117 results on '"R, Snanoudj"'
Search Results
2. Microbiologie, facteurs de risque et mortalité lors des péritonites polymicrobiennes en dialyse péritonéale: une étude de cohorte issue du RDPLF
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S. Beaudreuil, S. Novelli, R. Snanoudj, M. Zaidan, C. Verger, and V. Forté
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Nephrology - Abstract
Introduction Les peritonites polymicrobiennes en dialyse peritoneale (DP) sont associees a un mauvais pronostic mais les donnees francaises ne sont pas connues. Description Notre etude multicentrique inclut les adultes debutant la DP entre le 1er janvier 2014 et le 12 novembre 2020 et presentant au moins une peritonite. Les donnees demographiques, la microbiologie des episodes et le pronostic des patients proviennent du Registre de DP de Langue Francaise (RDPLF). Methodes Les patients avec peritonites polymicrobiennes ont ete compares aux monomicrobiennes puis les peritonites a germes enteriques (bacilles gram negatifs, streptocoques groupe B, enterocoques, fongiques, anaerobies) aux autres. Resultats Sur 8848 patients, 2055 presentaient une peritonite microbienne avec 3097 episodes monomicrobiens et 251 polymicrobiens (6 %). L’incidence etait de 0,29 episode/patients-annees. Les bacilles gram negatifs, enterocoques, anaerobies et germes fongiques etaient plus frequents lors des episodes polymicrobiens quand les staphylocoques et bacilles gram positifs l’etaient lors des monomicrobiens. Les patients avec peritonite polymicrobienne etaient plus âges (72 ans vs 69 ans, p = 0,004), plus souvent atteints de demence (4 % vs 2 %, p = 0,03) ou de maladie respiratoire chronique (11 % vs 6 %, p = 0,01). Apres analyses multivariees, le seul facteur de risque etait la demence (aOR: 2,7 [1,2–5,6], p = 0,01) et les peritonites polymicrobiennes etaient plus transferees que les monomicrobiennes (HR: 1,6 [1,1–2,3], p = 0,02) mais la mortalite n’etait pas differente (HR: 0,9 [0,6–1,6], p = 0,83). A l’inverse, les peritonites a germes enteriques etaient severes, associees a l’interruption de la DP (HR: 1,7 [1,4–2,2], p Fig. 1 ). Conclusion Les peritonites polymicrobiennes sont associees aux transferts en hemodialyse mais pas a la mortalite, contrairement aux germes enteriques.
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- 2021
3. Transplantation rénale : réalisation et suivi précoce
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Christophe Legendre, Jean-Paul Duong, R Snanoudj, Alexandre Loupy, Lynda Bererhi, Anne Scemla, Dominique Prié, Dany Anglicheau, Guillaume Canaud, Frank Martinez, Clémentine Rabaté, Marion Rabant, Rebecca Sberro-Soussan, Claire Tinel, Frank Bienaime, Marc-Olivier Timsit, Julien Zuber, Olivier Hélénon, Marianne Delville, Jean-Michel Correas, Marie-France Mamzer-Bruneel, Arnaud Mejean, and Université de Paris (UP)
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03 medical and health sciences ,0302 clinical medicine ,Nephrology ,[SDV]Life Sciences [q-bio] ,030232 urology & nephrology ,3. Good health - Abstract
Resume Plus de 50 ans apres le succes des deux premieres transplantations renales realisees a Boston et a l’hopital Necker a Paris, la transplantation renale est devenue le traitement de choix de l’insuffisance renale chronique terminale, car elle ameliore non seulement la qualite de vie des patients, mais aussi leur quantite de vie. En France, plus de 3700 transplantations renales sont realisees chaque annee, et plus de 40 000 patients vivent avec un greffon fonctionnel. Ce traitement de l’insuffisance renale chronique terminale requiert une evaluation precise du futur receveur puis une prise en charge specialisee multidisciplinaire capable de prevenir, depister et traiter l’ensemble des pathologies associees et des complications de l’immunosuppression. L’ambition de cet article n’est pas de decrire de maniere exhaustive tous les aspects de la transplantation renale, mais a partir de l’experience d’une equipe, des donnees de la litterature recente et des recommandations nationales et internationales, d’essayer de fournir une vision synthetique et chronologique du suivi precoce apres la transplantation.
