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Objectifs Nous decrivons une technique de vaporisation de la prostate apres enucleation partielle au laser thulium de l’adenome. Technique derivee de « la mushroom technique » decrite par Hochreiter et al. en 2002. Methodes Cette technique utilise les capacites de section et de vaporisation du laser thulium. Le materiel utilise est un resectoscope a embout bisaute Ch. 24,5, une fibre laser 1000 μ et un generateur laser thulium 120 W. L’intervention debute par une section a 50 W du col vesical au veru montanum a 5 et 7 heures. Le lobe median est ensuite repousse vers le col dans le plan de la capsule. Une fois pedicule, le lobe est vaporise a 120 W. Les lobes lateraux sont detaches de l’apex prostatique en regard du veru et liberes du plan capsulaire. Une fois pedicules, les lobes lateraux sont vaporises. Resultats L’enucleation a faible energie des lobes prostatiques dans le plan de la capsule permet de delimiter le bon plan de dissection de l’adenome tout en assurant une hemostase de bonne qualite. Cette technique evite de delivrer une energie excessive sur la capsule et evite les traumatismes que pourrait engendrer l’utilisation excessive de la poussee mecanique du bec du resectoscopie pour l’enucleation. La vaporisation a haute energie (120 W) des lobes pedicules et partiellement devascularises reduit le risque hemorragique et minimise l’impact de la diffusion de la chaleur sur la capsule. Cette technique evite les contraintes d’une morcellation. Conclusion La « mushroom technique » au laser thulium est une technique fiable et reproductible pour les prostates de volume est inferieure a 60 mL. Des etudes cliniques sont necessaires pour evaluer les resultats fonctionnels et les comparer aux techniques standards.

Objectifs Evaluer les resultats carcinologiques et fonctionnels du traitement HIFU focal chez les patients presentant une recidive locale d’un cancer de prostate initialement traite par radiotherapie. Methodes De mars 2009 a decembre 2014, tous les patients avec recidive locale unilaterale (IRM et biopsies dirigees) sans metastase decelable d’un cancer de prostate initialement traite par radiotherapie ont ete inclus dans une etude de traitement focal par HIFU (hemi-ablation). Traitements realises avec l’Ablatherm a focalisation dynamique jusqu’en juin 2013 puis FocalOne ensuite. Soixante patients, suivi moyen : 20 mois (3–34 mois), âge moyen : 70 ± 7 ans (mediane 72). Le risque de D’Amico avant radiotherapie : faible : 9 patients intermediaire : 26, haut : 13 et non connu : 26. La dose moyenne recue etait de 65 Gy. Delai moyen entre radiotherapie et HIFU : 6 ans. PSA moyen avant HIFU : 5,18 ± 5 ng/mL (mediane : 3,5 ng/mL). Resultats Le score de Gleason a la recidive etait de 6 chez 4 patients 7 chez 28, ≥ 8 chez 18 et non determine chez 11. PSA nadir moyen : 0,82 ± 2 ng/mL (mediane 0,18 ng/mL). Nombre session HIFU : une = 88,3 % et 2 = 11,7 % (n = 2). A 48 mois : survie specifique = 100 %, sans metastases = 93 % [IC : 74–98] et sans progression = 75 % [IC : 54–87]. Le taux de survie sans progression n’a pas ete significativement influence par le taux de PSA et le score de Gleason de la recidive (p = 0,7), mais il a ete influence par le status initial du patient avant radiotherapie. Complications : incontinence severe (grade 2/3) : n = 5 (8 %) (avec pose de 2 sphincter), sclerose uretre prostatique : n = 2, osteite pubienne (regressive apres antibiotherapie prolongee) n = 2. Deux lithiases vesicales ont ete traitees par endoscopie. Conclusion Le traitement par hemi-ablation HIFU des cancers de prostate en recidives limitee a un seul lobe prostatique apres radiotherapie permet d’obtenir un resultat carcinologique satisfaisant dans 75 % des cas avec un taux d’effets secondaire inferieur a celui habituellement observe apres traitement HIFU total.

Introduction La survie renale apres un rejet humoral (RH) est heterogene et difficilement predictible au niveau individuel. Elle depend de la pathogenicite des DSA qui est fortement liee a leur aptitude a activer le complement [1] . Les degâts causes par les DSA sont responsables de l’infiltration du greffon par des cellules inflammatoires. Nous avons emis l’hypothese qu’une strategie integrant un phenotypage quantitatif et qualitatif precis de l‘infiltrat inflammatoire et l’evaluation de la capacite des DSA a activer le complement permettrait d’identifier au mieux les patients a risque de perdre leur greffon au moment d’un RH. Patients et methodes Parmi les 69 patients ayant presente un RH entre 2004 et 2012, 52 avaient suffisamment de materiel histologique pour l’analyse. Apres des marquages immuno-histochimiques, une analyse informatisee a ete utilisee pour quantifier les cellules CD68+ (macrophage), CD3+ (lymphocyte T), CD66b+ (granulocyte), CD20+ (lymphocyte B) ou CD56+ (natural killer) dans l’interstitium, les glomerules et les capillaires. La capacite des DSA a fixer le complement (C3d) au moment du RH a ete evaluee par technique Luminex. Resultats Seul le nombre de cellules CD68+ dans les capillaires et dans l’interstitium permettait d’identifier les patients a risque de perte de greffon (HR = 3,18, p Discussion Le test C3d isole a une excellente valeur predictive negative (89,5 % pour la perte de greffon a 1 an) mais une valeur predictive positive perfectible (52,9 %) [1] . La quantification des monocytes permet de preciser le pronostic des patients dans le groupe C3d+. Conclusion La quantification topographique informatisee des monocytes permet d’ameliorer la stratification du risque de perte de greffon au moment du diagnostic de RH.

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.

