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1. The role of donor hypertension and angiotensin II in the occurrence of early pancreas allograft thrombosis

Author

Christophe Masset, Julien Branchereau, Fanny Buron, Georges Karam, Maud Rabeyrin, Karine Renaudin, Florent Le Borgne, Lionel Badet, Xavier Matillon, Christophe Legendre, Denis Glotz, Corinne Antoine, Magali Giral, Jacques Dantal, Diego Cantarovich, DIVAT Consortium, Maria Brunet, Rémi Cahen, Ricardo Codas, Sameh Daoud, Valérie Dubois, Coralie Fournie, Arnaud Grégoire, Alice Koenig, Charlène Lévi, Emmanuel Morelon, Claire Pouteil-Noble, Thomas Rimmelé, Olivier Thaunat, Gilles Blancho, Agnès Chapelet, Clément Deltombe, Lucile Figueres, Raphael Gaisne, Claire Garandeau, Caroline Gourraud-Vercel, Maryvonne Hourmant, Clarisse Kerleau, Delphine Kervella, Aurélie Meurette, Simon Ville, Christine Kandell, Anne Moreau, Florent Delbos, Alexandre Walencik, Anne Devis, Lucile Amrouche, Dany Anglicheau, Olivier Aubert, Lynda Bererhi, Alexandre Loupy, Frank Martinez, Arnaud Méjean, Rébecca Sberro-Soussan, Anne Scemla, Marc-Olivier Timsit, Julien Zuber, Gillian Divard, and Carmen Lefaucheur

Subjects
body mass index (BMI), pre-procurement pancreas suitability score, pancreas transplantation, allograft thrombosis, high blood pressure, immunothrombosis, Immunologic diseases. Allergy, RC581-607
Abstract

BackgroundAbout 10–20% of pancreas allografts are still lost in the early postoperative period despite the identification of numerous detrimental risk factors that correlate with graft thrombosis.MethodsWe conducted a multicenter study including 899 pancreas transplant recipients between 2000 and 2018. Early pancreas failure due to complete thrombosis, long-term pancreas, kidney and patient survivals were analyzed and adjusted to donor, recipient and perioperative variables using a multivariate cause-specific Cox model stratified to transplant centers.ResultsPancreas from donors with history of hypertension (6.7%), as well as with high body mass index (BMI), were independently associated with an increased risk of pancreas failure within the first 30 post-operative days (respectively, HR= 2.57, 95% CI from 1.35 to 4.89 and HR= 1.11, 95% CI from 1.04 to 1.19). Interaction term between hypertension and BMI was negative. Donor hypertension also impacted long-term pancreas survival (HR= 1.88, 95% CI from 1.13 to 3.12). However, when pancreas survival was calculated after the postoperative day 30, donor hypertension was no longer a significant risk factor (HR= 1.22, 95% CI from 0.47 to 3.15). A lower pancreas survival was observed in patients receiving a pancreas from a hypertensive donor without RAAS (Renin Angiotensin Aldosterone System) blockers compared to others (50% vs 14%, p < 0.001). Pancreas survival was similar among non-hypertensive donors and hypertensive ones under RAAS blockers.ConclusionDonor hypertension was a significant and independent risk factor of pancreas failure. The well-known pathogenic role of renin-angiotensin-aldosterone system seems to be involved in the genesis of this immediate graft failure.

Published
2024
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2. Belatacept in Pancreas Transplantation: Promising Insights From a Cohort Series

Author

Christophe Masset, Claire Garandeau, Simon Ville, Magali Giral, Aurélie Houzet, Julien Branchereau, Ismaël Chelghaf, Benoit Mesnard, Gilles Blancho, Jacques Dantal, and Diego Cantarovich

Subjects
pancreas transplantation, belatacept conversion, calcineurin inhibitor toxicity, pancreas allograft function, rejection, Specialties of internal medicine, RC581-951
Published
2024
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3. Primary Graft Function and 5 Year Insulin Independence After Pancreas and Islet Transplantation for Type 1 Diabetes: A Retrospective Parallel Cohort Study

Author

Mikael Chetboun, Christophe Masset, Mehdi Maanaoui, Frédérique Defrance, Valéry Gmyr, Violeta Raverdy, Thomas Hubert, Caroline Bonner, Lisa Supiot, Clarisse Kerleau, Gilles Blancho, Julien Branchereau, Georges Karam, Ismaël Chelghaf, Aurélie Houzet, Magali Giral, Claire Garandeau, Jacques Dantal, Kristell Le Mapihan, Arnaud Jannin, Marc Hazzan, Robert Caiazzo, Julie Kerr-Conte, Marie-Christine Vantyghem, Diego Cantarovich, and François Pattou

Subjects
insulin independence, prediction, islet transplant, pancreas allograft, primary graft function, Specialties of internal medicine, RC581-951
Abstract

In islet transplantation (ITx), primary graft function (PGF) or beta cell function measured early after last infusion is closely associated with long term clinical outcomes. We investigated the association between PGF and 5 year insulin independence rate in ITx and pancreas transplantation (PTx) recipients. This retrospective multicenter study included type 1 diabetes patients who underwent ITx in Lille and PTx in Nantes from 2000 to 2022. PGF was assessed using the validated Beta2-score and compared to normoglycemic control subjects. Subsequently, the 5 year insulin independence rates, as predicted by a validated PGF-based model, were compared to the actual rates observed in ITx and PTx patients. The study enrolled 39 ITx (23 ITA, 16 IAK), 209 PTx recipients (23 PTA, 14 PAK, 172 SPK), and 56 normoglycemic controls. Mean[SD] PGF was lower after ITx (ITA 22.3[5.2], IAK 24.8[6.4], than after PTx (PTA 38.9[15.3], PAK 36.8[9.0], SPK 38.7[10.5]), and lower than mean beta-cell function measured in normoglycemic control: 36.6[4.3]. The insulin independence rates observed at 5 years after PTA and PAK aligned with PGF predictions, and was higher after SPK. Our results indicate a similar relation between PGF and 5 year insulin independence in ITx and solitary PTx, shedding new light on long-term transplantation outcomes.

Published
2023
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4. Case Report: Long-term observations from the tacrolimus weaning randomized clinical trial depicts the challenging aspects for determination of low-immunological risk patients

Author

Christophe Masset, Jacques Dantal, Jean-Paul Soulillou, Alexandre Walencik, Florent Delbos, Sophie Brouard, Magali Giral, the Nantes DIVAT Consortium, Gilles Blancho, Julien Branchereau, Diego Cantarovich, Anne Cesbron, Agnès Chapelet, Anne Devis, Clément Deltombe, Lucile Figueres, Raphael Gaisne, Claire Garandeau, Caroline Gourraud-Vercel, Maryvonne Hourmant, Christine Kandel-Aznar, Georges Karam, Clarisse Kerleau, Delphine Kervella, Claire Leman, Alice Leclech, Aurélie Meurette, Karine Renaudin, and Simon Ville

Subjects
kidney transplantation, calcineurin inhibitor withdrawal, allograft rejection, donor specific antibodies, case report, Immunologic diseases. Allergy, RC581-607
Abstract

Whilst calcineurin inhibitors (CNI) are the cornerstone of immunosuppressive maintenance therapy in kidney transplantation, several studies have investigated the safety of CNI withdrawal in order to avoid their numerous side effects. In this context, we performed several years ago a clinical randomized trial evaluating CNI weaning in stable kidney transplant recipients without anti-HLA immunization. The trial was interrupted prematurely due to a high number of de novo DSA (dnDSA) and biopsy proven acute rejection (BPAR) in patients who underwent tacrolimus weaning, resulting in treatment for rejection and resumption of tacrolimus. We report here the long-term outcomes of patients included in this clinical trial. Ten years after randomization, all patients are alive with a functional allograft. They all receive tacrolimus therapy except one with recurrent cutaneous neoplasia issues. Long-term eGFR was comparable between patients of the two randomized groups (46.4 ml/min vs 42.8 ml/min). All dnDSA that occurred during the study period became non-detectable and all rejections episodes were reversed. The retrospective assessment of HLA DQ single molecule epitope mismatching determined that a majority of patients who developed dnDSA after tacrolimus withdrawal would have been considered at high immunological risk. Minimization of immunosuppression remains a challenging objective, mainly because of the issues to properly select very low immunological risk patients. Valuable improvements have been made the last decade regarding evaluation of the allograft rejection notably through the determination of numerous at-risk biomarkers. However, even if the impact of such tools still need to be clarify in clinical routine, they may permit an improvement in patients’ selection for immunosuppression minimization without increasing the risk of allograft rejection.

