suggest that conversion to ERL improves the prognosis of de novo malignancies after LT for alcoholic cirrhosis. Prospective studies are needed to confirm this benefit.
- Published
- 2014
38. Recurrent or de novo nonalcoholic fatty liver disease after liver transplantation: Natural history based on liver biopsy analysis
- Author
-
Olivier Boillot, Mélanie Vallin, Jérôme Dumortier, Jean-Yves Scoazec, Olivier Guillaud, and Valérie Hervieu
- Subjects
Transplantation ,medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,nutritional and metabolic diseases ,Liver transplantation ,medicine.disease ,digestive system ,Gastroenterology ,digestive system diseases ,Liver biopsy ,Internal medicine ,Diabetes mellitus ,Nonalcoholic fatty liver disease ,medicine ,Surgery ,Steatosis ,Steatohepatitis ,Complication ,business - Abstract
Nonalcoholic fatty liver disease (NAFLD) is a potential long-term complication after liver transplantation (LT) and can occur as recurrent disease in patients undergoing transplantation for NAFLD or as de novo NAFLD in others. The aim of this study was to compare these 2 different entities. From a cohort of adult patients undergoing transplantation between 2000 and 2010, we selected all patients with a diagnosis of NAFLD made during liver biopsy examinations during post-LT follow-up; clinical, biological, and histological features of patients with recurrent NAFLD and patients with de novo NAFLD were compared. The diagnosis of post-LT NAFLD was made for 91 patients during the study period: 11 cases were classified as recurrent NAFLD, and 80 cases were classified as de novo NAFLD. The groups were not statistically different with respect to the sex ratio, age, prevalence of hypercholesterolemia, prevalence of obesity, or prevalence of hypertension. The prevalence of diabetes mellitus was higher in patients with recurrent NAFLD (100% versus 37.5%, p
- Published
- 2014
39. Optimization of intra-voxel incoherent motion imaging at 3.0 Tesla for fast liver examination
- Author
-
Frank Pilleul, Hervé Saint-Jalmes, Olivier Beuf, C. Rabrait, Jean-Yves Scoazec, Olivier Guillaud, Jérôme Dumortier, and Benjamin Leporq
- Subjects
business.industry ,Respiratory gating ,computer.software_genre ,Advanced fibrosis ,Voxel ,Healthy volunteers ,Medicine ,Radiology, Nuclear Medicine and imaging ,Diffusion gradient ,business ,Nuclear medicine ,computer ,Free breathing ,Intravoxel incoherent motion - Abstract
Background Optimization of multi b-values MR protocol for fast intra-voxel incoherent motion imaging of the liver at 3.0 Tesla. Methods A comparison of four different acquisition protocols were carried out based on estimated IVIM (DSlow, DFast, and f) and ADC-parameters in 25 healthy volunteers. The effects of respiratory gating compared with free breathing acquisition then diffusion gradient scheme (simultaneous or sequential) and finally use of weighted averaging for different b-values were assessed. An optimization study based on Cramer-Rao lower bound theory was then performed to minimize the number of b-values required for a suitable quantification. The duration-optimized protocol was evaluated on 12 patients with chronic liver diseases Results No significant differences of IVIM parameters were observed between the assessed protocols. Only four b-values (0, 12, 82, and 1310 s.mm−2) were found mandatory to perform a suitable quantification of IVIM parameters. DSlow and DFast significantly decreased between nonadvanced and advanced fibrosis (P
- Published
- 2014
40. Long term results of liver transplantation for Wilson’s disease: Experience in France
- Author
-
Olivier Guillaud, Jérôme Dumortier, Rodolphe Sobesky, Dominique Debray, Philippe Wolf, Claire Vanlemmens, François Durand, Yvon Calmus, Christophe Duvoux, Sébastien Dharancy, Nassim Kamar, Karim Boudjema, Pierre Henri Bernard, Georges-Philippe Pageaux, Ephrem Salamé, Jean Gugenheim, Alain Lachaux, Dalila Habes, Sylvie Radenne, Jean Hardwigsen, Olivier Chazouillères, Jean-Marc Trocello, France Woimant, Philippe Ichai, Sophie Branchereau, Olivier Soubrane, Denis Castaing, Emmanuel Jacquemin, Didier Samuel, Jean-Charles Duclos-Vallée, service d'Hépato-gastro-entérologie, Hospices Civiles de Lyon-Hôpital Edouard Heriault, Service de Chirurgie Générale et Transplantation Multi Organes, CHU Strasbourg, Service