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1. Influence of Anemia on Patient and Graft Survival After Renal Transplantation: results from the French DIVAT cohort

Author: I. Szwarc, Jean-Paul Soulillou, Christophe Legendre, Fanny Buron, Marc Ladrière, Lionel Rostaing, Emmanuel Morelon, Nassim Kamar, Henri Kreis, Valérie Garrigue, Pascal Daguin, Magali Giral, Michèle Kessler, Georges Mourad, Service de Néphrologie, Dialyse et Transplantation (Hôpital Lapeyronie [Montpellier] CHU), Hôpital Lapeyronie [Montpellier] (CHU), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Réseau CENTAURE [Nantes], Université de Nantes (UN)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*)-Centre hospitalier universitaire de Nantes (CHU Nantes), Université Paris Descartes - Paris 5 (UPD5), Service de Transplantation Rénale et de Soins Intensifs [Hôpital Necker - APHP], Université Paris Descartes - Paris 5 (UPD5)-PRES Sorbonne Paris Cité-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de transplantation rénale [CHRU Nancy], Centre Hospitalier Universitaire de Nancy (CHU Nancy), Département de Néphrologie, dialyse et transplantation [Hôpital de Rangueil, Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Department of Nephrology, Transplantation and Clinic Immunology [Hospices civils de Lyon], Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Le Bihan, Sylvie, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Réseau CENTAURE, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Néphrologie - Immunologie Clinique [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-PRES Université de Toulouse, Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)
Subjects: Adult, Male, medicine.medical_specialty, Anemia, Renal function, urologic and male genital diseases, Cohort Studies, Hemoglobins, Postoperative Complications, Internal medicine, hemic and lymphatic diseases, medicine, Humans, Renal Insufficiency, Chronic, Intensive care medicine, Aged, Retrospective Studies, Transplantation, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Hazard ratio, Graft Survival, Retrospective cohort study, Middle Aged, medicine.disease, Kidney Transplantation, female genital diseases and pregnancy complications, 3. Good health, surgical procedures, operative, Cohort, Female, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Kidney disease, Cohort study
Abstract: International audience; Background and Objectives. Contradictory results are reported concerning the influence of anemia on patient and graft survival after renal transplantation. Assuming that level of renal function and anemia are strongly correlated, posttransplantation anemia (PTA) may have a different impact depending on the stage of chronic kidney disease (CKD).Methods. This study is a retrospective multicenter analysis using the DIVAT French database. The prevalence, risk factors, and influence of 12-month PTA (World Health Organization's definition) on patient and graft survival were analyzed according to CKD stage (Modification of Diet in Renal Disease equation).Results. The prevalence of 12-month PTA in our cohort of 4217 patients was 41.1%. Multivariate analysis demonstrated that worse renal function, donor age, period of transplantation, induction therapy, and mTOR inhibitors were significant risk factors for PTA. Posttransplantation anemia was a significant risk factor for all-cause mortality in CKD stages 1 to 2T (hazard ratio, 2.39; 95% confidence interval, 1.99Y4.40) and 3T (hazard ratio, 1.52; 95% confidence interval, 1.08Y2.15) and for cardiovascular mortality only on CKD stages 1T and 2T. In renal transplant recipients with CKD stages 4 to 5T, patient and graft survival were similar in patients with versus without anemia. Graft survival was not influenced by PTA, whatever the CKD stage.Conclusions. Posttransplantation anemia is associated with decreased patient survival only in CKD stages 1T, 2T, and 3T. Posttransplantation anemia has no influence on graft survival regardless of CKD stage.
Published: 2014
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2. Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes

Author: Simon, Ville, Marine, Lorent, Clarisse, Kerleau, Anders, Asberg, Christophe, Legendre, Emmanuel, Morelon, Fanny, Buron, Valérie, Garrigue, Moglie, Le Quintrec, Sophie, Girerd, Marc, Ladrière, Laetitia, Albano, Antoine, Sicard, Denis, Glotz, Carmen, Lefaucheur, Julien, Branchereau, David, Jacobi, Magali, Giral, Etienne, Sicard, Institut de Transplantation et de Recherche en Transplantation [CHU Nantes] (ITERT), Centre hospitalier universitaire de Nantes (CHU Nantes), European cohort for Kidney Transplantation Epidemiology (EKiTE), Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Oslo University Hospital [Oslo], Réseau CENTAURE, Service Néphrologie et transplantation rénale Adultes [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Lapeyronie [Montpellier] (CHU), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département de Néphrologie - Hôpital Pasteur [Nice], Hôpital Pasteur [Nice] (CHU), Service d'Urologie [CHU Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), and Salvy-Córdoba, Nathalie
Subjects: Graft Rejection, Male, Time Factors, Databases, Factual, Epidemiology, Kidney, Critical Care and Intensive Care Medicine, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Organ transplantation, MESH: Kidney Transplantation, MESH: Delayed Graft Function, Kidney transplantation / nephrology, MESH: Incidence, Prospective Studies, Kidney transplantation, MESH: Aged, MESH: Middle Aged, Norway, Ischemia-reperfusion, Incidence, Graft Survival, Hazard ratio, Middle Aged, Constriction, medicine.anatomical_structure, Nephrology, Cardiology, Female, France, Adult, medicine.medical_specialty, MESH: Circadian Clocks, MESH: Graft Survival, Delayed Graft Function, MESH: Graft Rejection, Cadaver organ transplantation, MESH: Norway, Circadian Clocks, Internal medicine, medicine, Humans, Circadian rhythm, Aged, Transplantation, MESH: Humans, business.industry, MESH: Time Factors, MESH: Adult, Original Articles, Odds ratio, medicine.disease, Organ transplant, MESH: Databases, Factual, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Kidney Transplantation, MESH: Male, MESH: Prospective Studies, Confidence interval, MESH: France, business, MESH: Female
Abstract: International audience; Background and objectives The fact that metabolism and immune function are regulated by an endogenous molecular clock that generates circadian rhythms suggests that the magnitude of ischemia reperfusion, and subsequent inflammation on kidney transplantation, could be affected by the time of the day. Design, setting, participants, & measurements We evaluated 5026 individuals who received their first kidney transplant from deceased heart-beating donors. In a cause-specific multivariable analysis, we compared delayed graft function and graft survival according to the time of kidney clamping and declamping. Participants were divided into those clamped between midnight and noon ( ante meridiem [ am ] clamping group; 65%) or clamped between noon and midnight ( post meridiem [ pm ] clamping group; 35%), and, similarly, those who underwent am declamping (25%) or pm declamping (75%). Results Delayed graft function occurred among 550 participants (27%) with am clamping and 339 (34%) with pm clamping (adjusted odds ratio, 0.81; 95% confidence interval, 0.67 to 0.98; P =0.03). No significant association was observed between clamping time and overall death-censored graft survival (hazard ratio, 0.92; 95% confidence interval, 0.77 to 1.10; P =0.37). No significant association of declamping time with delayed graft function or graft survival was observed. Conclusions Clamping between midnight and noon was associated with a lower incidence of delayed graft function, whereas declamping time was not associated with kidney graft outcomes.
Published: 2021
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3. Cohort study: 'Outcomes of kidney transplantation in patients with prosthetic heart valves'

Author: Ouahmi, Hajar, Moceri, Pamela, Zorzi, Kevin, Albano, Laetitia, Durand, Matthieu, Karimi, Fatimaezzahra, Morelon, Emmanuel, Buron, Fanny, Le Quintrec, Moglie, Pernin, Vincent, Ladriere, Marc, Girerd, Sophie, Dantal, Jacques, Loupy, Alexandre, Couzi, Lionel, Ferrari, Emile, Esnault, Vincent, Merville, Pierre, Legendre, Christophe, Giral, Magali, Sicard, Antoine, Badet, Lionel, Brunet, Maria, Cahen, Rémi, Codas, Ricardo, Daoud, Sameh, Dubois, Valérie, Fournie, Coralie, Grégoire, Arnaud, Koenig, Alice, Lévi, Charlène, Pouteil‐Noble, Claire, Rabeyrin, Maud, Rimmelé, Thomas, Thaunat, Olivier, Abdo, Nicolas, Delmas, Sylvie, Perrochia, Hélène, Serre, Jean‐Emmanuel, Szwarc, Ilan, Aarnink, Alice, Alla, Asma, Eschwege, Pascal, Frimat, Luc, Hubert, Jacques, Kormann, Raphaël, Lagrange, François, Laurain, Emmanuelle, Lecoanet, Pierre, Lemelle, Jean‐Louis, Mannuguerra, Anthony, Mazeaud, Charles, Peres, Michael, Blancho, Gilles, Branchereau, Julien, Cantarovich, Diego, Chapelet, Agnès, Deltombe, Clément, Figueres, Lucile, Garandeau, Claire, Gourraud‐Vercel, Caroline, Hourmant, Maryvonne, Karam, Georges, Kerleau, Clarisse, Meurette, Aurélie, Ville, Simon, Kandell, Christine, Moreau, Anne, Renaudin, Karine, Cesbron, Anne, Delbos, Florent, Walencik, Alexandre, Devis, Anne, Chevallier, Daniel, Tibi, Brannwel, Ahallal, Younes, Amrouche, Lucile, Anglicheau, Dany, Aubert, Olivier, Bererhi, Lynda, Martinez, Frank, Sberro‐Soussan, Rébecca, Scemla, Anne, Tinel, Claire, Zuber, Julien, Glotz, Denis, Lefaucheur, Carmen, Université Côte d'Azur - Faculté de Médecine (UCA Faculté Médecine), Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice (CHU Nice), CIC CHU Lyon (inserm), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Réseau CENTAURE, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), CHU Bordeaux [Bordeaux], Immunology from Concept and Experiments to Translation (ImmunoConcept), Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de PhysioMédecine Moléculaire (LP2M), 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)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), DIVAT Consortium: Lionel Badet, Maria Brunet, Fanny Buron, Rémi Cahen, Ricardo Codas, Sameh Daoud, Valérie Dubois, Coralie Fournie, Arnaud Grégoire, Alice Koenig, Charlène Lévi, Emmanuel Morelon, Claire Pouteil-Noble, Maud Rabeyrin, Thomas Rimmelé, Olivier Thaunat, Nicolas Abdo, Sylvie Delmas, Moglie Le Quintrec, Vincent Pernin, Hélène Perrochia, Jean-Emmanuel Serre, Ilan Szwarc, Alice Aarnink, Asma Alla, Pascal Eschwege, Luc Frimat, Sophie Girerd, Jacques Hubert, Raphaël Kormann, Marc Ladriere, François Lagrange, Emmanuelle Laurain, Pierre Lecoanet, Jean-Louis Lemelle, Anthony Mannuguerra, Charles Mazeaud, Michael Peres, Gilles Blancho, Julien Branchereau, Diego Cantarovich, Agnès Chapelet, Jacques Dantal, Clément Deltombe, Lucile Figueres, Claire Garandeau, Magali Giral, Caroline Gourraud-Vercel, Maryvonne Hourmant, Georges Karam, Clarisse Kerleau, Aurélie Meurette, Simon Ville, Christine Kandell, Anne Moreau, Karine Renaudin, Anne Cesbron, Florent Delbos, Alexandre Walencik, Anne Devis, Laetitia Albano, Fatimaezzahra Karimi, Antoine Sicard, Hajar Ouahmi, Daniel Chevallier, Brannwel Tibi, Matthieu Durand, Younes Ahallal, Lucile Amrouche, Dany Anglicheau, Olivier Aubert, Lynda Bererhi, Christophe Legendre, Alexandre Loupy, Frank Martinez, Rébecca Sberro-Soussan, Anne Scemla, Claire Tinel, Julien Zuber, Denis Glotz, Carmen Lefaucheur, and Retiveau, Nolwenn
Subjects: medicine.medical_specialty, medicine.medical_treatment, MESH: Heart Valves, Postoperative Hemorrhage, MESH: Kidney Transplantation, Cohort Studies, Diabetes mellitus, Internal medicine, Biological heart valve, Medicine, Endocarditis, Humans, Prospective Studies, MESH: Cohort Studies, Kidney transplantation, Dialysis, Retrospective Studies, Kidney, Transplantation, MESH: Humans, business.industry, Cardiac valve replacement, End-stage kidney disease, MESH: Postoperative Hemorrhage, MESH: Retrospective Studies, medicine.disease, Heart Valves, Kidney Transplantation, MESH: Prospective Studies, [SDV.TOX] Life Sciences [q-bio]/Toxicology, medicine.anatomical_structure, Prosthetic heart valve, Mechanical heart valve, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Cohort, Cardiology, business, Cohort study
Abstract: Main problem The number of kidney transplant candidates with prosthetic heart valves (PHVs) is increasing. Yet, outcomes of kidney transplantation in these patients are still unclear. This is the first report of post-transplant outcomes in patients with PHVs at time of kidney transplantation. Methods We conducted a matched cohort study among recipients from the multicentric and prospective DIVAT cohort to compare outcomes in patients with left-sided PHVs at time of transplantation and a group of recipients without PHV matched according to age, dialysis time, initial disease, pre-transplant DSA, diabetes and cardiovascular events. Results Of 23018 patients, 92 patients with PHVs were included and compared to 276 patients without PHV. Delayed graft function and post-operative bleeding occurred more frequently in patients with PHVs. Kidney graft survival was similar between groups. 5-year overall survival was 68.5 % in patients with PHV versus 87.9 % in patients without PHV (HR, 2.72[1.57-4.70], p=0.0004). Deaths from infection, endocarditis and bleeding were more frequent in patients with PHV. Mechanical valves, but not bioprosthetic valves, were independent risk factors for mortality (HR, 2.89[1.68-4.97], p=0.0001). Conclusions Patients with PHV have high mortality rates after kidney transplantation. These data suggest that mechanical valves, but not biological valves, increase risks of post-transplant mortality.
Published: 2021
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4. Ribavirin for Hepatitis E Virus Infection After Organ Transplantation