Published
2022
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5. Cryptococcal Meningitis in Kidney Transplant Recipients: A Two-Decade Cohort Study in France

Author

Laurène Tardieu, Gillian Divard, Olivier Lortholary, Anne Scemla, Éric Rondeau, Isabelle Accoceberry, Rémi Agbonon, Alexandre Alanio, Adela Angoulvant, Laetitia Albano, Philippe Attias, Anne Pauline Bellanger, Dominique Bertrand, Julie Bonhomme, Françoise Botterel, Nicolas Bouvier, Matthias Buchler, Taieb Chouaki, Thomas Crépin, Marie-Fleur Durieux, Guillaume Desoubeaux, Gary Doppelt, Loïc Favennec, Arnaud Fekkar, Ophélie Fourdinier, Marie Frimat, Jean-Pierre Gangneux, Claire Garandeau, Lilia Hasseine, Christophe Hennequin, Xavier Iriart, Nassim Kamar, Hannah Kaminski, Raphael Kormann, Laurence Lachaud, Christophe Legendre, Moglie Le Quintrec Donnette, Jordan Leroy, Charlène Levi, Marie Machouart, David Marx, Jean Menotti, Valérie Moal, Florent Morio, Natacha Mrozek, Muriel Nicolas, Philippe Poirier, Marie-Noelle Peraldi, Benjamin Poussot, Stéphane Ranque, Jean-Philippe Rerolle, Boualem Sendid, Renaud Snanoudj, Jérôme Tourret, Marc Vasse, Cécile Vigneau, Odile Villard, Laurent Mesnard, Fanny Lanternier, and Cédric Rafat

Subjects
cryptococcosis, opportunistic infection, transplant associated diseases, renal transplantation, cryptococcal meningitis, graft outcome, Medicine
Abstract

Cryptococcosis is the third most common cause of invasive fungal infection in solid organ transplant recipients and cryptococcal meningitis (CM) its main clinical presentation. CM outcomes, as well as its clinical features and radiological characteristics, have not yet been considered on a large scale in the context of kidney transplantation (KT). We performed a nationwide retrospective study of adult patients diagnosed with cryptococcosis after KT between 2002 and 2020 across 30 clinical centers in France. We sought to describe overall and graft survival based on whether KT patients with cryptococcosis developed CM or not. Clinical indicators of CNS involvement and brain radiological characteristics were assessed. Eighty-eight cases of cryptococcosis were diagnosed during the study period, with 61 (69.3%) cases of CM. Mortality was high (32.8%) at 12 months (M12) but not significantly different whether or not patients presented with CM. Baseline hyponatremia and at least one neurological symptom were independently associated with CM (p < 0.001). Positive serum cryptococcal antigen at diagnosis was also significantly associated with CM (p < 0.001). On magnetic resonance imaging (MRI), three patterns of brain injury were identified: parenchymal, meningeal, and vascular lesions. Although CM does not affect graft function directly, it entails a grim prognosis.

Published
2022
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6. A Phase I/IIa study of autologous tolerogenic dendritic cells immunotherapy in kidney transplant recipients

Author

Aurélie Moreau, Delphine Kervella, Laurence Bouchet-Delbos, Cécile Braudeau, Soraya Saïagh, Pierrick Guérif, Sophie Limou, Anne Moreau, Sylvain Bercegeay, Mathias Streitz, Birgit Sawitzki, Ben James, Paul N. Harden, David Game, Qizhi Tang, James F. Markmann, Ian S.D. Roberts, Edward K. Geissler, Brigitte Dréno, Régis Josien, Maria-Cristina Cuturi, Gilles Blancho, Julien Branchereau, Diego Cantarovich, Agnès Chapelet, Jacques Dantal, Clément Deltombe, Lucile Figueres, Raphael Gaisne, Claire Garandeau, Magali Giral, Caroline Gourraud-Vercel, Maryvonne Hourmant, Georges Karam, Clarisse Kerleau, Christophe Masset, Aurélie Meurette, Simon Ville, Christine Kandell, Karine Renaudin, Florent Delbos, Alexandre Walencik, Anne Devis, Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Team 1 : Mononuclear phagocytes, Immunopathology, Immunovirology (U1064 Inserm - CR2TI), Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université (Nantes Univ), Centre hospitalier universitaire de Nantes (CHU Nantes), Team 3 : Integrative transplantation, HLA, Immunology and genomics of kidney injury (U1064 Inserm - CR2TI), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Néphrologie et Immunologie Clinique [CHU de Nantes], Unité de Thérapie Cellulaire et Génique [CHU Nantes] (UTCG), Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), UMR 1064 Centre de Recherche en Transplantation et Immunologie, Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1064, ITUN - Institut de Transplantation Urologie Nephrologie, Nantes Université - École Centrale de Nantes (Nantes Univ - ECN), Clinical and Translational Research in Skin Cancer (CRCINA-ÉQUIPE 2), Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Friedrich-Loeffler-Institut (FLI), University of Regensburg, Oxford University Hospitals NHS Trust, University of Oxford, Guy's and St Thomas' Hospital [London], University of California [San Francisco] (UC San Francisco), University of California (UC), Massachusetts General Hospital [Boston], University Hospital Regensburg, Fraunhofer Institute for Toxicology and Experimental Medicine (Fraunhofer ITEM), Fraunhofer (Fraunhofer-Gesellschaft), Immunology and New Concepts in ImmunoTherapy (INCIT), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Service de dermatologie [Nantes], LabEX IGO Immunothérapie Grand Ouest, DIVAT consortium: Gilles Blancho, Julien Branchereau, Diego Cantarovich, Agnès Chapelet, Jacques Dantal, Clément Deltombe, Lucile Figueres, Raphael Gaisne, Claire Garandeau, Magali Giral, Caroline Gourraud-Vercel, Maryvonne Hourmant, Georges Karam, Clarisse Kerleau, Delphine Kervella, Christophe Masset, Aurélie Meurette, Simon Ville, Christine Kandell, Anne Moreau, Karine Renaudin, Florent Delbos, Alexandre Walencik, Anne Devis., and KERANDEL-DION, Céline

Subjects
[SDV] Life Sciences [q-bio], tolerance, Nephrology, [SDV]Life Sciences [q-bio], transplantation, clinical trial, dendritic cells, cell therapy
Abstract

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

Published
2023
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7. Subclinical rejection-free diagnostic after kidney transplantation using blood gene expression

