186 results on '"Lefrançois N"'
Search Results
52. Les variations diastratiques du français au Grand-Duché de Luxembourg
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Lefrançois Nicolas
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Social Sciences - Abstract
Dans la triglossie luxembourgeoise – allemand, français, luxembourgeois - le français tient une place particulière puisque tant son statut que son expansion ont varié au cours de l’histoire récente du pays. Langue littéraire de l’élite à l’époque de l’indépendance en 1831 dans un pays germanophone le français connait un pic de diffusion sociale durant la deuxième moitié du XXe siècle, suite à un fort besoin de main-d’oeuvre issue de la Belgique et de la France voisines ainsi que de l’immigration principalement portugaise. Cette « démocratisation » du français s’accompagne alors d’une dévalorisation pour les Luxembourgeois remettant en cause son statut de langue officielle du Grand-Duché.
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- 2020
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53. CYCLOSPORINE PLASMA LEVELS SIX HOURS AFTER ORAL ADMINISTRATION.
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Cantarovich, F., Bizollon, Ch., Cantarovich, D., Lefrançois, N., Dubernard, J. M., and Traeger, J.
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- 1988
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54. 5 Third renal transplantation: Is it really the best option?
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Badet, L., Lefrancois, N., Fassi-Fehri, H., Cherasse, A., Colombel, M., and Martin, X.
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- 2004
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55. Comparison of Echodoppler and Clearance Method for the Evaluation of Renal Vascular Resistances.
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Traeger, J., Bétuel, H., Dubernard, J. M., Revillard, J. P., Dupuy, C., Daoud, S., Poix, D., Garnier, J. L., Guerard, A., Lefrançois, N., Touraine, J. L., and Hadj-Aïssa, A.
- Abstract
We studied 104 patients - 45 females, 59 males - aged 20 to 64 years (mean = 42.4±11.5 years). All patients were recipients of cadaveric kidney transplants. They received conventional immunosuppressive therapy (prednisolone, ciclosporine, azathioprine). [ABSTRACT FROM AUTHOR]
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- 1998
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56. Comparative Influence of HLA in the Survival of the First and Second Renal Grafts.
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Traeger, J., Bétuel, H., Revillard, J. P., Dupuy, C., Garnier, J. L., Gebuhrer, L., Daoud, S., Lefrançois, N., Guérard, A., Bonnet, M. C., Carrie, J., Dubernard, J. M., and Touraine, J. L.
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In a retrospective study, we have analysed the outcome of the first and the second graft according to HLA compatibility and duration of the first graft. [ABSTRACT FROM AUTHOR]
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- 1998
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57. INCIDENCE AND RISK FACTORS FOR NEW ONSET DIABETES MELLITUS AFTER RENAL TRANSPLANTATION: RESULTS OF THE MULTICENTRIC OBSERVATIONAL STUDY DIAPASON.
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Kamar, N, Mariat, C, Delahousse, M, Lefrançois, N, Dantal, J, and Benhamou, P -Y
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- 2006
58. 9b Pancreatic transplantation: indications and results
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Martin, X., Dubernard, J.M., and Lefrancois, N.
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- 1994
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59. Intérêt du ribotypage pour l'étude des infections nosocomiales à Xanthomonas maltophilia. A propos d'une épidémie dans un Centre de Transplantation Rénale
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Zambardi, G., Meugnier, H., Tissot-Guerraz, F., Perraud, M., Lefrancois, N., Martin, X., Freney, J., and Feleurette, J.
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- 1993
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60. Co-infection by hepatitis B virus and hepatitis C virus in renal transplantation: morbidity and mortality in 1098 patients
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Pouteil-Noble, C., Tardy, J. C., Chossegros, P., Mion, F., Chevallier, M., Gérard, F., Chevallier, P., Megas, F., Lefrançois, N., and Touraine, J. L.
- Abstract
The aim of the study was to analyse the influence of co-infection by hepatitis B virus (HBV) and hepatitis C virus (HCV) as compared with HCV infection alone in 1098 patients who received a kidney transplant between 1 January and 31 December 1991. At transplantation, the prevalence of anti-HCV antibodies was 21.40% (235/1098) while the prevalence of HBV infection was 9.85% (108/1096); 46 patients were co-infected with HBV and HCV, either 19.70% of HCV-infected patients and 42.60% of HBV-infected patients. Liver tests, galactose clearance and liver biopsy were compared in the 46 co-infected patients (HCV+HBV+) and in the 189 HCV-infected patients (HCV+HBV−). At the time of transplantation, cytolysis was present in 31.45% of HCV+HBV− patients (50/159) and in 40% of HCV+HBV− patients (16/40); cholestasis was present in 34.18% of HCV+HBV− patients (34/158) and 42.11% of HCV+HBV+ patients (16/38). At 6 months the incidence of biological abnormalities increased to 37% in HCV+HBV− patients (55/150) and to 52.5% in HCV+HBV− patients (21/40), suggesting a more deleterious effect of the immunosuppressive therapy in the co-infected group. Over the course of transplantation, chronic hepatitis was present in 50% of HCV+HBV− patients and in 64.1% of HCV+HBV+ patients. Liver failure occurred in 7% of HCV+HBV− patients (12/156) and 17% of HCV+HBV+ patients (7/41). Galactose clearance was performed as a functional test in 68 patients: it was not significantly different in either group. Liver biopsy was performed in 108 patients at least once. Minimal changes were more frequent in HCV+HBV− patients while the incidence of cirrhosis was 10% in HCV+HBV− patients (8/81) and 26% in HCV+HBV+ patients (7/27). Serum HCV RNA detected by polymerase chain reaction was present in 81% of the HCV+HBV− patients (43/53) and 70% of the HCV+HBV+ patients (14/20). Patient survival rate was not significantly different in both groups at 12 years.
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- 1995
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61. First double hand transplantation: results after 18 months.
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Dubernard, J.M., Henry, P., Parmentier, H., Vallet, B., Vial, D., Badet, L., Petruzzo, P., Lefrançois, N., Lanzetta, M., Owen, E., and Hakim, N.
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TRANSPLANTATION of organs, tissues, etc. , *HAND surgery - Abstract
Aim of the study: The previous results achieved in single hand transplantations confirmed the feasibility of this procedure and encouraged us to perform the first human double hand transplantation, which was performed in January 2000. In the present study we reported the results obtained eighteen months after transplantation.Patient and methods: The recipient was a 33-year old man suffering from a traumatic amputation of both hands in 1996. Surgery included procurement of the upper extremities from a 18-year old multiorgan cadaveric donor, preparation of the graft and recipient’s stumps, transplantation of the hands, which included bone fixation, arterial and venous anastomoses, nerve suture, joining of tendons and muscles, and skin closure. Immunosuppressive protocol included tacrolimus, prednisone and mycophenolate mofetil. An intensive rehabilitation program was performed. Follow-up included immunological tests, skin biopsies, arteriography, bone scintigraphy, electromyography and brain functional magnetic resonance imaging.Results: No surgical complications, infectious complications and graft-versus-host-disease occurred. Two episodes of acute skin rejection were demonstrated and they were completely reversed increasing steroid dose . Nerve regeneration and cortical reorganization were shown. Sensorimotor recovery was encouraging and life quality improved.Conclusion: This double hand transplantation showed that conventional immunosuppressive protocol is effective and safe as well as that functional results are at least as good as those achieved in replanted upper extremities. [Copyright &y& Elsevier]
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- 2002
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62. Ameboma: an unusual cause of gastrointestinal bleeding during severe leptospirosis.
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Legris T, Jaffar-Bandjee MC, Favre O, Lefrançois N, Genin R, Ragot C, Fernandez C, and Reboux AH
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- Acute Kidney Injury etiology, Diagnosis, Differential, Entamoebiasis complications, Gastrointestinal Hemorrhage etiology, Humans, Jaundice etiology, Leptospirosis complications, Male, Middle Aged, Entamoeba histolytica isolation & purification, Entamoebiasis diagnosis, Leptospirosis diagnosis
- Abstract
Background: Severe leptospirosis occurs mainly in a tropical environment and includes icterus, acute renal failure and hemorrhages. These bleedings, which are mainly a consequence of acute homeostatic disturbances, can also reveal simultaneous diseases. Coinfections with other tropical diseases have been previously reported during leptospirosis. To our knowledge, invasive amebiasis, which can induce gastrointestinal bleedings, has never been described in the course of severe leptospirosis., Case Presentation: In this report, we describe a case of a 60 year-old man living in Reunion Island (Indian Ocean, France) admitted to our intensive care unit for severe Leptospira interrogans serovar icterohaemorrhagiae infection with neurological, renal, liver and hematological involvement. Two lower gastrointestinal bleedings occurred 7 and 15 days after admission. The first episode was promoted by hemostatic disturbances while the second bleeding occurred during low-dose heparin therapy. Colonoscopy revealed a pseudo-tumoral inflammatory mass of the recto-sigmoid junction. Histological examination found trophozoites inside mucinous exudate suggestive of Entamoeba histolytica. Amoebic serology was strongly positive whereas careful detection of cysts or trophozoites on saline-wet mount was negative in three consecutive samples of stools. Amoxicillin followed by metronidazole therapy, combined with supportive care, led to an improvement in the clinical and biological patient's condition and endoscopic appearances., Conclusion: Clinicians should be aware that gastrointestinal bleeding during severe leptospirosis could not solely be the consequences of hemostatic disturbances. Careful endoscopic evaluation that may reveal curable coinfections should also be considered.