Author: Kamar, Nassim, Legrand-Abravanel, Florence, Behrendt, Patrick, Hofmann, Jörg, Pageaux, Georges Phillippe, Barbet, Christelle, Moal, Valerie, Couzi, Lionel, Horvatits, Thomas, de Man, Robert, Cassuto, Elisabeth, Elsharkawy, Ahmed, Riezebos-Brilman, Annelies, Scemla, Anne, Hillaire, Sophie, Donnelly, Mhairi, Radenne, Sylvie, Sayegh, Johnny, Garrouste, Cyril, Dumortier, Jérôme, Glowaki, François, Matignon, Marie, Coilly, Audrey, Figueres, Lucile, Mousson, Christiane, Minello, Anne, Dharancy, Sébastien, Rerolle, Jean Philippe, Lebray, Pascal, Etienne, Isabelle, Perrin, Peggy, Choi, Mira, Olivier, Marion, Izopet, Jacques, Bellière, J, Cointault, O., del Bello, Arnaud, Espostio, L, Hebral, A, Lavayssière, L, Lhomme, S, Mansuy, J, Wedemeyer, H, Nickel, P, Bismuth, M., Stefic, K, Buchler, M., D’alteroche, L, Colson, P., Bufton, S, Ramière, C, Trimoulet, P., Pischke, S, Todesco, E, Sberro Soussan, R, Legendre, C, Mallet, V., Johannessen, I, Simpson, K, Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, 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), CHU Toulouse [Toulouse], Université Fédérale Toulouse Midi-Pyrénées, Hannover Medical School [Hannover] (MHH), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Département d'Hépato-Gastroentérologie et de Transplantation Hépatique [CHU Saint-Eloi], Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM), Service de néphrologie et immunologie clinique [CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Assistance Publique - Hôpitaux de Marseille (APHM), Institut Hospitalier Universitaire Méditerranée Infection (IHU Marseille), CHU Bordeaux [Bordeaux], Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Centre Hospitalier Universitaire de Nice (CHU Nice), University Hospitals Birmingham [Birmingham, Royaume-Uni], University Medical Center Groningen [Groningen] (UMCG), Réseau CENTAURE, Hôpital Foch [Suresnes], Royal Infirmary of Edinburgh, Service d'Hépatologie [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), CHU Clermont-Ferrand, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Paul Brousse, Centre hospitalier universitaire de Nantes (CHU Nantes), Service de néphrologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service d'Hépato-Gastro-Entérologie (CHU de Dijon), Hôpital Claude Huriez [Lille], CHU Lille, Service de Néphrologie, Dialyse, Transplantations [CHU Limoges], CHU Limoges, Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Rouen, Normandie Université (NU), CHU Strasbourg, Département de Néphrologie et Transplantation d'organes [Toulouse], Service de virologie et d'immunologie biologique, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Gastroenterology & Hepatology, CHU Toulouse [Toulouse]-Hôpital de Rangueil, Université de Montpellier (UM)-CHU Saint-Eloi, Service de néphrologie et immunologie clinique [CHRU Tours] (EA4245 UT), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours, Département de Néphrologie et Transplantation d'organes, Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Service de néphrologie et immunologie clinique, 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), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Toulouse (UT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), 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), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10
Subjects: 0301 basic medicine, MESH: Antiviral Agents / therapeutic use, Sofosbuvir, viruses, medicine.disease_cause, Gastroenterology, THERAPY, Organ transplantation, Hepatitis E virus / genetics, Hepatitis E / drug therapy, Humans, chemistry.chemical_compound, 0302 clinical medicine, Hepatitis E virus, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine, MUTATION, MESH: Hepatitis E* / drug therapy, POLYMERASE, organ transplantation, virus diseases, MESH: Ribavirin / therapeutic use, Anemia, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Hepatitis E, anemia, 3. Good health, PREDICTS, Sustained virological response, Infectious Diseases, MESH: RNA, Viral, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, RNA, Viral, 030211 gastroenterology & hepatology, sustained virological response, medicine.drug, Microbiology (medical), medicine.medical_specialty, ribavirin, MESH: Organ Transplantation / adverse effects, RNA, Viral Retrospective Studies, Ribavirin / therapeutic use, Alpha interferon, MESH: Organ Transplantation* / adverse effects, hepatitis E virus, Antiviral Agents, Virus, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Internal medicine, Ribavirin, Retrospective Studies, MESH: Hepatitis E virus* / genetics, MESH: Humans, business.industry, Retrospective cohort study, MESH: Retrospective Studies, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, IN-VITRO, medicine.disease, digestive system diseases, 030104 developmental biology, chemistry, SOFOSBUVIR, HEV, REPLICATION, INTERFERON-ALPHA, business
Abstract: Background Ribavirin is currently recommended for treating chronic hepatitis E virus (HEV) infection. This retrospective European multicenter study aimed to assess the sustained virological response (SVR) in a large cohort of solid organ transplant (SOT) recipients with chronic HEV infection treated with ribavirin monotherapy (N = 255), to identify the predictive factors for SVR, and to evaluate the impact of HEV RNA mutations on virological response. Methods Data from 255 SOT recipients with chronic HEV infection from 30 European centers were analyzed. Ribavirin was given at the median dose of 600 (range, 29–1200) mg/day (mean, 8.6 ± 3.6 mg/kg/day) for a median duration of 3 (range, 0.25–18) months. Results After a first course of ribavirin, the SVR rate was 81.2%. It increased to 89.8% when some patients were offered a second course of ribavirin. An increased lymphocyte count at the initiation of therapy was a predictive factor for SVR, while poor hematological tolerance of ribavirin requiring its dose reduction (28%) and blood transfusion (15.7%) were associated with more relapse after ribavirin cessation. Pretreatment HEV polymerase mutations and de novo mutations under ribavirin did not have a negative impact on HEV clearance. Anemia was the main adverse event. Conclusions This large-scale retrospective study confirms that ribavirin is highly efficient for treating chronic HEV infection in SOT recipients and shows that the predominant HEV RNA polymerase mutations found in this study do not affect the rate of HEV clearance. This large-scale retrospective study that included 255 solid organ transplant recipients confirms that ribavirin is highly efficient for treating chronic hepatitis E virus (HEV) infection and shows that HEV RNA polymerase mutations do not play a role in HEV clearance.
Published: 2020
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5. Covariates adjustment questioned conclusions of predictive analyses: an illustration with the Kidney Donor Risk Index

Author: Etienne Dantan, Yohann Foucher, Magali Giral, Florent Le Borgne, Anne-Hélène Querard, Angelina Dion, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), IDBC/A2com [Pace, France], Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Réseau CENTAURE, CHD Vendée - Hôpital Les Oudairies [La Roche sur Yon], Centre hospitalier universitaire de Nantes (CHU Nantes), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), and Dantan, Etienne
Subjects: Adult, Male, medicine.medical_specialty, Graft failure, Epidemiology, Risk Assessment, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Risk index, Mean Survival Time, Internal medicine, Covariate, medicine, Humans, 030212 general & internal medicine, Registries, Kidney transplantation, ComputingMilieux_MISCELLANEOUS, Aged, Kidney, [STAT.ME] Statistics [stat]/Methodology [stat.ME], business.industry, Graft Survival, Reproducibility of Results, Middle Aged, medicine.disease, Kidney Transplantation, Confidence interval, Tissue Donors, medicine.anatomical_structure, ROC Curve, Graft survival, Female, France, business, [STAT.ME]Statistics [stat]/Methodology [stat.ME], 030217 neurology & neurosurgery
Abstract: Objectives We aimed to illustrate that considering covariates can lead to meaningful interpretation of the discriminative capacities of a prognostic marker. For this, we evaluated the ability of the Kidney Donor Risk Index (KDRI) to discriminate kidney graft failure risk. Study design and setting From 4114 French patients, we estimated the adjusted area under the time-dependent ROC curve by standardizing the marker and weighting the observations. By weighting the contributions, we also studied the impact of KDRI-based transplantations on the patient and graft survival. Results The covariate-adjusted AUC varied from 55% (95% confidence interval [CI]: 51–60%) for a prognostic up to 1 year post-transplantation to 56% (95% CI: 52–59%) up to 7 years. The Restricted Mean Survival Time (RMST) was 6.44 years for high-quality graft recipients (95% CI: 6.30–6.56) and would have been 6.31 years (95% CI: 6.13–6.46) if they had medium-quality transplants. The RMST was 5.10 years for low-quality graft recipients (95% CI: 4.90–5.31) and would have been 5.52 years (95% CI: 5.17–5.83) if they had medium-quality transplants. Conclusion We demonstrated that the KDRI discriminative capacities were mainly explained by the recipient characteristics. We also showed that counterfactual estimations, often used in causal studies, are also interesting in predictive studies, especially regarding the new available methods.
Published: 2020
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6. Comparison of longitudinal quality of life outcomes in preemptive and dialyzed patients on waiting list for kidney transplantation