d'hépatologie, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Jean Minjoz-Université de Franche-Comté (UFC), Service de Chirurgie Digestive, CHU Cochin [AP-HP], Pôle Recherche Clinique-Santé Publique [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri-Mondor, Hôpital Claude Hurriez, Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (... - 2019) (UNS), Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département Digestif, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital de l'Archet, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Hospices Civils de Lyon (HCL)-Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Service de Chirurgie, Assistance Publique - Hôpitaux de Marseille (APHM)-Hospices Civiles de Marseille-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION ), Service d'hépatologie [Saint-Antoine], CHU Saint-Antoine [APHP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Pierre et Marie Curie - Paris 6 (UPMC), Service de neurologie [Saint-Antoine], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Service de neurologie [Univ. Paris VII], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Centre National de Référence pour la maladie de Wilson (CNR wilson), CNR Wilson, Service de Neurologie, Hôpital Lariboisière, Pathogénèse et traitement de l'hépatite fulminante et du cancer du foie, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hépato-biliaire (CHB), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de chirurgie pédiatrique, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bicêtre, Service de chirurgie, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse, Service d'hépato-gastro-entérologie pédiatrique, Virus Hépatotropes et Cancers, Université Paris-Sud - Paris 11 (UP11)-IFR89-EA 3541, Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Assistance Publique - Hôpitaux de Marseille (APHM)-Hospices Civiles de Marseille-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Adolescent ,[SDV]Life Sciences [q-bio] ,Fulminant ,medicine.medical_treatment ,Renal function ,Liver transplantation ,Chronic liver disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Fulminant hepatic failure ,Hepatolenticular Degeneration ,Internal medicine ,medicine ,Humans ,Child ,Survival rate ,Aged ,Retrospective Studies ,Immunosuppression Therapy ,Hepatitis ,Hepatology ,business.industry ,Graft Survival ,Middle Aged ,medicine.disease ,Liver Transplantation ,3. Good health ,Surgery ,Wilson's disease ,Treatment Outcome ,Female ,030211 gastroenterology & hepatology ,France ,business ,030217 neurology & neurosurgery - Abstract
International audience; BACKGROUND & AIMS: Liver transplantation (LT) is the therapeutic option for severe complications of Wilson's disease (WD). We aimed to report on the long-term outcome of WD patients following LT. METHODS: The medical records of 121 French patients transplanted for WD between 1985 and 2009 were reviewed retrospectively. Seventy-five patients were adults (median age: 29 years, (18-66)) and 46 were children (median age: 14 years, (7-17)). The indication for LT was (1) fulminant/subfulminant hepatitis (n = 64, 53%), median age = 16 years (7-53), (2) decompensated cirrhosis (n = 50, 41%), median age = 31.5 years (12-66) or (3) severe neurological disease (n = 7, 6%), median age = 21.5 years (14.5-42). Median post-transplant follow-up was 72 months (0-23.5). RESULTS: Actuarial patient survival rates were 87% at 5, 10, and 15 years. Male gender, pre-transplant renal insufficiency, non elective procedure, and neurological indication were significantly associated with poorer survival rate. None of these factors remained statistically significant under multivariate analysis. In patients transplanted for hepatic indications, the prognosis was poorer in case of fulminant or subfulminant course, non elective procedure, pretransplant renal insufficiency and in patients transplanted before 2000. Multivariate analysis disclosed that only recent period of LT was associated with better prognosis. At last visit, the median calculated glomerular filtration rate was 93 ml/min (33-180); 11/93 patients (12%) had stage II renal insufficiency and none had stage III. CONCLUSIONS: Liver failure associated with WD is a rare indication for LT (\textless1%), which achieves an excellent long-term outcome, including renal function.