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- 2019
4. Long-term survival benefit with dual kidney transplantation: analysis of French cohort between 2002 and 2014 and strategies to optimize the allocation of very extended criteria donor kidneys
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C. Legeai, Yann Neuzillet, M. Peraldi, P. Grimbert, Emilie Savoye, R. Snanoudj, Matthieu Durand, F. Kerbaul, Lionel Badet, M. Macher, N. Ouali, M. Pastural, and C. Legendre
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Pediatrics ,medicine.medical_specialty ,Dual kidney transplantation ,business.industry ,Urology ,Cohort ,Long term survival ,medicine ,Extended criteria ,business - Published
- 2021
5. Severe infections requiring intensive care unit admission in kidney transplant recipients: impact on graft outcome
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N. Bige, Benoit Schlemmer, Ch. Legendre, R. Snanoudj, Lara Zafrani, Sylvie Chevret, Marie-Noëlle Peraldi, Danielle Reuter, Virginie Lemiale, Elie Azoulay, Jérôme Lambert, and Emmanuel Canet
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Graft Rejection ,medicine.medical_specialty ,medicine.medical_treatment ,Opportunistic Infections ,Pneumocystis carinii ,law.invention ,Sepsis ,Risk Factors ,law ,Internal medicine ,Humans ,Medicine ,Pneumocystis jirovecii ,Renal replacement therapy ,Kidney transplantation ,Retrospective Studies ,Transplantation ,biology ,business.industry ,Septic shock ,Pneumonia, Pneumocystis ,Mortality rate ,Bacterial pneumonia ,Bacterial Infections ,medicine.disease ,biology.organism_classification ,Kidney Transplantation ,Intensive care unit ,Surgery ,Hospitalization ,Intensive Care Units ,Infectious Diseases ,business ,Immunosuppressive Agents - Abstract
Background Kidney transplant recipients are at risk for life-threatening infections, which may affect the long-term prognosis. Methods We retrospectively included all kidney transplant recipients admitted for sepsis, severe sepsis, or septic shock to the medical intensive care unit (ICU) of the Saint-Louis Hospital, Paris, France, between 2000 and 2010. The main objective was to identify factors associated with survival without graft impairment 90 days after ICU discharge. Results Data were available for 83 of 100 eligible patients. The main sites of infection were the lungs (54%), urinary tract (24%), and bloodstream (22%). Among documented infections (55/83), 80% were bacterial. Fungal infections were more common among patients transplanted after 2005 (5% vs. 23%, P = 0.02). Mechanical ventilation was used in 46 (56%) patients, vasopressors in 39 (47%), and renal replacement therapy (RRT) in 34 (41%). In-hospital and day-90 mortality rates were 20% and 22%, respectively. On day 90, among the 65 survivors, 39 (47%) had recovered their previous graft function and 26 (31%) had impaired graft function, including 16 (19%) who were dependent on RRT. Factors independently associated with day-90 survival and graft function recovery were baseline serum creatinine (odds ratio [OR] for a 10 μmol/L increase 0.94, 95% confidence interval [CI] 0.88–1.00) and cyclosporine therapy (OR 0.30, 95% CI 0.11–0.79). Conclusion Sepsis was chiefly related to bacterial pneumonia or urinary tract infection. Pneumocystis jirovecii was the leading opportunistic agent, with a trend toward an increase over time. Infections often induced severe graft function impairment. Baseline creatinine and cyclosporine therapy independently predicted the outcome.