Author: Magali Giral, Myriam Blanchin, Jean-Benoit Hardouin, Emmanuel Morelon, Line Auneau-Enjalbert, Aurélie Meurette, Véronique Sébille, Elisabeth Cassuto, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Plateforme de Méthodologie et Biostatistique, Direction de la Recherche [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Réseau CENTAURE [Nantes], Université de Nantes (UN)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*)-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Transplantation, Néphrologie et Immunologie Clinique [Hôpital Edouard Herriot, HCL], Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Département de Néphrologie - Hôpital Pasteur [Nice], Hôpital Pasteur [Nice] (CHU), Biostatistique, Recherche Clinique et Mesures Subjectives en Santé, Université de Nantes (UN), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*), and Le Bihan, Sylvie
Subjects: Adult, Male, Quality of life, Pediatrics, medicine.medical_specialty, Psychometrics, Waiting Lists, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Population, Emotions, Waiting list, Peritoneal dialysis, Kidney transplantation, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Surveys and Questionnaires, Medicine, Humans, Renal replacement therapy, education, Dialysis, education.field_of_study, business.industry, 030503 health policy & services, Public Health, Environmental and Occupational Health, Preemptive, Middle Aged, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Transplantation, 030220 oncology & carcinogenesis, Female, Hemodialysis, 0305 other medical science, business, Peritoneal Dialysis
Abstract: International audience; PURPOSE:The waiting list period for kidney transplantation can be lengthy and associated with a deteriorated health-related quality of life (HRQoL). It might also be experienced differently depending on the experience of renal replacement therapy (preemptive or dialyzed patients), and the type of dialysis. The main objective of this study is to measure and compare HRQoL changes in preemptive, hemodialysis (HD), and peritoneal dialysis (PD) patients during the waiting list period for kidney transplantation.METHODS:A sample of adult patients on kidney transplant waiting list from three French University Hospital centers was recruited. HRQoL was measured using the SF-36 and a specific questionnaire (ReTransQol), which were collected every 6 months before transplantation in preemptive, HD, and PD patients. Mixed-effects models taking into account time and possible confounding factors were used to compare HRQoL changes between the three groups.RESULTS:Preemptive (n = 230), HD (n = 177), and PD patients (n = 39) were enrolled. The renal replacement therapy modalities, time (time on waiting list and age at registration), and gender were associated with HRQoL changes. The HD and PD patients had a significantly lower perceived HRQoL on Role Physical, Social Functioning, and Role Emotional dimensions than the preemptive patients, with lower scores for PD compared to HD patients. The HRQoL scores of all patients were lower compared to the French general population for all dimensions.CONCLUSIONS:A better understanding of pre-transplantation patients' experience can help improving patient care with adapted educational programs and psychological support depending on the type of renal replacement therapy.
Published: 2019
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7. The 1-year Renal Biopsy Index: a scoring system to drive biopsy indication at 1-year post-kidney transplantation

Author: Dany Anglicheau, Grégoire Couvrat-Desvergnes, Magali Giral, Chloé Paul, Emmanuel Morelon, Sophie Brouard, Maarten Naesens, Karine Renaudin, Redmer Luning, Alexandre Huneau, Etienne Dantan, Yohann Foucher, Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Immunoregulation And Immunointervention in Transplantation and Autoimmunity (Team 4 - U1064 Inserm - CRTI), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Anatomo-cyto-pathologie [Hôtel-Dieu, Nantes], Hôtel-Dieu de Nantes, Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), University Hospitals Leuven [Leuven], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Réseau CENTAURE, Department of Nephrology, Transplantation and Clinic Immunology [Hospices civils de Lyon], Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Service de Néphrologie, dialyse, transplantation [CHD Vendée] (Site de La Roche sur Yon), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Centre hospitalier universitaire de Nantes (CHU Nantes), The Roche Pharma, Novartis, and Sanoﬁ laboratories ., ANR-11-JSV1-0008,CSM (Composite Surrogate Marker),Construction d'un marqueur composite de substitution de la survie à long terme : application à la transplantation rénale(2011), Le Bihan, Sylvie, Jeunes Chercheuses et Jeunes Chercheurs - Construction d'un marqueur composite de substitution de la survie à long terme : application à la transplantation rénale - - CSM (Composite Surrogate Marker)2011 - ANR-11-JSV1-0008 - JCJC - VALID, Kidney Transplant Center [CHU Necker], Université Paris Descartes - Paris 5 (UPD5)-Sorbonne Université (SU)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Départemental Vendée, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Université Paris Descartes - Paris 5 (UPD5), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
Subjects: medicine.medical_specialty, 030232 urology & nephrology, Urology, kidney transplantation, 030230 surgery, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Biopsy, Medicine, Kidney transplantation, Transplantation, Creatinine, Kidney, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, medicine.diagnostic_test, histological diagnostic, business.industry, Histology, predictive score, medicine.disease, 3. Good health, medicine.anatomical_structure, chemistry, Cohort, surveillance biopsy, Renal biopsy, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Surveillance biopsies after renal transplantation remain debatable. To drive the decision of such intervention, we propose a predictive score of abnormal histology at 1-year post-transplantation, named 1-year Renal Biopsy Index (1-RBI). We studied 466 kidney recipients from the DIVAT cohort alive with a functioning graft and a surveillance biopsy at 1-year post-transplantation. Patients displaying abnormal histology (49%) (borderline, acute rejection, interstitial fibrosis and tubular atrophy [IFTA] grade 2 or 3, glomerulonephritis) were compared to the normal or subnormal (IFTA grade 1) histology group. Obtained from a lasso penalized logistic regression , the 1-RBI was composed of recipient gender, serum creatinine at 3, 6, and 12 month post-transplantation and anticlass II immunization at transplantation (internal validation: AUC = 0.71, 95% CI [0.53-0.83]; external validation: AUC = 0.62, 95% CI [0.58-0.66]). While we could not determinate a threshold able to identify patients at high chance of normal or subnormal histology, we estimated and validated a discriminating threshold capable of identifying a subgroup of 15% of the patients with a risk of abnormal histology higher than 80%. The 1-RBI is computable online at www.divat.fr. The 1-RBI could be a useful tool to standardize 1-year biopsy proposal and may for instance help to indicate one in case of high risk of abnormal histology.
Published: 2019
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8. Lack of impact of pre-emptive deceased-donor kidney transplantation on graft outcomes: a propensity score-based study

Author: Magali Giral, Marc Ladrière, Sophie Girerd, Christophe Legendre, Laetitia Albano, Fanny Buron, Denis Glotz, Valérie Garrigue, Florent Le Borgne, Emmanuel Morelon, Carmen Lefaucheur, Yohann Foucher, Georges Mourad, Elisabeth Cassuto, MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Centre hospitalier universitaire de Nantes (CHU Nantes), IDBC/A2com [Pace, France], Réseau CENTAURE, Département de Néphrologie [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hospices Civils de Lyon (HCL), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de transplantation rénale [CHRU Nancy], Centre Hospitalier Universitaire de Nancy (CHU Nancy), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Ecotaxie, microenvironnement et développement lymphocytaire (EMily (UMR_S_1160 / U1160)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hopital Saint-Louis [AP-HP] (AP-HP), Hôpital Pasteur [Nice] (CHU), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Immunoregulation And Immunointervention in Transplantation and Autoimmunity (Team 4 - U1064 Inserm - CRTI), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Le Bihan, Sylvie, Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Kidney Transplant Center [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Université Paris Descartes - Paris 5 (UPD5), Department of Nephrology, Transplantation and Clinic Immunology [Hospices civils de Lyon], Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Service de Néphrologie, Dialyse et Transplantation (Hôpital Lapeyronie [Montpellier] CHU), Hôpital Lapeyronie [Montpellier] (CHU), Paris Translational Research Center for Organ Transplantation & Department of Nephrology and Transplantation, Université Paris Diderot - Paris 7 (UPD7)-Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de néphrologie et transplantation rénale [Nice], and Université Paris Descartes - Paris 5 (UPD5)-Sorbonne Université (SU)-CHU Necker - Enfants Malades [AP-HP]
Subjects: Male, medicine.medical_specialty, Time Factors, Waiting Lists, medicine.medical_treatment, 030232 urology & nephrology, 030204 cardiovascular system & hematology, patient and graft survival, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Risk Factors, Internal medicine, medicine, Humans, Renal replacement therapy, Prospective Studies, causal inference, Propensity Score, Dialysis, Kidney transplantation, Transplantation, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Graft Survival, pre-emptive kidney transplantation, Middle Aged, medicine.disease, Kidney Transplantation, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Tissue Donors, 3. Good health, Treatment Outcome, Nephrology, Cohort, Propensity score matching, Kidney Failure, Chronic, dialysis, Observational study, Female, observational study, Hemodialysis, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract: International audience; BACKGROUND: A significant number of studies have compared graft outcomes between patients with Pre-emptive Kidney Transplantation (PreKT) and patients on Dialysis before their Kidney Transplantation (DiaKT). These studies have suffered from the limitation that the DiaKT group is composed of all the dialysed patients, including those placed on a waiting list at the time of their first dialysis session. This seriously questions the comparability of these patients with those placed on the waiting list a long time before the need for renal replacement therapy. The aim of this study was to precisely evaluate the causal effect of PreKT from deceased donors.METHODS: Data were extracted from the multicentric French DIVAT (Données Informatisées et VAlidées en Transplantation) cohort. The DiaKT group was composed of patients placed on the waiting list with an initial intention of pre-emptive transplantation. Cause-specific Cox models with propensity scores (inverse probability weighting) were used to study the patient and graft outcomes.RESULTS: Among the 1138 included patients, 554 patients were in the PreKT group. The outcomes of the PreKT group were similar compared with the DiaKT group. In particular, the life expectancy with a functioning graft was 8.51 years [95% confidence interval (CI) 8.20-8.81] for the PreKT recipients versus 8.49 years (95% CI 8.15-8.84) for the DiaKT recipients.CONCLUSIONS: Our results challenge the utility of PreKTs from deceased donors, especially with regard to the consequential increase in the waiting list.
Published: 2019
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9. Diagnosis and management of asymptomatic bacteriuria in kidney transplant recipients

