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Islet transplantation has been associated with better metabolic control and quality of life than insulin treatment alone, but direct evidence of its effect on hard clinical endpoints is scarce. We aimed to assess the effect of islet transplantation on patient-graft survival in kidney transplant recipients with type 1 diabetes.

El trasplante renal es el tratamiento de referencia de la insuficiencia renal terminal. Permite a la vez aumentar la esperanza de vida de los pacientes y mejorar su calidad. La tasa de complicaciones quirúrgicas ha disminuido progresivamente, al beneficiarse a la vez del perfeccionamiento de las técnicas quirúrgicas, pero también de los grandes avances de la inmunosupresión en el receptor, sin que se haya alcanzado una incidencia nula. Con una incidencia del 20%, el reconocimiento de estas complicaciones es particularmente importante para limitar su impacto y las consecuencias sobre la función y la supervivencia del trasplante renal, en particular en esta población frágil que suele presentar muchas enfermedades concurrentes. Las complicaciones se dividen en complicaciones precoces (plazo de aparición inferior a 1 mes después del trasplante) y tardías (plazo de aparición mayor a 1 mes después del trasplante). Pueden ser específicas (y, en tal caso, afectar al sistema urinario, vascular o linfático), pero también pueden ser comunes a todas las cirugías. En este artículo se presenta una revisión de las complicaciones a partir de los datos de la literatura.

L’objectif de notre étude a été d’analyser la morbidité et la mortalité ainsi que les résultats oncologiques des patients pris en charge chirurgicalement d’un cancer du rein avec extension dans la veine cave inférieure.

Kidney transplant survival is shortened by chronic rejection and side effects of standard immunosuppressive drugs. Cell-based immunotherapy with tolerogenic dendritic cells has long been recognized as a promising approach to reduce general immunosuppression. Published trials report the safety and the absence of therapy-related adverse reactions in patients treated with tolerogenic dendritic cells suffering from several inflammatory diseases. Here, we present the first phase I clinical trial results using human autologous tolerogenic dendritic cells (ATDC) in kidney transplantation. Eight patients received ATDC the day before transplantation in conjunction with standard steroids, mycophenolate mofetil and tacrolimus immunosuppression with an option to taper mycophenolate mofetil. ATDC preparations were manufactured in a Good Manufacturing Practice–compliant facility and fulfilled cell count, viability, purity and identity criteria for release. A control group of nine patients received the same standard immunosuppression, except basiliximab induction replaced ATDC therapy and mycophenolate tapering was not allowed. During the three-year follow-up, no deaths occurred and there was 100% graft survival. No significant increase of adverse events was associated with ATDC infusion. Episodes of rejection were observed in two patients from the ATDC group and one patient from the control group. However, all rejections were successfully treated by glucocorticoids. Mycophenolate was successfully reduced/stopped in five patients from the ATDC group, allowing tacrolimus monotherapy for two of them. Regarding immune monitoring, reduced CD8 T cell activation markers and increased Foxp3 expression were observed in the ATDC group. Thus, our results demonstrate ATDC administration safety in kidney-transplant recipients.

We characterize the boundedness properties on the spaces Lp(H2)of the maximal operator MBwhere Bis an arbitrary family of hyperbolic triangles stable by isometries.

The pathogenic role of terminally differentiated effector memory (TEMRA) CD8+T cells has been implicated in kidney transplant failure. The authors showed that humoral rejection of kidney allografts is associated with an accumulation of cytolytic TEMRA CD8+T cells in blood and in kidney graft biopsies. They demonstrated that TEMRA CD8+T cells from kidney transplant recipients exhibit enhanced migratory properties compared with effector memory CD8+T cells and that the chemokine CXCL12 not only promotes migration of TEMRA CD8+T cells toward nonlymphoid organs but also triggers a purinergic P2X4 receptor–dependent proinflammatory response. They also found that agents aimed at potential TEMRA CD8+T cell–specific targets inhibited the migration of TEMRA CD8+T cells from kidney transplant recipients, suggesting a possible strategy in treating kidney transplant failure.