Author

Richard Danger, Ludmilla Le Berre, Marion Cadoux, Clarisse Kerleau, Emmanuelle Papuchon, Hoa Le Mai, Thi-Van-Ha Nguyen, Pierrick Guérif, Emmanuel Morelon, Olivier Thaunat, Christophe Legendre, Dany Anglicheau, Carmen Lefaucheur, Lionel Couzi, Arnaud Del Bello, Nassim Kamar, Moglie Le Quintrec, Valentin Goutaudier, Karine Renaudin, Magali Giral, Sophie Brouard, Lionel Badet, Maria Brunet, Fanny Buron, Rémi Cahen, Ricardo Codas, Sameh Daoud, Valérie Dubois, Coralie Fournie, François Gaillard, Arnaud Grégoire, Alice Koenig, Charlène Lévi, Claire Pouteil-Noble, Maud Rabeyrin, Thomas Rimmelé, Gilles Blancho, Julien Branchereau, Diego Cantarovich, Agnès Chapelet, Jacques Dantal, Clément Deltombe, Lucile Figueres, Raphael Gaisne, Claire Garandeau, Caroline Gourraud-Vercel, Maryvonne Hourmant, Georges Karam, Delphine Kervella, Christophe Masset, Aurélie Meurette, Simon Ville, Christine Kandell, Anne Moreau, Florent Delbos, Alexandre Walencik, Anne Devis, Lucile Amrouche, Olivier Aubert, Lynda Bererhi, Alexandre Loupy, Frank Martinez, Arnaud Méjean, Rébecca Sberro-Soussan, Anne Scemla, Marc-Olivier Timsit, and Julien Zuber

Subjects
Nephrology
Published
2023
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8. COVID-19 Severity in Kidney Transplant Recipients According to Their Postvaccination Serological Assessment

Author

Christophe Masset, Claire Garandeau, Aurélie Houzet, Delphine Kervella, Simon Ville, Diego Cantarovich, Alice Leclech, Claire Leman, Raphael Gaisne, Cécile Guillot-Gueguen, Océane Salomon, Clarisse Kerleau, Magali Giral, Jacques Dantal, Gilles Blancho, Julien Branchereau, Anne Cesbron, Agnès Chapelet, Anne Devis, Florent Delbos, Clément Deltombe, Lucile Figueres, Caroline Gourraud-Vercel, Maryvonne Hourmant, Christine Kandel-Aznar, Georges Karam, Aurélie Houzet-Meurette, Karine Renaudin, Alexandre Walencik, Centre hospitalier universitaire de Nantes (CHU Nantes), Team 4 : Deciphering organ immune regulation in inflammation and transplantation (DORI-t) (U1064 Inserm - CR2TI), Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Service de Néphrologie et Immunologie Clinique [CHU de Nantes], Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Team 3 : Integrative transplantation, HLA, Immunology and genomics of kidney injury (U1064 Inserm - CR2TI), Nantes DIVAT Consortium: Gilles Blancho, Julien Branchereau, Diego Cantarovich, Anne Cesbron, Agnès Chapelet, Jacques Dantal, Anne Devis, Florent Delbos, Clément Deltombe, Lucile Figueres, Raphael Gaisne, Claire Garandeau, Magali Giral, Caroline Gourraud-Vercel, Maryvonne Hourmant, Christine Kandel-Aznar, Georges Karam, Clarisse Kerleau, Delphine Kervella, Claire Leman, Alice Leclech, Christophe Masset, Aurélie Houzet-Meurette, Karine Renaudin, Simon Ville, Alexandre Walencik, and KERANDEL-DION, Céline

Subjects
Coronavirus-19 disease, Monoclonal Antibody, [SDV]Life Sciences [q-bio], Calcineurin Inhibitors, Intensive Care Unit, Acute Kidney Injury, [SDV] Life Sciences [q-bio], BMI, RAAS, mRNA vaccine, Nephrology, kidney transplant recipient, Binding Antibody Units, kidney transplant recipients, Covid-19, variant of concern, Severe Acute Respiratory Syndrome Coronavirus-2
Abstract

International audience; No abstract available

Published
2022
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9. Does defending victimized peers put youth at risk of being victimized?

Author

Jessica Trach, Christina Salmivalli, Sarah Malamut, and Claire Garandeau

Subjects
Pediatrics, Perinatology and Child Health, Developmental and Educational Psychology, Social Development, Education
Abstract

Contains fulltext : 283403.pdf (Publisher’s version ) (Open Access) Defending peers who have been bullied is often thought to put defenders at risk of becoming victimized themselves. The study investigated the concurrent and prospective associations between defending and (peer- and self-reported) victimization, and examined popularity and classroom norms as potential moderators. Participants included 4085 Finnish youth (43.9% boys; Mage = 14.56, SD = .75; 97% born in Finland). Concurrently, defending was positively associated with self-reported victimization in classrooms with high bullying-popularity norms (b = .28, SE = .16). Defending was negatively associated with peer-reported victimization in classrooms with high defending-popularity norms (b = -.07, SE = .03). Defending was not significantly associated with future victimization, suggesting that it is generally not a risk factor for victimization. 15 p.

Published
2023

10. Humoral Response to BNT162b2 mRNA SARS-CoV-2 Vaccine in Patients with Nondialysis Chronic Kidney Disease

Author

Claire Garandeau, Celine Phelizot, Pierre Braud, Delphine Kervella, Gilles Blancho, Lucile Figueres, Xavier Ambrosi, and Maryvonne Hourmant

Subjects
Transplantation, Messenger RNA, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Epidemiology, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Critical Care and Intensive Care Medicine, medicine.disease, Virology, Research Letters, Nephrology, medicine, In patient, business, Kidney disease
Published
2021
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11. Clinical utility of C‐peptide measurement after pancreas transplantation with especial focus on early graft thrombosis

Author

Aurélie Meurette, Georges Karam, Diego Cantarovich, Maryvonne Hourmant, Christophe Masset, Julien Branchereau, Magali Giral, Clarisse Kerleau, Delphine Kervella, Jacques Dantal, Simon Ville, Gilles Blancho, and Claire Garandeau

Subjects
medicine.medical_specialty, medicine.medical_treatment, 030230 surgery, Pancreas transplantation, C-peptide measurement, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Humans, Transplantation, Homologous, Medicine, Postoperative Period, Retrospective Studies, Transplantation, C-Peptide, business.industry, C-peptide, Graft Survival, Thrombosis, medicine.disease, Surgery, medicine.anatomical_structure, chemistry, Biomarker (medicine), Allograft Thrombosis, 030211 gastroenterology & hepatology, Pancreas Transplantation, business, Pancreas
Abstract

Since the beginning of our pancreas transplant programme, plasma C-peptide was routinely measured daily during the postoperative period. We aimed to evaluate the clinical interest of the C-peptide in the follow-up of pancreas transplantation with a particular look on early graft failure. From 2000 to 2016, 384 pancreas transplantations were evaluated. We collected and compared C-peptide, glycaemia and adjusted C-peptide (aCP; calculated based on C-peptide, glycaemia and creatininaemia) in patients with and without pancreas failure within 30 days after surgery. Variations of glycaemia, C-peptide and aCP between the day before and the day of failure were also recorded. The difference of aCP was significant during the first week after transplantation between patients with thrombosis and those with functional allograft: 63.2 vs. 26.7 on day 1, P = 0.0003; 61.4 vs. 26.7 on day 3, P

Published
2021
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12. Time-Limited Therapy with Belatacept in Kidney Transplant Recipients

Author

Thibault, Letellier, Delphine, Kervella, Abderrahmane, Sadek, Christophe, Masset, Claire, Garandeau, Cynthia, Fourgeux, Victor, Gourain, Jeremie, Poschmann, Gilles, Blancho, Simon, Ville, On Behalf Of The Divat Consortium, Service de Néphrologie et Immunologie Clinique [CHU de Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Institut de Transplantation et de Recherche en Transplantation [CHU Nantes] (ITERT), Institut de Transplantation Urologie-Néphrologie ( ITUN), Team 3 : Integrative transplantation, HLA, Immunology and genomics of kidney injury (U1064 Inserm - CR2TI), Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Team 4 : Deciphering organ immune regulation in inflammation and transplantation (DORI-t) (U1064 Inserm - CR2TI), Team 6 : Impact of acute inflammation on host pathogen interactions and lung homeostasis (U1064 Inserm - CR2TI), Team 2 : Cell and gene engineering in tolerance, fertility and regenerative medicine (U1064 Inserm - CR2TI), and KERANDEL-DION, Céline