- Published
- 2014
41. Cardiovascular Risk 10 Years After Liver Transplant
- Author
-
Yves Bouffard, Jérôme Dumortier, L. Sebbag, Thomas Walter, Olivier Guillaud, and Olivier Boillot
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Cirrhosis ,Treatment outcome ,Cardiovascular risk factors ,Disease ,Risk Assessment ,Risk Factors ,Internal medicine ,Prevalence ,medicine ,Humans ,Aged ,Retrospective Studies ,Transplantation ,business.industry ,Age Factors ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Transplant Recipients ,Liver Transplantation ,Treatment Outcome ,Cardiovascular Diseases ,Coronary risk ,Cohort ,Female ,France ,business ,Risk assessment - Abstract
Objectives We sought to evaluate the frequency of cardiovascular risk factors in a cohort of patients 10 years after a liver transplant, and to assess their 10-year risk of fatal cardiovascular disease using Systematic COronary Risk Evaluation (SCORE) charts. Materials and methods Between January 1990 and June 1996, one hundred eighty-nine adults underwent a first liver transplant in our center. Fifty-nine patients (31%) died before reaching their tenth year, and 115 patients were available with complete clinical data at 10 years. Results The main indications for liver transplant were alcoholic (38%) and viral cirrhosis (40%). The median age of patients was 56 (range, 29-73 y), 80% were men, 23% were obese, 16% were active smokers, 18% were diabetic, 40% had hypercholesterolemia, and 77% had hypertension. Before the tenth year after transplant, 6 deaths were because of cardiovascular diseases, which represents the third cause of late death (> 1 year after liver transplant). After liver transplant, 5% of the surviving patients underwent ischemic cardiovascular events during the first decade. At a 10-year assessment, the median estimated 10-year risk of fatal cardiovascular disease was 1% (range, 0%-9%) and 10% of the patients had a high risk (ie, SCORE ≥ 5%). Conclusions Our results suggest that the frequency of cardiovascular events is relatively low after a liver transplant, even if most of the patients had 1 or more cardiovascular risk factors. Nevertheless, clinicians should perform a similar evaluation 15 or 20 years after the liver transplant because cardiovascular risk exponentially increases with age.
- Published
- 2014
42. Safety and efficacy of protease inhibitors to treat hepatitis C after liver transplantation: A multicenter experience
- Author
-
Olivier Guillaud, Georges-Philippe Pageaux, Si-nafaa Si-ahmed, S. Radenne, Jérôme Dumortier, Jean-Charles Duclos-Vallée, Vincent Leroy, Didier Samuel, Danielle Botta-Fridlund, Stéphanie Haim-Boukobza, Anne-Marie Roque-Afonso, Teresa Antonini, Bruno Roche, and Audrey Coilly
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Ribavirin ,Hepatitis C virus ,medicine.medical_treatment ,Hepatitis C ,Liver transplantation ,medicine.disease_cause ,medicine.disease ,Gastroenterology ,Telaprevir ,chemistry.chemical_compound ,Model for End-Stage Liver Disease ,chemistry ,Pegylated interferon ,Boceprevir ,Internal medicine ,Immunology ,medicine ,business ,medicine.drug - Abstract
Background & Aims Protease inhibitors (PI) with peginterferon/ribavirin have significantly improved SVR rates in HCV G1 patients. Their use to treat HCV recurrence after liver transplantation (LT) is a challenge. Methods This cohort study included 37 liver transplant recipients (male, 92%, age 57±11years), treated with boceprevir (n=18) or telaprevir (n=19). The indication for therapy was HCV recurrence (fibrosis stage ⩾F2 (n=31, 83%) or fibrosing cholestatic hepatitis (n=6, 16%). Results Eighteen patients were treatment-naive, five were relapsers and fourteen were non-responders to dual therapy after LT. Twenty-two patients received cyclosporine and fifteen tacrolimus. After 12weeks of PI therapy, a complete virological response was obtained in 89% of patients treated with boceprevir, and 58% with telaprevir ( p =0.06). The end of treatment virological response rate was 72% (13/18) in the boceprevir group and 40% (4/10) in the telaprevir group ( p =0.125). A sustained virological response 12weeks after treatment discontinuation was observed in 20% (1/5) and 71% (5/7) of patients in the telaprevir and boceprevir groups, respectively ( p =0.24). Treatment was discontinued in sixteen patients (treatment failures (n=11), adverse events (n=5)). Infections occurred in ten patients (27%), with three fatal outcomes (8%). The most common adverse effect was anemia (n=34, 92%), treated with erythropoietin and/or a ribavirin dose reduction; thirteen patients (35%) received red blood cell transfusions. The cyclosporine dose was reduced by 1.8±1.1-fold and 3.4±1.0-fold with boceprevir and telaprevir, respectively. The tacrolimus dose was reduced by 5.2±1.5-fold with boceprevir and 23.8±18.2-fold with telaprevir. Conclusions Our results suggest that triple therapy is effective in LT recipients, particularly those experiencing a severe recurrence. The occurrence of anemia and drug-drug interactions, and the risk of infections require close monitoring.