Chronic kidney disease (CKD) is frequently associated with protein energy wasting which has been recognized as a strong predictive factor of mortality. Zinc α2-glycoprotein (ZAG) has been proposed as a new adipokine involved in body weight control through its lipid mobilizing activity. We hypothesized that the uremic environment in CKD could alter ZAG production by white adipose tissue and contribute to CKD-associated metabolic disturbances. ZAG protein was quantified in 3T3-L1 adipocytes after incubation with plasma from healthy volunteers and CKD patients (20%, v/v). ZAG was also measured in white adipose tissue (WAT) from 5/6 nephrectomized rodents (Nx5/6) and subcutaneous adipose tissue biopsies from end-stage renal disease patients. Uremic plasma induced a significant increase in ZAG synthesis in 3T3-L1 adipocytes (+124%, p

Organ shortage is a major problem in organ transplantation. For this reason, transplantation teams have found it necessary to revisit their organ acceptance criteria. Uncontrolled deceased donors after cardiac arrest could increase the donor pool by 20%, but at the same time there is a greater risk of delayed graft function and primary non-function. Dual kidney transplantation is an option when single kidney transplantation cannot be carried out because of lack of organ quality. We report for the first time our four first dual kidney transplantation from uncontrolled deceased donors after cardiac arrest with a follow up longer than 1 year. We described graft outcomes until 5 years, and histology at 3 and 12 months after transplantation. All organs were machine perfused in order to assess their quality leading to a single kidney transplantation or dual kidney transplantation decision. After 1 year of follow up, all grafts were functional with a mean estimated glomerular filtration rate of 44.5 ± 3.3 mL/min/1.73 m(2), and a mean inulin clearance of 43.7 ± 13.6 mL/mn/1.73 m(2). These findings suggest that dual kidney transplantation can represent a viable option for kidneys unsuitable for single kidney transplantation without increasing the rate of surgical complications. Successful transplantation is linked to histological, biological and donor clinical criteria, as well as perfusion parameters.

Adrenal insufficiency is a rare but life-threatening disease. Replacement therapy sometimes fails to prevent an acute adrenal crisis and most often does not lead to restoration of well-being. We report here the 1-year outcome of the first simultaneous kidney-adrenal gland-pancreas transplantation in a 33-year-old patient with type 1 diabetes and concomitant autoimmune adrenal insufficiency. En bloc left adrenal gland and kidney grafts were anastomosed on the left iliac vessels in normal vascular conditions and the pancreas graft was anastomosed on the right iliac vessels. The immunosuppressive regimen was not modified by the addition of the adrenal gland. We observed no additional morbidity due to the adrenal gland transplantation, as there were no surgical complications. One-year kidney and pancreas graft functions were satisfactory (estimated glomerular filtration rate: 55 mL/min/1.73 m(2) and HbA1c: 4.8%). The adrenal graft functioned well at 12 months with a normalization of cortisol and aldosterone baseline levels. Functional imaging at 3 months showed good uptake of [(123) I]-metaiodobenzylguanidine by the adrenal graft. Transplantation of the adrenal gland en bloc with the left kidney appears to be a good therapeutic option in patients with adrenal insufficiency awaiting kidney or kidney-pancreas transplantation.

Objectifs Evaluer la possibilite de realiser un traitement focal par HIFU FocalOne guide par IRM avec fusion IRM/echographie. La definition d’un traitement purement focal etait un traitement concernant moins de 50 % du volume prostatique. Methodes Nous avons repris les differents traitements focaux realises dans notre centre dans differents protocoles et selectionner ceux dont le traitement avait concerne moins de 50 % du volume de la prostate pour traiter un cancer unilateral identifie par IRM et biopsies ciblees avec un score de Gleason maximum de 7 (4 + 3). Objectif principal : absence de cancer cliniquement significatif (CCS) (Gleason Resultats Vingt-quatre patients ont ete inclus, d’âge moyen 67,4 ans. Le volume traite etait de 12,6 ± 4,9 cc soit 32 % du volume total. Parmi les patients, 62,5 % ont eu un complement de traitement suite a l’echographie de contraste realise a la fin du traitement. Le PSA a un an avait baisse de 56 % en moyenne. Sur les biopsies de controle, 91,7 % des patients ne presentaient pas de CCS. Les traitements de rattrapages ont comporte un HIFU controlateral et une radiotherapie. A 12 mois, la continence etait de 100 % et les erections etaient maintenues dans 92 % des cas. Les questionnaires qualite de vie n’etaient pas differents avant et a un an apres le traitement. Conclusion Les resultats precoces de traitements purement focaux par HIFU FocalOne a un an retrouvent une absence de cancer cliniquement significatif dans 91,7 % des cas avec une tres faible morbidite.

Objectifs La RTE est le traitement de rattrapage le plus souvent utilise en cas de recidive locale apres HIFU. Le traitement par HIFU est une option en cas de recidive locale apres RTE. Aucune etude randomisee n’est disponible comparant ces deux sequences therapeutiques. L’objectif de l’etude a ete de comparer les resultats oncologiques et les complications, a long terme, de ces deux sequences therapeutiques. Methodes Etude retrospective monocentrique incluant les patients traites pendant la meme periode (1994–2014) par une des deux sequences therapeutiques. Une analyse comparative a ete effectuee apres appariement des patients en matched pair 1:1, au stade de la prise en charge initiale sur les criteres suivants : taux de PSA, score de Gleason et stade de d’Amico. Concernant les resultats oncologiques : le critere de jugement principal a ete la survie specifique. Les criteres secondaires ont ete la survie sans metastases et la survie sans hormonotherapie palliative. Les complications ont ete evaluees selon la classification de Clavien en ne prenant en compte que les grades ≥ 3. Resultats Sur les 424 patients traites par une des deux sequences therapeutiques, 342 patients ont pu etre apparies en 2 groupes de 171 patients. Il n’existait aucune difference statistiquement significative entre les 2 groupes concernant les criteres d’appariement ( p > 0,5). A 9 ans a partir du traitement de rattrapage, les taux de survies specifiques, de survies sans metastases ( Figure 1 ), et de survies sans hormonotherapie palliative ( Figure 2 ) sont significativement superieurs dans le groupe HIFU-SRTE par rapport au groupe RTE-SHIFU (95 % versus 81 %, p = 0,021 ; 94 % versus 73 %, p p p = 0,001). Conclusion Dans notre etude, a stade initial equivalent de la maladie et en cas de recidive locale, le controle oncologique a ete meilleur et le taux de complications de grade ≥ 3 inferieur chez les patients traites par HIFU-SRTE par rapport aux patients traites par RTE-SHIFU.