Subjects
[SDV] Life Sciences [q-bio], medicine_pharmacology_other, [SDV]Life Sciences [q-bio], calcineurin inhibitor, kidney transplantation, belatacept, transcriptome, RNAseq, General Medicine
Abstract

Introduction: In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit–risk ratio, we established a strategy consisting of time-limited belatacept therapy/transient calcineurin inhibitor withdrawal, whose results are analyzed in that study. Methods: We considered all the kidney transplant recipients that had been switched from conventional immunosuppressive therapy to belatacept and then for whom belatacept has been withdrawn intentionally. Furthermore, in the first 8 patients, we assessed changes in peripheral blood mononuclear cells (PBMC) transcriptome using RNAseq before and 3 months after belatacept withdrawal. Results: Over the study period, 28 out of 94 patients had belatacept intentionally withdrawn including 25 (89%) switched to low-dose CNI. One rejection due to poor compliance occurred. The eGFR after 12 months remained stable from 48 ± 19 mL.1.73 m−2 to 46 ± 17 mL.1.73 m−2 (p = 0.68). However, patients that resumed belatacept/withdrew CNIs (n = 10) had a trend towards a better eGFR comparing with the others (n = 15): 54 ± 20 mL.1.73 m−2 vs. eGFR 43 ± 16 mL.1.73 m−2, respectively (p = 0.15). The only factor associated with belatacept resumption was when the withdrawal took place during the COVID-19 outbreak. Transcriptome analysis of PBMCs, did not support rebound in alloimmune response. Conclusions: These findings underpin the use of belatacept as part of a time-limited therapy, in selected kidney transplant recipients, possibly as an approach to allow efficient vaccination against SARS-CoV-2.

Published
2022
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13. Nocardiosis in graft recipients of kidneys from extended‐criteria donors following switch to belatacept complicated by acute rejection

Author

Simon Ville, Christophe Masset, Lescornet Tanguy, Benjamin Gaborit, Jeremy Meyer, and Claire Garandeau

Subjects
Graft Rejection, Transplantation, medicine.medical_specialty, business.industry, Graft Survival, Nocardiosis, Nocardia Infections, Kidney, Extended criteria, medicine.disease, Belatacept, Tissue Donors, Transplant Recipients, Surgery, Abatacept, Humans, Medicine, business, Immunosuppressive Agents, medicine.drug
Published
2020
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14. Occurrence of de novo Donor Specific Antibodies after Covid-19 in kidney transplant recipients is low despite immunosuppression modulation

Author

Christophe Masset, Gabriela Gautier-Vargas, Diego Cantarovich, Simon Ville, Jacques Dantal, Florent Delbos, Alexandre Walencik, Clarisse Kerleau, Maryvonne Hourmant, Claire Garandeau, Aurélie Meurette, Magali Giral, Ilies Benotmane, Sophie Caillard, Gilles Blancho, Service de Néphrologie et Immunologie Clinique [CHU de Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), CHU Strasbourg, and Le Bihan, Sylvie

Subjects
[SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Human Leucocyte Antigen, HLA, Coronavirus-19 disease, Covid-19, allograft rejection, de novo Donor Specific Antibodies, dnDSA, COVID-19, Standard Deviation, SD, Real Time Polymerase Chain Reaction, RT-PCR, Mean Fluorescence Index, MFI, DSA, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, [SDV.IMM.II]Life Sciences [q-bio]/Immunology/Innate immunity, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Intensive Care Unit, ICU, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Nephrology, Clinical Research, Severe Acute Respiratory Syndrome Coronavirus-2, SARS-Cov-2, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Antibody Mediated Rejection, ABMR, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, T-Cell Mediated Rejection, TCMR, [SDV.IMM.II] Life Sciences [q-bio]/Immunology/Innate immunity
Abstract

Introduction Decreased immunosuppression has been proposed for kidney transplant recipients infected with Covid-19 but the impact on the alloreactive immune response during and after infection has been poorly investigated. We assessed the occurrence of anti HLA donor specific antibodies (post-Covid DSA) and rejection episodes following Covid-19 with particular focus on immunosuppression modulation. Methods Kidney transplant recipients from two French institutions had anti-HLA antibody screening before and after Covid-19. Management of immunosuppression, rejection episodes, Covid-19 severity, inflammatory markers and antiviral therapies were recorded. Results From 251 recruited patients, 72 were excluded because of Covid-19 related death (n= 25) and incomplete immunological follow-up (n= 47). Among the remaining 179 included patients, almost half were hospitalized (49.2%). Antimetabolites were interrupted in 47% of patients (82% in hospitalized, median time of resumption of 23 days and in 15% non-hospitalized, median time of resumption of 7 days). Calcineurin inhibitors were interrupted in 12% of patients (all hospitalized, median time of resumption of 11 days). The incidence of post-Covid DSA was 4% (8% and 0% in hospitalized and non-hospitalized, respectively). Allograft rejection occurred in 3 patients (1.7%) and all were hospitalized. Younger age, transplantation less than one year and preexisting DSA were more frequently observed in post-Covid DSA positive patients, whereas inflammatory markers, lymphopenia and use of antiviral therapies were not. Conclusion The incidence of post-Covid DSA among Covid-19 positive kidney transplant recipients was low (4%) despite a significant decrease in immunosuppression and was mainly restricted to high-risk immunological patient’s status. Covid-19 severity was not associated with post-Covid DSA and/or rejection., Graphical abstract

Published
2022
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16. Observations on improving COVID-19 vaccination responses in kidney transplant recipients: heterologous vaccination and immunosuppression modulation

Author

Christophe Masset, Simon Ville, Claire Garandeau, Florent Le Borgne, Thibaut Letellier, Diego Cantarovich, Aurélie Meurette, Cécile Guillot-Gueguen, Maxime Bentoumi-Loaec, Magali Giral, Jacques Dantal, Gilles Blancho, Service de Néphrologie et Immunologie Clinique [CHU de Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Institut de Transplantation et de Recherche en Transplantation [CHU Nantes] (ITERT), Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR des Sciences Pharmaceutiques et Biologiques (Nantes Université - UFR Pharmacie), IDBC/A2com [Pace, France], and Le Bihan, Sylvie

Subjects
[SDV] Life Sciences [q-bio], Immunosuppression Therapy, COVID-19 Vaccines, Nephrology, SARS-CoV-2, [SDV]Life Sciences [q-bio], Vaccination, COVID-19, Humans, Letter to the Editor, Kidney Transplantation, ComputingMilieux_MISCELLANEOUS, Transplant Recipients
Abstract

International audience; No abstract available

Published
2021
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17. Incidence, Risk Factors and Outcomes of Kidney and Liver Cyst Infection in Kidney Transplant Recipient With ADPKD

Author

Charles Ronsin, Anis Chaba, Ondrej Suchanek, Jean-Philippe Coindre, Clarisse Kerleau, Claire Garandeau, Aurélie Houzet, Diego Cantarovich, Jacques Dantal, Gilles Blancho, Magali Giral, Grégoire Couvrat-Desvergnes, Simon Ville, Service de Néphrologie et Immunologie Clinique [CHU de Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Institut de Transplantation et de Recherche en Transplantation [CHU Nantes] (ITERT), Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre Hospitalier Le Mans (CH Le Mans), Team 4 : Deciphering organ immune regulation in inflammation and transplantation (DORI-t) (U1064 Inserm - CR2TI), Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Service de Néphrologie, dialyse, transplantation [CHD Vendée] (Site de La Roche sur Yon), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), and KERANDEL-DION, Céline

Subjects
cyst infection, autosomal dominant polycystic kidney disease, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Nephrology, incidence, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, kidney transplantation, risk factors, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology
Abstract