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- 2014
6. TRANSPLANTATION BASIC SCIENCE, ALLOGENIC AND XENOGENIC TOLERANCE
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L. Berthelot, T. Robert, T. Tabary, V. Vuiblet, M. Drame, O. Toupance, P. Rieu, R. C. Monteiro, F. Toure, S. Ferrario, V. Cantaluppi, M. De Lena, S. Dellepiane, S. Beltramo, M. Rossetti, A. M. Manzione, M. Messina, M. Gai, C. Dolla, L. Biancone, G. Camussi, P. Pontrelli, A. R. Oranger, M. Accetturo, F. Rascio, M. Gigante, G. Castellano, A. Schena, M. Fiorentino, A. Zito, G. Zaza, G. Stallone, L. Gesualdo, G. Grandaliano, E. F. Pattonieri, M. Gregorini, V. Corradetti, C. Rocca, S. Milanesi, A. Peloso, J. Ferrario, M. Cannone, F. Bosio, N. Maggi, M. A. Avanzini, P. Minutillo, M. Paulli, M. Maestri, T. Rampino, A. Dal Canton, K. S. T. Wu, O. Coxall, Y. Luque, S. Candon, M. Rabant, L.-H. Noel, E. Thervet, L. Chatenoud, R. Snanoudj, D. Anglicheau, C. Legendre, J. Zuber, P. Hruba, I. Brabcova, E. Krepsova, J. Slatinska, A. Sekerkova, I. Striz, R. Zachoval, O. Viklicky, T. M. Scholbach, H.-K. Wang, C.-C. Loong, A.-H. Yang, T.-H. Wu, H. Guberina, V. Rebmann, P. Dziallas, S. Dolff, J. Wohlschlaeger, F. M. Heinemann, O. Witzke, Y. M. Zoet, F. H. J. Claas, P. A. Horn, A. Kribben, I. I. N. Doxiadis, N. Prasad, B. Yadav, V. Agarwal, A. Jaiswal, M. Rai, C. M. Hope, P. T. Coates, P. S. Heeger, R. Carroll, V. Masola, M. F. Secchi, M. Onisto, G. Gambaro, A. Lupo, M. Matsuyama, T. Kobayashi, Y. Yoneda, J. Chargui, J. L. Touraine, R. Yoshimura, D. Vizza, A. Perri, S. Lupinacci, G. Toteda, D. Lofaro, F. Leone, P. Gigliotti, A. La Russa, T. Papalia, R. Bonofilgio, A. Sentis Fuster, J. Kers, U. Yapici, N. Claessen, F. J. Bemelman, I. J. M. Ten Berge, S. Florquin, D. Glotz, L. Rostaing, J.-P. Squifflet, P. Merville, C. Belmokhtar, G. Le Ny, Y. Lebranchu, D. A. Papazova, M. Friederich-Persson, M. P. Koeners, J. A. Joles, M. C. Verhaar, H. L. Trivedi, A. V. Vanikar, S. D. Dave, B. Suarez Alvarez, S. Garcia Melendreras, R. Carvajal Palao, C. Diaz Corte, M. Ruiz Ortega, C. Lopez-Larrea, A. K. Yadav, D. Bansal, V. Kumar, M. Minz, V. Jha, D. Kaminska, K. Koscielska-Kasprzak, P. Chudoba, O. Mazanowska, M. Banasik, M. Zabinska, M. Boratynska, A. Lepiesza, K. Korta, M. Klinger, R. Csohany, A. Prokai, D. Pap, N. Balicza-Himer, A. Vannay, A. Fekete, K. Kis-Petik, J. Peti-Peterdi, A. Szabo, A. Masajtis-Zagajewska, K. Muras, M. Niewodniczy, M. Nowicki, J. Pascual, T. R. Srinivas, S. Chadban, F. Citterio, M. Henry, F. Oppenheimer, P.-C. Lee, H. Tedesco-Silva, M. Zeier, Y. Watarai, G. Dong, M. Hexham, P. Bernhardt, F. Vincenti, M. T. Rocchetti, J. Su owicz, A. Wojas-Pelc, E. Ignacak, K. Janda, M. Krzanowski, W. Su owicz, M. Mitsuhashi, T. Murakami, A. Benso, D. Leuning, M. Reinders, E. Lievers, J. Duijs, A. J. Van Zonneveld, C. Van Kooten, M. Engelse, T. Rabelink, A. Assounga, S. Omarjee, Z. Ngema, A. Ersoy, A. Gultepe, E. Isiktas Sayilar, H. Akalin, F. Coskun, M. Oner Torlak, Y. Ayar, M. Riegersperger, M. Plischke, C. Steinhauser, A. Jallitsch-Halper, G. Sengoelge, W. C. Winkelmayer, G. Sunder-Plassmann, M. Foedinger, M. Kaziuk, M. Kuz'Niewski, A. B Tkowska- Prokop, K. Pa Ka, P. Dumnicka, W. Kolber, and W. Su Owicz
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Transplantation ,medicine.medical_specialty ,Nephrology ,business.industry ,Basic science ,medicine ,Intensive care medicine ,business - Published
- 2014
7. Single graft loss in dual renal transplant recipients: impact of graft placement on recipient outcomes