Author: Coussement, Julien, Maggiore, Umberto, Manuel, Oriol, Scemla, Anne, López-Medrano, Francisco, Nagler, Evi, Aguado, José María, Abramowicz, Daniel, Adams, Brigitte, Agnelli, Caroline, Ailioaie, Oana, Akan, Hamdi, Amrouche, Lucile, Andrés, Amado, Anglicheau, Dany, Arnouts, Paul, Baas, Marije, Balgradean, Cristian, Bammens, Bert, Battaglia, Yuri, Baudoux, Thomas, Berto, Bert, Binet, Isabelle, Bistrup, Claus, Bonofiglio, Renzo, Bosmans, Jean-Louis, Bouatou, Yassine, Bouvier, Nicolas, Braconnier, Philippe, Bredewold, Edwin, Broeders, Nilufer, BRUNET, Philippe, Buchler, Matthias, Budde, Klemens, Buron, Fanny, Burtey, Stephane, Buscaroli, Andrea, Büttner, Stefan, Byrne, Catherine, Caldara, Rossana, Cassuto, Elisabeth, Catalano, Concetta, Cavaille, Guilhem, Corbel, Alice, Couzi, Lionel, Crespo, Marta, Daga, Sunil, Debellé, Frederic, Dedinska, Ivana, Devine, Paul, Dickenmann, Michael, Dratwa, Max, Drgona, Lubos, Durlik, Magdalena, Egidi, Maria Francesca, Errasti, Pedro, Etienne, Isabelle, Fariñas, María Carmen, Fehr, Thomas, Fernández-Ruiz, Mario, Founta, Paraskevi, Fourtounas, Konstantinos, Frangou, Eleni, Frimat, Luc, Furian, Luc, Garjau, Maria, Garrigue, Valérie, Gatault, Philippe, Geddes, Colin, Gerlinger, Paul, Gheuens, Eric, Ghisdal, Lidia, Gibbs, Paul, Giral, Magali, Girerd, Sophie, Golshayan, Dela, Gompou, Athina, Grossi, Paolo Antonio, Guglielmetti, Gabriele, Guirado, Luis, Hadaya, Karine, Hazzan, Marc, Helbert, Mark, Hellemans, Rachel, Heller, Katharina, Heemann, Uwe, Henckes, Manu, Hernandez, Domingo, Hertig, Alexandre, Hiesse, Christian, Hilbrands, Luuk, Hilton, Rachel, Hirzel, Cédric, Horcajada, Juan Pablo, Hougardy, Jean-Michel, Huynh-Do, Uyen, Idrizi, Alma, Ismaili, Khalid, Jiménez, Carlos, Jourde-Chiche, Noemie, Kamar, Nassim, Kaminski, Hannah, Kanter, Julia, Karras, Alexandre, Kemlin, Delphine, Kes, Petar, Kianda, Mireille, Klinger, Maria, Knight, Simon, Koneth, Irene, Krrashi, Anita, Kuypers, Dirk, Langlois, Anne, Lang, Philippe, Lauzurica, Ricardo, Le Moine, Alain, Lebeaux, David, Legendre, Christophe, Lemy, Anne, Len, Oscar, Liakopoulos, Vassilios, Lichodziejewska-Niemierko, Monika, Yague, Maria, Lopau, Kai, Madhoun, Philippe, Magott-Procelewska, Maria, Malik, Shafi, Montero, Anna Manonelles, Marchini, Marc, Marega, Alessandra, Mariat, Maria, Mark, Mark, Martin, Pierre-Yves, Martín, Leyre, Martín, Paloma Leticia, Massart, Annick, Matignon, Marie, Maurel, Stéphane, Mazuecos, Auxiliadora, Melexopoulou, Christina, Melilli, Edoardo, Merino, Esperanza, Mesic, Enisa, Messa, Piergiorgio, Michalak, Magdalena, Minetti, Enrico, Miserlis, Grigorios, Montejo, Miguel, Moriconi, Diego, Mottola, Clément, Mourad, Georges, Mueller, Thomas, Muñoz, Patricia, Nabokow, Alexander, Naesens, Maarten, Nikodimopoulou, Maria, Oberbauer, Rainer, Olmedo, María, Olsburgh, Jonathon, Oniscu, Gabriel, Øzbay, Lara Aygen, Palmisano, Alessandra, Papagianni, Aikaterini, Papasotiriou, Mario, Parodi, Angelica, Parry, Rob, Pascual, Julio, Flores, Isabel Pérez, Pérez-Sáez, María, Peruzzi, Licia, Petit-Hoang, Camille, Phelan, Paul, Pillebout, Evangeline, Piotti, Giovanni, Pipeleers, Lissa, Pleros, Christos, Popoola, Joyce, Pretagostini, Renzo, Psimenou, Erasmia, Puig, Josep, Rafat, Cédric, Bloudickova, Silvie Rajnochova, Bushljetikj, Irena Rambabova, Ratkovic, Marina, Redondo, Dolores, Reischig, Tomas, Robert, Thomas, Ferrero, Luis, Rroji, Merita, Rutkowski, Przemyslaw, Rydzewska-Rosolowska, Alicja, Sabé, Núria, Sahali, Dil, Salzberger, Bernd, San-Juan, Rafael, Sobrino, Beatriz Sánchez, Sandrini, Silvio, Santos, Lídia, Sava, Roxana, Schaub, Stefan, Schikowski, Johan, Schvartz, Betoul, Sester, Urban, Silva, Jose Tiago, Snanoudj, Renaud, Somenzi, Danio, Sørensen, Søren, Spanos, Georgios, Steiger, Jürg, Suwelack, Barbara, Theodoropoulou, Eleni, Thervet, Eric, Thorban, Stefan, Tognarelli, Giuliana, Tournay, Yasmina, Tricot, Leïla, Tulissi, Patrizia, Vacher-Coponat, Henri, Valerio, Maricela, Van Der Meijden, W, Van Hamersvelt, Henk, Van Laecke, Steven, Vandivinit, Alain, Vanholder, Raymond, Veroux, Massimiliano, Viklicky, Ondrej, Vigo, Emanuela, Viscoli, Claudio, Watschinger, W, Weekers, W, Welberry Smith, W, Martin, W, Zeneli, Nereida, Zervos, Angelos, Zibar, Lada, Zuber, Julien, Zukunft, Bianca, Nephrology, Department Infections Diseases, Université Libre de Bruxelles [Bruxelles] (ULB), Azienda Ospedaliero-Universitaria di Parma, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Réseau CENTAURE, Service des maladies infectieuses et tropicales [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Service Néphrologie et transplantation rénale Adultes [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Bases moléculaires de la réponse aux xénobiotiques (U775 (IFR95)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut d’Électronique, de Microélectronique et de Nanotechnologie (IEMN) - UMR 8520 (IEMN), Centre National de la Recherche Scientifique (CNRS)-Université de Lille-Université Polytechnique Hauts-de-France (UPHF)-Ecole Centrale de Lille-Université Polytechnique Hauts-de-France (UPHF)-Institut supérieur de l'électronique et du numérique (ISEN), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Department of Nephrology, Humboldt Universität zu Berlin, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Chirurgie urologique et transplantation rénale [Hôpital de la Conception - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION ), Centre recherche en CardioVasculaire et Nutrition (C2VN), Institut National de la Recherche Agronomique (INRA)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de néphrologie, Hôpital Pasteur [Nice] (CHU), Hôpital de Brabois, CHU de Nancy, Vandoeuvre-lès-Nancy, Service de Néphrologie-transplantation-dialyse [Bordeaux], CHU Bordeaux [Bordeaux], Laboratoire des interactions plantes micro-organismes (LIPM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Recherche Agronomique (INRA), CHU Rouen, Normandie Université (NU), Unit Infectious Diseases, Hospital 12 de Octubre, Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Pédiatrie spécialisée, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Université de Lille, Department of Pulmonary Medicine, Tampere University Hospital, Urgences néphrologiques et transplantation rénale [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Tenon [APHP], Service de néphrologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Swiss Transplantation Cohort Study, University of Basel (Unibas), Department of Nephrology and Hypertension, and Department of Clinical Research, University of Bern, Centro de Investigación en Ciencias del Mar y Limnología (CIMAR), Universidad Nacional de Costa Rica, Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Université de Bordeaux (UB), Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania [Philadelphia], Department of Nephrology and Renal Transplantation, University Hospitals Leuven [Leuven]-Catholic University Leuven, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes (UGA), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Service de néphrologie adultes [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], Centre de Recherches Pétrographiques et Géochimiques (CRPG), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milano, Université de Lorraine (UL), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Clinical Microbiology and Infectious Diseases Department, Universidad Complutense de Madrid [Madrid] (UCM), University Hospitals Leuven [Leuven], Department of Internal Medicine III, Medizinische Universität Wien = Medical University of Vienna, Service de rhumatologie, Kidney and Pancreas Transplantation, Department d'enginyeria quimica agraria i tecnologia agroalimentaria, Universitat de Girona (UdG), Néphrologie Transplantation, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Section of Microbiology [Copenhagen], Department of Biology [Copenhagen], Faculty of Science [Copenhagen], University of Copenhagen = Københavns Universitet (KU)-University of Copenhagen = Københavns Universitet (KU)-Faculty of Science [Copenhagen], University of Copenhagen = Københavns Universitet (KU)-University of Copenhagen = Københavns Universitet (KU), University Hospital Basel [Basel], Service Néphrologie Transplantation Rénale, Hôpital Foch [Suresnes], Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION )-Assistance Publique - Hôpitaux de Marseille (APHM), Renal Division, Freiburg University Medical Center, Nephrology Section [Ghent], Ghent University Hospital, Dept. of Nephrology, Institute for Clinical and Experimental Medicine, Division of Infectious Diseases, University of Genoa (UNIGE)-San Martino University Hospital, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université libre de Bruxelles (ULB), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut d’Électronique, de Microélectronique et de Nanotechnologie - UMR 8520 (IEMN), Centrale Lille-Institut supérieur de l'électronique et du numérique (ISEN)-Université de Valenciennes et du Hainaut-Cambrésis (UVHC)-Université de Lille-Centre National de la Recherche Scientifique (CNRS)-Université Polytechnique Hauts-de-France (UPHF), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Humboldt University Of Berlin, Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Université de Mons (UMons), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), University of Pennsylvania, Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), University of Copenhagen = Københavns Universitet (UCPH)-University of Copenhagen = Københavns Universitet (UCPH)-Faculty of Science [Copenhagen], University of Copenhagen = Københavns Universitet (UCPH)-University of Copenhagen = Københavns Universitet (UCPH), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Universitäts Klinikum Freiburg = University Medical Center Freiburg (Uniklinik), Università degli studi di Genova = University of Genoa (UniGe)-San Martino University Hospital, ERA-EDTA, ESCMID, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Humboldt-Universität zu Berlin, Institut National de la Recherche Agronomique (INRA)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut national des sciences de l'Univers (INSU - CNRS)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Maladies Infectieuses et Tropicales [CHU Pitié-Salpêtrière], Service d'Urgences néphrologiques et transplantation rénale [CHU Tenon], Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION ), and San Martino University Hospital-University of Genoa (UNIGE)
Subjects: Nephrology, Male, Cross-sectional study, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Practice Patterns, 030230 surgery, Antimicrobial stewardship, urologic and male genital diseases, 0302 clinical medicine, Surveys and Questionnaires, Bacteriuria/diagnosis, Medicine, Practice Patterns, Physicians'/statistics & numerical data, Practice Patterns, Physicians', Asymptomatic Infections, Kidney transplantation, ComputingMilieux_MISCELLANEOUS, Asymptomatic bacteriuria, Questionnaire, Transplantation, Urinary tract infection, Adult, Anti-Bacterial Agents, Bacteriuria, Cross-Sectional Studies, Europe, Female, Humans, Kidney Transplantation, Transplant Recipients, Response rate (survey), Kidney Transplantation/adverse effects, 16. Peace & justice, 3. Good health, medicine.medical_specialty, Asymptomatic Infections/epidemiology, Europe/epidemiology, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Internal medicine, Dialysis, Physicians', business.industry, medicine.disease, Anti-Bacterial Agents/therapeutic use, Human medicine, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business
Abstract: Background Asymptomatic bacteriuria is frequent in kidney transplant recipients (KTRs). However, there is no consensus on diagnosis or management. We conducted a European survey to explore current practice related to the diagnosis and management of asymptomatic bacteriuria in adult KTRs. Methods A panel of experts from the European Renal Association-European Dialysis Transplant Association/Developing Education Science and Care for Renal Transplantation in European States working group and the European Study Group for Infections in Compromised Hosts of the European Society of Clinical Microbiology and Infectious Diseases designed this cross-sectional, questionnaire-based, self-administered survey. Invitations to participate were e-mailed to European physicians involved in the care of KTRs. Results Two hundred and forty-four participants from 138 institutions in 25 countries answered the survey (response rate 30%). Most participants [72% (176/244)] said they always screen for asymptomatic bacteriuria in KTRs. Six per cent (15/240) reported never treating asymptomatic bacteriuria with antibiotics. When antimicrobial treatment was used, 24% of the participants (53/224) said they would start with empirical antibiotics. For an episode of asymptomatic bacteriuria caused by a fully susceptible microorganism and despite no contraindications, a majority of participants (121/223) said they would use a fluoroquinolone (n = 56), amoxicillin/clavulanic acid (n = 38) or oral cephalosporins (n = 27). Conclusions Screening for and treating asymptomatic bacteriuria are common in KTRs despite uncertainties around the benefits and harms. In an era of antimicrobial resistance, further studies are needed to address the diagnosis and management of asymptomatic bacteriuria in these patients.
Published: 2018
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10. Severe dermatophytosis in solid organ transplant recipients: A French retrospective series and literature review