Objectifs L’objectif de l’etude a ete d’evaluer les symptomes mictionnels, la continence, la fonction erectile, les complications postoperatoires au moyen d’un score composite (Hexafecta) a six mois d’une enucleation prostatique par laser Holmium (technique HoLEP). Methodes Il s’agit d’une etude retrospective monocentrique portant sur l’ensemble des patients operes d’une hypertrophie benigne de prostate par la technique HoLEP entre mai 2013 et novembre 2015. Les resultats a 6 mois etaient etablis a partir d’un score composite Hexafecta comprenant les complications postoperatoire selon la classification de Clavien, les scores IPSS, QOL-IPSS, IIEF-5, ICI-SF et la debitmetrie ( Tableau 1 ). Resultats Parmi 90 patients traites, 1 patient a necessite une conversion en adenomectomie voie haute. Soixante-seize patients ont ete revus a 6 mois. Le score Hexafecta complet etait disponible chez 53 patients. Trente-neuf patients (73 %) avaient un Qmax ≥ 15 mL/s, 49 patients (92 %) avaient une diminution significative du score IPSS, et le QOL-IPSS etait inferieure ou egale a 2 chez 46 (87 %) d’entre eux. Quarante-cinq patients (87 %) avaient un score ICIQ-SF a 0. Quarante-quatre patients (83 %) avaient un score IIEF5 inchange ou ameliore. Quatre patients (7,5 %) avaient un Clavien superieur a 2. Aucune revision chirurgicale n’a ete necessaire. Vingt-trois patients (43 %) validaient l’ensemble des criteres Hexafecta proposes et 43 (81 %) satisfaisaient au moins 5 des 6 criteres ( Fig. 1 ). Conclusion La technique HoLEP est efficace et peu morbide et les resultats fonctionnels a 6 mois sont satisfaisants. L’utilisation d’un score composite est interessante pour l’evaluation des resultats d’une chirurgie fonctionnelle et merite d’etre developpe et valide par d’autres etudes.

Objectifs Comparer la duree d’hospitalisation et les complications de l’enucleation de prostate au laser Holmium (HoLEP) des patients a risque hemorragique (anti-agregants plaquettaires, anti-coagulant, trouble de l’hemostase primaire (THP) aux patients sans facteur de risque hemorragique). Methodes Etude de cohorte retrospective incluant tous les patients operes consecutivement d’une hypertrophie benigne de prostate par HoLEP entre mai 2013 et mai 2016. Les patients ont ete separes en trois groupes : un groupe sous antiagregants plaquettaires, un groupe sous anticoagulants ou presentant un THP, un groupe temoin. Les patients sous anticoagulants et sous antiagregants (clopidogrel) etaient relayes en preoperatoire par de l’heparine et de l’aspirine respectivement. Les patients etaient revus a 1 mois. Resultats Cent cinquante-six patients ont ete inclus, d’âge moyen 70,7 ans et de volume prostatique moyen 88,8 g ; dont 106 sans traitement modifiant l’hemostase (groupe temoin), 34 sous antiagregants, 16 sous anticoagulants ou avec THP. Il n’y avait pas de difference significative entre les 3 groupes concernant la duree d’intervention, la duree de morcellation, le volume irrigue, l’energie delivree et le volume prostatique enuclee. Le groupe anticoagulant presentait une duree d’hospitalisation significativement plus longue que le groupe temoin (2,0 vs 4,4 jours ; p Conclusion Les traitements antiagregants et anticoagulants ne semblent pas modifier le geste operatoire au cours de l’HoLEP. Les patients sous anticoagulants ou avec THP presentent une duree d’hospitalisation plus longue et semblent plus a risque de transfusion dont il faut les prevenir.

What's known on the subject? and What does the study add? Patients with end-stage renal disease (ESRD) have an increased risk of developing RCC in their native kidneys. The prevalence of RCC is 3-4% in cases of ESRD in dialyzed and/or transplanted patients, which corresponds to a rate 100-times higher than that in the general population. This is the first study, to our knowledge, comparing the characteristics of kidney cancer in the ESRD population according to their dialysis or transplantation status at the time of diagnosis. The differences in stage and survival we observed may be due to differences in surveillance strategies between transplanted and not transplanted patients, nevertheless, the differences in pathological subtypes suggest they could also be due to differences in the tumorigenesis process.• To compare clinical, pathological and outcome features of renal cell carcinomas (RCCs) arising in patients with chronic renal failure (CRF) with or without renal transplantation.• In all, 24 French University Departments of Urology and Kidney Transplantation participated in this retrospective study comparing RCCs arising in patients with CRF according to their dialysis or transplantation status at the time of diagnosis. • Information about age, sex, symptoms, duration of CRF, mode and duration of dialysis, renal transplantation, tumour staging and grading, histological subtype and outcome were recorded in a unique database. • Qualitative and quantitative variables were compared by using chi-square and Student statistical analysis. Survival was assessed by Kaplan-Meier and Cox methods.• Data on 303 RCC cases diagnosed between 1985 and 2009 were identified in 206 men (76.3%) and 64 women (23.7%). • Transplanted and not transplanted patients accounted for 213 (70.3%) and 90 cases (29.7%), respectively. • In transplant recipients, RCC was diagnosed at a younger age [mean (sd) 53 (11) vs 61 (14) years, P0.001), the mean tumour size was smaller [3.4 (2.3) vs 4.2 (3.1) cm, P= 0.02), pT1a stage (75 vs 60%, P= 0.009) and papillary histological subtype (44 vs 22%, P0.001) were more frequent than in their dialysis-only counterparts. • Nodal (1 vs 6%, P= 0.03) and distant metastases rates (0 vs 5%, P0.001) were significantly increased in patients who had not had a transplant. However, Fürhman grading, symptoms, tumour multifocality or bilaterality, presence of acquired cystic kidney disease, were not significantly different between the groups. • Estimated 5-year survival rates were 97% and 77% for transplanted and not transplanted patients, respectively (P0.001). In univariate analysis, presence of symptoms (P= 0.008), poor performance status (P= 0.04), large tumour size, advanced TNM stage (P0.001), high Führman grade (P= 0.005) and absence of transplantation (P0.001) were all adverse prognostic factors. In multivariate analysis, only T stage remained an independent predictor for cancer-related death (P0.001).• RCC arising in native kidneys of transplant patients seems to exhibit many favourable clinical, pathological and outcome features compared with those diagnosed in dialysis-only patients. Further research is needed to determine whether it is due to particular molecular pathways or to biases in relation to mode of diagnosis.

International audience; The use of uncontrolled deceased donors after cardiac arrest (uDDCA) has been developed in France to compensate for organ shortage. The quality of these kidneys remains unclear. We analyzed kidney graft function and histology from 27 uDDCA and compared them with kidneys from 30 extended criteria donors (ECD) and from 24 simultaneous pancreas kidney (SPK) donors as a control group of optimal deceased donors. Kidneys from ECD and SPK donors were preserved by static cold storage while kidneys from uDDCA were preserved by pulsatile perfusion. The uDDCA graft function at 3 years posttransplantation (estimated with MDRD and measured with inulin clearance) did not differ from that of the ECD group (eGFR 44.1 vs. 37.4 mL/min/1.73 m2, p = 0.13; mGFR 44.6 vs. 36.1 mL/min/1.73 m2, p = 0.07 in the uDDCA and ECD groups, respectively). The histological assessment of 3-month and 1-year protocol biopsies did not show differences for interstitial lesions between the uDDCA and ECD grafts (IF score at M3 was 30 vs. 28% and at M12 36 vs. 33%, p = NS). In conclusion, the results at 3 years with carefully selected and machine-perfused uDDCA kidneys have been comparable to ECD kidneys and encourage continuation of this program and development of similar programs.