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- 2014
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63. Efficacy and safety of de novo or early everolimus with low cyclosporine in deceased-donor kidney transplant recipients at specified risk of delayed graft function: 12-month results of a randomized, multicenter trial.
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Dantal J, Berthoux F, Moal MC, Rostaing L, Legendre C, Genin R, Toupance O, Moulin B, Merville P, Rerolle JP, Bayle F, Westeel PF, Glotz D, Kossari N, Lefrançois N, Charpentier B, Quéré S, Di Giambattista F, and Cassuto E
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- Adult, Aged, Everolimus, Female, Glomerular Filtration Rate, Graft Survival, Humans, Immunosuppressive Agents therapeutic use, Kidney Transplantation methods, Male, Middle Aged, Prospective Studies, Risk, Sirolimus therapeutic use, Treatment Outcome, Wound Healing, Cyclosporine therapeutic use, Sirolimus analogs & derivatives
- Abstract
Immediate or early use of proliferation signal inhibitor (PSI)/mammalian target of rapamycin (mTOR) inhibitor therapy can avoid high exposure to calcineurin inhibitors but concerns exist relating to the risk of delayed graft function (DGF) and impaired wound healing with the mTOR sirolimus. CALLISTO was a 12-month, prospective, multicenter, open-label study. Deceased-donor kidney transplant patients at protocol-specified risk of DGF were randomized to start everolimus on day 1 (immediate everolimus, IE; n = 65) or week 5 (delayed everolimus, DE; n = 74). Incidence of the primary endpoint (biopsy-proven acute rejection, BPAR; graft loss, death, DGF, wound healing complications related to transplant surgery or loss to follow-up) was 64.6% and 66.2% in the IE and DE groups, respectively, at month 12 (P = 0.860). The overall incidence of BPAR was 20.1%. Median estimated glomerular filtration rate was 48 ml/min/1.73 m(2) and 49 ml/min/1.73 m(2) in the IE and DE groups, respectively, at month 12. DGF and wound healing complications were similar between groups. Adverse events led to study drug discontinuation in 17 IE patients (26.2%) and 28 DE patients (37.8%) (NS). In conclusion, introduction of everolimus immediately or early posttransplant in DGF-risk patients is associated with good efficacy, renal function and safety profile. There seems no benefit in delaying initiation of everolimus., (© 2010 The Authors. Journal compilation © 2010 European Society for Organ Transplantation.)
- Published
- 2010
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64. Thymoglobulin induction and sirolimus versus tacrolimus in kidney transplant recipients receiving mycophenolate mofetil and steroids.
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Glotz D, Charpentier B, Abramovicz D, Lang P, Rostaing L, Rifle G, Vanrenterghem Y, Berthoux F, Bourbigot B, Delahousse M, Chalopin JM, Cassuto E, and Lefrançois N
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- Adolescent, Adult, Aged, Antilymphocyte Serum chemistry, Calcineurin chemistry, Calcineurin Inhibitors, Child, Child, Preschool, Female, Glomerular Filtration Rate, Humans, Immunosuppressive Agents therapeutic use, Male, Middle Aged, Mycophenolic Acid therapeutic use, Treatment Outcome, Antibodies, Monoclonal metabolism, Kidney Transplantation methods, Mycophenolic Acid analogs & derivatives, Sirolimus therapeutic use, Steroids therapeutic use, Tacrolimus therapeutic use
- Abstract
Background: To define the role of mammalian target of rapamycin inhibitors in kidney transplantation, we compared efficacy and safety of two immunosuppressive regimens-a calcineurin inhibitor-free regimen with depletive induction versus a calcineurin inhibitor-based regimen., Methods: De novo renal allograft recipients were randomized before transplantation to receive sirolimus (SRL; n=71, group A) or tacrolimus (n=70, group B). All patients received mycophenolate mofetil and corticosteroids. In group A, patients received rabbit antithymocyte globulin induction. In group B, antithymocyte globulin therapy could be given in case of delayed graft function. The estimated glomerular filtration rate (GFR) (Nankivell's formula) at month 12 was the primary endpoint., Results: GFR showed no significant difference at month 12, with 56.1 in group A versus 58.4 mL/min/1.73 m in group B. In functioning grafts, renal function was significantly better in the SRL group, with higher GFR values at months 1, 2, 3, 6, and 9 (P<0.05). At month 12, patient survival and incidence of biopsy-proven rejection were not different between groups (95.8% vs. 97.1%, and 16.9% vs. 12.9%, respectively). However, proportion of graft loss was higher with SRL at months 6 and 12 (11.3% vs. 0.0%, P=0.004; 14.1% vs. 4.3%, P=0.044, respectively). Adverse events and premature withdrawals were more frequent with SRL (P<0.001 and P<0.05, respectively), whereas cytomegalovirus infections were more frequent with tacrolimus (P<0.001)., Conclusion: Patients treated with induction plus SRL, mycophenolate mofetil, and corticosteroids may obtain good renal function but have a higher risk of adverse events, drug withdrawal, and graft loss.
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- 2010
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65. Preferential increase in memory and regulatory subsets during T-lymphocyte immune reconstitution after Thymoglobulin induction therapy with maintenance sirolimus vs cyclosporine.
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Morelon E, Lefrançois N, Besson C, Prévautel J, Brunet M, Touraine JL, Badet L, Touraine-Moulin F, Thaunat O, and Malcus C
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- Adolescent, Adult, Aged, Antilymphocyte Serum, CD4-Positive T-Lymphocytes cytology, CD4-Positive T-Lymphocytes immunology, Cell Proliferation drug effects, Female, Flow Cytometry, Humans, Lymphocyte Activation drug effects, Male, Middle Aged, Pilot Projects, T-Lymphocytes, Regulatory cytology, T-Lymphocytes, Regulatory immunology, Antibodies, Monoclonal pharmacology, CD4-Positive T-Lymphocytes drug effects, Cyclosporine pharmacology, Immunosuppressive Agents pharmacology, Sirolimus pharmacology, T-Lymphocyte Subsets drug effects, T-Lymphocytes, Regulatory drug effects
- Abstract
Background: Sirolimus maintenance therapy with Thymoglobulin induction is a promising regimen that may preserve renal function. Data are lacking, however, about the immunologic effects of combined Thymoglobulin-sirolimus., Methods: In a 12-month, prospective, randomised, open-label, single-centre pilot study, de novo deceased-donor kidney transplant patients were randomised to receive cyclosporine or sirolimus, with Thymoglobulin induction, mycophenolate mofetil and corticosteroids. Flow cytometry analysis of peripheral blood was used to evaluate immune reconstitution., Results: Nineteen patients were recruited (sirolimus 9, cyclosporine 10). Reconstitution of the CD4(+) T-lymphocyte subset was significantly lower with sirolimus versus cyclosporine over year 1, but CD8(+) reconstitution did not differ significantly between groups. The proportion of naïve CD4(+) T-lymphocytes showed an initial decrease with sirolimus versus cyclosporine. Naïve CD8(+) T-lymphocytes increased versus baseline in the cyclosporine cohort at months 1 and 3, but remained unchanged with sirolimus. Memory CD4(+) T-lymphocytes occurred more frequently in sirolimus- versus cyclosporine-treated patients during year 1. The proportion of memory CD8(+) T-lymphocytes decreased at months 1 and 3 compared to baseline in the CsA arm, but did not change in the sirolimus cohort. By month 12, the proportion of both naïve and memory CD4(+) and CD8(+) T-lymphocytes had become similar with sirolimus or cyclosporine. There were fewer naïve B-lymphocytes in the sirolimus cohort and more CD19(-)IgD(+/-)CD27(+) memory B-lymphocytes., Conclusions: In this small population, homeostatic reconstitution after Thymoglobulin induction showed disproportionately high recovery of memory T-lymphocyte subsets during sirolimus therapy, which may explain the higher rejection rate seen with sirolimus versus cyclosporine following kidney transplantation., (Copyright (c) 2010 Elsevier B.V. All rights reserved.)