- Published
- 2014
43. Survival and prognostic factors after adjuvant
- Author
-
Jonathan, Olesinski, François, Mithieux, Olivier, Guillaud, Marie-Noëlle, Hilleret, Catherine, Lombard-Bohas, Luc, Henry, Olivier, Boillot, Thomas, Walter, Christian, Partensky, Pierre, Paliard, Pierre-Jean, Valette, Jean-Philippe, Vuillez, Françoise, Borson-Chazot, Jean-Yves, Scoazec, and Jérôme, Dumortier
- Subjects
Adult ,Aged, 80 and over ,Male ,Carcinoma, Hepatocellular ,Liver Neoplasms ,Middle Aged ,Prognosis ,Cohort Studies ,Iodine Radioisotopes ,Young Adult ,Ethiodized Oil ,Treatment Outcome ,Recurrence ,Humans ,Female ,Radiotherapy, Adjuvant ,Safety ,Aged ,Retrospective Studies - Abstract
Hepatocellular carcinoma (HCC) has high recurrence rate after curative treatment. The aim of the present study was to report our experience with adjuvant use ofAll patients treated withOne hundred and six patients were included. The median (range) follow-up was 6 years (0.3-22). Forty-three patients (41%) had cirrhosis. Recurrence-free survival rates at 1, 2, 5, 10, and 20 years were 73, 57, 40, 30, and 14%, respectively. Cirrhosis was an independent predictive factor of recurrence [RR = 1.18, 95% CI (1.11-3.02), p = 0.019]. Overall, survival rates at 1, 2, 5, 10, and 20 years were 90, 83, 59, 37, and 23%, respectively. Prognostic factors were recurrence [RR = 2.73, 95% CI (1.35-5.54); p = 0.005], age over 60 years (RR = 1.91, 95% CI [1.02-3.61]; p = 0.044), and tumor number over 3 [RR = 3.31, 95% CI (1.25-8.77); p = 0.016].Our results suggest that the effect of
- Published
- 2016
44. Tacrolimus exposure after liver transplantation for alcohol-related liver disease: Impact on complications
- Author
-
Olivier Guillaud, Olivier Boillot, Franck-Nicolas Bardou, Christine Chambon-Augoyard, Domitille Erard-Poinsot, Mélanie Vallin, Jérôme Dumortier, Elsa Thimonier, Université Claude Bernard Lyon 1 (UCBL), and Université de Lyon
- Subjects
Male ,Risk ,medicine.medical_specialty ,Skin Neoplasms ,Time Factors ,Drug-Related Side Effects and Adverse Reactions ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,Immunology ,030230 surgery ,Liver transplantation ,Gastroenterology ,Tacrolimus ,03 medical and health sciences ,Liver disease ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,Humans ,Immunology and Allergy ,Medicine ,Adverse effect ,Liver Diseases, Alcoholic ,Transplantation ,business.industry ,Middle Aged ,medicine.disease ,Liver Transplantation ,3. Good health ,stomatognathic diseases ,Immunosuppressive drug ,Cytomegalovirus Infections ,Hypertension ,Female ,France ,business ,Immunosuppressive Agents ,Dyslipidemia ,Follow-Up Studies ,030215 immunology - Abstract
Alcohol-related liver disease (ALD) is one of the main indications for liver transplantation (LT). For 20 years, tacrolimus (Tac) is the cornerstone immunosuppressive drug used after LT and is very efficient for the prevention of rejection. Nevertheless, the major drawback of long-term use of Tac is the risk for developing dose-dependent adverse effects.The aim of the present study was to assess the impact of Tac exposure (trough concentrations and concentration/dose (C/D) ratio) during the first year after LT, on short- and long-term complications after LT for ALD.All patients who underwent a LT for ALD at Lyon Edouard Herriot Hospital from October 1990 to September 2010, and who were treated with Tac for at least one year after LT, were analyzed.The study population consisted in 251 patients, mean age 53.4 ± 7.3 years, and followed during 11.6 ± 4.8 years. Post-LT complications included severe infectious events (44.6%), malignancies (41.4%), arterial hypertension (49.4%) dyslipidemia (44.2%), diabetes (18.7%) and cardiovascular events (15.5%). De novo hypertension, cardiovascular event, CMV infection, non-melanoma skin cancers and HCC recurrence after transplantation were significantly associated with higher Tac trough blood concentration. In addition, Tac fast-metabolizers (defined as C/D 1.8) had significantly more impaired renal function at 1, 5, and 10 years and more cardiovascular events, PTLD, diabetes and hypertension than slow-metabolizers.Our results strongly support that, in addition to blood trough concentrations, Tac metabolism, as estimated by the simple C/D ratio, could be an efficient parameter in daily practice to identify LT patients at risk to develop long term general complications of Tac.