The impact of pelvic irradiation on kidney transplant surgery is still unclear. The main objective of our study is to evaluate the feasibility and the safety of renal transplantation following pelvic radiotherapy.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2009.09.022 Byline: Ludovic Canaud, Kheira Hireche, Jean-Philippe Berthet, Pascal Branchereau, Charles Marty-Ane, Pierre Alric Abbreviations: ASA, American Society of Anesthesiologists; BT, brachiocephalic trunk; LCCA, left common carotid artery; LSA, left subclavian artery Abstract: The aim of this study was to assess the short- and midterm results after endovascular repair of the aortic arch in high-risk patients or after previous aortic surgery. Author Affiliation: Department of Vascular and Thoracic Surgery Arnaud de Villeneuve Hospital, Montpellier, France Article History: Received 13 March 2009; Revised 30 July 2009; Accepted 8 September 2009 Article Note: (footnote) Disclosures: None.

La greffe d’organes reste le traitement de dernier recours en cas de défaillance terminale d’un organe vital (poumon, foie, cœur, intestin) ou non vital (essentiellement le rein et le pancréas) pour lesquels il existe des traitements supplétifs. Elle reste la meilleure alternative que ce soit en termes de qualité et d’espérance de vie des patients, qu’en termes de dépense de santé publique. Ces dernières années, en France, chaque année près de 5900 patients bénéficient d’une transplantation d’organe, tandis que dans le même temps, environ 25 000 patients sont candidats. En moyenne, seulement 25 % environ des patients en attente de greffon sont transplantés chaque année. Cette situation a conduit à envisager de nouvelles populations de donneurs (décédés par mort encéphalique à critères élargis ou décédés après arrêt circulatoire). Ces organes sont sensibles aux conditions de conservation durant la phase d’ischémie qui impactent le devenir du greffon à court et à long terme. Cette évolution rend nécessaire une prise en charge plus adaptée du don d’organe et l’optimisation des conditions de conservation. Dans cette revue générale, les différents aspects de la conservation seront envisagés. Initialement en hypothermie à l’aide de solutions spécifiques, la conservation est en pleine évolution avec la perfusion oxygénée en hypothermie ou en normothermie permettant le maintien du métabolisme tissulaire. Ce temps de conservation est appelé à devenir un temps d’évaluation afin de pouvoir prédire la qualité de l’organe, de le réparer et d’optimiser le choix du receveur.

El trasplante de páncreas es actualmente el mejor tratamiento para la diabetes tipo 1, ya que mejora la supervivencia y la calidad de vida de los pacientes. La técnica quirúrgica en el trasplante de páncreas siempre se ha considerado una dificultad mayor que reduce la tasa de éxito del trasplante. Las complicaciones estaban relacionadas (y lo siguen estando) con el control de las secreciones exocrinas y la derivación venosa. El control de las secreciones exocrinas ha sido fuente de numerosas modificaciones técnicas debido a las graves complicaciones sépticas observadas en los primeros trasplantes efectuados por Lillehei. La técnica de páncreas segmentario con inyección de un adhesivo sintético (neopreno) disminuyó su gravedad, pero no la incidencia de fístulas pancreáticas, incluso cuando esta técnica se aplicó a un páncreas total. La introducción de la ciclosporina y la mejora en el tratamiento global de los diabéticos llevó al desarrollo del páncreas total, pero con derivación vesical para evitar la abertura de la cavidad abdominal y las complicaciones asociadas a la abertura intestinal. Los resultados mejoraron entonces de forma espectacular y fue posible volver a la técnica original, considerada más fisiológica, con el perfeccionamiento técnico de la derivación venosa hacia el sistema porta y no hacia la circulación sistémica a través de la vena cava inferior. El trasplante de páncreas como «órgano» no ha impedido el desarrollo del trasplante de islotes de Langerhans, cuyos resultados están mejorando claramente, pero cuyo futuro dependerá de las mejoras en las técnicas de preparación de los islotes, la minimización de los protocolos de inmunosupresión y la inducción de un estado de tolerabilidad a los islotes.