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- 2010
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66. Incidence of delayed graft function and wound healing complications after deceased-donor kidney transplantation is not affected by de novo everolimus.
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Albano L, Berthoux F, Moal MC, Rostaing L, Legendre C, Genin R, Toupance O, Moulin B, Merville P, Rerolle JP, Bayle F, Westeel PF, Glotz D, Kossari N, Lefrançois N, Charpentier B, Blanc AS, Di Giambattista F, and Dantal J
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- Aged, Delayed Graft Function etiology, Delayed Graft Function mortality, Drug Administration Schedule, Drug Therapy, Combination, Everolimus, Female, France epidemiology, Graft Rejection etiology, Graft Rejection prevention & control, Graft Survival drug effects, Humans, Immunosuppressive Agents adverse effects, Incidence, Kidney Function Tests, Kidney Transplantation mortality, Male, Middle Aged, Prospective Studies, Sirolimus administration & dosage, Sirolimus adverse effects, Time Factors, Transplantation Tolerance drug effects, Treatment Outcome, Delayed Graft Function prevention & control, Immunosuppressive Agents administration & dosage, Kidney Transplantation adverse effects, Sirolimus analogs & derivatives, Wound Healing drug effects
- Abstract
Background: Concerns about delayed graft function (DGF) and wound healing complications with sirolimus has led to suggestions that everolimus introduction could be delayed after transplantation., Methods: In a prospective, multicenter, open-label study, deceased-donor kidney transplant recipients at protocol-specified risk of DGF (defined as > or =1 dialysis session during the first week posttransplant excluding day 1) were randomized to start everolimus therapy on day 1 posttransplant (immediate everolimus [IE]), or from week 5 (delayed everolimus [DE]) with mycophenolic acid until everolimus was initiated. All patients received anti-interleukin-2 receptor antibodies, cyclosporine A, and corticosteroids. A planned 3-month analysis from this 12-month study is presented here., Results: One hundred and thirty-nine patients were randomized (IE 65, DE 74). The primary composite endpoint: biopsy-proven acute rejection, graft loss, death, DGF, wound healing events, or lost to follow-up at month 3, occurred in 36 IE patients (55.4%) and 47 DE patients (63.5%, P=0.387). The incidence of DGF was similar between groups (IE 24.6%, DE 24.3%; n.s.). Wound healing events of any type occurred in 40.0% and 41.9% of IE and DE patients (n.s.); events relating to initial transplant surgery occurred in 36.9% IE patients and 37.8% DE patients (n.s.), most of which were fluid collections. Study drug was discontinued due to adverse events or graft loss in 13 IE (20.0%) and 17 DE patients (23.0%)., Conclusions: Findings from this randomized, multicenter trial indicate that kidney function recovery, wound healing, efficacy, and tolerance are similar at 3 months posttransplant with immediate or DE in patients at protocol-specified risk of DGF.
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- 2009
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67. IGL-1 solution in kidney transplantation: first multi-center study.
- Author
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Codas R, Petruzzo P, Morelon E, Lefrançois N, Danjou F, Berthillot C, Contu P, Espa M, Martin X, and Badet L
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- Adolescent, Adult, Aged, Creatinine blood, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Prospective Studies, Young Adult, Kidney Transplantation, Organ Preservation Solutions
- Abstract
IGL-1 solution is characterized by inversion of K+ and Na+ concentrations in the University Wisconsin (UW) solution and polyethylene glycol 35 (PEG 35) substitution for hydroxy ethyl starch. In this prospective study, 121 patients transplanted with kidneys preserved in IGL-1 solution were compared to 102 patients grafted with kidneys preserved in UW solution. Serum creatinine and creatinine clearance, delayed graft function (DGF) and rejection episodes, patient and graft survival were evaluated in the first post-transplant year. Groups were comparable regarding to donor and recipient characteristics. Median creatinine levels were significantly lower in IGL-1 group from day 6 to day 14 and it decreased more rapidly in the IGL-1 group (from day 4 to day 15: p < 0.05). Creatinine clearance values were usually higher in the IGL-1 group for the first 15 d. During the follow-up period serum creatinine concentrations were lower in IGL-1 group at one, three, six and 12 months after transplantation (p = 0.04; p = 0.06, p = 0.01 and p = 0.08, respectively) while creatinine clearance values were similar during the follow-up. No significant difference in DGF and rejection rates as well as in patient and graft survival was shown between the two groups. Kidneys preserved in IGL-1 solution showed to have the same function as kidneys preserved in UW solution.
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- 2009
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68. [Incidence and management of anemia in renal transplantation: an observational-French study].
- Author
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Choukroun G, Deray G, Glotz D, Lebranchu Y, Dussol B, Bourbigot B, Lefrançois N, Cassuto-Viguier E, Toupance O, Hacen C, Lang P, Mazouz H, and Martinez F
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- Adult, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Creatinine blood, Erythropoiesis physiology, Female, France epidemiology, Glomerular Filtration Rate, Hemoglobins metabolism, Hospitals, University, Humans, Kidney Function Tests, Kidney Transplantation physiology, Male, Middle Aged, Anemia epidemiology, Anemia therapy, Kidney Transplantation adverse effects
- Abstract
The management of anemia after kidney transplantation remains poorly explored. The Management of Anemia in French Kidney Transplant Patients (MATRIX) study is an observational study conducted in 10 academic hospitals among kidney-transplant patients designed to evaluate the prevalence, associated factors and management of post-transplant anemia. Over two consecutive weeks, 418 recipients (males: 248; age: 50.8+/-12.7 years) were included, all were transplanted for more than six months. Mean serum creatinine (Scr) was 152+/-67 micromol/l and mean hemoglobin (Hb) was 12.4+/-1.8 g/dl (males: 12.8+/-1.9 g/dl; females 11.9+/-1.6 g/dl). Irrespective of the delay following transplantation, 23% of patients (n=95) were severely anemic (Hb < or = 11 g/dl). Eighteen percent of the patients received an antianemic treatment (10% oral iron, 7% erythropoiesis stimulating agents (ESA), 4% folic acid) and only 35% of the severely anemic patients were actually treated (n=33). A significantly-negative correlation was observed between eGFR and Hb levels (R= -0.347, p<0.02). Ninety-six percent of the 193 patients transplanted for more than six months and a Scr greater than 150 micromol/l (n=185) suffered at least one comorbidity (89% hypertension, 32% hypercholesterolemia, 13% diabetes); this group represent the second cohort. Seventy-four percent of them were treated with mycophenolate mofetil, 16% with azathioprine, and 62% with an ACEI or angiotensin II receptor antagonists. Since the transplantation, 127 patients (66%) have been anemic (Hb < or = 11 g/dl) and 58% (n=112) were treated (iron and/or ESA, respectively 81 and 55%). Among the patients not treated for anemia, 74% had an Hb level below 12g/dl. ESA-treated patients received a mean dose of 8500 UI+/-2800 per week. Anemia is under-diagnosed and under-treated in renal-transplant recipients, despite its high prevalence. As expected, a correlation between renal function and Hb levels was observed, as in CKD patients. Prospective studies are underway to assess the consequences of postkidney transplant anemia on quality of life, cardiovascular morbidity and chronic allograft nephropathy and to define the benefit of the treatment.
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- 2008
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69. [Dual kidney transplant: the E. Herriot Hospital Lyon experience].