- Published
- 2019
45. What's Hot in the Red Journal This Month
- Author
-
Astrid Herrero, François-René Pruvot, Jean-Yves Scoazec, Olivier Guillaud, Stéphanie Faure, Sébastien Dharancy, Amélie Cannesson, Olivier Boillot, Philippe Mathurin, Benjamin Rolland, Georges-Philippe Pageaux, Jérôme Dumortier, Guillaume Lassailly, and Hélène Rigole-Donnadieu
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Gastroenterology ,Medicine ,business - Published
- 2015
46. Conversion from twice daily tacrolimus to once daily tacrolimus in long-term stable liver transplant recipients: A single-center experience with 394 patients
- Author
-
Olivier Boillot, Olivier Guillaud, and Jérôme Dumortier
- Subjects
Transplantation ,medicine.medical_specialty ,Hepatology ,business.industry ,medicine.medical_treatment ,Urology ,Retrospective cohort study ,Liver transplantation ,Single Center ,Organ transplantation ,Tacrolimus ,Surgery ,Calcineurin ,Medicine ,Trough level ,business - Abstract
After organ transplantation, strategies for simplifying the therapeutic regimen may improve adherence and prevent acute organ rejection and/or late graft loss. The aim of the present study was to evaluate the safety and efficacy of conversion from a tacrolimus (TAC) twice daily (bid) formulation to a once daily (qd) formulation in a large cohort of adult liver transplantation (LT) patients. This retrospective, observational, single-center study included 394 LT patients with at least 6 months' posttransplant follow-up and no rejection episodes in the last 3 months. The conversion from a bid formulation to a qd formulation was based on a 1:1 ratio. The mean age at the time of conversion was 53 years (range = 18-72 years); 66% were men. The main indication for LT was alcoholic cirrhosis (41%). The mean conversion time after LT was 74 months (range = 6-218 months). The mean serum TAC trough level decreased after conversion (6.1 ± 5.6 ng/mL before conversion versus 4.9 ± 2.5 ng/mL after conversion, P
- Published
- 2013
47. Anti-viral triple therapy with telaprevir in haemodialysed HCV patients: Is it feasible?
- Author
-
Olivier Guillaud, Emmanuel Morelon, Jérôme Dumortier, Laurent Juillard, Vincent Leroy, Marie-Claude Gagnieu, and Bénédicte Janbon
- Subjects
Adult ,Male ,medicine.medical_specialty ,Antiviral Agents ,Gastroenterology ,End stage renal disease ,Telaprevir ,chemistry.chemical_compound ,Renal Dialysis ,Pegylated interferon ,Virology ,Boceprevir ,Internal medicine ,Ribavirin ,Humans ,Medicine ,Kidney transplantation ,business.industry ,Anemia ,Hepatitis C ,Hepatitis C, Chronic ,Middle Aged ,Viral Load ,medicine.disease ,Treatment Outcome ,Infectious Diseases ,chemistry ,Tolerability ,Kidney Failure, Chronic ,RNA, Viral ,Drug Therapy, Combination ,Female ,Interferons ,business ,Oligopeptides ,medicine.drug - Abstract
Introduction Chronic hepatitis C virus (HCV) infection is the most common chronic liver disease in patients with end stage renal disease (ESRD) and is well known as a frequent cause of mortality and graft loss among haemodialysed and kidney transplant patients. Up to now, there are no data on antiviral efficacy and tolerability of available protease inhibitors (telaprevir and boceprevir) in HCV infected haemodialysed patients. Methods We report 4 cases of HCV infected haemodialysed patients, who have not responded to a prior course of pegylated interferon (Peg-IFN) and ribavirin (RBV) and who were listed for kidney transplantation (KTx). These 4 patients received a second-line antiviral treatment with Peg-IFN, RBV and telaprevir. Results After 12 weeks of triple therapy, tolerability was acceptable and HCV-RNA became undetectable in 3/4 patients. Mild side-effects included anaemia leading to increasing the doses of erythropoietin (EPO). Dose of RBV ranged from 200 mg three times a week to 200 mg/day. Conclusion Triple therapy with a first generation protease inhibitor could be the new standard for the treatment of HCV patients with ESRD. This needs to be confirmed by larger series.