International audience; Introduction: Cyst infection is a known complication of autosomal dominant polycystic kidney disease (ADPKD). Here, we describe incidence, risk factors, clinical presentation, and outcomes of cyst infection in kidney transplant recipient.Methods: We conducted a single-center retrospective cohort study of patients with ADPKD with renal allografts between January 1, 2009, and October 31, 2020. Cyst infection diagnosis was based on previously described clinical and radiological criteria, using positron emission tomography when available.Results: A total of 296 patients with ADPKD with renal allografts were included, and 21 patients experienced 22 episodes of cyst infection over a median follow-up of 4 (2–7) years. The cumulative incidence rate was 3% at 1 year, 6 % at 5 years, and 12% at 10 years after transplantation. In multivariate analysis, history of cyst infection before transplantation was the only significant risk factor identified to predict the occurrence of cyst infection after kidney transplantation (hazard ratio [HR] 3.47, 95% CI 1.29–9.31). The clinical presentation at diagnosis of cyst infection included isolated fever in 5 (23%) episodes, acute kidney injury in 12 (55%), and severe sepsis/septic shock in 3 (14%) episodes. Among the 16 (73%) episodes with culture positivity, Escherichia coli was the most common pathogen. There was no difference between early (≤1 year after transplantation) and late (>1 year) cyst infection episodes in terms of clinical presentation and outcomes. Cyst infection was significantly associated with graft loss (HR 3.93, 95% CI 1.21–12.80), but no causal relationship could be established.Conclusion: Incidence of cyst infection in ADPKD after kidney transplantation is low, history of cyst infection representing the main risk factor.

Published
2021
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22. A third injection of BNT162b2 mRNA Covid-19 vaccine in kidney transplant recipients improves the humoral immune response

Author

Delphine Kervella, Jacques Dantal, Cécile Guillot-Gueguen, Maryvonne Hourmant, Diego Cantarovich, Simon Ville, Magali Giral, Aurélie Houzet, C. Kerleau, Christophe Masset, Claire Garandeau, Irène Guihard, and Gilles Blancho

Subjects
Messenger RNA, 2019-20 coronavirus outbreak, COVID-19 Vaccines, Coronavirus-19 disease, Covid-19, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Kidney Transplantation, Kidney transplant, Transplant Recipients, Immunity, Humoral, Immune system, mRNA vaccine, Nephrology, Immunology, Humans, Medicine, kidney transplant recipient, business, Letters to the Editor, Covid-19, BNT162 Vaccine
Published
2021

23. Resurgence of BK virus following Covid‐19 in kidney transplant recipients

Author

Benjamin Gaborit, Amaury Dujardin, Lola Jacquemont, Franck Halary, Sabine Lebot, Jacques Dantal, Simon Ville, Delphine Kervella, Celine Bressolette‐Bodin, Lucille Figueres, Aurélie Meurette, Christophe Masset, Maryvonne Hourmant, Gilles Blancho, Clément Deltombe, Diego Cantarovich, Claire Garandeau, and Magali Giral

Subjects
Male, viruses, medicine.medical_treatment, Population, Viremia, 030230 surgery, medicine.disease_cause, Mycophenolic acid, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, education, Kidney transplantation, Immunosuppression Therapy, education.field_of_study, Polyomavirus Infections, Transplantation, business.industry, SARS-CoV-2, virus diseases, COVID-19, Immunosuppression, Middle Aged, medicine.disease, Kidney Transplantation, Transplant Recipients, BK virus, Calcineurin, Tumor Virus Infections, Infectious Diseases, BK Virus, Immunology, 030211 gastroenterology & hepatology, Female, business, Immunosuppressive Agents, medicine.drug
Abstract

Kidney transplant recipients have been supposed vulnerable to severe Covid-19 infection, due to their comorbidities and immunosuppressive therapies. Mild-term complications of Covid-19 are currently unknown, especially in this population. Herein, we report two cases of BKV replication after non-severe SARS-CoV-2 infection. The first case was a 59-year-old man, transplanted 3 months ago, with recent history of slight BKV viremia (3.3 log10 DNA copies/ml). Despite strong reduction of maintenance immunosuppression (interruption of mycophenolic acid and important decrease of calcineurin inhibitors), BKV replication largely increased after Covid-19 and viremia persisted at 4.5 log copy/ml few months later. The second case was a 53-year-old woman, transplanted 15 years ago. She had a recent history of BKV cystitis, which resolved with a decrease of MPA dosage. Few weeks after SARS-CoV-2 infection, she presented recurrence of lower urinary tract symptoms. Our reports highlight that SARS-CoV-2 infection, even without severity, could disrupt immune system and particularly lymphocytes, thus leading to viral replication. Monitoring of viral replications after Covid-19 in kidney transplant recipients could permit to confirm these preliminary observations.

Published
2020
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24. Impact of antiviral prophylaxis in adults Epstein-Barr Virus-seronegative kidney recipients on early and late post-transplantation lymphoproliferative disorder onset: a retrospective cohort study

Author

Jacques Dantal, Aurélie Meurette, Simon Ville, Marianne Coste-Burel, Claire Garandeau, Magali Giral, Maryvonne Hourmant, Berthe-Marie Imbert-Marcille, Diego Cantarovitch, Gilles Blancho, Le Bihan, Sylvie, Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Néphrologie et Immunologie Clinique [CHU de Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Immunotherapy in Transplantation And Autoimmunity (Team 3 - U1064 Inserm - CRTI), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Laboratoire de Virologie [CHU Nantes], Dendritic cells and immunoregulation in transplantation and immunopathology (Team 1 - U1064 Inserm - CRTI), Immunoregulation And Immunointervention in Transplantation and Autoimmunity (Team 4 - U1064 Inserm - CRTI), and Genetic and Cellular Engineering in Immunology and Regenerative Medicine (Team 2 - U1064 Inserm - CRTI)

Subjects
Adult, Male, 0301 basic medicine, Ganciclovir, Epstein-Barr Virus Infections, medicine.medical_specialty, complications, Late onset, 030230 surgery, medicine.disease_cause, Antiviral Agents, Gastroenterology, post-transplantation lymphoproliferative disorder, Pathogenesis, Young Adult, 03 medical and health sciences, 0302 clinical medicine, hemic and lymphatic diseases, Internal medicine, medicine, Humans, Aciclovir, Risk factor, malignancies and long term compliations, Aged, Retrospective Studies, Transplantation, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, Incidence (epidemiology), Retrospective cohort study, Middle Aged, Kidney Transplantation, Epstein–Barr virus, infection, Lymphoproliferative Disorders, kidney clinical, 030104 developmental biology, DNA, Viral, Immunology, Female, business, Epstein-Barr Virus, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

International audience; Post-transplantation lymphoproliferative disorder (PTLD) pathogenesis is related to EBV infection. Mismatch with the donor (EBV D+/R-) is the main risk factor for both early PTLD (1 year). In these at-risk patients, the role of antiviral prophylaxis for preventing PTLD remains controversial. We analyzed the impact of antivi-ral drugs given to prevent CMV disease in a monocentric retrospective cohort of 73 adult kidney or kidney-pancreas EBV-seronegative recipients, transplanted between 01/01/2000 and 01/01/2016. Thirty-seven (50.7%, prophylaxis group) received (val-)aciclovir or (val-)ganciclovir for 3-6 months and 36 (49.3%, no-prophylaxis group) received no-prophy-laxis. Mean follow-up was 69 ± 7.2 months in the prophylaxis group and 91 ± 10.3 months in the no-prophylaxis group. Monitoring of EBV PCR revealed that prophylaxis delayed primary infection at 100 days (43% vs. 84%, P = 0.02). Early PTLD incidence was not different between groups (4/37 vs. 4/36, P = 0.99). Concerning late events, EBV-related neoplasia incidence was significantly lower in treated patients among whom no cases were observed, while in the no-prophylaxis group 6 cases were reported (P = 0.02). Despite a weak level of evidence our study suggests that antivi-ral prophylaxis could prevent late onset PTLD.