Author: Dany Anglicheau, Claire Rouzaud, Roderick J. Hay, Jean-David Bouaziz, Olivier Chosidow, Marie-Elisabeth Bougnoux, Anne Scemla, Anabelle Brocard, Fanny Lanternier, Olivier Lortholary, Sylvie Fraitag, Nicolas Dupin, Service des Maladies infectieuses et tropicales [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Dermatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'anatomie pathologique [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Réseau CENTAURE, Département de Néphrologie [CHU Necker], Service de Dermatologie [AP-HP Hôpital Saint-Louis], Hopital Saint-Louis [AP-HP] (AP-HP), Hôpital Cochin [AP-HP], Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Unité de Parasitologie-Mycologie, Service de Microbiologie [Hôpital Necker-Enfants-Malades, Paris], Assistance Publique - Hôpitaux de Paris, King's College Hospital (KCH), Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals (CNRMA), Institut Pasteur [Paris], Société de Pathologie Infectieuse de Langue Française (SPILF)Société Française de Mycologie Médicale (SFMM)Groupe Peau et Greffe d'Organe (GPGO) of the Société Française de Dermatologie (SFD), Institut Pasteur [Paris] (IP), Université Paris Descartes - Paris 5 (UPD5)-CHU Necker - Enfants Malades [AP-HP]-Institut des Maladies Génétiques Imagine [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri-Mondor, CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], Hopital Saint-Louis, Assistance Publique – Hôpitaux de Paris (AP-HP), and CHU Cochin [AP-HP]
Subjects: Adult, Male, 0301 basic medicine, medicine.medical_specialty, Posaconazole, dermatophytosis, Majocchi's granuloma, medicine.medical_treatment, 030106 microbiology, deep dermatophytosis, Trichophyton rubrum, Severity of Illness Index, [SDV.MP.PRO]Life Sciences [q-bio]/Microbiology and Parasitology/Protistology, Organ transplantation, Immunocompromised Host, 03 medical and health sciences, Tinea, Trichophyton, Severity of illness, Humans, Medicine, 10. No inequality, Solid-organ transplant, Kidney transplantation, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, Transplantation, immunosuppression, business.industry, Deep dermatophytosis, Immunosuppression, Organ Transplantation, Middle Aged, medicine.disease, Kidney Transplantation, Dermatology, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Transplant Recipients, 3. Good health, Infectious Diseases, Terbinafine, Female, France, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract: OBJECTIVE Severe dermatophytosis is described in immunocompromised patients with defective cellular immunity. We report here a large series and a literature review of severe dermatophytosis in solid-organ transplant (SOT) recipients. METHOD The data main source was a national French retrospective study of severe dermatophytosis in SOT recipients between 2010 and 2016. Inclusion criteria were the presence of dermatophytes in skin culture and 1 severity criteria: dermal invasion by dermatophytes (invasive dermatophytosis) or involvement of at least two body sites or >10% of body surface area (extensive dermatophytosis). RESULTS A total of 12 patients were included (8 men, median age of 56 years [range: 33-71]). Of the 12 patients, 10 underwent kidney transplantation. The median time from transplantation to severe dermatophytosis diagnosis was 16 months [range: 2-94]. Clinical signs of superficial dermatophytosis were present in 8/12 patients before the emergence of severe dermatophytosis. Nine patients had invasive forms and three extensive ones, and nodules of the lower extremities were found in eight. Trichophyton rubrum was isolated in 11 cases. First-line treatment was terbinafine (7/12), posaconazole (3/12), or topical treatment alone (2/12). Immunosuppressive therapy was reduced in 3 patients because of associated infections. Complete response was obtained for 3/3 and 5/9 patients with extensive or invasive forms, respectively, after a median treatment's duration of 2.5 [range: 1.5-5] months and 7.5 months [range: 4-12]. Unrelated deaths (n = 2) and graft function impairment (n = 3) occurred. CONCLUSION Severe dermatophytosis is a late complication in SOT recipients presenting with lower limb nodules, which might be prevented by prompt treatment of superficial dermatophytosis.
Published: 2018
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11. Propensity score-based comparison of the graft failure risk between kidney transplant recipients of standard and expanded criteria donor grafts: Toward increasing the pool of marginal donors

Author: Georges Mourad, Yohann Foucher, Magali Giral, Fanny Buron, Angelina Dion, Lionel Rostaing, Etienne Dantan, F. Le Borgne, Emmanuel Morelon, Anne-Hélène Querard, Nassim Kamar, Valérie Garrigue, Ch. Legendre, Alexandre Loupy, CHD Vendée - Hôpital Les Oudairies [La Roche sur Yon], MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), IDBC/A2com [Pace, France], LabEx TRANSPLANTEX [CHU de Nantes], Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Lapeyronie [Montpellier] (CHU), Hôpital de Rangueil, CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Réseau CENTAURE, Université Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), Service de néphrologie adultes [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Degauque, Nicolas, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
Subjects: Graft Rejection, Male, Time Factors, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, genetic structures, donors and donation: extended criteria, kidney transplantation/nephrology, 030230 surgery, Expanded Criteria Donor, 01 natural sciences, 010104 statistics & probability, 0302 clinical medicine, Risk Factors, donors and donation: standard criteria, Epidemiology, Immunology and Allergy, Pharmacology (medical), Prospective Studies, Graft Survival, Middle Aged, Prognosis, Tissue Donors, Survival Rate, surgical procedures, operative, Cohort, [SDV.IMM]Life Sciences [q-bio]/Immunology, epidemiology, Female, Adult, medicine.medical_specialty, Tissue and Organ Procurement, [SDV.IMM] Life Sciences [q-bio]/Immunology, Urology, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, clinical research/practice, Donor Selection, 03 medical and health sciences, medicine, Humans, 0101 mathematics, Propensity Score, Aged, Transplantation, business.industry, Proportional hazards model, organ procurement and allocation, Kidney Transplantation, Confidence interval, Transplant Recipients, Relative risk, Propensity score matching, Quality of Life, Kidney Failure, Chronic, business, Follow-Up Studies
Abstract: International audience; From a prospective and multicentric French cohort, we proposed an external validation study for the expanded criteria donor (ECD), based on 4833 kidney recipients transplanted for the first time between 2000 and 2014. We estimated the subject-specific effect from a multivariable Cox model. We confirmed a 1.75-fold (95% confidence interval [CI] 1.53-2.00, P < .0001) increase in graft failure risk if a given patient received an ECD graft compared to a graft from a donor with standard criteria (standard criteria donor [SCD]). Complementarily, we estimated the population-average effect using propensity scores. We estimated a 1.34-fold (95% CI 1.09-1.64, P = .0049) increase in graft failure risk among ECD patients receiving an ECD graft compared to receiving a SCD graft. With a 10-year follow-up, it corresponded to a decrease of 8 months of the mean time to graft failure due to ECD transplantation (95% CI 2-14 months). The population-average relative risk due to ECD transplantation and the corresponding absolute effect seem finally not so high. Regarding the increase of quality of life in transplantation, our study constitutes an argument to extend the definition marginality by considering more grafts at high risk and thereby enlarging the pool of kidney grafts.
Published: 2017
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12. Horizontal mixture model for competing risks: a method used in waitlisted renal transplant candidates

Author: Magali Giral, Anne-Hélène Querard, Yohann Foucher, Katy Trébern-Launay, Serge Briançon, Michèle Kessler, Sahar Bayat-Makoei, Le Bihan, Sylvie, Jeunes Chercheuses et Jeunes Chercheurs - Construction d'un marqueur composite de substitution de la survie à long terme : application à la transplantation rénale - - CSM (Composite Surrogate Marker)2011 - ANR-11-JSV1-0008 - JCJC - VALID, Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Réseau CENTAURE [CHU Nantes] (Fondation, Centre d’Investigation Clinique en Biothérapie), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Unité d'épidémiologie et de biostatistique [Rennes], École des Hautes Études en Santé Publique [EHESP] (EHESP), Service de Néphrologie, dialyse, transplantation [CHD Vendée] (Site de La Roche sur Yon), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre hospitalier universitaire de Nantes (CHU Nantes), Grants from the French Ministry of Health (PHRC, PROG/11/85, 2011). Grant for epidemiology and biostatistics research from the RTRS ‘CENTAURE’., ANR-11-JSV1-0008,CSM (Composite Surrogate Marker),Construction d'un marqueur composite de substitution de la survie à long terme : application à la transplantation rénale(2011), Unité de néphrologie [CHRU Nancy-Brabois], Centre Hospitalier Départemental Vendée, Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, and Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Male, Time Factors, Epidemiology, medicine.medical_treatment, Disease, Comorbidity, Overweight, 01 natural sciences, 010104 statistics & probability, 0302 clinical medicine, Neoplasms, 030212 general & internal medicine, Registries, Kidney transplantation, Event (probability theory), Mixture model, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Age Factors, Middle Aged, Prognosis, 3. Good health, Cardiovascular Diseases, Female, France, medicine.symptom, Adult, medicine.medical_specialty, Waiting Lists, Risk Assessment, Time-to-Treatment, 03 medical and health sciences, Renal Dialysis, Diabetes mellitus, medicine, Humans, 0101 mathematics, Intensive care medicine, Dialysis, Probability, Models, Statistical, Prognostic study, business.industry, medicine.disease, Kidney Transplantation, Transplantation, Competing events, Diabetes Mellitus, Type 2, Kidney Failure, Chronic, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; When a patient is registered on renal transplant waiting list, she/he expects a clear information on the likelihood of being transplanted. Nevertheless, this event is in competition with death and usual models for competing events are difficult to interpret for non-specialists. We used a horizontal mixture model. Data were extracted from two French dialysis and transplantation registries. The ''Ile-de-France'' region was used for external validation. The other patients were randomly divided for training and internal validation. Seven variables were associated with decreased long-term probability of transplantation: age over 40 years, comorbidities (diabetes, cardiovascular disease, malig-nancy), dialysis longer than 1 year before registration and blood groups O or B. We additionally demonstrated longer mean time-to-transplantation for recipients under the age of 50, overweight recipients, recipients with blood group O or B and with pre-transplantation anti-HLA class I or II immunization. Our model can be used to predict the long-term probability of transplantation and the time in dialysis among transplanted patients, two easily interpretable parts. Discriminative capacities were validated on both the internal and external (AUC at 5 years = 0.72, 95% CI from 0.68 to 0.76) validation samples. However, calibration issues were highlighted and illustrated the importance of complete re-estimation of the model for other countries. We illustrated the ease of interpretation of horizontal modelling, which constitutes an alternative to sub-hazard or cause-specific approaches. Nevertheless, it would be useful to test this in practice, for instance by questioning both the physicians and the patients. We believe that this model should also be used in other chronic diseases, for both etiologic and prognostic studies.
Published: 2017
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13. Prospective Evaluation of Serum β-Glucan Testing in Patients With Probable or Proven Fungal Diseases