Institut Georges Lopez-1 (IGL-1) is a preservation solution similar to University of Wisconsin (UW) with reversed Na/K contents. In this study, we assessed the impact of IGL-1, UW, and Celsior (CS) solutions on islet isolation and transplant outcome.We retrospectively analyzed 376 islet isolations from pancreases flushed and transported with IGL-1 (n=95), UW (n=204), or CS (n=77). We determined isolation outcome and β-cell function in vitro. Transplanted patients were divided into three groups depending on preservation solution of pancreas, and islet graft function was assessed by decrease in daily insulin needs, C-peptide/glucose ratios, β-scores, and transplant estimated function at 1- and 6-month follow-up.IGL-1, UW, and CS groups were similar according to donor age, body mass index, and pancreas weight. There was no difference in islet yields between the three groups. Success rates, transplant rates, β-cell secretory function, and viability were similar for all three groups. We observed no difference in decreased insulin needs, C-peptide glucose ratios, β-scores, and transplant estimated function at 1- and 6-month follow-up between IGL-1, UW, and CS groups.Our study shows that IGL-1 is equivalent to UW or CS solutions for pancreas perfusion and cold storage before islet isolation and transplantation.

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.

BACKGROUND Simultaneous pancreas-kidney transplantation (SPKT) is a promising therapy for type 1 diabetes mellitus with chronic kidney disease. Although the long-term outcome of SPKT is extensively documented, the incidence of early complications within the first weeks after the surgery is less described. The aim of this study was to assess the incidence, causes, and risk factors of early relaparotomy after SPKT. METHODS All SPKT performed in the university hospital between 2005 and 2008 were enrolled. The primary endpoint was defined as the need for at least one relaparotomy after SPKT within the initial hospital stay. The secondary endpoints were the incidence of vascular graft thrombosis, postoperative sepsis, patient, and graft survival. RESULTS Sixty-one patients were included. During their initial hospital stay, 27 (44.3%) SPKT recipients required at least one relaparotomy. The main causes of relaparotomy were hemorrhage (59.3%) and vascular graft thrombosis (22.2%). First relaparotomy occurred at a median postoperative time of 1 day (interquartile range, 1-6). Pretransplant dialysis and nontraumatic cause of donor brain death were identified as independent risk factors for early relaparotomy. Thirty-two patients (52.4%) experienced a symptomatic or asymptomatic vascular graft thrombosis. CONCLUSIONS The early postoperative period remains a high-risk phase for relaparotomy. The selection of recipients before initiation of long-term dialysis and of donors deceased from traumatic causes may reduce the rate of these early complications after SPKT. Vascular graft thrombosis and bleeding are two major issues that arise during this critical period, suggesting the importance an adequate management of postoperative anticoagulation and hemostasis.

BACKGROUND: The first human facial allotransplantation, a 38-year-old woman, was performed on November 27, 2005. The aesthetic aspect and functional recovery and the risk-to-benefit ratio are evaluated 5 years later. MATERIALS AND METHODS: The facial transplantation included nose, chin, part of cheeks, and lips. The immunosuppressive protocol included tacrolimus, mycophenolate mofetil, prednisone, and antithymocyte globulins. In addition, donor bone marrow cells were infused on days 4 and 11 after transplantation. RESULTS: The aesthetic aspect is satisfying. The patient has normal protective and discriminative sensibility. She showed a rapid motion recovery, which has remained stable for 3 years posttransplantation. She can smile, chew, swallow, and blow normally whereas pouting and kissing is still difficult. Phonation recovery was impressive therefore the patient can talk normally. Two episodes of acute rejection developed during the first year. Donor-specific anti-human leukocyte antigen antibodies were never detected. Five-year mucosal biopsy showed a slight perivascular inflammatory infiltrate while skin biopsy was normal. The main side effect of the immunosuppressive treatment was a progressive decrease in renal function, which improved after switching from tacrolimus to sirolimus. Moreover, she developed arterial hypertension, an increase in lipid levels, and in situ cervix carcinoma treated by conization. Since 2008, she showed mild cholangitis possibly caused by sirolimus. In September 2010, bilateral pneumopathy occurred and was successfully treated with antibiotics. CONCLUSION: Despite some long-term complications, which are similar to those reported after solid organ transplantation, the patient is satisfied of her new face and has normal social interaction.

Graft survival is worse in recipient aged less than 5 years due to the greater risk of vascular thrombosis. Thrombosis may be prevented by the choice of the donor, method of surgery, perioperative hemodynamic optimisation and preventive anti-coagulation. Normal growth is a major objective of the management of transplanted children. The mean final height increased during the 20 last years to be between -1.63 and -0.92 SDS depending on age and period of the transplantation.

International audience; BACKGROUND.: Insulin independence after islet transplantation is generally achieved after multiple infusions. However, single infusion would increase the number of recipients. Our aim was to evaluate the results of islet-after-kidney transplantation according to the number of infusions. METHODS.: Islets were isolated at the Geneva University, shipped, and transplanted into French patients from the Swiss-French GRAGIL network, on the "Edmonton" immunosuppression protocol between 2004 and 2010. RESULTS.: Nineteen patients were transplanted with 33 preparations. Fifteen patients reached 24 months follow-up; eight subjects were single-graft recipients and seven were double-graft recipients. Finally, single-graft recipients received a median of 5312 islet equivalents/kg (5186-6388) vs. 10,564 (10,054-11,375) for double-graft recipients (P=0.0003) with similar islet mass at first infusion. Insulin independence was achieved in five of eight single-graft subjects (62.5%) versus five of seven in double-graft subjects (71.4%), not significant. Median insulin independence duration was 4.7 (3.1-15.2) months after one infusion vs. 19 (9.6-20.8) months after two infusions (not significant). At 24 months posttransplant, comparing single- with double-graft patients, insulin doses were 0.23 (0.11-0.34) U/kg vs. 0.02 (0.0-0.23) U/kg, P=0.11; HbA1c was 6.5% (5.9%-6.8%) vs. 6.2% (5.9%-6.3%), P=0.16; and basal C-peptide was 302 (143-480) pmol/L vs. 599 (393-806) pmol/L, P=0.05. Only 37.5% of single-graft patients had a β-score ≥4 compared with 100% of double-graft patients (P=0.03). Two recipients experienced postinfusion bleeding, and two patients (13%) showed renal dysfunction in the absence of biopsy-proven rejection. CONCLUSIONS.: One infusion achieves good glycemic control and sometimes insulin independence. However, double-graft patients remain insulin-free longer, tend to have lower HbA1c, and show better graft function 24 months after transplant.