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Rognant N, Codas Duarte R, De la Torre Abril L, Fassi Fehri H, Cuzin B, Colombel M, Dawahra M, McGregor B, Lefrançois N, Brunet M, Daoud S, Emmanuel M, Martin X, and Badet L
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- Aged, Aged, 80 and over, Female, Humans, Male, Kidney Transplantation methods
- Abstract
Introduction: In the current context of a high incidence end-stage kidney disease and a shortage of organs for kidney transplantation, the increasing use of transplants considered to be "borderline" represents a potential source of transplants. Over the last 10 years, some centers have developed a transplantation strategy, which consists of transplanting two borderline kidneys that cannot be proposed separately in a single recipient. The authors report their experience of dual kidney transplant., Materials and Methods: Since 2001, 15 dual kidney transplants have been performed in a single centre according to a local protocol based on the correspondence between the weight of the donor kidney and the recipient's weight, weighted by the number of fibrotic glomeruli observed on the initial biopsy. In this study, the authors analyze the postoperative complications and functional results observed in patients transplanted according to this protocol., Results: Dual kidney transplants represented less than 5% of all transplants performed during the study period concerned, which remained lower than the objectives initially announced by the ABM. The surgical technique was left to the surgeon's discretion. The mean follow-up was 26.3 months. Fourteen of the 15 recipients were alive with a functional graft. Surgical complications were globally more frequent when kidneys were transplanted on the same side (versus transplanted on both sides). Mean serum creatinine was 119.4 mol/l at six months (creatinine clearance according to MDRD formula: 57.3 ml/min per 1.73 m2), 118.8 mol/l at 12 months (creatinine clearance: 55.8) and 132.4 mol/l at 24 months (creatinine clearance: 44.2). One year post-transplant, mean renal function measured by inulin clearance was 55.5 ml/min per 1.73 m2. Four of the 15 patients had experienced an episode of acute rejection and three patients experienced delayed return of transplant function., Conclusion: In view of the results obtained, the authors consider that dual kidney transplant could be a reasonable and effective option for selected patients. Positioning of the transplants in each iliac fossa limited the surgical complication rate.
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- 2008
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70. Diabetes mellitus after kidney transplantation: a French multicentre observational study.
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Kamar N, Mariat C, Delahousse M, Dantal J, Al Najjar A, Cassuto E, Lefrançois N, Cointault O, Touchard G, Villemain F, Di Giambattista F, and Benhamou PY
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- Adult, Blood Glucose metabolism, Body Mass Index, Calcineurin Inhibitors, Cyclosporine administration & dosage, Cyclosporine therapeutic use, Diabetes Mellitus epidemiology, Diabetes Mellitus therapy, Emulsions, Fasting blood, Female, France epidemiology, Hepatitis C complications, Humans, Immunosuppressive Agents adverse effects, Immunosuppressive Agents therapeutic use, Incidence, Kidney Diseases complications, Kidney Diseases surgery, Male, Middle Aged, Retrospective Studies, Risk Factors, Tacrolimus adverse effects, Tacrolimus therapeutic use, Time Factors, Diabetes Mellitus etiology, Kidney Transplantation adverse effects
- Abstract
Background: New-onset diabetes mellitus (NODM)-a common complication of kidney transplantation-is associated with increases in graft loss, morbidity and mortality., Methods: This is a purely observational study of 527 patients taking a calcineurin inhibitor (CNI), based on data collected at a single routine visit 6-24 months after kidney transplantation. Diabetes was defined according to ADA/WHO guidelines., Results: The mean age of the patients was 47.2 years and 61.1% were men; 49.5% were receiving cyclosporine microemulsion (CsA-ME) and 50.5% tacrolimus (Tac). NODM developed in 7.0% after a median interval of 1.6 months. In CsA-ME-treated patients, the unadjusted cumulative risks of NODM were 5.5% and 8.4% at 1- and 2-year post-transplantation, while in Tac-treated patients, the risks were respectively 17.4% and 21%. Four independent risk factors (RFs) were identified by multivariate analysis: maximum lifetime body mass index>25 [odds ratio (OR)=5.1], pre-transplantation impaired fasting glucose (OR=4.7), hepatitis C status (OR=4.7) and Tac vs CsA-ME treatment (OR=3.0)., Conclusions: NODM is associated with certain RFs present prior to kidney transplantation, and with treatment with Tac as opposed to CsA-ME.
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- 2007
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71. Renal function with delayed or immediate cyclosporine microemulsion in combination with enteric-coated mycophenolate sodium and steroids: results of follow up to 30 months post-transplant.
- Author
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Mourad G, Karras A, Kamar N, Garrigue V, Legendre C, Lefrançois N, Charpentier B, Bourbigot B, Pouteil-Noble C, Bayle F, Lebranchu Y, Mariat C, Le Meur Y, Kessler M, Moulin B, Ducloux D, Delahousse M, Lang P, Merville P, Chaouche-Teyara K, and Rostaing L
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- Creatinine blood, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Kidney physiopathology, Kidney Function Tests, Male, Middle Aged, Tablets, Enteric-Coated, Time Factors, Cyclosporine administration & dosage, Immunosuppressive Agents administration & dosage, Kidney Transplantation immunology
- Abstract
Background: In the multicenter, open-label Myriade study, renal transplant patients were randomized to early cyclosporine microemulsion (CsA-ME, day 0) or delayed CsA-ME (day 6) with enteric-coated mycophenolate sodium (EC-MPS), steroids and interleukin-2 receptor induction. One-yr results have been published previously. We now report the results of an extension study in which patients were followed up for a period of three yr post-transplant., Methods: All patients completing the one-yr core study on-treatment were eligible to enter the extension study., Results: Of the 203 patients, 153 completed the core trial on-treatment; 144 (94%) entered the extension study with a minimum follow-up of one yr (73 early CsA-ME, 71 delayed CsA-ME). In 75% of patients receiving EC-MPS during the extension, the recommended dose was administered (1440 mg/d). Median creatinine clearance remained constant (57 mL/min) at 12, 24 and 30 months post-transplant and was similar in the early and delayed CsA-ME groups as well as in subpopulations with or without delayed graft function. One patient in the early CsA-ME group died. No grafts were lost. The incidence of BPAR from time of transplant to the end of the extension study was 17% (24/139). Seven patients (5%) discontinued the extension study prematurely because of adverse events., Conclusion: These results suggest that a regimen of CsA-ME, EC-MPS and steroids results in excellent survival rates with stable renal function over a mean follow-up of 30 months. Immediate introduction of CsA-ME has no deleterious effect on long-term renal function, even among patients with delayed graft function.
- Published
- 2007
- Full Text
- View/download PDF
72. Clinicopathologic monitoring of the skin and oral mucosa of the first human face allograft: Report on the first eight months.
- Author
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Kanitakis J, Badet L, Petruzzo P, Béziat JL, Morelon E, Lefrançois N, Françès C, Claudy A, Martin X, Lengelé B, Testelin S, Devauchelle B, and Dubernard JM
- Subjects
- Adult, Bites and Stings surgery, Facial Injuries surgery, Female, Graft Survival, Humans, Monitoring, Physiologic, Tissue Donors, Transplantation, Homologous, Bites and Stings pathology, Face pathology, Facial Injuries pathology, Graft Rejection pathology, Mouth Mucosa pathology, Skin pathology, Skin Transplantation
- Abstract
Background: The first human face allograft was performed in France on November 27, 2005. We report herein the clinicopathologic findings from the skin and oral mucosa of this allograft during the first eight months., Methods: Sequential biopsies were taken from the facial skin (n = 3), oral mucosa (n = 20), and sentinel skin graft (n = 11) from day 3 to day 220 postgraft and examined (immuno)histologically, using a pathological score previously proposed for evaluation of rejection in composite tissue (hand) transplantation., Results: The patient developed clinically rejection episodes at day 20 and during the eighth month postgraft, manifesting with redness and edema of the facial skin, oral mucosa, and sentinel graft skin. Pathologically, changes suggestive of rejection grades 0, I, II, and III were seen in 1, 1, 1, and 0 biopsies of facial skin, 7, 2, 1, and 1 biopsies of sentinel skin graft and 3, 5, 8, and 4 biopsies of oral mucosa, respectively. Pathological changes were generally more severe in the oral mucosa than in facial and sentinel graft skin (mean scores 1.85, 0.64, and 1, respectively)., Conclusions: As it happens with other composite tissue allografts, close clinicopathologic monitoring of the skin (and oral mucosa) seems to be the most reliable way to detect rejection in the setting of human facial tissue allotransplantation. Apart from these rejection episodes, the skin and mucosa maintained a normal microscopic structure, paralleling functional recovery.