Author: Fanny Lanternier, Anne-Laure Roupie, Christophe d'Enfert, Bénédicte Neven, Felipe Suarez, Anne Scemla, Marie-Elisabeth Bougnoux, Aurélie Dupuis, Denis Caillot, Cécile Schrimpf, Etienne Paubelle, Pierre Frange, Frédéric Dalle, Cécile Angebault, Olivier Lortholary, Aurélie Agathine, Université Paris Descartes - Paris 5 (UPD5), Laboratoire de Microbiologie Clinique [AP-HP Hôpital Necker-Enfants Malades], CHU Necker - Enfants Malades [AP-HP], Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire (CNRMA), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Centre d'infectiologie Necker-Pasteur [CHU Necker], Laboratoire de parasitologie mycologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Réseau CENTAURE, Service Néphrologie et transplantation rénale Adultes [CHU Necker], Service d'immuno-hématologie pédiatrique [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], Service d'Hématologie Clinique (CHU de Dijon), Biologie et Pathogénicité fongiques, Institut National de la Recherche Agronomique (INRA)-Institut Pasteur [Paris], This work was supported by the Association pour la Promotion de l′Enseignement et de la Recherche en Mycologie., Université Paris Descartes - Paris 5 ( UPD5 ), Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire ( CNRMA ), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Institut National de la Recherche Agronomique ( INRA ) -Institut Pasteur [Paris], 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)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut Pasteur [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pasteur [Paris]-Institut National de la Recherche Agronomique (INRA), Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Biologie et Pathogénicité fongiques (BPF), Institut National de la Recherche Agronomique (INRA)-Institut Pasteur [Paris] (IP), and Bougnoux, Marie-Elisabeth
Subjects: 0301 basic medicine, Antifungal, medicine.medical_specialty, Systemic mycosis, medicine.drug_class, 030106 microbiology, invasive fungal diseases, Aspergillosis, Gastroenterology, Prospective evaluation, Major Articles, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, In patient, 030212 general & internal medicine, Candida albicans, [ SDV.MP.MYC ] Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, (1-3)-beta-D-glucan, diagnostic tool, kinetics, biology, (1-3)-β-d-glucan, business.industry, Odds ratio, Invasive candidiasis, medicine.disease, biology.organism_classification, 3. Good health, Infectious Diseases, Oncology, Immunology, business
Abstract: We evaluated the positivity of (1-3)-β-D-glucan, a serum marker of invasive fungal diseases (IFD), at diagnosis and during treatment. (1-3)-β-D-Glucan may not be an early marker but could prove useful for diagnosis of chronic IFD., Background. Early diagnosis and treatment are crucial in invasive fungal diseases (IFD). Serum (1-3)-β-d-glucan (BG) is believed to be an early IFD marker, but its diagnostic performance has been ambiguous, with insufficient data regarding sensitivity at the time of IFD diagnosis (TOD) and according to outcome. Whether its clinical utility is equivalent for all types of IFD remains unknown. Methods. We included 143 patients with proven or probable IFD (49 invasive candidiasis, 45 invasive aspergillosis [IA], and 49 rare IFD) and analyzed serum BG (Fungitell) at TOD and during treatment. Results. (1-3)-β-d-glucan was undetectable at TOD in 36% and 48% of patients with candidemia and IA, respectively; there was no correlation between negative BG results at TOD and patients' characteristics, localization of infection, or prior antifungal use. Nevertheless, patients with candidemia due to Candida albicans were more likely to test positive for BG at TOD (odds ratio = 25.4, P = .01) than patients infected with other Candida species. In 70% of the patients with a follow-up, BG negativation occurred in >1 month for candidemia and >3 months for IA. A slower BG decrease in patients with candidemia was associated with deep-seated localizations (P = .04). Thirty-nine percent of patients with rare IFD had undetectable BG at TOD; nonetheless, all patients with chronic subcutaneous IFD tested positive at TOD. Conclusions. Undetectable serum BG does not rule out an early IFD, when the clinical suspicion is high. After IFD diagnostic, kinetics of serum BG are difficult to relate to clinical outcome.
Published: 2016
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14. Improving Long-Term Outcome in Allograft Transplantation: Role of Ionic Composition and Polyethylene Glycol

Author: Frédéric Favreau, Thierry Hauet, Benoit Barrou, Raphael Thuillier, Thibault Desurmont, Jean-Michel Goujon, Michel Eugene, Sébastien Giraud, Ischémie - Reperfusion en transplatation rénale, Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Poitiers (CHU Poitiers), FLIRT, Fédération pour L'étude de l'Ischémie Reperfusion en Transplantation, Université de Poitiers, Université Pierre et Marie Curie - Paris 6 (UPMC), CHU Henri Mondor, Réseau CENTAURE, Conseil General de la Vienne, Region Poitou Charentes, Banque Tarneaud, Poitiers, CHU de Poitiers and Inserm, Societe Francophone de Transplantation, French Foundation of Transplantation, and CHU Henri Mondor [Créteil]
Subjects: Male, Graft outcome, Necrosis, Swine, [SDV]Life Sciences [q-bio], medicine.medical_treatment, TO-MESENCHYMAL TRANSITION, 030232 urology & nephrology, ISCHEMIA-REPERFUSION INJURY, Adaptive Immunity, 030230 surgery, Hydroxyethyl starch, Polyethylene Glycols, chemistry.chemical_compound, 0302 clinical medicine, AUTOTRANSPLANTED PIG KIDNEYS, SURFACE MODIFICATION, Hypoxia, Interstitial fibrosis, MOLECULAR-MECHANISMS, RENAL-TRANSPLANTATION, Immunosuppression, Kidney preservation, 3. Good health, Treatment Outcome, Reperfusion Injury, medicine.symptom, medicine.drug, medicine.medical_specialty, Organ Preservation Solutions, Polyethylene glycol, TUBULAR EPITHELIAL-CELLS, STEALTH ERYTHROCYTES, PRESERVATION SOLUTION, Andrology, 03 medical and health sciences, In vivo, PEG ratio, medicine, Animals, Transplantation, Homologous, Immune response, Transplantation, business.industry, medicine.disease, Kidney Transplantation, Immunity, Innate, Surgery, chemistry, 48-HOUR COLD-STORAGE, business, Reperfusion injury, Ischemia reperfusion injury
Abstract: International audience; Background. Ischemia reperfusion injury (IRI) is inherent to transplantation, and correlates with negative outcome. Limiting IRI requires new preservation. Fourth generation solutions are emerging, using new colloid based on polyethylene glycol (PEG) polymers and extracellular ionic composition. We evaluated their eventual benefits for optimal resistance to IRI and improved outcome. Methods. Using primary cell culture and a preclinical pig model of low-mismatch kidney allograft transplantation, not requiring immunosuppression, we compared the following solutions: UW (University of Wisconsin), high potassium with hydroxyethyl starch, gold standard in preservation; IGL-1 (Institute George Lopez-1), low potassium solution using PEG (35 kDa, 1 g/L); and SCOT (Solution de Conservation des Organes et Tissus), plasma-like ionic composition, containing PEG 20 kDa (30 g/L). Results. In vitro, SCOT-preserved cells had better viability and less necrosis. In vivo, SCOT-grafts had better function recovery, with limited histological injury compared with the other solutions. During the 3 months follow-up, we found low innate and adaptative immune response in SCOT organs, whereas other groups presented high rate of invasion and antigen presentation. SCOT-preserved kidneys showed low fibrosis, transforming growth factor-beta expression and apoptosis compared with the other groups. These differences impacted survival at 3 months, which was low in UW (20%) and IGL-1 (40%) groups, whereas it remained high for SCOT animals (80%, P < 0.05 to UW). Conclusions. In conclusion, plasma-like ionic composition and nontoxic molecule PEG provide high resistance against IRI and optimize graft outcome. Such solutions could be invaluable for the use of fragile organs, such as from extended criteria or deceased after cardiac death donors.
Published: 2011
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15. A personalized follow-up of kidney transplant recipients using video conferencing based on a 1-year scoring system predictive of long term graft failure (TELEGRAFT study): protocol for a randomized controlled trial

Author: Angélique Bonnaud-Antignac, Christophe Legendre, Magali Giral, Sabrina Chailan, Sandra Gaboriau, Emmanuel Morelon, Aurélie Meurette, Emmanuelle Papuchon, Philippe Tessier, Jean-Benoit Hardouin, Yohann Foucher, Pascal Daguin, Karine Neau, Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, PRES Université Nantes Angers Le Mans (UNAM), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Délégation à la recherche clinique et à l'innovation [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Transplantation Rénale et de Soins Intensifs [Hôpital Necker - APHP], Université Paris Descartes - Paris 5 (UPD5)-PRES Sorbonne Paris Cité-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Transplantation, Néphrologie et Immunologie Clinique [Hôpital Edouard Herriot, HCL], Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Réseau CENTAURE [CHU Nantes] (Fondation, Centre d’Investigation Clinique en Biothérapie), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*), This work was supported by a grant from the French Ministry of Health (PHRC, PROG/20-12, 2011). The protocol was also independently peer-reviewed by this institution. The Region 'Pays de la Loire' and the Regional Health Agency (ARS) also support the rental of the tablets and the equipment deployed in Nantes Universality hospital., and Le Bihan, Sylvie
Subjects: Nephrology, Graft Rejection, Male, medicine.medical_specialty, Telemedicine, Personalized follow-up, Randomzed clinical trial, medicine.medical_treatment, 030232 urology & nephrology, computer.software_genre, law.invention, Kidney transplantation, 03 medical and health sciences, Study Protocol, 0302 clinical medicine, Videoconferencing, Randomized controlled trial, law, Internal medicine, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, Dialysis, Protocol (science), [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Video conferencing, Graft Survival, medicine.disease, 3. Good health, Term (time), surgical procedures, operative, Female, Randomized clinical trial, business, computer, Immunosuppressive Agents, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Background: Numerous well-established clinical parameters are taken into consideration for the follow-up adaptation of kidney transplant recipients, but there are important disparities between countries, centres and clinicians. Therefore, novel scoring systems have been developed, for instance the Kidney Transplant Failure Score (KTFS) which aims to stratify patients according to their risk of return to dialysis. We hypothesize that the efficiency of the follow-up after one year post-transplantation can be improved by adapting it to the risk of graft failure defined by the KTFS estimation.Methods/design: We propose a phase IV, open label, randomized, multicentric and prospective study. The study is registered with the Clinical Trials Registry NCT01615900. 250 patients will be allocated to one of two arms: the eHealth program versus the standard of care at hospital. In the standard group, patients classified at low-risk (KTFS ≤ 4.17) will be scheduled 4 visits at hospital per year, whilst high-risk patients will visit hospital 6 times. In the eHealth group, patients classified at low-risk will be interviewed 3 times by video conferencing and once at hospital, whilst 6 visits at hospital and 6 video conferencing will be scheduled for high-risk patients. Discussion: The current study allows to scientifically evaluate the etiologic impact of a novel eHealth program. This is important to clarify the possible contribution of telemedicine in the improvement of medical follow-up. The proposed design based on 4 different subgroups can be interesting to evaluate other personalized medicine programs.
Published: 2015
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16. A useful scoring system for the prediction and management of delayed graft function following kidney transplantation from cadaveric donors