: The true incidence and natural history of renal artery aneurysm (RAA) remain unclear and still exists controversy over indication for treatment. Several techniques of conventional surgical reconstructions are described in literature, and more recently endovascular therapies have been reported with satisfying results and lower complication rate. This paper aims to investigate the outcomes of both endovascular and open repair of RAA achieved in a single institution involving 3 medical teams (urology, vascular surgery and neuroradiology).

Comprehensive evidence‐based guidelines for the practice of pancreas transplantation are yet to be established. The First World Consensus Conference on Pancreas Transplantation was convened for this purpose. A steering committee selected the participants and defined the questions to be addressed. A group of literature reviewers identified 597 studies to be included in summaries for guidelines production. Expert groups formulated the first draft of recommendations. Two rounds of discussion and voting occurred online, using the Delphi method (agreement rate ≥85%). After each round, critical responses of experts were reviewed, and recommendations were amended accordingly. Recommendations were finalized after live discussions. Each session was preceded by expert presentations and a summary of results of systematic literature review. Up to three voting rounds were allowed for each recommendation. To avoid potential conflicts of interest, deliberations on issues regarding the impact of pancreas transplantation on the management of diabetes were conducted by an independent jury. Recommendations on technical issues were determined by experts and validated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Quality of evidence was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) methodology. Each recommendation received a GRADE rating (Grading of Recommendations, Assessment, Development and Evaluations). This article presents the results of literature search and the methods used to provide evidence‐based guidelines for the practice of pancreas transplantation at the First World Consensus Conference on Pancreas Transplantation.

The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts’ recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas‐kidney transplantation (SPK) and pancreas transplantation alone can improve long‐term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long‐term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st‐world‐consensus‐conference‐of‐pancreas‐transplantation/246. This article described how pancreas transplantation impacts on life expectancy, quality of life, and course of diabetic complications based on the jury deliberations and expert recommendations from the First World Consensus Conference on Pancreas Transplantation.

The objective was to evaluate, by self-questionnaire, the feeling of participants in surgical training sessions on a live porcine model.

El objetivo de este artículo es ofrecer una visión actualizada sobre el lugar del autotrasplante renal en el tratamiento de las afecciones renales complejas como los aneurismas de la arteria renal, las estenosis extensas del uréter y algunos tumores renales bilaterales o que se desarrollan en un riñón único anatómico o funcional. Estas intervenciones se realizaban inicialmente por una doble vía de acceso, lumbar e ilíaca, o por una incisión medial xifopúbica. Las técnicas quirúrgicas han evolucionado mucho con la utilización de la laparoscopia y más recientemente con la asistencia robótica. Han permitido que se recobre el interés por este procedimiento al disminuir la morbilidad y la mortalidad a la vez que se mantiene el mismo nivel de seguridad que con la cirugía abierta. Sin embargo, esta cirugía debe quedar limitada a centros expertos que cuenten con cirujanos experimentados tanto en el trasplante renal como en la laparoscopia robótica.

Controlled donation after circulatory death (cDCD) is used for “extended criteria” donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain‐dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12–1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20–2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31–2.44). The 1‐year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol. A nationwide protocol for kidneys from controlled donation after circulatory death donors, characterized by systematic normothermic regional perfusion after death until kidney recovery, hypothermic machine perfusion until transplantation, and short cold ischemia times, is associated with significantly lower risk of delayed graft function and comparable 1‐year graft and patient survival rates, compared to kidneys from brain death donors.

Ileal ureter is a technique that consists of replacing the ureter by a segment of ileum to treat a long ureteric lesion or a lesion involving the lumbar ureter. The primary objective of our study was to assess the early perioperative morbidity of ileal ureter according to the Clavien–Dindo classification. The secondary objectives were to assess the morbidity and the medium- and long-term outcome of renal function.