- Published
- 2006
- Full Text
- View/download PDF
73. Subsequent skin cancers in kidney and heart transplant recipients after the first squamous cell carcinoma.
- Author
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Euvrard S, Kanitakis J, Decullier E, Butnaru AC, Lefrançois N, Boissonnat P, Sebbag L, Garnier JL, Pouteil-Noble C, Cahen R, Morelon E, Touraine JL, Claudy A, and Chapuis F
- Subjects
- Adult, Age Factors, Female, Humans, Immunosuppression Therapy adverse effects, Male, Middle Aged, Risk Factors, Sunlight adverse effects, Carcinoma, Squamous Cell etiology, Heart Transplantation adverse effects, Kidney Transplantation adverse effects, Skin Neoplasms etiology
- Abstract
Background: The increased incidence of skin cancers in transplant patients is well documented; however, few data exist on the risk of subsequent skin tumors in a given patient after the first skin cancer. The aim of this study was to compare the individual rate of subsequent skin cancers in kidney (KTR) and heart transplant recipients (HTR) after the first squamous cell carcinoma (SCC) and to assess risk factors for tumor multiplicity., Methods: In all, 188 patients (121 KTR/67 HTR) were studied for up to 5 years. The cumulative number of SCC, basal cell carcinomas, Bowen's diseases, premalignant keratoses, and keratoacanthomas was recorded yearly after the first SCC., Results: Overall, 71% of patients developed 757 new skin tumors. At 5 years, 100% of HTR and 88% of KTR had presented new tumors. However, the mean number of all tumors was significantly higher in KTR (3.4 vs. 2.0, 4.8 vs. 2.6, 6.6 vs. 2.9, 8.5 vs. 3.5, and 9.7 vs. 4.6 at 1, 2, 3, 4, and 5 years, respectively). Transplantation before 1984, multiple tumors at first consultation, eye and hair color, and skin type were predictive of multiple tumors. Early minimization of immunosuppression and of sun exposure tended to be associated with a reduced rate of all tumors and of SCC, respectively., Conclusions: Although the proportion of HTR developing new tumors is greater as compared with KTR, the mean number of tumors per patient is higher in KTR. This could be due to a longer immunosuppression in patients younger at transplantation.
- Published
- 2006
- Full Text
- View/download PDF
74. [Kaposi's sarcoma and organ transplantation: 22 cases].
- Author
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Bécuwe C, Euvrard S, Bosshard S, Pouteil-Noble C, Garnier JL, Lefrançois N, Boillot O, Kanitakis J, Touraine JL, and Claudy A
- Subjects
- Adult, Aged, Cadaver, Female, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, Sarcoma, Kaposi virology, Serologic Tests, Tissue Donors, Herpesvirus 8, Human pathogenicity, Organ Transplantation adverse effects, Sarcoma, Kaposi etiology
- Abstract
Background: The discovery of the Human Herpes virus 8 (HHV8) improved our knowledge of the pathogenesis of Kaposi's sarcoma. After organ transplantation, Kaposi's sarcoma exhibits distinctive features compared with other forms of the disease., Patients and Methods: We report 22 cases of post-transplant Kaposi's sarcoma (12 kidneys, 2 kidney-pancreas, 6 livers and 2 hearts). The aim of this retrospective study was to analyze clinical and virological characteristics in these transplant patients and to specify the frequency of HHV8 seroconversions in this population., Results: Twenty-one patients showed cutaneous lesions and 9 had visceral involvement. HHV8 serology was positive in 16/20 patients at transplantation and in 21/22 cases at the time of Kaposi's sarcoma diagnosis. Most cases corresponded to viral reactivations whereas seroconversions occurred in 2 cases and may have been linked to viral transmission by the graft. Treatment led to recovery in 68p. 100 of the cases. Two heart-transplant patients died from their disease. We included in our series two cases of re-transplanted patients without recurrence of Kaposi's sarcoma and one case of familial Kaposi's sarcoma., Discussion: Seroconversions after transplantation emphasize the interest of systematic screening of HHV8 serology in transplant recipients and their donors.
- Published
- 2005
- Full Text
- View/download PDF
75. Effect of venous drainage site on insulin action after simultaneous pancreas-kidney transplantation.
- Author
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Petruzzo P, Laville M, Badet L, Lefrançois N, Bin-Dorel S, Chapuis F, Andreelli F, and Martin X
- Subjects
- Adult, Diabetes Mellitus, Type 1 surgery, Diabetic Nephropathies surgery, Drainage, Fasting, Female, Glucose Clamp Technique, Glucose Tolerance Test, Humans, Hyperinsulinism urine, Kidney Transplantation physiology, Lipids blood, Male, Middle Aged, Pancreas Transplantation physiology, Transplantation, Homologous, Blood Glucose metabolism, Kidney Transplantation methods, Pancreas Transplantation methods, Portal Vein surgery
- Abstract
Background: The aim of the present study was to determine the influence of the venous drainage site on insulin homeostasis in simultaneous pancreas-kidney (SPK) transplant recipients., Methods: The study included 12 SPK patients with portal venous drainage (P) and 11 SPK patients with systemic venous drainage (S) of pancreas allograft. All of the participants presented similar characteristics. The euglycemic hyperinsulinemic clamp was performed using a 0.4-mU/kg/min insulin infusion. An infusion of [6,6-(2)H2] glucose was used to determine glucose turnover at the basal state and during the clamp to determine liver and peripheral tissue sensitivity to insulin., Results: Minor changes in glycemia and insulinemia were shown: fasting plasma glucose was significantly higher in the SPK-P group and insulinemia was higher in the SPK-S group. Hepatic glucose production was similar in both groups. During the clamp, insulin levels were higher in SPK-S recipients, but hepatic glucose production was suppressed in both groups. Glucose use was lower in SPK-S recipients than in SPK-P recipients, 3.32 +/-1.41 mg/kg/min and 4.70 +/-1.64 mg/kg/min, respectively (P<0.02). Basal and under-clamp free fatty acid levels were similar. In addition, no significant difference in cholesterol and low-density lipoprotein levels was shown, whereas high-density lipoprotein levels were higher in the SPK-S group; triglycerides during fasting and under clamp were significantly higher in the SPK-P group., Conclusions: In both groups, neither hepatic nor peripheral insulin resistance was detected. In SPK-S recipients, the authors have showed only a lower insulin clearance and a slight decreased peripheral responsiveness to insulin without modifications of lipid status.
- Published
- 2004
- Full Text
- View/download PDF
76. First human double hand transplantation: efficacy of a conventional immunosuppressive protocol.
- Author
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Petruzzo P, Revillard JP, Kanitakis J, Lanzetta M, Hakim NS, Lefrançois N, Owen E, and Dubernard JM
- Subjects
- Adult, Amputation, Traumatic surgery, Graft Rejection drug therapy, Graft Survival, Hand Injuries surgery, Humans, Male, Treatment Outcome, Hand Transplantation, Immunosuppressive Agents therapeutic use
- Abstract
Based on the results achieved in single human hand transplantations, we decided to perform the first double hand transplantation with a conventional immunosuppressive protocol in a patient with a high potential for functional recovery. Two years after transplantation the efficacy and the safety of this immunosuppressive protocol are evaluated. The recipient was a 33-yr-old man suffering from a traumatic amputation of both hands in 1996. Five HLA-A, -B, and -DR mismatches were present with the donor; T and B cell cross-match was negative. Immunosuppressive protocol included tacrolimus, prednisone, mycophenolate mofetil and, for induction, antithymocyte globulins and then anti CD25 monoclonal antibody. Reconstitution of lymphocyte populations proceeded normally. Neither anti-HLA antibodies nor chimerism in peripheral blood were detected. Two episodes of acute rejection characterized by maculopapular lesions occurred on days 53 and 82 after transplantation. Skin biopsies revealed a dermal lymphocytic infiltrate. Both episodes were completely and rapidly reversed by topical clobetasol and increased systemic corticosteroid therapy. The only side-effects related to treatment were reversible serum sickness and hyperglycemia. No infectious complications and malignancies occurred. No signs of graft-versus-host disease have been detected. This case of double hand transplantation shows that conventional immunosuppression is effective and safe to ensure survival and functional recovery of the grafted limb.
- Published
- 2003
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- View/download PDF
77. Acute thrombosis of renal transplant artery: graft salvage by means of intra-arterial fibrinolysis.
- Author
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Rouvière O, Berger P, Béziat C, Garnier JL, Lefrançois N, Martin X, and Lyonnet D
- Subjects
- Acute Disease, Adult, Female, Follow-Up Studies, Humans, Male, Middle Aged, Thrombosis etiology, Graft Survival, Kidney Transplantation adverse effects, Renal Artery, Thrombolytic Therapy, Thrombosis therapy
- Abstract
Background: Arterial thrombosis in a transplanted kidney is a serious complication that usually leads to graft loss. The purpose of our study was to evaluate intra-arterial fibrinolysis as a treatment of acute renal transplant artery thrombosis and to determine the maximum period of occlusion allowing a reasonable chance of graft salvage., Methods and Results: Four patients underwent intra-arterial fibrinolysis for acute transplant artery thrombosis. Transplantations had been performed 29 days to 10 years before the fibrinolysis. Fibrinolysis was carried out by using recombitant tissue plasminogen activator (n=1) or urokinase (n=3). In one patient, anuric for 13 hr at admittance, fibrinolysis could not revascularize the graft artery. In a second patient, anuric for 48 hr at admittance, fibrinolysis did revascularize the graft artery, but dialysis could not be discontinued. In the two remaining patients, anuric for 19 and 20 hr at admittance, the graft artery was successfully revascularized and dialysis could be discontinued 1 week later. One of these two patients returned to dialysis 71 months later because of chronic rejection. Thirty-four months after the acute episode, the remaining patient had a patent artery and did not require dialysis., Conclusions: Fibrinolysis seems an efficient treatment that may save transplants after up to 24 hr of the arterial occlusion.