Author: Georges Mourad, Fanny Buron, Lionel Rostaing, Florent Le Borgne, Michèle Kessler, Magali Giral, Valérie Garrigue, Christophe Legendre, Emmanuel Morelon, Pascal Daguin, Katy Launay, Jean-Paul Soulillou, Henri Kreis, Marion Chapal, Yohann Foucher, Lucile Offredo, Marc Ladrière, Nassim Kamar, Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Réseau CENTAURE [Nantes], Université de Nantes (UN)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*)-Centre hospitalier universitaire de Nantes (CHU Nantes), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), LabEx TRANSPLANTEX [CHU de Nantes], Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, PRES Université Nantes Angers Le Mans (UNAM), Service Néphrologie et transplantation rénale Adultes [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), Service de Néphrologie, Dialyse et Transplantation (Hôpital Lapeyronie [Montpellier] CHU), Hôpital Lapeyronie [Montpellier] (CHU), Service de Néphrologie [Lyon], Hospices Civils de Lyon (HCL)-Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Département de Néphrologie et Transplantation d'organes, Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Service de transplantation rénale [CHRU Nancy], Centre Hospitalier Universitaire de Nancy (CHU Nancy), Roche Laboratory., ANR-11-JSV1-0008,CSM (Composite Surrogate Marker),Construction d'un marqueur composite de substitution de la survie à long terme : application à la transplantation rénale(2011), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*), 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), Le Bihan, Sylvie, and Jeunes Chercheuses et Jeunes Chercheurs - Construction d'un marqueur composite de substitution de la survie à long terme : application à la transplantation rénale - - CSM (Composite Surrogate Marker)2011 - ANR-11-JSV1-0008 - JCJC - VALID
Subjects: Male, 030232 urology & nephrology, 030230 surgery, Body Mass Index, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, risk factors, Prospective Studies, Young adult, Child, Prospective cohort study, Kidney transplantation, Aged, 80 and over, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Cold Ischemia, Age Factors, Induction Chemotherapy, Middle Aged, Mobile Applications, Tissue Donors, 3. Good health, Nephrology, statistics, Area Under Curve, Child, Preschool, Creatinine, Predictive value of tests, Female, Smartphone, Immunosuppressive Agents, Cohort study, Adult, medicine.medical_specialty, Adolescent, kidney transplantation, Decision Support Techniques, Young Adult, 03 medical and health sciences, delayed graft function, Predictive Value of Tests, Cadaver, medicine, Humans, Aged, Antilymphocyte Serum, business.industry, transplant outcomes, Infant, medicine.disease, Surgery, Transplantation, ROC Curve, chemistry, business, Complication, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: International audience; Delayed graft function (DGF) is a common complication in kidney transplantation and is known to be correlated with short-and long-term graft outcomes. Here we explored the possibility of developing a simple tool that could predict with good confidence the occurrence of DGF and could be helpful in current clinical practice. We built a score, tentatively called DGFS, from a French multicenter and prospective cohort of 1844 adult recipients of deceased donor kidneys collected since 2007, and computerized in the Données Informatisées et VAlidées en Transplantation databank. Only five explicative variables (cold ischemia time, donor age, donor serum creatinine, recipient body mass index, and induction therapy) contributed significantly to the DGF prediction. These were associated with a good predictive capacity (area under the ROC curve at 0.73). The DGFS calculation is facilitated by an application available on smartphones, tablets, or computers at www.divat.fr/en/online-calculators/ dgfs. The DGFS should allow the simple classification of patients according to their DGF risk at the time of transplantation, and thus allow tailored-specific management or therapeutic strategies.
Published: 2014
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17. Pretransplant Sensitization Against Angiotensin II Type 1 Receptor Is a Risk Factor for Acute Rejection and Graft Loss

Author: Aurélie Philippe, Anne Cesbron, Duska Dragun, J. P. D. Van Huyen, Magali Giral, Stéphanie Castagnet, Yohann Foucher, Alexandre Dufay, A. Devys, J. P. Soulillou, Karine Renaudin, Anne Moreau, Björn Hegner, Ralf Dechend, Harald Heidecke, Sophie Brouard, Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Institut de Transplantation et de Recherche en Transplantation [CHU Nantes] (ITERT), Centre hospitalier universitaire de Nantes (CHU Nantes), Réseau CENTAURE [Nantes], Université de Nantes (UN)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*)-Centre hospitalier universitaire de Nantes (CHU Nantes), LabEx TRANSPLANTEX [CHU de Nantes], CIC biothérapies CBT 0503 [Nantes], Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé, PRES Université Nantes Angers Le Mans (UNAM), Service d’Anatomopathologie [CHU Nantes], Clinic for Nephrology and Intensive Care Medicine [Berlin, Germany], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Experimental and Clinical Research Center [Berlin, Germany], Max Delbrück Center for Molecular Medicine [Berlin] (MDC), Helmholtz-Gemeinschaft = Helmholtz Association-Helmholtz-Gemeinschaft = Helmholtz Association-Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], CellTrend [Luckenwalde, Germany], Etablissement Français du Sang [Nantes], Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*), and Le Bihan, Sylvie
Subjects: Graft Rejection, Male, Angiotensin receptor, allosensitization, antibody mediated rejection, 030232 urology & nephrology, 030230 surgery, Gastroenterology, Acute allograft rejection, 0302 clinical medicine, HLA Antigens, Immunology and Allergy, Medicine, Pharmacology (medical), Prospective Studies, Prospective cohort study, Kidney transplantation, Kidney, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Graft Survival, Middle Aged, 3. Good health, medicine.anatomical_structure, Acute Disease, Female, Kidney Diseases, Adult, medicine.medical_specialty, Enzyme-Linked Immunosorbent Assay, survival, Receptor, Angiotensin, Type 1, 03 medical and health sciences, angiotensin II receptors, Transplantation Immunology, Internal medicine, Preoperative Care, Humans, Transplantation, Homologous, Risk factor, Autoantibodies, Transplantation, business.industry, Proportional hazards model, medicine.disease, Kidney Transplantation, Angiotensin II, Immunology, business, pretransplant, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract: International audience; The angiotensin II type 1 receptor (AT1R) is an emerging target of functional non-HLA antibodies (Ab). We examined the potential of determining the degree of presensitization against AT1R as a risk factor for graft survival and acute rejection (AR). The study included 599 kidney recipients between 1998 and 2007. Serum samples were analyzed in a blinded fashion for anti-AT1R antibodies (AT1R-Abs) using a quantitative solid-phase assay. A threshold of AT1R-Ab levels was statistically determined at 10 U based on the time to graft failure. An extended Cox model determined risk factors for occurrence of graft failure and a first AR episode. AT1R-Abs >10 U were detected in 283 patients (47.2%) before transplantation. Patients who had a level of AT1R-Abs >10 U had a 2.6-fold higher risk of graft failure from 3 years posttransplantation onwards (p = 0.0005) and a 1.9-fold higher risk of experiencing an AR episode within the first 4 months of transplantation (p = 0.0393). Antibody-mediated rejection (AMR) accounted for 1/3 of AR, whereby 71.4% of them were associated with >10 U of pretransplant AT1R-Abs. Pretransplant anti-AT1R-Abs are an independent risk factor for long-term graft loss in association with a higher risk of early AR episodes.
Published: 2013
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18. Benefits of active oxygenation during hypothermic machine perfusion of kidneys in a preclinical model of deceased after cardiac death donors

Author: Benoit Barrou, Thierry Hauet, Géraldine Allain, Lionel Badet, Henri G. D. Leuvenink, O. Celhay, William Hebrard, Raphael Thuillier, Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Poitiers, Service de Biochimie [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), FLIRT, Fédération pour L'étude de l'Ischémie Reperfusion en Transplantation, Service de Chirurgie Cardio-Thoracique, Service d'Urologie, Groupement Scientifique - Ibisa (Ibisa), Institut National de la Recherche Agronomique (INRA), Service d'urologie et transplantation rénales [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Réseau CENTAURE, Departement of surgery, University of Groningen [Groningen], Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Urologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), This study was supported by Conseil Général de la Vienne, Région Poitou Charentes, the Banque Tarneaud, Poitiers, CHU de Poitiers and INERM, the Société Francophone de Transplantation, the French Foundation of Transplantation, and the Agence de Biomédecine., Groningen Institute for Organ Transplantation (GIOT), Groupement Scientifique - Ibisa (IBISA), and Hauet, Thierry
Subjects: Male, Pathology, Swine, 030232 urology & nephrology, 030230 surgery, Kidney, chemistry.chemical_compound, 0302 clinical medicine, Hypothermia, Induced, preclinical, Kidney transplantation, Lipocalins, Tissue Donors, 3. Good health, Death, Perfusion, medicine.anatomical_structure, Creatinine, Models, Animal, dcd, ORGAN PRESERVATION, medicine.medical_specialty, Urinary system, Urology, Cold storage, kidney transplantation, RM3, 03 medical and health sciences, COLD-STORAGE, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, INJURY, medicine, Animals, Vimentin, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, Aspartate Aminotransferases, Machine perfusion, Marginal donors, TRANSPLANTATION, business.industry, machine perfusion, Recovery of Function, medicine.disease, Transplantation, chemistry, CELLS, marginal donor, Surgery, Reactive Oxygen Species, business, oxygen
Abstract: Background: Deceased after cardiac death donors (DCDs) represent a valuable source of organs; however, preventing poor outcome is difficult, even with the use of machine perfusion (MP). It is of paramount importance to improve this method. We proposed to evaluate the benefits of active oxygenation during kidney graft hypothermic MP using a novel perfusion machine: Kidney Assist (KA).Methods: We used a pig model of DCD transplantation in Large White pigs. Cold preservation was performed by conventional non-oxygenated MP (KAnoO(2)) or oxygenated MP (KA).Results: In the first 2 wk post-transplant, KA grafts displayed a lower serum creatinine peak and a faster return to normal levels compared with KAnoO(2) animals, translating into a smaller area under the curve. Urinary neutrophil gelatinase-associated lipocalin levels and serum aspartate amino transferase levels were lower in KA animals compared with the non-oxygenated group. These correlated with better chronic function. Longer follow-up of the animals (3 mo) permitted evaluation of chronic outcome lesions. Interstitial fibrosis was reduced in the KA group, and these kidneys also displayed significantly lower levels of vimentin staining. Further histologic investigation also showed a trend toward decreased chronic inflammation in kidneys preserved with oxygen.Conclusions: This new MP system is efficient in preserving DCD kidneys, greatly enhancing the capacity of the graft to withstand preservation stress and improving outcome. Oxygen delivery during preservation is thus valuable for highly damaged organs and offers an important therapeutic tool for transplant teams faced with decreased quality of donor organs. (C) 2013 Elsevier Inc. All rights reserved.
Published: 2013
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19. Chronic renoprotective effect of pulsatile perfusion machine RM3 and IGL-1 solution in a preclinical kidney transplantation model