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Christophe Legendre, Marc-Olivier Timsit, Marion Rabant, Yannick Rouach, Ambroise Salin, Sayeed K. Malek, Arnaud Mejean, Daniel Cohen, Henri Kreis, and R Snanoudj
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Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Iliac fossa ,Renal function ,Graft loss ,medicine.disease ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Renal transplant ,Medicine ,Graft survival ,business ,Dialysis ,Kidney transplantation - Abstract
We aimed to assess the impact of graft placement in dual renal transplantation on the risk for single graft loss and to report recipient outcomes. Between 2004 and 2007, 55 dual renal transplants were performed at our institution. Allografts were placed bilaterally (one in each iliac fossa) in 42 patients and unilaterally (both in the same iliac fossa) in 14 patients. Nine recipients (16.4%) underwent explantation of a single graft as a consequence of vascular thrombosis designated as the SINGLE group, whereas 46 had two functional allografts (DUAL group). There was a higher rate of graft loss in case of unilateral placement (n = 5/14) compared with bilateral placement (n = 4/41) (35.7% vs. 9.8%, P = 0.035). One-year glomerular filtration rate was significantly lower in the SINGLE group (29.4 ml/min/1.73 m(2) vs. 49.4 ml/min/1.73 m(2) in the DUAL group, P < 0.05). Significantly, none of the nine recipients of the SINGLE group returned to dialysis with a mean follow-up of 34.1 months. Graft survival at 1 year was 100% and 97.9% in SINGLE and DUAL groups, respectively. Unilateral placement of both allografts is associated with an increased risk of single graft loss and therefore lower renal function at 1 year. However, this strategy is safe in selected indications.
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- 2010
8. Aspects éthiques de la transplantation rénale (donneurs et receveurs)
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M.-F. Mamzer Bruneel, E. Grand Laforêt, H. Kreis, E. Thervet, F. Martinez, R. Snanoudj, C. Hervé, and C. Legendre
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- 2006
9. Traitements immunosuppresseurs : mécanismes d'action et utilisation clinique
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E. Thervet, J. Zuber, R. Sberro, G. Canaud, D. Anglicheau, R. Snanoudj, M.-F. Mamzer-Brunel, F. Martinez, and C. Legendre
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- 2006
10. Kidney transplantation at Necker Hospital: the most recent 5-year period (2004-2009)
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Ch, Legendre, H, Kreis, F, Martinez, R, Snanoudj, M F, Mamzer, R, Sberro, L, Bererhi, D, Anglicheau, J, Zuber, A, Loupy, E, Thervet, N, Pallet, A, Sartorius, D, Bertrand, G, Canaud, L H, Noël, M, Rabant, M O, Timsit, and A, Méjean
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Adult ,Aged, 80 and over ,Graft Rejection ,Male ,Paris ,Time Factors ,Adolescent ,National Health Programs ,Hospitals, Public ,Graft Survival ,Middle Aged ,Kidney Transplantation ,Risk Assessment ,Tissue Donors ,Young Adult ,Treatment Outcome ,Risk Factors ,Humans ,Female ,Immunosuppressive Agents ,Aged - Abstract
The results of our last 5 years activity in kidney transplantation clearly show that it is possible to perform high-risk transplantations with very acceptable results: ECD kidneys, dual transplantation, recipients with DSAs. In depth statistical analysis of these data should allow a clearer definition of the best strategies to use in these situations.