- Published
- 2002
- Full Text
- View/download PDF
78. Simultaneous pancreas-kidney transplantation: portal versus systemic venous drainage of the pancreas allografts.
- Author
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Petruzzo P, Da Silva M, Feitosa LC, Dawahra M, Lefrançois N, Dubernard JM, and Martin X
- Subjects
- Diabetes Mellitus, Type 1 mortality, Diabetic Nephropathies mortality, Female, Graft Survival, Humans, Kidney Failure, Chronic mortality, Male, Postoperative Complications epidemiology, Postoperative Complications mortality, Survival Rate, Diabetes Mellitus, Type 1 surgery, Diabetic Nephropathies surgery, Drainage methods, Kidney Failure, Chronic surgery, Kidney Transplantation methods, Kidney Transplantation mortality, Kidney Transplantation physiology, Pancreas Transplantation methods, Pancreas Transplantation mortality, Pancreas Transplantation physiology, Postoperative Care
- Abstract
Simultaneous pancreas-kidney (SPK) transplantation is considered a valid therapeutic option for patient with type I diabetes mellitus and end-stage diabetic nephropathy. This study was performed to determine whether the technique of pancreas venous drainage affects patient survival as well as graft survival and function. From October 1996 to April 1999 34 uremic patients with type I diabetes mellitus were randomly assigned to two groups: the first group (SV group = 17) received SPK transplantation with systemic venous drainage, and the second group (PV group = 17) received pancreas allograft with portal drainage. A Roux-en-Y loop was performed in all the patients. Patient follow-up included clinical course and metabolic studies. At 1 yr, patient survival rates were 88.2% in the SV group and 94.1% in the PV group while graft survival rate was 76.4% in both groups. Several surgical complications were attributed to the enteric drainage without any graft failure in both groups. One venous thrombosis occurred in each group. No significant differences have been evidenced in kidney and pancreas function. The preliminary results of this randomized trial did not evidence any significant differences between portal and systemic venous drainage of pancreas allograft.
- Published
- 2000
- Full Text
- View/download PDF
79. Evidence of recurrent type I diabetes following HLA-mismatched pancreas transplantation.
- Author
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Petruzzo P, Andreelli F, McGregor B, Lefrançois N, Dawahra M, Feitosa LC, Dubernard JM, Thivolet C, and Martin X
- Subjects
- Adolescent, Adult, Autoantibodies blood, Diabetes Mellitus, Type 1 drug therapy, Female, Graft Rejection immunology, Graft Rejection pathology, Humans, Insulin therapeutic use, Pancreas Transplantation pathology, Recurrence, Reoperation, Tissue Donors, Diabetes Mellitus, Type 1 immunology, Diabetes Mellitus, Type 1 surgery, Diabetic Nephropathies surgery, Histocompatibility Testing, Kidney Failure, Chronic surgery, Kidney Transplantation physiology, Pancreas Transplantation immunology
- Abstract
Type 1 diabetes mellitus is considered as an autoimmune disease against beta cells. Diabetes recurrence after pancreas transplantation is well known in HLA-identical twins while it is rarely reported in recipients of cadaveric pancreatic grafts. In the present case report, diabetes recurrence occurred in a recipient who underwent cadaveric combined pancreas kidney transplantation. Seven years after transplantation the patient exhibited progressive hyperglycemia needing insulin therapy while the renal graft was well functioning. The diagnosis of recurrent disease was obtained on the histological features such as selective loss of beta cells without clear signs of insulitis and on the presence of markers (GAD 65 and IA-2) for humoral autoimmunity. It is intriguing that, at the time of recurrence of type 1 diabetes, the patient had stopped steroids and azathioprine, while only cyclosporine was maintained as immunosuppressive treatment. Our case report underlines the relevance of studying the humoral autoimmune response directed to islet autoantigens in cadaveric pancreas allograft recipients. Furthermore, it suggests that an efficient immunosuppressive treatment after transplantation may be able to reduce the autoimmune response against the pancreatic allograft.
- Published
- 2000
80. First human hand transplantation. Case report.
- Author
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Dubernard JM, Owen E, Lefrançois N, Petruzzo P, Martin X, Dawahra M, Jullien D, Kanitakis J, Frances C, Preville X, Gebuhrer L, Hakim N, Lanzettà M, Kapila H, Herzberg G, and Revillard JP
- Subjects
- Accidents, Adult, Amputation, Surgical, Humans, Male, Movement, Transplantation, Homologous physiology, Transplantation, Homologous rehabilitation, Hand Transplantation, Transplantation, Homologous methods
- Published
- 2000
- Full Text
- View/download PDF
81. [Pancreas transplantation].
- Author
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Dubernard JM, Martin X, Lefrançois N, Dawahra M, Tajra LC, and Martin C
- Subjects
- Diabetes Mellitus physiopathology, France, Humans, Registries, Diabetes Mellitus surgery, Pancreas Transplantation statistics & numerical data
- Published
- 1999
82. Pancreas transplantation: results and indications.
- Author
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Dubernard JM, Tajra LC, Lefrançois N, Dawahra M, Martin C, Thivolet C, and Martin X
- Subjects
- Diabetic Nephropathies surgery, Humans, Kidney Failure, Chronic surgery, Treatment Outcome, Diabetes Mellitus, Type 1 surgery, Immunosuppression Therapy, Pancreas Transplantation
- Abstract
Pancreatic transplantation is the best method of replacing the endocrine function of the gland in Type 1 insulin-dependent diabetic patients. At the end of 1996, 9,000 pancreas transplants had been reported to the international Pancreas Transplant Registry. For 1994-1996, one-year pancreas survival rates were 81% for simultaneous pancreas and kidney transplantation (n = 1,516), 71% for pancreas after kidney (n = 141) and 64% for pancreas alone (n = 64). In patients with a functional graft, glycosylated haemoglobin, fasting blood sugar, and 24-h metabolic profiles are normal. The effect of pancreatic transplantation on secondary complications often appears after several years of normal pancreatic function. Successful transplantation is associated with an improvement in different aspects of the quality of life. The decision to perform pancreatic transplantation depends on the balance between the risks of transplantation, mainly surgical or related to immunosuppression, and those of diabetes development. The advantages and drawbacks of pancreatic transplantation and insulin therapy need to be honestly and carefully analysed for specific populations of diabetic patients as well as for each individual. At present, simultaneous pancreaticorenal transplantation is the best treatment for diabetic patients with chronic renal failure. Transplantation of the pancreas alone in non-uraemic patients may also be considered in carefully selected subjects.
- Published
- 1998
83. Renal transplantation between spouses.
- Author
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Cloix P, Marrast AC, Lefrançois N, Garnier JL, Gebührer M, Martin X, Dubernard JM, and Touraine JL
- Subjects
- Adult, Female, Follow-Up Studies, Graft Rejection epidemiology, Humans, Male, Middle Aged, Time Factors, Graft Survival, Kidney Failure, Chronic surgery, Kidney Transplantation physiology, Living Donors, Spouses
- Published
- 1996
84. Comparative efficacy of prophylactic monoclonal (OKT3) and polyclonal antibodies (ATG) in immunologic high-risk renal transplant recipients.
- Author
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Fukuuchi F, Lefrançois N, Chapuis F, Gebuhrer L, Bosshard S, Dubernard JM, and Touraine JL
- Subjects
- Azathioprine therapeutic use, Chi-Square Distribution, Cyclosporine therapeutic use, Cytomegalovirus Infections epidemiology, Humans, Immunization, Immunosuppressive Agents therapeutic use, Kidney Neoplasms mortality, Methylprednisolone therapeutic use, Postoperative Complications, Prednisolone therapeutic use, Retrospective Studies, Survival Rate, Time Factors, Antilymphocyte Serum therapeutic use, Graft Survival, Immunosuppression Therapy methods, Kidney Neoplasms immunology, Muromonab-CD3 therapeutic use
- Published
- 1996
85. Cytomegalovirus prophylaxis by ganciclovir followed by high-dose acyclovir in renal transplantation: a randomized, controlled trial.