The transplantation field requires the identification of specific risk factors associated with the level of immunosuppression. Here, our aim was to analyze the association between the number of circulating lymphocytes, monitored routinely by complete blood cell counts during outpatient visits, and patient and graft survival. In total, 2,999 kidney or combined kidney-pancreas recipients transplanted between 2000 and 2016, from two University hospitals, were enrolled. We investigated the etiological relationship between time-dependent lymphocyte count beyond one year after transplantation and patient and graft survival, viral infection and cancer risk using time-dependent multivariate Cox models. Model 1 considered kidney function at one year and model 2 as time-dependent variable. At the time of inclusion (one year after transplantation), 584 patients (19.4%) had deep lymphopenia (under 750 /mm3) and 1,072 (35.7%) had a normal count (over 1,500 /mm3). A patient with deep lymphopenia at a given follow-up time had significantly higher risks of graft failure, death and viral infection than comparable patients with a normal lymphocyte count at the same time point. Thus, after the first year of transplantation, the occurrence of deep lymphopenia within a patient’s follow-up is a risk factor for long-term graft failure, death and viral infection.

The choice of arterial ligation modality in the context of nephrectomies for living kidney donation poses a significant challenge. Due to the contraindication of Hem-O-Lock™ clips for this indication and the discontinuation of certain commercially available ligature devices suitable for this purpose, this issue remains particularly relevant. We report a serious adverse event with an arterial ligation device (Signia™ Stapling System, Medtronic, Dublin, Ireland). We observed intraoperative dislodgement of clips from the stump of the renal artery, resulting in significant bleeding and necessitating an emergency conversion to a subcostal approach. The experiential insights from each transplantation team regarding ligation modalities and the rigorous evaluation of medical devices are crucial imperative to ensure the donor's safety.

Currently, there are various types of patches available on the market for carotid endarterectomy (CEA) with enlargement angioplasty, prosthetic, and biological patches including bovine pericardial patches. Despite the increasing use of these biological patches, there are little data in the literature comparing the results of these 2 types of patch. The purpose of this study is to compare the short- and long-term results of bovine pericardium patches (BPPs) with prosthetic patches (PPs) in carotid thromboendarterectomy.

El hepatoblastoma es un tumor infrecuente del niño pequeño. Más del 90% de los casos se diagnostican en el niño menor de 5 años. Este tumor aparece en un hígado sano, en ausencia de cirrosis. Puede presentarse aislado o incluido en el marco de un síndrome de predisposición. Se sospecha rápidamente su diagnóstico ante la asociación de un tumor hepático y una concentración plasmática de alfa-feto-proteína elevada. Las pruebas de imagen permiten confirmar la localización intrahepática de la masa, descartar factores pronósticos locales, establecer la operabilidad del tumor e identificar localizaciones secundarias. La patología y los marcadores tisulares confirman el diagnóstico y permiten establecer criterios histológicos pronósticos. Se han identificado varias vías de señalización implicadas o no en el desarrollo del hígado, que permiten no sólo considerar nuevos objetivos terapéuticos, sino también establecer una clasificación de los hepatoblastomas. El tratamiento asocia quimioterapia con platinos y la exéresis quirúrgica del tumor, que en algunos casos puede requerir un trasplante hepático. El pronóstico de estos tumores es bueno, con una supervivencia global cercana al 80% a los 3 años, mayor en las formas de riesgo estándar que en las formas de alto riesgo caracterizadas por la presencia al menos de uno de los siguientes factores: presencia de metástasis, afectación difusa del hígado, concentración normal de alfa-feto-proteína, ruptura tumoral, invasión vascular o edad del niño superior o igual a 8 años. Sin embargo, la toxicidad auditiva del tratamiento con cisplatino sigue siendo un importante efecto secundario. Por lo tanto, el protocolo internacional de tratamiento PHITT (Pediatric Hepatic International Tumor Trial) recomienda una desescalada terapéutica en los tumores de bajo riesgo.