- Published
- 2013
48. Endoscopic treatment of sporadic small duodenal and ampullary neuroendocrine tumors
- Author
-
Christine Lefort, Thomas Walter, Jean-Alain Chayvialle, Jean-Christophe Saurin, Rodica Gincul, Bertrand Napoleon, Mustapha Adham, Jean Pialat, Thierry Ponchon, Olivier Guillaud, Vincent Lepilliez, Mihai Ciocirlan, Mathieu Pioche, and Jean-Yves Scoazec
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Neoplasm, Residual ,Endoscopic Mucosal Resection ,Common Bile Duct Neoplasms ,Lymph node metastasis ,Neuroendocrine tumors ,Gastroenterology ,Disease-Free Survival ,03 medical and health sciences ,0302 clinical medicine ,Duodenal Neoplasms ,Internal medicine ,Medicine ,Humans ,Endoscopic resection ,High surgical risk ,In patient ,Survival rate ,Aged ,Neoplasm Staging ,Aged, 80 and over ,business.industry ,Margins of Excision ,Middle Aged ,medicine.disease ,Optimal management ,Tumor Burden ,Survival Rate ,Neuroendocrine Tumors ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Feasibility Studies ,030211 gastroenterology & hepatology ,Female ,Neoplasm Grading ,Neoplasm Recurrence, Local ,business ,Endoscopic treatment - Abstract
Background and study aim: As duodenal neuroendocrine tumors (NETs) are rare, their optimal management has not been clearly established. The aim of this study was to evaluate the feasibility and outcome of endoscopic treatment of duodenal NETs. Patients and methods: We reviewed the files of all patients who underwent endoscopic resection of a sporadic duodenal or ampullary NET between 1996 and 2014 at two centers. Results: A total of 29 patients with 32 uT1N0M0 NETs Conclusions: Endoscopic treatment of small duodenal NETs was associated with significant morbidity, a difficulty in obtaining an R0 specimen, and the risk of lymph node metastasis. Nevertheless, it represents an interesting alternative in small grade 1 duodenal lesions and in patients at high surgical risk.
- Published
- 2016
49. Liver Transplantation in Wilson's Disease with Neurological Impairment: Evaluation in 4 Patients
- Author
-
Chloé Laurencin, Anne Sophie Brunet, Jérôme Dumortier, Laurence Lion-Francois, Stéphane Thobois, Jean Yves Mabrut, Rémi Dubois, France Woimant, Aurélia Poujois, Olivier Guillaud, Alain Lachaux, and Emmanuel Broussolle
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Neurological disability ,medicine.medical_treatment ,MEDLINE ,Liver transplantation ,03 medical and health sciences ,0302 clinical medicine ,Hepatolenticular Degeneration ,medicine ,Humans ,Dystonia ,business.industry ,Brain ,Middle Aged ,medicine.disease ,Liver Transplantation ,Copper Chelator ,Wilson's disease ,Neurology ,Physical therapy ,030211 gastroenterology & hepatology ,Female ,Neurology (clinical) ,business ,Cognition Disorders ,Neurological impairment ,030217 neurology & neurosurgery - Abstract
Background: The aim of this work is to report our early experiences about the benefits of liver transplantation (LT) in the treatment of persistent neurological symptoms in Wilson's disease (WD) patients. Methods: We describe our findings in 4 WD patients with neurological impairment or symptoms treated by LT: 2 patients had transplants due to worsening of neurological symptoms despite long-term appropriate medical treatment. The other 2 required LT because of symptoms associated with liver failure. Patients were evaluated using the modified Rankin scale and the Unified Wilson's Disease Rating Scale (UWDRS). Results: The 4 patients experienced neurological improvement after LT. The pre-LT Rankin score of the 2 patients transplanted due to neurological impairment was 4 compared to 3 and 2, respectively, post LT. The pre-LT Rankin scores of the 2 WD cases transplanted because of hepatic failure were 1 and 2, respectively, compared to 0 in both cases post LT. UWDRS score improved in 2 cases and remained stable in 1 less severely impaired case. Brain MRI abnormalities proved partially reversible in 3 patients and remained stable for 1 patient. Conclusions: These results suggest that LT could be envisaged for neurologically impaired WD patients.