Published
2018
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26. Shiga toxin–producing Escherichia coli–associated hemolytic uremic syndrome in solid organ transplant recipients

Author

Amandine Ydee, Emmanuel Canet, Véronique Frémeaux-Bacchi, Diego Cantarovich, François Provôt, Simon Ville, Adrien Tissot, Fadi Fakhouri, Claire Garandeau, Patricia Mariani-Kurkdjian, Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Service de Néphrologie [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Département de Néphrologie [CHRU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Médecine Intensive [CHU Nantes], Service de pneumologie [Nantes], Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CNR Escherichia coli [Hôpital Robert Debré - APHP], Hôpital Universitaire Robert-Debré (AP-HP), and Le Bihan, Sylvie

Subjects
0303 health sciences, medicine.medical_specialty, 030306 microbiology, business.industry, [SDV]Life Sciences [q-bio], Organ transplantation, 3. Good health, Microbiology, [SDV] Life Sciences [q-bio], 03 medical and health sciences, 0302 clinical medicine, Nephrology, medicine, 030212 general & internal medicine, Solid organ transplantation, business, Shiga toxin-producing Escherichia coli, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2019
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27. Tacrolimus- versus sirolimus-based immunosuppression after simultaneous pancreas and kidney transplantation: 5-year results of a randomized trial

Author

Florent Delbos, Maxime Leroy, Gilles Blancho, Magali Giral, Jacques Dantal, Diego Cantarovich, Christelle Volteau, Jean-Paul Soulillou, Claire Garandeau, Georges Karam, Aurélie Houzet, Delphine Kervella, Julien Branchereau, Karine Renaudin, Maryvonne Hourmant, Simon Ville, and Cécile Guillot-Gueguen

Subjects
Graft Rejection, medicine.medical_specialty, medicine.medical_treatment, Urology, 030230 surgery, Tacrolimus, 03 medical and health sciences, 0302 clinical medicine, Maintenance therapy, medicine, Clinical endpoint, Immunology and Allergy, Humans, Pharmacology (medical), Prospective Studies, Pancreas, Kidney transplantation, Immunosuppression Therapy, Sirolimus, Transplantation, business.industry, Graft Survival, Immunosuppression, Mycophenolic Acid, medicine.disease, Kidney Transplantation, Discontinuation, surgical procedures, operative, Pancreas Transplantation, business, Immunosuppressive Agents, medicine.drug, Follow-Up Studies
Abstract

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

Published
2019

28. The Case | A neoplastic cause of acute kidney injury

Author

Lucile Figueres, Karine Renaudin, Fadi Fakhouri, and Claire Garandeau

Subjects
Text mining, Nephrology, business.industry, MEDLINE, Acute kidney injury, Medicine, Humans, Acute Kidney Injury, business, medicine.disease, Bioinformatics
Published
2019

29. New rules of ABO-compatibility in kidney transplantation

Author

Maryvonne Hourmant, Lucile Figueres, Christine Kimmel, Aurélie Gicquel, and Claire Garandeau

Subjects
Graft Rejection, congenital, hereditary, and neonatal diseases and abnormalities, Waiting Lists, medicine.medical_treatment, Xenotransplantation, Clinical Biochemistry, 030204 cardiovascular system & hematology, ABO Blood-Group System, 03 medical and health sciences, 0302 clinical medicine, Gene Frequency, hemic and lymphatic diseases, ABO blood group system, parasitic diseases, medicine, Humans, Kidney transplantation, Immunosuppression Therapy, biology, business.industry, Biochemistry (medical), Graft Survival, Antibody titer, Immunosuppression, Hematology, medicine.disease, Kidney Transplantation, biological factors, Tissue Donors, Transplantation, Blood Grouping and Crossmatching, Blood Group Incompatibility, Histocompatibility, Immunology, Practice Guidelines as Topic, biology.protein, Rituximab, France, Antibody, business, 030215 immunology, medicine.drug
Abstract

ABO compatibility rules in kidney transplantation have been deeply modified with the possibility of ABO-incompatible transplantation. The recipient has to be prepared in the days preceding surgery with an objective of ABO antibody titers of 1/8 or less. This is obtained through a procedure including antibody removal, rituximab and IV immunoglobulins alone or in association according to the initial titer. All ABO combinations are possible. Due to the preparation of the recipient, living related transplantation has been first carried out but ABO-incompatible transplantation from a deceased donor is becoming common practice in some countries (A2 or A2B donor to a B recipient). Lower uncensored graft survival has been reported by some studies but not when ABO-incompatible kidney transplantations were compared with matched ABO-compatible ones. The infectious risk in the perioperative period, consequence of higher immunosuppression, raises concern. The interlaboratory variability in hemagglutination anti-A/B assays remains an important question among cohort studies which leads to development of new tests. ABO-incompatible transplantation is associated with a rare process, accommodation, that is well known in xenotransplantation and according to which, the transplant is protected against the consequences of ABO antibody binding. In human kidney ABO-incompatible transplantation, few studies are available but suggest that this protection against the post-transplant antibody rebound might be mediated by the expression of anti-complement molecules by endothelial cells.

Published
2019

30. Severe Allograft Rejection and Autoimmune Hemolytic Anemia After Anti-PD1 Therapy in a Kidney Transplanted Patient

Author

Clément Deltombe, Karine Renaudin, Claire Garandeau, and Maryvonne Hourmant

Subjects
0301 basic medicine, Graft Rejection, Male, Skin Neoplasms, Anemia, Programmed Cell Death 1 Receptor, Severity of Illness Index, 03 medical and health sciences, Immunocompromised Host, 0302 clinical medicine, Antineoplastic Agents, Immunological, Fatal Outcome, Risk Factors, Severity of illness, medicine, Humans, Melanoma, Kidney transplantation, Aged, Transplantation, Kidney, biology, business.industry, Antibodies, Monoclonal, medicine.disease, Allografts, Kidney Transplantation, 030104 developmental biology, medicine.anatomical_structure, Nivolumab, Treatment Outcome, Mechanism of action, 030220 oncology & carcinogenesis, Immunology, biology.protein, Disease Progression, Anemia, Hemolytic, Autoimmune, medicine.symptom, Antibody, Autoimmune hemolytic anemia, business, Immunosuppressive Agents
Abstract

Anti–programmed cell death 1 (PD-1) antibodies have demonstrated anticancer activities and survival benefit but, because of their mechanism of action, have been associated with autoimmune and alloimmune adverse events.1 We report the case of a kidney transplant patient who presented autoimmune hemol

Published
2018

31. 2658. Meningitis in Kidney Transplant Recipients: TransMéninges, a French Multicentric Retrospective Cohort Study

Author

Sunny Randhawa, Aurelia Retbi, Moglie Le Quintrec, Yanis Tamzali, Yosu Luque, Valérie Moal, Vincent Fihman, Pierre Taupin, Marie Matignon, Dominique Bertrand, Jonathan M. Chemouny, Ilham Cherrak, Jerôme Tourret-Arnaud, Claire Garandeau, Benoit Barrou, Anne Scemla, Charlène Levi, and Eric Thervet

Subjects
Abstracts, Pediatrics, medicine.medical_specialty, Infectious Diseases, Oncology, business.industry, Poster Abstracts, medicine, Retrospective cohort study, medicine.disease, business, Meningitis, Kidney transplant
Abstract