To assess the effect of machine perfusion (MP) on renal function recovery vs kidney preservation in static cold storage (CS), in a large animal preclinical model. To assess whether MP benefits are dependent on the preservation solution used.Using an established autotransplantation pig kidney model associated with a contralateral nephrectomy we studied the impact of MP against the deleterious effects of warm ischaemia (WI; 60 min), then 22 h of cold ischaemia using MP or static CS, followed by autotransplantation. We used Berzer MP solution (MPS), recommended for MP, and Institut Georges Lopez preservation solution (IGL-1), designed for CS. The pigs were divided into four study groups: MPS-CS: static CS with MPS (n = 7); MPS-MP: renal perfusion with MPS using the Waters Medical Systems (Rochester, MN, USA) RM3 pulsatile machine (n = 7); IGL-CS: static CS with IGL-1 solution (n = 7); IGL-MP: renal perfusion with IGL-1 solution (n = 7). The effect of ischaemia was determined using different variables: pig survival; plasma creatinine; proteinuria; oxidative stress; tubular sodium reabsorption rate; and tissue damage at 1 month.Pig survival was higher in MP and IGL groups compared to MPS-CS. Plasma creatinine levels did not differ among the groups, but proteinuria assay showed significant benefits for the MP vs static CS groups. Histological evaluation of kidney grafts showed more injury in the CS groups than in the MP groups. Urinary measurement of tubular enzyme activity differed substantially among the groups, highlighting the benefits of MP in maintaining brush border integrity.In our model reproducing the conditions of deceased after cardiac arrest donors we show that MP decreases the risk of renal dysfunction and preserves kidney parenchyma. A non-invasive urinary enzyme assay can provide valuable information on graft integrity. The preservation solution used is important as the wrong solution can decrease the benefits of MP.

International audience; BACKGROUND: Patients with end-stage renal disease (ESRD) are at risk of developing renal tumours. OBJECTIVE: Compare clinical, pathologic, and outcome features of renal cell carcinomas (RCCs) in ESRD patients and in patients from the general population. DESIGN, SETTING, AND PARTICIPANTS: Twenty-four French university departments of urology participated in this retrospective study. INTERVENTION: All patients were treated according to current European Association of Urology guidelines. MEASUREMENTS: Age, sex, symptoms, tumour staging and grading, histologic subtype, and outcome were recorded in a unique database. Categoric and continuous variables were compared by using chi-square and student statistical analyses. Cancer-specific survival (CSS) was assessed by Kaplan-Meier and Cox methods. RESULTS AND LIMITATIONS: The study included 1250 RCC patients: 303 with ESRD and 947 from the general population. In the ESRD patients, age at diagnosis was younger (55 ± 12 yr vs 62 ± 12 yr); mean tumour size was smaller (3.7 ± 2.6 cm vs 7.3 ± 3.8 cm); asymptomatic (87% vs 44%), low-grade (68% vs 42%), and papillary tumours were more frequent (37% vs 7%); and poor performance status (PS; 24% vs 37%) and advanced T categories (≥ 3) were more rare (10% vs 42%). Consistently, nodal invasion (3% vs 12%) and distant metastases (2% vs 15%) occurred less frequently in ESRD patients. After a median follow-up of 33 mo (range: 1-299 mo), 13 ESRD patients (4.3%), and 261 general population patients (27.6%) had died from cancer. In univariate analysis, histologic subtype, symptoms at diagnosis, poor PS, advanced TNM stage, high Fuhrman grade, large tumour size, and non-ESRD diagnosis context were adverse predictors for survival. However, only PS, TNM stage, and Fuhrman grade remained independent CSS predictors in multivariate analysis. The limitation of this study is related to the retrospective design. CONCLUSIONS: RCC arising in native kidneys of ESRD patients seems to exhibit many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population.

International audience; BACKGROUND: It has been suggested that the age of human organ donors might influence islet isolation and transplantation outcome in a negative way due to a decrease of in vivo function in islets isolated from older donors. METHODS: We retrospectively analyzed 332 islet isolations according to donor age. We determined isolation outcome by islet yields, transplantation rates, and [beta]-cell function in vitro. Transplanted patients were divided into two groups depending on donor age (n=25 and n=31 patients for 45-year-old donors, respectively). We assessed islet graft function by C-peptide/glucose ratio, [beta] score, secretory units of islets in transplantation index, and insulin independence rate at 1, 6, and 12 months after transplantation. RESULTS: There was no difference in islet yields between the two groups (251,900+/-14,100 and 244,600+/-8400 islet equivalent for 45-year-old donors, respectively). Transplantation rates and stimulation indices were similar in both groups as well. All islet graft function parameters were significantly higher at 1-month follow-up in patients who had received islets from younger donors. At 6-month follow-up after second or third injection and at 12-month follow-up, secretory units of islets in transplantation indices and C-peptide/glucose ratios were significantly higher in patients with donors aged 45 years or younger. CONCLUSIONS: These data suggest that, despite similar outcomes of the isolation procedure, islet graft function is significantly influenced by donor age. These results may have important consequences in the definition of pancreas allocation criteria.

Objectifs Evaluer retrospectivement la qualite de vie et les resultats fonctionnels urinaires de la neovessie ileale en W de Hautmann avec un recul minimum de 10 ans. Methodes Entre 1994 et 2004, 89 patients ont subi une cystoprostatectomie totale pour cancer de vessie avec remplacement ileal orthotopique en W. Parmi eux, 42 patients (47,2 %) sont decedes, 14 (15,7 %) sont perdus de vue et 30 (33,7 %) parmi les 33 contactes ont accepte d’etre revus en consultation. Le recul moyen etait de 157 mois (120–223), l’âge moyen de 72 ans (53–87). Une evaluation de leur qualite et vie (SF36, Ditrovie) et des resultats fonctionnels de leur derivation urinaire (USP, nombre de protections, debitmetrie, mesure du residu post-mictionnel) etait realisee. Resultats Les 8 dimensions du score SF36 etaient comparables a celles de la population francaise ( Fig. 1 ). Le score resume physique etait de 49,2, le score resume psychique de 48,3 contre respectivement 50,3 et 47,2 dans la population francaise. Le score Ditrovie (1–5) moyen etait a 1,83(1,1–4). La continence diurne etait satisfaisante (≤ 1 protection/jour) chez 29 patients (97 %). La continence nocturne etait satisfaisante (≤ 1 protection/nuit) chez 27 patients (90 %). Les scores moyens d’incontinence diurne (0–9), d’hyperactivite (0–21) et de dysurie (0–9) du questionnaire USP etaient respectivement de 1,5, 3,4 et 2,1. Le debit maximum etait en moyenne de 18 ml/s pour un volume mictionnel moyen de 324 ml et un residu post mictionnel median de 69 ml. Un seul patient (3,3 %) avait recours aux autosondages. Conclusion Nos resultats suggerent que la qualite de vie et le statut mictionnel des patients avec neovessie ileale orthotopique restent satisfaisants a long terme.