Proposer des recommandations pour la prise en charge du carcinome urothélial du patient transplanté rénal et du candidat à la transplantation rénale.

Le but du Comité de transplantation de l’association française d’urologie est de proposer des recommandations pour la prise en charge du carcinome à cellules rénales du rein natif (CCRN) chez le receveur d’un transplant rénal et du carcinome à cellules rénales (CCR) du patient malade rénal chronique terminal (MRCT) candidat à une transplantation rénale (TR).

Le but du Comité de transplantation de l’association française d’urologie est de proposer des recommandations pour l’usage des agents antiplaquettaires (AAP) et des anticoagulants d’action directe (AOD) chez les candidats à une transplantation rénale.

Proposer des recommandations pour la prise en charge des calculs urinaires chez le donneur ou le receveur d’un transplant rénal.

Proposer des recommandations pour la prise en charge des symptômes du bas appareil urinaire (SBAU) et de l’incontinence urinaire du patient transplanté rénal et du candidat à la transplantation rénale.

Proposer des recommandations chirurgicales pour la néphrectomie dans le cadre d’un don de rein pour transplantation.

Le but du Comité de transplantation de l’Association française d’urologie est de proposer des recommandations pour la prise en charge du cancer de la prostate localisé (CaP) chez le candidat ou le receveur d’un transplant rénal.

Il trapianto renale è oggi considerato il trattamento di scelta per l’insufficienza renale allo stadio terminale, nonostante le sue complicanze mediche e chirurgiche. Le principali complicanze chirurgiche sono urinarie. Sono la conseguenza di una scarsa qualità dell’uretere trapiantato e di un difetto di realizzazione dell’anastomosi urinaria. Sebbene abbiano scarso impatto sulla sopravvivenza a lungo termine del trapianto renale, sono responsabili di una pesante morbilità e di un costo aggiuntivo significativo. La loro incidenza è diminuita nel tempo a causa dei progressi nella conoscenza dei loro meccanismi e grazie al miglioramento delle tecniche chirurgiche. Quindi, l’incidenza attuale sembra stabilizzarsi nonostante il crescente ricorso a trapianti provenienti da donatori che rispondono a criteri cosiddetti estesi. Le complicanze urinarie possono verificarsi nel primo mese postoperatorio (fistole urinarie e ostruzioni ureterali da compressione estrinseca), ma anche a distanza dal trapianto (stenosi ureterale o reflusso vescicoureterale). La gestione di queste complicanze deve essere effettuata in centri “esperti”, al fine di preservare la funzionalità del trapianto. Questo articolo discute le complicanze urinarie del trapianto renale. Le fistole ureterali a esordio precoce, a nostro avviso, richiedono un trattamento chirurgico tempestivo, per evitare ulteriori complicanze tardive. Malgrado lo sviluppo dell’endourologia e della laparoscopia, le stenosi ureterali richiedono soluzioni chirurgiche convenzionali ancora in un certo numero di casi.

Chronic non cirrhotic extrahepatic portal vein obstruction (EHPVO) refers to the cavernomatous transformation of the portal vein (the so-called “portal cavernoma”) which occurs following acute thrombosis of the portal vein in the absence of recanalization. In adults, EHPVO mainly occurs following thrombosis, while in children it may be related to congenital malformations and/or neonatal umbilical venous catheterization. However, 50% of the cases of EHPVO remain idiopathic [1]. Risk factors and associated diseases should be investigated (chapter 1). Indeed, the presence of a thrombophilic alteration, in particular myeloproliferative neoplasm impacts prognosis and determine a causal treatment.