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- 2011
11. [Nephrotoxicity of calcineurin inhibitors: presentation, diagnostic problems and risk factors]
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R, Snanoudj, M, Rabant, V, Royal, N, Pallet, L-H, Noël, and C, Legendre
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Diagnosis, Differential ,Risk Factors ,Calcineurin Inhibitors ,Humans ,Kidney Diseases - Abstract
Nephrotoxicity of calcineurin inhibitors (CNIs) is an acute, reversible and chronic, irreversible pathology. Histologically, acute nephrotoxicity manifests as hemodynamic modifications caused by vasoconstriction of the essentially afferent arterioles resulting in a drop in the glomerular filtration rate. Chronic nephrotoxicity is characterized by arteriolar hyalinosis resulting in a variety of tubulointerstitial and glomerular lesions with an essentially ischemic mechanism. However, these histological lesions, whether chronic or acute, are not specific of CNI toxicity and can be seen in the course of many pathological circumstances in kidney transplantation. This absence of specificity makes the histological diagnosis of CNI nephrotoxicity difficult. In addition, the individual risk of developing CNI nephrotoxicity, difficult to predict based solely on the pharmacokinetic parameters of systemic CNI exposure, also involves local exposure (CNI concentrations in the graft) modulated by several, notably pharmacogenetic factors. The difficulty of diagnosing CNI nephrotoxicity and the interindividual variability of its risk require development of new diagnostic tools so that the patients at highest risk of developing severe CNI nephrotoxicity lesions, in whom minimization protocols would produce the best risk-benefit ratio, can be identified.
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- 2010
12. Intensive and prolonged treatment of focal and segmental glomerulosclerosis recurrence in adult kidney transplant recipients: a pilot study
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Julien Zuber, Eric Thervet, V. Royale, François Lefrère, Guillaume Canaud, Rebecca Sberro, R Snanoudj, Dany Anglicheau, Frank Martinez, Ch. Legendre, Marina Cavazzana-Calvo, L.-H. Noël, Arnaud Mejean, and K. Gaha
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Urinary system ,Urology ,Pilot Projects ,Young Adult ,Focal segmental glomerulosclerosis ,Recurrence ,medicine ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Age of Onset ,Child ,Kidney transplantation ,Retrospective Studies ,Transplantation ,Proteinuria ,business.industry ,Glomerulosclerosis, Focal Segmental ,Racial Groups ,Remission Induction ,Glomerulosclerosis ,medicine.disease ,Ciclosporin ,Kidney Transplantation ,Tissue Donors ,Surgery ,Child, Preschool ,Disease Progression ,Kidney Failure, Chronic ,Drug Therapy, Combination ,Female ,medicine.symptom ,business ,Immunosuppressive Agents ,Kidney disease ,medicine.drug - Abstract
No treatment has consistently induced long-term remission of proteinuria in adult patients with focal segmental glomerulosclerosis (FSGS) recurrence after kidney transplantation. We undertook an open-label, nonrandomized pilot trial of intensive and prolonged treatment of FSGS recurrence. Over an 18-month period, 10 adult kidney transplant recipients with FSGS recurrence received concomitantly high-dose steroids, intravenous cyclosporine for 14 days followed by oral cyclosporine therapy, and an intensive and prolonged course of plasma exchanges (PE). We compared this treatment with those of a control group of 19 patients with a FSGS recurrence transplanted between 1997 and 2005. Complete, rapid (mean 23 +/- 7 days) and sustained remission was obtained in 9/10 patients (90%) as opposed to 27% in the control group. At month 3 and month 12, proteinuria was 0.16 g/day (range 0.05-0.3 g/day) and 0.19 g/day (range 0.05-1 g/day) respectively. Only one patient remained in partial remission at month 12 but he had already lost two previous grafts due to FSGS recurrence. PEs were stopped at month 9 in all patients except for the patient with a partial remission who remains PE-dependent. This small pilot study provides very encouraging results demonstrating that this treatment rapidly achieves complete and sustained remission in a high proportion of patients.