Background New preservation solutions are emerging, of various ionic compositions and with hydroxyethyl starch replaced by polymers such as polyethylene glycols (PEGs), offering the potential for ‘immunocamouflage’. This experimental study investigated which of three clinically available preservation protocols offered the best graft protection, based on epithelial-to-mesenchymal transition (EMT) and fibrosis. Methods Kidneys were preserved for 24 h at 4 °C with University of Wisconsin solution (UW) as standard, compared with solutions containing either 1 g/l PEG 35 kDa (Institute Georges Lopez solution, IGL) or 30g/l PEG 20 kDa (solution de conservation des organes et des tissus, SCOT). Animals were followed for up to 3 months and development of EMT, tubular atrophy and fibrosis was evaluated in comparison with sham-operated animals. Results Functional recovery was better in the SCOT group compared with the other groups. Chronic fibrosis, EMT and inflammation were observed in the UW and IGL groups, but limited in the SCOT group. Levels of profibrosis markers such as transforming growth factor β1, plasminogen activator inhibitor 1 and connective tissue growth factor were increased in IGL and UW groups compared with the SCOT group. Hypoxia-inducible factor (HIF) 1α and 2α expression was increased at 3 months in grafts preserved in UW and IGL, but detected transiently on day 14 when SCOT was used. Expression of HIF-regulated genes vascular endothelial growth factor and erythropoietin was increased in UW and IGL groups. Conclusion The choice of colloid and ionic content is paramount in providing long-term protection against chronic graft injury after renal transplantation. Preservation solutions based on PEGs may optimize graft quality.

De novo tumors in renal allografts are rare and their prevalence is underestimated. We therefore analyzed renal cell carcinomas arising in renal allografts through a retrospective French renal transplant cohort. We performed a retrospective, multicentric survey by sending questionnaires to all French kidney transplantation centers. All graft tumors diagnosed after transplantation were considered as de novo tumors. Thirty-two centers participated in this study. Seventy-nine tumors were identified among 41 806 recipients (Incidence 0.19%). Patients were 54 men and 25 women with a mean age of 47 years old at the time of diagnosis. Mean tumor size was 27.8 mm. Seventy-four (93.6%), 53 (67%) and 44 tumors (55.6%) were organ confined (T1-2), low grade (G1-2) and papillary carcinomas, respectively. Four patients died of renal cell carcinomas (5%). The mean time lapse between transplantation and RCC diagnosis was 131.7 months. Thirty-five patients underwent conservative surgery by partial nephrectomy (n = 35, 44.3%) or radiofrequency (n = 5; 6.3%). The estimated 5 years cancer specific survival rate was 94%. Most of these tumors were small and incidental. Most tumors were papillary carcinoma, low stage and low grade carcinomas. Conservative treatment has been preferred each time it was feasible in order to avoid a return to dialysis.

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 naive CD4 + T-lymphocytes showed an initial decrease with sirolimus versus cyclosporine. Naive 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 naive and memory CD4 + and CD8 + T-lymphocytes had become similar with sirolimus or cyclosporine. There were fewer naive 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.

Aim Transplantations of kidneys from non–heart-beating donors (NHBD) are intended to increase the donor pool by 20% to 30%. Nevertheless the rate of primary nonfunction and delayed graft function is generally higher among this group of donors. The goal of this study was to assess whether kidney preservation by a pulsatile perfusion machine was able to limit the renal lesions due to ischemia reperfusion injuries as compared with static incubation. We have used a model of an autotransplanted kidney exposed to controlled warm ischemia in the pig to mimic the clinical conditions of NHBD. Material and Methods Left kidneys from 11 large white pigs aged 4 weeks were harvested after vascular clamping of the renal vessels for 1 hour. Kidneys were preserved for 22 hours. Two groups were studied: the MPS static group (static incubation with Belzer MPS; n = 6) versus the MPS RM group (renal perfusion with Belzer MPS; n = 5). Kidneys were then autotransplanted into pigs after a right nephrectomy. The primary end point was animal survival rate at 1 month. Secondary endpoints were evolution of the plasma creatinine values, proteinuria, tubular sodium reabsorption, and histological features at 1 month. Results For all biological parameters, the differences between the perfusion and the static incubation groups were significant, except creatinine, with favorable effects for the perfusion machine group. The histological data at 1 month showed recovery of the normal kidney architecture in the MPS RM group. Conclusion In our pig experimental model that reproduced the clinical conditions of a NHBD, we demonstrated better kidney preservation when the pulsatile perfusion machine was used as compared with static conservation.

Background: New organ preservation solutions that contain soluble polyethylene glycol (sPEG) molecules have been associated with reduction of acute rejection episodes. Methods: In the present manuscript we tested in vitro whether sPEG molecules were able to mask donor alloantigens and reduce graft immunogenicity. Results: Immunomasking effect was only evidenced when PEGmoleculeswerecovalentlyboundtodonorcellsurface. Conclusion: We concluded that sPEG in preservation solution are unlikely to display ‘immunocamoflage’ property.

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

The impact of portal or systemic venous pancreas graft drainage on patient and graft outcome remains controversial. In the present study, the impact of venous drainage type on long-term patient and graft survival is assessed. From July 1996 to December 2002 80 simultaneous pancreas-kidney transplants were enrolled into a prospective study: 44 received a pancreas allograft with portal (P-SPK group) and 36 with systemic venous drainage (S-SPK group). Enteric exocrine drainage was performed in all recipients receiving the same immunosuppressive treatment. At one yr, the patient survival rates were 91.7% and 95.5% both for S-SPK and P-SPK groups, respectively; no significant difference in survival was shown at any time point of the follow-up. The one-, three-, five-, and eight-yr pancreas survival rates were 75%, 60.6%, 56.7%, and 44%, respectively in the S-SPK group compared to 88.6%, 84.1%, 78.4%, and 31.3% in the P-SPK group. The one-, three-, five-, and eight-yr kidney survival rates were 91.7%, 78.15%, 74.1%, and 57.9%, respectively in the S-SPK group compared to 93.2%, 88.6%, 78.4%, and 38.9% in the P-SPK group. Comparing the two groups, no significant difference was shown in the total number of surgical complications as well as in the number of each complication. No significant difference in long-term outcomes between the two groups was shown, even if in S-SPK group a higher incidence of pancreas graft loss has been reported and it was in part correlated to a higher number of graft thromboses.