El trasplante de riñón es actualmente el mejor tratamiento para la insuficiencia renal terminal en cuanto a la supervivencia de los pacientes y la economía de la salud. Sin embargo, las complicaciones quirúrgicas no son infrecuentes, en particular las complicaciones vasculares, que son una causa potencial de fracaso precoz y deterioro funcional del injerto renal a largo plazo. El tratamiento endovascular es actualmente el tratamiento de primera línea para la estenosis de la arteria del injerto, que se produce en un plazo de 3 meses a 2 años después del trasplante, con una prevalencia muy variable, del 1 al 25%. Este tratamiento de primera línea está indicado a pesar de la falta de estudios aleatorizados que validen los resultados en comparación con la cirugía convencional.

Tacrolimus, the cornerstone immunosuppression after simultaneous pancreas and ‐kidney (SPK) transplantation, may exert nephrotoxic and diabetogenic effects. We therefore prospectively compared in an open‐label, randomized, monocentric, 5‐year follow‐up study, a tacrolimus‐ and a sirolimus‐based immunosuppressive regimen. Randomization using the block method allowing a blind allocation was done at the time of surgery. All patients received anti‐thymocyte globulin and maintenance therapy with tacrolimus, mycophenolate mofetil, and steroids. At month 3, tacrolimus was continued or replaced by sirolimus. The primary endpoint was kidney and pancreas graft survival at 1 and 5 years. Fifty patients were included in the final analysis in each group. At 1 year, differences for kidney and pancreas graft survival between sirolimus and tacrolimus were 0% (90% confidence interval −4.61% to 4.61%) and 6% (90% confidence interval −6.32% to 18.32%), respectively. There was no difference in renal and pancreas graft survival at 5 years. Thirty‐four patients (68%) in the sirolimus group vs three (6%) in the tacrolimus group needed definitive withdrawal of the study drug. Despite noninferiority of sirolimus compared to tacrolimus for kidney and pancreas graft survival, the high rate of sirolimus discontinuation does not favor its use as cornerstone therapy after SPK transplantation (NCT00693446). Sirolimus was not inferior to tacrolimus after simultaneous pancreas and kidney transplantation over 5 years of follow‐up despite a significant number of withdrawals.

La creciente escasez de injertos renales procedentes de donantes en muerte cerebral ha incitado la expansión del conjunto de donantes. Los donantes fallecidos tras paro circulatorio (DFPC) constituyen una fuente de injertos renales actualmente en pleno apogeo. El DFPC de categoría 2 es consecutivo a un paro cardíaco, generalmente extrahospitalario, en presencia de un testigo pero en el que la reanimación no permitirá la recuperación hemodinámica. El DFPC de categoría 3 es consecutivo a una limitación de las terapéuticas activas en reanimación. Este contexto de donante sólo se considera en el marco de protocolos nacionales establecidos, en el caso de Francia, por la Agence de la Biomédecine. Para el éxito de estos programas de trasplante es indispensable el estricto respeto de estos protocolos y de su calendario. El uso de la circulación regional normotérmica (CRN) precisa una formación específica y adecuada de los equipos y mejora los resultados de estos trasplantes. La instauración de la CRN se debe realizar lo más rápido posible tras la constatación del fallecimiento. La colocación quirúrgica de las cánulas ofrece seguridad, pero se debe realizar rápidamente con el fin de limitar la duración de la isquemia caliente funcional de los riñones. A continuación se realiza la extracción de los riñones en el quirófano tras la fase de CRN. Los riñones procedentes de DFPC se consideran como injertos procedentes de donantes denominados de «criterios ampliados» y deben perfundirse con la máquina de perfusión hipotérmica.

Le but de l’étude était d’évaluer le rôle pronostique de 4 solutions de conservation en transplantation hépatique (TH).