- Published
- 2016
50. Sofosbuvir-based antiviral therapy in hepatitis C virus patients with severe renal failure
- Author
-
Jérôme Dumortier, François Bailly, Anaïs Vallet-Pichard, Marie-Claude Gagnieu, Sylvie Radenne, Olivier Guillaud, François Habersetzer, Jean-Didier Grangé, Nassim Kamar, Anne Minello, Georges-Philippe Pageaux, Laurent Alric, Vincent Leroy, Service d'hépatogastroentérologie [Hôpital Edouard Herriot, Hospices Civils de Lyon], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'hépatogastroentérologie [Hôpital de la Croix-Rousse, Hospices Civils de Lyon], Hôpital de la Croix-Rousse [CHU - HCL], Département d'Hépato-Gastroentérologie et de Transplantation Hépatique [CHU Saint-Eloi], Université de Montpellier (UM)-CHU Saint-Eloi, Département d'hépatologie [CHU Cochin], Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Interactions Virus-Hôte et Maladies Hépatiques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Virologie, Pôle Hépato-digestif, Les Hôpitaux Universitaires de Strasbourg (HUS), Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Laboratoire de Biochimie et Biologie Moléculaire, Lyon, France, CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'Hépato-Gastro-Entérologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Département de Néphrologie et Transplantation d'organes, Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Service de Medecine Interne, CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), Institut d'oncologie/développement Albert Bonniot de Grenoble (INSERM U823), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'hépato-gastroentérologie [CHU Grenoble Alpes], Centre Hospitalier Universitaire Grenoble Alpes (CHU Grenoble Alpes), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Université de Montpellier ( UM ) -CHU Saint-Eloi, Institut Pasteur [Paris]-CHU Cochin [AP-HP]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut de Virologie, Service d'hépato-gastro-entérologie [Hôpital Tenon], CHU Tenon [APHP], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Centre de Physiopathologie de Toulouse Purpan ( CPTP ), Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), CHU Toulouse [Toulouse]-Hôpital de Rangueil, Pharmacochimie et Pharmacologie Pour le Développement ( PHARMA-DEV ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique ( CNRS ), Institut d'oncologie/développement Albert Bonniot de Grenoble ( INSERM U823 ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-EFS-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Universitaire Grenoble Alpes ( CHU Grenoble Alpes ), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC), Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Département de Néphrologie et Transplantation d'organes [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service Médecine interne [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), and Centre Hospitalier Universitaire [Grenoble] (CHU)
- Subjects
[ SDV.MHEP.UN ] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Simeprevir ,Male ,medicine.medical_specialty ,Daclatasvir ,Sofosbuvir ,Hepatitis C virus ,medicine.medical_treatment ,030232 urology & nephrology ,Hepacivirus ,medicine.disease_cause ,Gastroenterology ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Antiviral Agents ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Pegylated interferon ,Internal medicine ,medicine ,Humans ,Renal Insufficiency ,Retrospective Studies ,Transplantation ,direct-acting antiviral ,tolerance ,treatment ,business.industry ,Ribavirin ,Hepatitis C ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,3. Good health ,haemodialysis ,chemistry ,Nephrology ,030211 gastroenterology & hepatology ,Female ,Hemodialysis ,hepatitis C ,business ,medicine.drug ,Glomerular Filtration Rate - Abstract
IF 4.470; International audience; BackgroundChronic hepatitis C virus (HCV) infection is the most common chronic liver disease in patients with end-stage renal disease (ESRD). Over the last few years, second-generation direct-acting antivirals have been revolutionary in the treatment of hepatitis C, and sofosbuvir (SOF) is the backbone of most modern treatment strategies. Since SOF is eliminated through the kidney, the aim of this multicentre retrospective study was to assess its antiviral efficacy and safety in HCV-infected patients with severe renal failure [including haemodialysis (HD) patients].MethodsFifty patients (36 males, mean age ± standard deviation 60.5 ± 7.5 years) with chronic HCV infection (G1: 28/56%, cirrhosis: 27/54%) and severe renal failure [i.e. MDRD estimated glomerular filtration rate (eGFR)
- Published
- 2016
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.