International audience; The objective of this study was to retrospectively evaluate the results of radiofrequency ablation (RFA) of renal tumors with an impedance-based system using an expandable multitined electrode. Twenty-two patients (30 tumors) were treated with RFA over a 7-year period, percutaneously (16 tumors) or intraoperatively (14 tumors). Follow-up imaging was performed at 1-3, 6, and 12 months and yearly thereafter. Twenty-seven of 30 tumors (19/22 patients) showed no residual tumor on the first imaging control. Two residual tumors were successfully ablated by a second RFA procedure. Our mean follow-up period was 35 months (range, 3-84 months). Two tumors that had been completely ablated based on imaging criteria recurred 11 and 48 months after RFA. One was treated by partial nephrectomy. The other one was not treated because the patient developed bone metastases. One patient had nephrectomy because of an RFA-induced ureteropelvic junction stricture. Nine patients (11 sessions) had a pyeloperfusion of cooled saline during RFA. None developed symptomatic complications, even though in three patients the ablation zone extended to the closest calyx (3-5 mm from the tumor). We conclude that RFA of renal tumors is promising, but serious complications to the collecting system must be taken into consideration. Prophylactic per-procedural cooling of the collecting system is feasible but needs further assessment.

A 67-year-old man with a history of melanoma, treated surgically 7 years before, was referred for vomiting and right flank pain after three intravesical instillations of bacillus Calmette-Guerin (BCG) for superficial bladder cancer. A CT scan showed a mass on the right kidney, with a normal calyx in its centre. Percutaneous biopsy, obtained because of melanoma history, showed granulomatous reaction caused by BCG infection. The renal mass disappeared after 9 months of anti-tuberculous treatment. The presence of an unaffected calyx in the centre of the renal mass is an interesting finding for both teaching purposes--it clearly illustrates the pathogeny of the disease, with the bacillus invading the renal parenchyma through the papilla--and diagnostic purposes--a malignant tumour is likely to displace or destroy neighbouring calyces rather than leaving them unaffected. However, the diagnostic value of this sign remains to be determined by further research.

Hand allograft is a method in the stage of clinical experimentation, which is reserved in France for the treatment of bilateral traumatic amputees. This study reports the Lyon team experience, which is pioneer in this domain. Four patients (3 males and 1 female) underwent seven (one unilateral and three bilateral) hand transplantations from September 1998 to February 2007. The level of amputation was at the wrist or at the mid-forearm. Delay since hand loss ranged from 2.5 to 9 years. The surgical protocol was elaborated and planned case by case. All recipients received the same immunosuppressive treatment. Episodes of acute rejection were observed in the first 3 months after transplantation, which were easily managed after a few days increasing oral prednisone doses and applying topical immunosuppressants. Currently the patients receive the doses of immunosuppressants comparable to those in kidney-grafted patients. We have not registered any severe complication of immunosuppressive treatment up till now (7 years follow-up for the earliest graft). We performed analytical and functional clinical, as well as questionnaire evaluation of patients. The first case (unilateral graft) resulted in graft failure at 2 years due to non-compliance of the patient. The three bilateral graftees demonstrate a favorable evolution despite some immunological (hyperglycemia, serum sickness) and surgical (thrombosis, osteomyelitis, skin loss) complications, which could be managed. The middle and long-term follow-up evaluation revealed good to excellent sensorimotor recovery of 4 hands in both male recipients (4 and 7 years) with satisfactory social adaptation, higher or equal to those expected after post-traumatic replantations at the equivalent level and higher to those obtained with currently available myoelectric prosthesis. The last patient, a young female who has been grafted in February 2007, receives ongoing reeducation course and shows normal progress of functional restoration of both hands. The encouraging results of this clinical experimentation make us currently consider hand allografting as reasonable and useful both for the patients and for evolution of research in composite tissues allotransplantation (CTA). Further long-term careful research and worldwide monitoring of all patients with hand allografts is required to, on the one part, state on the authorization of this surgery, and, on the other part, to better elucidate the mechanisms of successful CTA.

Deposition of the C4d complement degradation product has been shown to be a marker of antibody-mediated rejection of solid organ allografts, including kidney, heart, liver, and lung. We investigated whether C4d deposition also would be useful in monitoring rejection in human composite tissue allografts. A total of 60 mucocutaneous formalin-fixed, paraffin-embedded and four frozen biopsy specimens from four patients with composite tissue allografts (three hands, one face) taken during a period of 7 days to 7 years after graft were immunostained for C4d by an immunoperoxidase and an immunofluorescence technique, respectively. C4d deposition was not found in any of the specimens studied, even though several of them showed pathological signs of rejection. No human leukocyte antigen alloantibodies were detected in any of the patients during the study period. These results suggest that humoral rejection occurs rarely, if at all, in the setting of human composite tissue allografts.

To present the results of ischaemic preconditioning (IPC), pharmacological preconditioning with vitamin C (Vit C) and a combination of the two modalities on functional recovery of rat kidneys after prolonged warm ischaemia.Forty six rats were divided into 5 experimental groups. Kidneys of the sham group (n = 9) were only submitted to dissection of the pedicle. Ischaemia (60 min, n = 10) was induced by clamping both kidneys. IPC (n = 9) consisted of two successive cycles (5 min/5 min) of ischaemia/reperfusion (I/R). Vit C (100 mg/Kg, n = 9) was administered by intravenous injection 30 min before warm ischaemia. The Vit C + IPC (n= 9) group received the combination of both treatments. Tissue malonedialdehyde (MDA), plasma lactate dehydrogenase (LDH), tubular reabsorption of sodium (TRNa) and creatinine clearance (GFR) were evaluated after 120 min of kidney reperfusion.Ischaemic kidneys showed a significant increase of MDA and LDH concentrations and a significant reduction of GFR and TRNa compared to the sham group. The use of lPC or Fit C induced a significant improvement of renal function compared to the ischaemia group. The combination of Vit C + IPC induced a slight improvement of experimental parameters compared to those of the ischaemia group, but did not improve kidney functioning compared to the use of either IPC or Vit C alone.IPC and Fit C improve the functional parameters of ischaemic kidneys. However the protective effects are attenuated when the two treatments are combined.

Living-donor transplantation has several obvious advantages for children: better graft-survival than cadaveric-transplantation, the possibility to be pre-emptive and avoid dialysis and its burden to the child, to be programmed during school holidays. However, its negative aspects must not be ignored. They are mainly psychological and concern the adolescent. The affective burden of both living-donation and transplantation is so strong that a psychological check-up is mandatory for the donor but also for the recipient and even the non-donor parent. In the medical evaluation of the donor, specific explorations, such as the search of a genetic mutation, could be necessary in the case of hereditary renal disease.