Host‐microbiota interactions can modulate the immune system both at local and systemic levels, with potential consequences for organ transplantation outcomes. In this study, we hypothesized that differences in the urinary microbiome following kidney transplantation would be associated with posttransplantation status: stable, minimally immunosuppressed, or tolerant. One hundred thirteen urine samples from stable (n = 51), minimally immunosuppressed (n = 19), and spontaneously tolerant (n = 16) patients, paired with age‐matched controls (n = 27) were profiled and compared to each other at a taxonomic level with special interest in the immunosuppressive regimen. All comparisons and correlations were adjusted on sex and time posttransplantation. Our results highlighted a unique and specific urinary microbiota associated with spontaneous tolerance characterized by a high diversity and a clear Proteobacteriaprofile. Finally, we report that this profile is (1) impacted by gender, (2) inversely correlated with immunosuppressive drugs (calcineurin inhibitors and mammalian target of rapamycin inhibitors), and (3) stable in time. Comparing taxonomic relative abundance and diversity of urinary microbiota between healthy volunteers and tolerant, stable, and minimally immunosuppressed kidney transplanted recipients, this study identifies and associates a specific Proteobacteriaprofile in the urine of kidney transplanted recipients with spontaneous tolerance.

IL‐7 is an important cytokine for T cell lymphopoiesis. Blockade of the IL‐7 signaling pathway has been shown to induce long‐term graft survival or graft tolerance in murine transplant models through inhibiting T cell homeostasis and favoring immunoregulation. In this study, we assessed for the first time the effects of a blocking anti‐human cluster of differentiation 127 (CD127) mAb administered in combination with low‐dose tacrolimus or thymoglobulin in a life‐sustaining kidney allograft model in baboons. Contrary to our expectation, the addition of an anti‐CD127 mAb to the treatment protocols did not prolong graft survival compared to low‐dose tacrolimus alone or thymoglobulin alone. Anti‐CD127 mAb administration led to full CD127 receptor occupancy during the follow‐up period. However, all treated animals lost their kidney graft between 1 week and 2 weeks after transplantation. Unlike in rodents, in nonhuman primates, anti‐CD127 mAb treatment does not decrease the absolute numbers of lymphocyte and lymphocyte subsets and does not effectively inhibit postdepletional T cell proliferation and homeostasis, suggesting that IL‐7 is not a limiting factor for T cell homeostasis in primates. Although targeting the IL‐7 signaling pathway can prolong graft survival and even induce graft tolerance in murine allograft models, this study shows that IL‐7 receptor blockade by a humanized anti‐CD127 monoclonal antibody fails to improve kidney allograft survival in nonhuman primates, indicating differences in IL‐7 biology between mouse and primates.

Introduction: The treatment of acute type B aortic dissection (ATBAD) is currently a challenge for vascular surgeons, because of the early morbidity and mortality rates and the high risk of late aortic events up to 50% at 5 years. This study presents the initial outcomes of ATBAD treatment using optimal medical therapy alone or combined with proximal entry tear stent-graft coverage. Additionally, it provides an analysis of the evolution of the aortic diameter and its clinical consequences during the chronic phase in each group.Materials and Methods: Conducted as a retrospective, single-center study, we enrolled all consecutive ATBAD patients (n=130) treated between 2008 and 2020. The primary analysis studies the entire patient cohort based on their initial management approach, namely, medical treatment alone for uncomplicated ATBAD (n=67) or combined with stent-graft entry tear coverage (n=63). We also conducted a subgroup analysis to investigate factors associated with disease progression in the medical management group.Results: Median follow-up was 29.5 months. During this time aneurysmal evolution was observed in: 42.4% of cases in the medical group compared with 21.8% in the stent-graft group, primarily affecting the thoracic aorta. The stent-graft group exhibited significant aortic remodeling, with a decrease in false lumen (FL) and thoracic aortic diameters. Initial aortic diameter ≥40 mm and FL ≥22 mm were independent risk factors for aneurysmal degeneration. Five-year survival was consistent at 76.1% in both groups.Conclusion: This study confirms the safety and efficacy of stent-graft entry tear coverage for ATBAD. Initial thoracic endovascular aortic repair (TEVAR) appears to reduce late aortic events by promoting aortic remodeling. Considering TEVAR’s safety and potential to prevent late aortic complications, it may be considered for uncomplicated ATBAD patients with an initial aortic diameter ≥40 mm or an FL ≥22 mm.Clinical Impact This study validates the efficacy and safety of using endovascular stent grafts to seal the proximal entry tear in cases of acute type B aortic dissections, compared to optimal medical therapy. Aortic remodelling significantly benefits from endovascular stent graft coverage of the proximal entry tear. Given the heightened risk of late aortic events observed in the medical therapy cohort, there appears to be a necessity for including endovascular interventions in the management of uncomplicated acute type B aortic dissections, particularly when aortic diameter is ≥40 mm and false lumen diameter is ≥22 mm.