- Author
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Pouteil-Noble C, Megas F, Chapuis F, Bosshard S, Colin C, Hadj-Aissa A, Pozet N, Martin X, Lefrançois N, Garnier JL, Aymard M, and Touraine JL
- Subjects
- Cytomegalovirus Infections classification, Cytomegalovirus Infections epidemiology, Follow-Up Studies, Graft Rejection epidemiology, Graft Survival, Humans, Incidence, Placebos, Probability, Acyclovir therapeutic use, Antiviral Agents therapeutic use, Cytomegalovirus Infections prevention & control, Ganciclovir therapeutic use, Kidney Transplantation, Postoperative Complications
- Published
- 1996
86. [Treatment of lymphocele after kidney transplantation].
- Author
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Martin X, Aboutaieb R, Dawahra M, Lagha K, Garnier JL, Pangaud C, Lefrançois N, Marechal JM, Gelet A, and Dubernard JM
- Subjects
- Adult, Female, Humans, Lymphocele etiology, Male, Middle Aged, Kidney Transplantation adverse effects, Lymphocele therapy
- Abstract
Lymphocele is a possible postoperative complication of renal transplantation and its treatment is still controversial. Over a 3-year period (January 1992 to December 1993), 7 patients with a complicated lymphocele were treated by various modalities. Puncture-drainage was used in 7 cases, Povidone sclerotherapy was performed in 4 cases and internal drainage was performed by surgical marsupialization in one case and by laparoscopy in 4 cases. The results of external drainage and sclerotherapy were disappointing, with 1 good result out of 7 and 1 moderate result out of 4, respectively. On the other hand, internal drainage was effective in every case, whether it was performed by surgical or laparoscopic marsupialization. The latter technique avoids the disadvantages of open surgery in high-risk patients. Laparoscopy appears to be the treatment of choice for post-renal transplantation lymphoceles, as it is simple, rapid and effective.
- Published
- 1996
87. [Role of celioscopy in the treatment of lymphocele after transplantation].
- Author
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Martin X, Pangaud C, Dawahra M, Lefrançois N, Marechal JM, and Dubernard JM
- Subjects
- Adult, Female, Humans, Lymphocele etiology, Male, Middle Aged, Retrospective Studies, Kidney Transplantation adverse effects, Laparoscopy, Lymphocele surgery
- Abstract
Lymphoceles can be observed after renal transplantation. Sometimes lymphoceles can cause symptoms (renal insufficiency, pain). In these cases they require surgical treatment. From january 92 to december 1993 seven patients with complicated lymphoceles were treated. Simple drainage with injections of polyvidone iodine was used in 4 cases without effect. Surgical drainage was performed in 5 cases with complete disappearance of the pouch (on open surgical procedure, four celioscopic procedures). Celioscopic marsupialization of lymphoceles after transplantation is a method of choice and is preferred to open surgery for lymphoceles which develop internally.
- Published
- 1996
88. Hodgkin's disease after renal transplantation.
- Author
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Garnier JL, Lebranchu Y, Lefrançois N, Martin X, Dubernard JM, Berger F, and Touraine JL
- Subjects
- Adolescent, Adult, Follow-Up Studies, Herpesviridae Infections diagnosis, Herpesvirus 4, Human isolation & purification, Hodgkin Disease virology, Humans, Male, Neoplasm Staging, Reed-Sternberg Cells pathology, Reed-Sternberg Cells virology, Time Factors, Tumor Virus Infections diagnosis, Hodgkin Disease pathology, Kidney Transplantation, Postoperative Complications
- Published
- 1995
89. Simultaneous adrenal gland and kidney allotransplantation after synchronous bilateral renal cell carcinoma: a case report.
- Author
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Dubernard JM, Cloix P, Tajra LC, Alduglihan W, Borson F, Lefrançois N, and Martin X
- Subjects
- Adrenal Cortex physiology, Adrenal Glands physiology, Adrenocorticotropic Hormone, Aldosterone blood, Antilymphocyte Serum therapeutic use, Autopsy, Azathioprine therapeutic use, Carcinoma, Renal Cell pathology, Carcinoma, Renal Cell radiotherapy, Carcinoma, Renal Cell secondary, Cyclosporine therapeutic use, Fatal Outcome, Humans, Hypophysectomy, Kidney Neoplasms pathology, Male, Middle Aged, Pituitary Neoplasms radiotherapy, Pituitary Neoplasms secondary, Pituitary Neoplasms surgery, Prednisone therapeutic use, Adrenal Glands transplantation, Carcinoma, Renal Cell surgery, Kidney Neoplasms surgery, Kidney Transplantation immunology, Kidney Transplantation pathology, Kidney Transplantation physiology, Transplantation, Homologous immunology, Transplantation, Homologous pathology, Transplantation, Homologous physiology
- Published
- 1995
90. Early postoperative period: study of metabolic profiles after segmental or total pancreas transplantation.
- Author
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Tajra LC, Molina G, Albalate P, Lefrançois N, Brunet M, Martin X, and Dubernard JM
- Subjects
- Blood Glucose metabolism, Diabetes Mellitus, Type 1 blood, Diabetes Mellitus, Type 1 drug therapy, Duodenum surgery, Duodenum transplantation, Humans, Insulin blood, Insulin therapeutic use, Postoperative Period, Time Factors, Urinary Bladder surgery, Diabetes Mellitus, Type 1 surgery, Pancreas Transplantation methods, Pancreas Transplantation physiology
- Published
- 1994
91. Conversion of total bladder-drained pancreas into total injected grafts.
- Author
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Martin X, Jemni M, Lefrançois N, Laville M, Tajra LC, Molina G, Dawhara M, and Dubernard JM
- Subjects
- Drainage, Humans, Pancreatitis prevention & control, Reoperation, Retrospective Studies, Duodenum surgery, Pancreas Transplantation methods, Postoperative Complications surgery, Urinary Bladder surgery
- Published
- 1994
92. [Lymphoproliferative syndromes associated with Epstein-Barr virus in transplantation].
- Author
-
Garnier JL, Touraine JL, Berger F, Magaud JP, Lefrançois N, Pouteil-Noble C, Betuel H, Martin X, Dubernard JM, and Lenoir G
- Subjects
- Antigens, CD analysis, Antigens, CD immunology, Humans, Immune Tolerance, Lymphoma, B-Cell immunology, Tumor Virus Infections immunology, Tumor Virus Infections microbiology, Herpesvirus 4, Human isolation & purification, Kidney Transplantation adverse effects, Lymphoma, B-Cell etiology, Pancreas Transplantation adverse effects, Tumor Virus Infections complications
- Abstract
We report 23 cases of lymphoproliferative diseases which occurred among 2,100 patients with kidney or combined kidney+pancreas transplant. Eleven patients developed a severe diffuse disease within the first 3 months post-transplantation; immunoblastic B cells of recipient origin infiltrated the bone-marrow, transplanted organs, liver, spleen, lymph nodes, lungs, and brain; immunoglobulin abnormalities with fever, leuko-thrombocytopenia and liver dysfunction constituted the symptoms; all patients received anti-lymphocyte globulins; 9 patients were also treated with cyclosporin. Three out of 6 tumors analysed were monoclonal. Epstein-Barr virus was present in 3 lesions analysed. Treatment consisted of cessation of immunosuppressive therapy. Nine patients died with lactic acidosis. Five patients had a less severe form. Seven patients had solid tumors involving the tonsils, lungs (2), lymph nodes (2), and bladder, 8 months after transplantation. All patients received cyclosporin; 4 also received anti-lymphocyte globulins and 3 OKT3. Tumor cells were immunoblasts expressing B cells markers at a late stage of B cell differentiation; 4 tumors were monoclonal. C myc was negative. Treatment consisted of cessation of immunosuppressive therapy, antiviral agents, and monoclonal antibodies (mAb): anti-CD21 and anti-CD24 mAb therapy was followed by cure of the lymphoma in 1 patient, by transient remission in a second one and by failure in the third patient. Two patients had a recurrence of the lymphoma and received chemotherapy; 2 patients died of the lymphoma, 1 died of unrelated cause; 4 are alive, 3 of them having a good graft function.