The authors report two cases of hepatic cirrhosis complicated by portal hypertension with splenorenal venous shunt presenting with left renal tumour that was treated by left radical nephrectomy with preservation of the shunt.

The objective of this prospective study was to describe the nature of the lesions observed during brain-dead cadavre donor kidney harvesting in France and to identify the risk factors for these lesions.A questionnaire elaborated by the AFU Transplantation Committee concerning the quality of kidneys harvested from cadavre donors was sent to all centres performing renal transplantation in France in 2000. This prospective study was conducted over a period of 1 year and concerned the overall multi-organ harvesting procedure based on all data concerning the renal parenchyma, arteriovenous and ureteric characteristics, and the outcome of the transplants.Twelve centres completed the survey, allowing analysis of the data of 201 donor kidneys. 91% of harvesting surgeons were urologists. Various incidents were reported during 11% of harvesting procedures, but 1/3 of the abnormalities were not recorded by the harvesting surgeon. Isolated kidney harvesting was found to be a risk factor (20% vs 8.6%). The rate of parenchymal abnormalities was 50%, 2/3 of which were related to inadequate removal of perirenal fat. Atheroma was a risk factor for arterial lesions during harvesting (21% vs 6.50). Venous abnormalities were detected in 9% of cases: 89% of them were due to the harvesting procedure and 59% of them were not identified by the harvesting surgeon. The fact of not being a transplant surgeon was a risk factor for venous lesions (21.9% vs 6.5%). 4% of ureteric lesions were observed with no consequence on graft outcome.Adequate removal of perirenal fat before conditioning is not acquired. Isolated kidney harvesting and atheroma were risk factors for parenchymal and arterial lesions, respectively. Venous harvesting anomalies were more frequent among non-transplant surgeons.

Whether islet transplantation should be aimed at restoring insulin independence or providing adequate metabolic control is still debated. The GRAGIL2 trial was designed as a phase 1-2 study where primary outcome was the rate of insulin independence, and secondary outcome was the success rate defined by a composite score based upon basal C-peptide, HbA1c, hypoglycemic events, and exogenous insulin needs.C-peptide negative type 1 brittle diabetic patients experiencing severe hypoglycemia were eligible to receive a maximum of two islet preparations totalizing 10,000 IE/kg or more, with a threshold of 5,000 IE/kg for the first infusion, according to the Edmonton protocol, within the Swiss-French GRAGIL multicentric network. A sequential analysis with a triangular test was performed in every five patients after 6- and 12-month follow-up. Maximal inefficiency was set at 40% and minimal efficiency at 66%.From September 2003 to October 2005, 10 patients were included. Median waiting time was 6.7 months (first injection) and 9 weeks (second injection). All but one patient received 11,089+/-505 IE/kg: one received a single graft of 5398 IE/kg. At 6 months, insulin independence and composite success rates were 6 of 10 and 6 of 10, respectively. At 12 months, insulin independence was observed in 3 of 10 patients and success in 5 of 10 patients.Based upon our sequential analysis settings, islet transplantation failed to achieve the primary goal, insulin independence, but tended to succeed in reaching the secondary goal, successful metabolic control. Currently it appears to be a successful biological closed-loop glucose control method for brittle diabetes.

Objectifs Evaluer par des etudes prospectives la faisabilite, la morbidite et les resultats fonctionnels des traitements pas HIFU focal des adenocarcinomes de la prostate. Methodes De 2013 a 2014, 2 protocoles de traitement focal par HIFU (FocalOne) ont ete realises. Criteres d’inclusions : 50 a 80 ans, PSA ≤ 10 ng/mL, stade T1/T2a, IRM et biopsies ciblees, Gleason ≤ 7 (3 + 4), pas de geste endoscopique. Pour 10 patients, des biopsies precoces (dans les 3 semaines) etaient realisees pour evaluer la fiabilite de l’echographie de contraste Sonovue. Marge de securite de 6 mm. Les patients avaient des questionnaires continence, sexualite et QOL avant et apres. IRM et biopsies de controle entre 6 mois et un an du traitement. Resultats preliminaires Quarante patients inclus, âge moyen 65,3 ans, 80 % de score T1, 70 % Gleason 6, PSA moyen : 4,94 ng/mL inclusion et a 3 mois : 2,9 ng/mL. IIEF > 17 chez 85 % des patients a 3 mois et 95 % a un an, 100 % biopsies negatives a un mois sous echographie de contraste (10 patients) et 70 % a un an (10 % positive homolateral, 20 % controlateral). Pas d’upstaging aux biopsies. Conclusion La prise en charge focale des adenocarcinomes prostatiques permet une preservation de la qualite de vie, de la sexualite et des mictions. Lors du suivi, 30 % de biopsies positives sont retrouve sans migration de stade. Des traitements de rattrapages sont possibles.

Objectifs L’HIFU a montre son efficacite dans le traitement de premiere intention des cancers de prostate localise et apres radiotherapie. Les deux options therapeutiques pouvant etre proposes pour une recidive locale apres chirurgie associee a une radiotherapie sont la cryotherapie et l’HIFU. Le but de cette etude est de rapporter les premiers resultats carcinologiques et fonctionnels du traitement par HIFU des recidives apres chirurgie et radiotherapie. Methodes De 2009 a 2015, ont ete inclus les patients presentant une recidive de cancer prostatique apres chirurgie et radiotherapie. Une IRM et un PET-TDM ont permis de localiser la recidive chez tous les patients et d’eliminer une extension metastatique a distance. Des biopsies dirigees ont ete systematiquement realisees. Une IRM etait realisee en postoperatoire afin de verifier l’etendue de la necrose. Le PSA etait dose a j1, m3, m6. Resultats Sept patients ont ete inclus (âge moyen : 69,2 ans). L’examen histologique des pieces de prostatectomie retrouvaient des PT3 pour 5 des 7 patients. Ils avaient beneficie d’une radiotherapie de rattrapage. Le PSA moyen avant traitement etait de 2,91 ng/mL. L’IRM a permis de localiser la recidive dans chaque cas. Les biopsies ont montre des tumeurs de Gleason 4 + 4 : 8 pour 3 patients et 4 + 3 : 7 pour 4 patients. Trois patients ont necessite un nouveau traitement car l’IRM postoperatoire montrait une zone insuffisamment traitee pour 2 patients, et 1 patient a eu une radiotherapie ganglionnaire, associee a un retraitement par HIFU. Deux patients ont obtenu un PSA Conclusion Le traitement par HIFU est une des seules options therapeutiques dans le traitement des recidives locales apres chirurgie et radiotherapie, avec une bonne preservation de la qualite de vie.