Background The management of meningitis requires the prompt introduction of high-dose probabilistic anti-infectious therapy. The literature reporting on meningitis in kidney transplant recipients (KTR) is scarce and no recommendation exists for this specific population. Methods We retrospectively included all adult KTRs diagnosed with meningitis (cerebro-spinal fluid (CSF) cell count >10/mm3 or positive fungal antigen or direct examination) between 2007 and 2018 in 16 French hospitals. Clinical, biological, and therapeutic data, and 1-year kidney and patient survival were collected. Results Meningitis occurred in 134 KTRs (mean age 57+/11.8 years, 56% male), after a median time of 27 months (IQR 8–65); 25% of patients received an immunosuppressive treatment before kidney transplantation, induction treatment included lymphocyte-depleting antibodies in 63%, and 53% presented diabetes (34% before and 19% after the transplantation). The etiologies included Cryptococcus neoformans (30%), Herpesviridae (22%, including Varicella-Zoster Virus 15%), idiopathic forms (11%), Gram-negative bacilli (8% of which 20% produced an extended spectrum β-lactamase), %), infusion of intravenous immunoglobulins (6%), post-transplant lymphoproliferative disorders (5%), Aspergillus fumigatus (4%), Listeria monocytogenes (4%), Enterovirus (4%), and Mycobacterium tuberculosis (3%). The most common symptoms were fever (82.5%), headaches (75%), encephalitis (55%), and convulsion (22.5%). CSF hypercellularity (found in 92% of the cases) was lymphocytic in 65% of the cases and neutrophilic in 35%. Initial anti-infectious therapy was inappropriate in 27% of the cases. One-year patient, graft, and death-censored graft survival rates were 84%, 76%, and 89%, respectively. Conclusion Meningitis after kidney transplantation encompasses a wide range of causes, with C. neoformans and VZV explaining more than 50% of the cases. Gram-negative bacilli are the most represented bacteria with a high rate of antimicrobial resistance. Treatment guidelines should be reconsidered in the specific population of KTRs as the etiology greatly differs from what is observed in the general population. Disclosures All authors: No reported disclosures.

Published
2019
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32. Intérêt de la désensibilisation non-active des patients hyper-immunisés en attente de transplantation rénale

Author

Florent Delbos, Sabine Le Bot, Stéphanie Malard, Maryvonne Hourmant, Claire Garandeau, and Anne Cesbron

Subjects
Biochemistry (medical), Clinical Biochemistry, Hematology
Abstract

Les patients hyper-immunises ont un acces a la transplantation limite malgre le programme de priorite national. Le nombre de ces patients sur liste d’attente est en constante augmentation. Afin d’ameliorer les possibilites de greffe, nous avons etabli un protocole monocentrique de desensibilisation non active (DNA) ou les anticorps anti-HLA de MFI 85 %), sur liste d’attente depuis en moyenne 4,7 ans. Nous avons pu retirer en moyenne 30 % des anticorps. Le TGI est passe de 98,5 % a 94,5 % et le NFAG a augmente en moyenne de 2 a 17,5. Vingt cinq patients ont ete transplantes, 11 sans hDSA et 14 avec au moins un hDSA. La MFI mediane des DSA sur le serum du jour de la greffe etait de 228. Le pic de MFI historique median etait de 8421, avec un delai median de 7 ans entre le pic et la transplantation. La survie et la fonction du greffon des patients greffes avec et sans hDSA etaient similaires a 1 an de la greffe. Nos resultats suggerent que le protocole DNA base sur la decroissance spontanee des anticorps ameliore l’acces a la transplantation des patients hyperimmunises, sans engendrer de sur-risque immunologique de rejet.

Published
2019
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33. Prevalence of the reversed halo sign in neutropenic patients compared with non-neutropenic patients: Data from a single-centre study involving 27 patients with pulmonary mucormycosis (2003-2016)

Author

Philippe Moreau, Patrice Chevallier, Isabelle Danner-Boucher, Pierre Peterlin, Florent Morio, Claire Defrance, Claire Garandeau, Thomas Gastinne, Jessie Bourcier, Fanny Rialland-Battisti, Patrice Le Pape, Eric Frampas, and Pierre-Marie Heudes

Subjects
0301 basic medicine, Mucorales, Adult, Male, Pediatrics, medicine.medical_specialty, Neutropenia, Adolescent, 030106 microbiology, Dermatology, 03 medical and health sciences, Young Adult, Age Distribution, Internal medicine, medicine, Prevalence, Humans, Mucormycosis, Sex Distribution, Pulmonary mucormycosis, Child, Halo sign, Aged, Retrospective Studies, biology, Lung Diseases, Fungal, business.industry, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, biology.organism_classification, Exact test, Infectious Diseases, Child, Preschool, Cohort, Female, medicine.symptom, business, Tomography, X-Ray Computed
Abstract

Pulmonary mucormycosis (PM) is a life-threatening infection and the diagnosis can be challenging. The objective was to retrospectively explore the value of the RHS in our cohort of 27 patients with mucormycosis and its relation to neutropenia. This was a retrospective study including all patients with a diagnosis of probable or proven invasive PM according to the 2008 EORTC/MSG criteria between September 2003 to April 2016. Fisher's exact test and Mann-Whitney test, with a P-value statistically significant under .05 (P

Published
2017

34. L’évolution de la transplantation rénale ces 20 dernières années

Author

Maryvonne Hourmant and Claire Garandeau

Subjects
medicine.medical_specialty, Kidney, Pediatrics, business.industry, medicine.medical_treatment, General Medicine, medicine.disease, Living donor, Surgery, End stage renal disease, Transplantation, surgical procedures, operative, medicine.anatomical_structure, Quality of life, medicine, business, Contraindication, Kidney transplantation, Dialysis
Abstract

Key points Kidney transplantation is an efficient treatment of end stage renal disease, decreasing patient mortality by comparison with mortality in dialysis and improving patient quality of life. The number of patients living in France with a functioning transplant is almost as high as the number of patients on dialysis (33,000 versus 37,500 in 2009). The constant progress in immunosuppressive treatments has made graft survival improve. According to the “Agence de biomedecine”, the national institution in charge of transplantation regulation and management, overall graft survival is 68% at 10 years but 80% for living donor transplantation. Transplantation indications have been extended with time to more difficult patients: retransplanted patients and elderly patients, to the point that age per se is no more a contraindication to transplantation. Increase in transplant activity has followed increase in kidney harvesting in marginal donors, called “extended criteria donors”: older, hypertensive, having atherosclerotic pathologies. Kidney from these donors are attributed to recipients of similar age. With organ shortage, new sources of donors are proposed, non heart beating donors and living donors. Living donor transplantation is the best transplantation with the best results but it is insufficiently developed in France (8–10% of the total annual number of renal transplantations versus 30–50% in the Scandinavian and Anglo-Saxon countries). Extension of the definition of the living donor through the successive revisions of the Law of Bioethics should hopefully improved this situation.

Published
2011
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35. Successful treatment of acute promyelocytic leukemia with arsenic trioxide and all-trans retinoic acid in a double lung and kidney transplanted patient

Author

Alice Garnier, Patrice Chevallier, Antoine Bonnet, Sophie Vantyghem, Steven Le Gouill, Pierre Peterlin, Maryvonne Hourmant, Claire Garandeau, Adrien Tissot, Marie C. Béné, Thierry Guillaume, Philippe Moreau, and Delphine Houreau-Langlard

Subjects
0301 basic medicine, Acute promyelocytic leukemia, Kidney, business.industry, medicine.medical_treatment, Retinoic acid, Hematology, General Medicine, medicine.disease, 03 medical and health sciences, chemistry.chemical_compound, Leukemia, 030104 developmental biology, 0302 clinical medicine, medicine.anatomical_structure, chemistry, Tretinoin, 030220 oncology & carcinogenesis, medicine, Cancer research, Lung transplantation, Arsenic trioxide, business, Kidney transplantation, medicine.drug
Published
2016
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36. [The evolution of kidney transplantation over the last 20 years]

Author

Maryvonne, Hourmant and Claire, Garandeau

Subjects
Immunosuppression Therapy, Renal Dialysis, Graft Survival, Living Donors, Quality of Life, Tissue and Organ Harvesting, Humans, Kidney Failure, Chronic, Kidney Transplantation, Tissue Donors, Forecasting
Abstract

Kidney transplantation is an efficient treatment of end stage renal disease, decreasing patient mortality by comparison with mortality in dialysis and improving patient quality of life. The number of patients living in France with a functioning transplant is almost as high as the number of patients on dialysis (33,000 versus 37,500 in 2009). The constant progress in immunosuppressive treatments has made graft survival improve. According to the "Agence de biomédecine", the national institution in charge of transplantation regulation and management, overall graft survival is 68% at 10 years but 80% for living donor transplantation. Transplantation indications have been extended with time to more difficult patients: retransplanted patients and elderly patients, to the point that age per se is no more a contraindication to transplantation. Increase in transplant activity has followed increase in kidney harvesting in marginal donors, called "extended criteria donors": older, hypertensive, having atherosclerotic pathologies. Kidney from these donors are attributed to recipients of similar age. With organ shortage, new sources of donors are proposed, non heart beating donors and living donors. Living donor transplantation is the best transplantation with the best results but it is insufficiently developed in France (8-10% of the total annual number of renal transplantations versus 30-50% in the Scandinavian and Anglo-Saxon countries). Extension of the definition of the living donor through the successive revisions of the Law of Bioethics should hopefully improved this situation.