- Published
- 1992
93. Ophthalmologic follow-up of type I diabetic patients after kidney and pancreas transplantation.
- Author
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Zech JC, Trepsat C, Gain-Gueugnon M, Lefrançois N, Martin X, and Dubernard JM
- Subjects
- Adult, Cataract etiology, Female, Follow-Up Studies, Humans, Male, Retrospective Studies, Cataract physiopathology, Diabetes Mellitus, Type 1 physiopathology, Diabetes Mellitus, Type 1 surgery, Diabetic Nephropathies physiopathology, Diabetic Nephropathies surgery, Diabetic Retinopathy physiopathology, Kidney Transplantation physiology, Pancreas Transplantation physiology, Visual Acuity
- Published
- 1992
94. Electrophysiologic evolution of diabetic polyneuropathy after combined pancreas and renal transplantation.
- Author
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Vial C, Martin X, Lefrançois N, Dubernard JM, Chauvin F, and Bady B
- Subjects
- Adult, Diabetic Nephropathies physiopathology, Electrophysiology methods, Female, Follow-Up Studies, Humans, Male, Pancreas Transplantation methods, Time Factors, Diabetes Mellitus, Type 1 physiopathology, Diabetes Mellitus, Type 1 surgery, Diabetic Nephropathies surgery, Diabetic Neuropathies physiopathology, Kidney Transplantation physiology, Motor Neurons physiology, Neural Conduction, Pancreas Transplantation physiology, Peripheral Nerves physiopathology
- Published
- 1992
95. [Islets of Langerhans grafts and pancreas transplantation].
- Author
-
Lefrançois N and Martin X
- Subjects
- Diabetes Mellitus, Type 1 complications, Humans, Diabetes Mellitus, Type 1 surgery, Islets of Langerhans Transplantation methods, Pancreas Transplantation methods
- Abstract
In theory, transplantation of the islets of Langerhans is the method of choice for the treatment of insulin-dependent diabetes. In actual fact, medical teams who have been working on this subject for about two decades have met with the problem of islet isolation, and for the time being this treatment cannot be considered effective. Pancreas transplantation gives satisfactory results in diabetics with renal impairment when it is coupled with kidney transplantation. However, it cannot yet be applied to all diabetics as its results are mediocre when performed alone, and it requires chronic immunosuppression. Pancreas transplantation not only increases the quality of life but also has the advantage of acting on degenerative complications: it may improve diabetic nephropathy, retinopathy and neuropathy. The results obtained are getting better year after year, and they are now close to those observed with other organ transplantations.
- Published
- 1992
96. [Influence of HLA compatibility on cytomegalovirus infection in kidney transplantation].
- Author
-
Pouteil-Noble C, Bétuel H, Raffaele P, Megri K, Louvier C, Lefrançois N, Bosshard S, Dubernard JM, Aymard M, and Touraine JL
- Subjects
- Cytomegalovirus Infections epidemiology, Cytomegalovirus Infections etiology, HLA-A Antigens immunology, Humans, Incidence, Transplantation Immunology, Cytomegalovirus Infections immunology, HLA-B Antigens immunology, HLA-DR Antigens immunology, Kidney Transplantation adverse effects
- Abstract
The influence of HLA A, B, DR on the incidence and symptoms of cytomegalovirus (CMV) infection was investigated in 143 patients who, between October 1st, 1987 and December 31st, 1989, received kidneys from cadaveric donors. Systematic virological monitoring was carried out weekly during the first hospitalization and thereafter at each new hospitalization or in the presence of clinical signs suggestive of viral infection. The diagnosis of CMV was based on positive isolation in blood or urine, or seroconversion, or 4-dilution rise in the anti-CMV antibodies titre. HLA grouping of all recipients was made in the same histocompatibility laboratory. Immunosuppression was obtained with a quadruple therapy consisting of corticosteroids (15 mg/kg before transplantation, then 1 mg/kg for 10 days, then gradually tapering off dosage), azathioprine (2 to 3 mg/day), cyclosporin A (2 mg/kg i.v. followed by an oral dose adjusted to the residual levels) and a randomized treatment with either monoclonal anti-CD3 antibody or anti-thymocyte globulins administered during the first 10 days. The incidence of CMV infection was 56 percent (80/143), with 25 percent of primary infection (20/80). The number of DR compatibilities was found to have a significant influence on the incidence of CMV infection, which rose from 22 to 50 and 65 percent respectively in the group of patients with 2.1 or 0 DR compatibility (P less than 0.02). The degree of B + DR compatibility was also associated with the occurrence of CMV infection, the incidence of which rose from 0 to 36, 59, 43.5 and 71 percent respectively in the group of patients with 4, 3, 2, 1, 0 B + DR compatibility (P less than 0.03). The incidence of primary CMV infection increased with the number of DR incompatibilities, rising from 0 to 29 and 52 percent respectively in the group of patients with 0, 1 or 2 DR incompatibilities. The symptoms and severity of CMV infection were significantly influenced by the degree of DR and B + DR compatibility. Despite a very strong association between graft rejection and CMV infection (P less than 0.000001), no influence of HLA, and particularly DR or B + DR compatibility on the incidence and number of graft rejections could be demonstrated. It is concluded that, under the above-described quadruple therapy, the HLA DR and B + DR compatibility exerts a predominant influence on the occurrence and severity of CMV infection, and that this effect is independent of any action on graft rejection.(ABSTRACT TRUNCATED AT 400 WORDS)
- Published
- 1991
97. Prophylactic polyclonal versus monoclonal antibodies in kidney and pancreas transplantation.
- Author
-
Lefrançois N, Raffaele P, Martinenghi S, Martin X, Betuel H, Touraine JL, Pozza G, and Dubernard JM
- Subjects
- Adult, Clinical Trials as Topic, Follow-Up Studies, Humans, Immunosuppression Therapy, Random Allocation, Renin blood, Antibodies, Monoclonal therapeutic use, Antilymphocyte Serum therapeutic use, Diabetes Mellitus, Type 1 surgery, Diabetic Nephropathies surgery, Kidney Transplantation immunology, Pancreas Transplantation immunology
- Published
- 1990
98. Whole versus segmental pancreas graft: two years metabolic results.
- Author
-
La Rocca E, Martin X, Secchi A, Lefrançois N, Martinenghi S, Melandri M, Touraine JL, Pozza G, and Dubernard JM
- Subjects
- Biomarkers blood, Clinical Trials as Topic, Diabetes Mellitus, Type 1 blood, Diabetic Nephropathies surgery, Duodenum transplantation, Follow-Up Studies, Glucose Tolerance Test, Glycated Hemoglobin analysis, Humans, Kidney Failure, Chronic surgery, Kidney Transplantation physiology, Pancreas Transplantation physiology, Blood Glucose metabolism, Diabetes Mellitus, Type 1 surgery, Pancreas Transplantation methods
- Published
- 1990
99. Evolution of metabolic and endocrine function in ten neoprene-injected segmental pancreas allografts at three to 54 months after transplantation, versus preliminary results in nine whole pancrease allografts with enteric diversion.
- Author
-
Cantarovich D, Traeger J, La Rocca E, Monti LD, Lefrançois N, Cantarovich F, Betuel H, Blanc-Brunat N, Faure JL, and Gelet A
- Subjects
- Adult, Blood Glucose, Circadian Rhythm, Diabetes Mellitus, Type 1 physiopathology, Diabetes Mellitus, Type 1 therapy, Diabetic Nephropathies therapy, Female, Glucose Tolerance Test, Humans, Insulin blood, Kidney Transplantation, Male, Pancreas physiopathology, Time Factors, Neoprene, Pancreas Transplantation, Polyenes
- Published
- 1987
100. Is serum creatinine a reliable expression of an adequate cyclosporine immunosuppression?
- Author
-
Cantarovich F, Cantarovich D, Suso E, Lefrançois N, Touraine JL, and Traeger J
- Subjects
- Adult, Cyclosporins administration & dosage, Female, Humans, Male, Time Factors, Creatinine blood, Cyclosporins therapeutic use, Graft Survival, Kidney Transplantation
- Abstract
In 13 renal transplant patients with an excellent graft function, but concomitant abnormal T6 CsA plasma levels (CsA plasma level, 6 hours after oral administration of the drug), dose adjustments of CsA were performed until a normal T6 was achieved. A significant decrease of serum creatinine values was obtained after dose modification. Prophylactic monitoring of CsA immunosuppression by T6 could be a means of avoiding nephrotoxicity or undertreatment in patients with acceptable serum creatinine levels and unsuspected drug related renal dysfunction.
- Published
- 1988
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