Author: Alexandre Valagier, Hubert Lathelize, Olivier Page, Thierry Hauet, Etienne Marchand, Lionel Badet, Ricardo Codas, Raphael Thuillier, Service de Biochimie [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Fédération pour L'étude de l'Ischémie Réperfusion en Transplantation (FLIRT), Service d'Urologie et Chirurgie de la Transplantation, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques ( IRTOMIT), Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie Vasculaire [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Fédération Hospitalière Tours-Poitiers-CHU Trousseau [APHP], Service de Chirurgie Vasculaire [Poitiers], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Réseau CENTAURE, Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*), Plateforme IBiSA d'Expérimentations Pré-Cliniques, Institut National de la Recherche Agronomique (INRA), Conseil Général de la Vienne, Région Poitou Charentes, the Banque Tarneaud, Poitiers, CHU de Poitiers and Inserm, the Société Francophone de Transplantation, the French Foundation of Transplantation, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Nantes (UN)-Institut de Transplantation et de Recherche en Transplantation (ITUN - Institut Transplantation Urologie Néphroplogie*)-Centre hospitalier universitaire de Nantes (CHU Nantes), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Poitiers, and BMC, Ed.
Subjects: Swine, medicine.medical_treatment, 030232 urology & nephrology, Pulsatile flow, lcsh:Medicine, Kidney, 0302 clinical medicine, Fibrosis, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Kidney transplantation, Medicine(all), [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Proteinuria, Reverse Transcriptase Polymerase Chain Reaction, General Medicine, Phenotype, medicine.anatomical_structure, Pulsatile Flow, 030220 oncology & carcinogenesis, Models, Animal, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine.symptom, medicine.medical_specialty, Epithelial-Mesenchymal Transition, Organ Preservation Solutions, Urology, Cold storage, Protective Agents, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, medicine, Animals, Cryopreservation, Inflammation, Machine perfusion, Biochemistry, Genetics and Molecular Biology(all), business.industry, Research, lcsh:R, Recovery of Function, medicine.disease, Kidney Transplantation, Survival Analysis, Autotransplantation, Surgery, Chronic Disease, Multivariate Analysis, business, Biomarkers, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Background Machine perfusion (MP) of kidney graft provides benefits against preservation injury, however decreased graft quality requires optimization of the method. We examined the chronic benefits of MP on kidney grafts and the potential improvements provided by IGL-1 solution. Method We used an established autotransplantation pig kidney model to study the effects of MP against the deleterious effects of warm ischemia (WI: 60 minutes) followed by 22 hours of cold ischemia in MP or static cold storage (CS) followed by autotransplantation. MPS and IGL-1 solutions were compared. Results Animal survival was higher in MPS-MP and both IGL groups. Creatinine measurement did not discriminate between the groups, however MPS-MP and both IGL groups showed decreased proteinuria. Chronic fibrosis level was equivalent between the groups. RTqPCR and immunohistofluorescent evaluation showed that MP and IGL-1 provided some protection against epithelial to mesenchymal transition and chronic lesions. IGL-1 was protective with both MP and CS, particularly against chronic inflammation, with only small differences between the groups. Conclusion IGL-1 used in either machine or static preservation offers similar levels of protection than standard MP. The compatibility of IGL-1 with both machine perfusion and static storage could represent an advantage for clinical teams when choosing the correct solution to use for multi-organ collection. The path towards improving machine perfusion, and organ quality, may involve the optimization of the solution and the correct use of colloids.
Published: 2012
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20. New Computerized Color Image Analysis for the Quantification of Interstitial Fibrosis in Renal Transplantation

Author: Aude Servais, Jean-Christophe Olivo-Marin, Christophe Legendre, Henri Kreis, Clarisse Panterne, Vannary Meas-Yedid, Nicole Brousse, Paul Landais, Laure-Hélène Noël, Emmanuel Morelon, Nicolas Hervé, Eric Thervet, Analyse d'Images Quantitative (AIQ), Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Réseau CENTAURE, Unité de Recherche en Epidémiologie Nutritionnelle (UREN), Université Paris 13 (UP13)-Institut National de la Recherche Agronomique (INRA)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Immunité infection vaccination (I2V), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-IFR128-Institut National de la Santé et de la Recherche Médicale (INSERM), and This work was supported by the 'Agence de la Biomédecine' by a 'Programme Transversal de Recherche' Faculté Necker-Institut Pasteur and by the Centaure Foundation.
Subjects: Banff classification Masson trichrome, Pathology, medicine.medical_specialty, Biopsy, Renal function, Color, [SDV.CAN]Life Sciences [q-bio]/Cancer, Interstitial fibrosis quantification, Kidney, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Chronic allograft nephropathy, [INFO.INFO-LG]Computer Science [cs]/Machine Learning [cs.LG], Fibrosis, Trichrome, medicine, Image Processing, Computer-Assisted, Humans, Transplantation, Homologous, Kidney transplantation, Observer Variation, Transplantation, medicine.diagnostic_test, business.industry, Color image, Reproducibility of Results, [INFO.INFO-CV]Computer Science [cs]/Computer Vision and Pattern Recognition [cs.CV], Renal transplantation, [SDV.IMM.IMM]Life Sciences [q-bio]/Immunology/Immunotherapy, medicine.disease, Kidney Transplantation, medicine.anatomical_structure, [INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV], Nuclear medicine, business, Algorithms, Software, Color image analysis
Abstract: International audience; Background. Chronic allograft injury, the primary cause of late allograft failure in renal transplantation, can be diagnosed early at a preclinical stage by histopathological changes such as interstitial fibrosis (IF). Currently, assessed by semiquantitative analysis in the Banff classification, IF quantification is limited by pathologist's subjective interpretation.Methods. We have designed algorithms dedicated to quantify IF by computerized color image analysis. This innovative and objective software automatically extracts the green areas characteristic of IF in Masson's trichrome based on color image segmentation followed by removal of nonspecific IF staining (capsula, sclerosis glomeruli and normal glomeruli, normal basement membrane) and computes an index. It also counts automatically the number of glomeruli. Sixty-seven Masson stained renal transplant biopsies at various IF stages were imaged using a digital color camera mounted on a microscope. We tested the robustness of the method against varying acquisition parameters.Results. We demonstrated that the parameters do not have an impact on this quantification and that the algorithm is able to handle biopsy color variations. The intra- and interobserver reproducibility was good (P
Published: 2011
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21. Interstitial Fibrosis Evolution on Early Sequential Screening Renal Allograft Biopsies Using Quantitative Image Analysis

Author: Vannary Meas-Yedid, Eric Thervet, Ch. Legendre, F. Martinez, Aude Servais, Jean-Christophe Olivo-Marin, M.O. Timsit, L.-H. Noël, Julien Zuber, Henri Kreis, Clarisse Panterne, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Analyse d'Images Quantitative (AIQ), Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Centre de recherche Croissance et signalisation (UMR_S 845), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Réseau CENTAURE, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), and Meas-Yedid, Vannary
Subjects: Graft Rejection, Male, Pathology, Biopsy, Interstitial fibrosis, Kidney, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, [INFO.INFO-CV] Computer Science [cs]/Computer Vision and Pattern Recognition [cs.CV], Fibrosis, Calcineurin inhibitors, Image Processing, Computer-Assisted, Immunology and Allergy, Pharmacology (medical), medicine.diagnostic_test, Middle Aged, Tissue Donors, Treatment Outcome, [INFO.INFO-TI] Computer Science [cs]/Image Processing [eess.IV], [INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV], Female, [SDV.IMM.IMM] Life Sciences [q-bio]/Immunology/Immunotherapy, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Urology, Renal function, [SDV.CAN]Life Sciences [q-bio]/Cancer, screening renal biopsies, Tacrolimus, Text mining, [INFO.INFO-LG]Computer Science [cs]/Machine Learning [cs.LG], [SDV.CAN] Life Sciences [q-bio]/Cancer, image analysis, Diabetes mellitus, medicine, Humans, Transplantation, business.industry, [INFO.INFO-CV]Computer Science [cs]/Computer Vision and Pattern Recognition [cs.CV], [SDV.IMM.IMM]Life Sciences [q-bio]/Immunology/Immunotherapy, [INFO.INFO-LG] Computer Science [cs]/Machine Learning [cs.LG], interstitial fibrosis, medicine.disease, Kidney Transplantation, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Calcineurin, business
Abstract: International audience; Screening renal biopsies (RB) may assess early changes of interstitial fibrosis (IF) after transplantation. The aim of this study was to quantify IF by automatic color image analysis on sequential RB. We analyzed RB performed at day (D) 0, month (M) 3 and M12 from 140 renal transplant recipients with a program of color segmentation imaging. The mean IF score was 19 ± 9% at D0, 27 ± 11% at M3 and 32 ± 11% at M12 with a 8% progression during the first 3 months and 5% between M3 and M12. IF at M3 was correlated with estimated glomerular rate (eGFR) at M3, 12 and 24 (p < 0.02) and IF at M12 with eGFR at M12 and 48 (p < 0.05). Furthermore, IF evolution between D0 and M3 (ΔIFM3-D0) was correlated with eGFR at M24, 36 and 48 (p < 0.03). IF at M12 was significantly associated with male donor gender and tacrolimus dose (p = 0.03). ΔIFM3-D0 was significantly associated with male donor gender, acute rejection episodes (p = 0.04) and diabetes mellitus (p = 0.02). Thus, significant IF is already present before transplantation. IF evolution is more important during the first 3 months and has some predictive ability for change in GFR. Intervention to decrease IF should be applied early, i.e. before 3 months, after transplantation.
Published: 2011
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21 results on '"Réseau CENTAURE"'

1. Influence of Anemia on Patient and Graft Survival After Renal Transplantation: results from the French DIVAT cohort

2. Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes

3. Cohort study: 'Outcomes of kidney transplantation in patients with prosthetic heart valves'

4. Ribavirin for Hepatitis E Virus Infection After Organ Transplantation

5. Covariates adjustment questioned conclusions of predictive analyses: an illustration with the Kidney Donor Risk Index

6. Comparison of longitudinal quality of life outcomes in preemptive and dialyzed patients on waiting list for kidney transplantation

7. The 1-year Renal Biopsy Index: a scoring system to drive biopsy indication at 1-year post-kidney transplantation

8. Lack of impact of pre-emptive deceased-donor kidney transplantation on graft outcomes: a propensity score-based study

9. Diagnosis and management of asymptomatic bacteriuria in kidney transplant recipients

10. Severe dermatophytosis in solid organ transplant recipients: A French retrospective series and literature review

11. Propensity score-based comparison of the graft failure risk between kidney transplant recipients of standard and expanded criteria donor grafts: Toward increasing the pool of marginal donors

12. Horizontal mixture model for competing risks: a method used in waitlisted renal transplant candidates

13. Prospective Evaluation of Serum β-Glucan Testing in Patients With Probable or Proven Fungal Diseases

14. Improving Long-Term Outcome in Allograft Transplantation: Role of Ionic Composition and Polyethylene Glycol

15. A personalized follow-up of kidney transplant recipients using video conferencing based on a 1-year scoring system predictive of long term graft failure (TELEGRAFT study): protocol for a randomized controlled trial

16. A useful scoring system for the prediction and management of delayed graft function following kidney transplantation from cadaveric donors

17. Pretransplant Sensitization Against Angiotensin II Type 1 Receptor Is a Risk Factor for Acute Rejection and Graft Loss

18. Benefits of active oxygenation during hypothermic machine perfusion of kidneys in a preclinical model of deceased after cardiac death donors

19. Chronic renoprotective effect of pulsatile perfusion machine RM3 and IGL-1 solution in a preclinical kidney transplantation model

20. New Computerized Color Image Analysis for the Quantification of Interstitial Fibrosis in Renal Transplantation

21. Interstitial Fibrosis Evolution on Early Sequential Screening Renal Allograft Biopsies Using Quantitative Image Analysis

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