Published
2011

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

Author

Ouahmi, Hajar, Moceri, Pamela, Zorzi, Kevin, Albano, Laetitia, Durand, Matthieu, Karimi, Fatimaezzahra, Morelon, Emmanuel, Buron, Fanny, Le Quintrec, Moglie, Pernin, Vincent, Ladriere, Marc, Girerd, Sophie, Dantal, Jacques, Loupy, Alexandre, Couzi, Lionel, Ferrari, Emile, Esnault, Vincent, Merville, Pierre, Legendre, Christophe, Giral, Magali, Sicard, Antoine, Badet, Lionel, Brunet, Maria, Cahen, Rémi, Codas, Ricardo, Daoud, Sameh, Dubois, Valérie, Fournie, Coralie, Grégoire, Arnaud, Koenig, Alice, Lévi, Charlène, Pouteil‐Noble, Claire, Rabeyrin, Maud, Rimmelé, Thomas, Thaunat, Olivier, Abdo, Nicolas, Delmas, Sylvie, Perrochia, Hélène, Serre, Jean‐Emmanuel, Szwarc, Ilan, Aarnink, Alice, Alla, Asma, Eschwege, Pascal, Frimat, Luc, Hubert, Jacques, Kormann, Raphaël, Lagrange, François, Laurain, Emmanuelle, Lecoanet, Pierre, Lemelle, Jean‐Louis, Mannuguerra, Anthony, Mazeaud, Charles, Peres, Michael, Blancho, Gilles, Branchereau, Julien, Cantarovich, Diego, Chapelet, Agnès, Deltombe, Clément, Figueres, Lucile, Garandeau, Claire, Gourraud‐Vercel, Caroline, Hourmant, Maryvonne, Karam, Georges, Kerleau, Clarisse, Meurette, Aurélie, Ville, Simon, Kandell, Christine, Moreau, Anne, Renaudin, Karine, Cesbron, Anne, Delbos, Florent, Walencik, Alexandre, Devis, Anne, Chevallier, Daniel, Tibi, Brannwel, Ahallal, Younes, Amrouche, Lucile, Anglicheau, Dany, Aubert, Olivier, Bererhi, Lynda, Martinez, Frank, Sberro‐Soussan, Rébecca, Scemla, Anne, Tinel, Claire, Zuber, Julien, Glotz, Denis, Lefaucheur, Carmen, Université Côte d'Azur - Faculté de Médecine (UCA Faculté Médecine), Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice (CHU Nice), CIC CHU Lyon (inserm), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Réseau CENTAURE, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), CHU Bordeaux [Bordeaux], Immunology from Concept and Experiments to Translation (ImmunoConcept), Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de PhysioMédecine Moléculaire (LP2M), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), DIVAT Consortium: Lionel Badet, Maria Brunet, Fanny Buron, Rémi Cahen, Ricardo Codas, Sameh Daoud, Valérie Dubois, Coralie Fournie, Arnaud Grégoire, Alice Koenig, Charlène Lévi, Emmanuel Morelon, Claire Pouteil-Noble, Maud Rabeyrin, Thomas Rimmelé, Olivier Thaunat, Nicolas Abdo, Sylvie Delmas, Moglie Le Quintrec, Vincent Pernin, Hélène Perrochia, Jean-Emmanuel Serre, Ilan Szwarc, Alice Aarnink, Asma Alla, Pascal Eschwege, Luc Frimat, Sophie Girerd, Jacques Hubert, Raphaël Kormann, Marc Ladriere, François Lagrange, Emmanuelle Laurain, Pierre Lecoanet, Jean-Louis Lemelle, Anthony Mannuguerra, Charles Mazeaud, Michael Peres, Gilles Blancho, Julien Branchereau, Diego Cantarovich, Agnès Chapelet, Jacques Dantal, Clément Deltombe, Lucile Figueres, Claire Garandeau, Magali Giral, Caroline Gourraud-Vercel, Maryvonne Hourmant, Georges Karam, Clarisse Kerleau, Aurélie Meurette, Simon Ville, Christine Kandell, Anne Moreau, Karine Renaudin, Anne Cesbron, Florent Delbos, Alexandre Walencik, Anne Devis, Laetitia Albano, Fatimaezzahra Karimi, Antoine Sicard, Hajar Ouahmi, Daniel Chevallier, Brannwel Tibi, Matthieu Durand, Younes Ahallal, Lucile Amrouche, Dany Anglicheau, Olivier Aubert, Lynda Bererhi, Christophe Legendre, Alexandre Loupy, Frank Martinez, Rébecca Sberro-Soussan, Anne Scemla, Claire Tinel, Julien Zuber, Denis Glotz, Carmen Lefaucheur, and Retiveau, Nolwenn

Subjects
medicine.medical_specialty, medicine.medical_treatment, MESH: Heart Valves, Postoperative Hemorrhage, MESH: Kidney Transplantation, Cohort Studies, Diabetes mellitus, Internal medicine, Biological heart valve, Medicine, Endocarditis, Humans, Prospective Studies, MESH: Cohort Studies, Kidney transplantation, Dialysis, Retrospective Studies, Kidney, Transplantation, MESH: Humans, business.industry, Cardiac valve replacement, End-stage kidney disease, MESH: Postoperative Hemorrhage, MESH: Retrospective Studies, medicine.disease, Heart Valves, Kidney Transplantation, MESH: Prospective Studies, [SDV.TOX] Life Sciences [q-bio]/Toxicology, medicine.anatomical_structure, Prosthetic heart valve, Mechanical heart valve, [SDV.TOX]Life Sciences [q-bio]/Toxicology, Cohort, Cardiology, business, Cohort study
Abstract

Main problem The number of kidney transplant candidates with prosthetic heart valves (PHVs) is increasing. Yet, outcomes of kidney transplantation in these patients are still unclear. This is the first report of post-transplant outcomes in patients with PHVs at time of kidney transplantation. Methods We conducted a matched cohort study among recipients from the multicentric and prospective DIVAT cohort to compare outcomes in patients with left-sided PHVs at time of transplantation and a group of recipients without PHV matched according to age, dialysis time, initial disease, pre-transplant DSA, diabetes and cardiovascular events. Results Of 23018 patients, 92 patients with PHVs were included and compared to 276 patients without PHV. Delayed graft function and post-operative bleeding occurred more frequently in patients with PHVs. Kidney graft survival was similar between groups. 5-year overall survival was 68.5 % in patients with PHV versus 87.9 % in patients without PHV (HR, 2.72[1.57-4.70], p=0.0004). Deaths from infection, endocarditis and bleeding were more frequent in patients with PHV. Mechanical valves, but not bioprosthetic valves, were independent risk factors for mortality (HR, 2.89[1.68-4.97], p=0.0001). Conclusions Patients with PHV have high mortality rates after kidney transplantation. These data suggest that mechanical valves, but not biological valves, increase risks of post-transplant mortality.

Published
2021
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