Les innovations de l’imagerie diagnostique et de la radiologie interventionnelle ont permis l’optimisation de la prise en charge des patients atteints de pathologies aortiques. Au stade aigu, le risque vital est à considérer en priorité. La visualisation par scanner de toute l’aorte permet de décider de la meilleur option entre chirurgie et radiologie interventionnelle (fenestration, endoprothèse couverte, endoprothèse périphérique). Les algorithmes décisionnels, basés sur la compréhension des complications et risques évolutifs, ont été modifiés notamment pour les dissections aortiques. Au stade chronique, le médecin vasculaire et le généraliste doivent surveiller l’aorte et les facteurs de risques cardiovasculaires afin d’éviter les complications. L’IRM est alors indiquée.

L’utilisation de clips en polymère avec verrouillage (Weck* Hem-o-lok*, Teleflex Medical), est largement plébiscitée pour le contrôle des vaisseaux lors des interventions de néphrectomies coelioscopiques. Or ces clips sont contre-indiqués pour l’occlusion de l’artère lors des néphrectomies pour don de rein depuis 2005. Nous avons passé en revue les aspects réglementaires, les différentes méta-analyses et les recommandations publiées sur les différents systèmes pour ligaturer l’artère rénale au cours d’une néphrectomie coelioscopique pour don de rein. Nous avons également interrogé 31 centres français de transplantation rénale sur leur technique d’occlusion de l’artère rénale. Cette enquête a été comparée à celles précédemment publiées en Amérique du Nord et en Europe.

Après le développement de la néphrectomie laparoscopique de donneur vivant en 1995, puis l’évolution vers la laparoscopie robot-assistée en 1999, certaines équipes ont évalué l’apport de ces techniques en transplantation rénale.

objective: In France, kidney transplantations (KT) are mainly performed by urologist. Young urologists and residents are involved in this activity mostly performed in emergency.

La conservation hypothermique d’un organe réduit l’effet néfaste de l’ischémie. Bien qu’il soit admis de conserver les reins dans un liquide de conservation à 4°C, il n’existe pas d’étude à notre connaissance évaluant l’effet de l’hypothermie sur la température intra-tissulaire des reins. Cette étude sur modèle porcin vise à évaluer la température intra-tissulaire des reins pendant la conservation statique et la perfusion par machine hypothermique.

Devant un axe aortoiliaque très calcifié, la transplantation rénale avec implantation de l’artère sur prothèse vasculaire peut être proposée. Cette intervention rare est réputée difficile et morbide. L’objectif principal de ce travail a été d’évaluer la survie globale et spécifique du transplant implanté sur une prothèse vasculaire. L’objectif secondaire a été l’étude des complications et de l’évolution de la fonction rénale du transplant.

La técnica de trasplante de riñón no ha sufrido ningún cambio importante desde la descripción de Kuss en la década de 1950. En cambio, se ha adaptado a pacientes que hasta hace pocos años no eran elegibles, que tenían anomalías urológicas o que necesitaban un trasplante de otro órgano como el páncreas. Se han hecho necesarias adaptaciones técnicas. En este artículo, los autores describen la técnica llamada «básica» y luego todas las variantes según el receptor y sus antecedentes quirúrgicos y según el injerto y sus anomalías. En un momento en que los injertos son escasos y valiosos, es imprescindible conocer todas las posibilidades quirúrgicas para optimizar el uso de los órganos y evitar su pérdida.