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- 2009
13. [Screening biopsies in kidney transplantation: from subclinical acute rejection to chronic allograft lesions]
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R, Snanoudj, F, Martinez, R, Sberro Soussan, E, Thervet, and C, Legendre
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Graft Rejection ,Biopsy ,Graft Survival ,Prognosis ,Kidney Transplantation ,Early Diagnosis ,Isoantibodies ,Acute Disease ,Chronic Disease ,Humans ,Multicenter Studies as Topic ,Transplantation, Homologous ,Prospective Studies ,Primary Graft Dysfunction ,Biomarkers ,Immunosuppressive Agents ,Randomized Controlled Trials as Topic - Abstract
Kidney biopsies for screening purposes have the advantage of revealing the early appearance of lesions having a poor prognosis before kidney function is altered. Early screening of subclinical rejections allows preventive treatment of kidney transplantation in patients taking cyclosporine or azathioprine, thus improving their renal function and reducing the incidence of chronic histological lesions. However, this benefit has yet to be demonstrated in patients taking tacrolimus or mycophenolic acid. As for interstitial fibrosis lesions and tubular atrophy, biopsies can screen subclinical immunological lesions or those related to nephrotoxicity of anticalcineurins, which have a negative prognostic value in terms of graft survival. In addition, detection of these lesions could be a very useful criterion of efficacy in clinical studies. Moreover, they could help decide on modifying immunosuppressor treatment and evaluate the therapeutic strategies in patients at risk for humoral rejection. Finally, given the cost of biopsies and the inconvenience for the patient, the question of the timing and the number of screening biopsies is crucial. However, interventional studies evaluating notably immunosuppressor treatment modifications based on histological data are necessary to justify the daily use of screening biopsies.
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- 2008
14. Recurrence of HUS due to CD46/MCP mutation after renal transplantation: a role for endothelial microchimerism
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N. Arzouk, R. Snanoudj, Antoine Durrbach, Sophie Ferlicot, Bernard Charpentier, and Véronique Frémeaux-Bacchi
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Adult ,Endothelium ,Biopsy ,Enzyme-Linked Immunosorbent Assay ,urologic and male genital diseases ,Chimerism ,Membrane Cofactor Protein ,Postoperative Complications ,Recurrence ,medicine ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Kidney transplantation ,Transplantation ,Kidney ,Vascular disease ,business.industry ,CD46 ,Reverse Transcriptase Polymerase Chain Reaction ,Endothelial Cells ,Microchimerism ,DNA ,Acute Kidney Injury ,medicine.disease ,Kidney Transplantation ,female genital diseases and pregnancy complications ,medicine.anatomical_structure ,Immunology ,Hemolytic-Uremic Syndrome ,Mutation ,Female ,business ,Kidney disease ,Follow-Up Studies - Abstract
Mutations in the gene of the membrane cofactor protein (MCP/CD46), a complement regulatory protein, were recently described as a cause of hemolytic uremic syndrome (HUS). MCP is a transmembrane glycoprotein expressed in kidneys; therefore, the transplantation of a normal kidney should not be complicated by HUS recurrence. However, we report the case of a 32-year-old woman with an MCP mutation who developed a recurrence of HUS after renal transplantation. We found that she had vascular microchimerism of endothelial cells. We suggest that recurrence may be favored by vascular microchimerism, in which the mutated protein is produced in the in the kidney graft by endothelial cells originating from recipient.
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- 2007
15. Single-center experience with cyclosporine therapy for kidney transplantation: analysis of a twenty-year period in 1200 patients
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A Durrbach, F Kriaa, N. Arzouk, R. Snanoudj, C Hiesse, Séverine Beaudreuil, and B Charpentier
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Adult ,Graft Rejection ,medicine.medical_specialty ,Renal function ,Azathioprine ,Single Center ,Gastroenterology ,chemistry.chemical_compound ,Postoperative Complications ,Chronic allograft nephropathy ,Internal medicine ,Neoplasms ,medicine ,Humans ,Acute tubular necrosis ,Kidney transplantation ,Retrospective Studies ,Transplantation ,Creatinine ,business.industry ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Survival Analysis ,Tissue Donors ,Surgery ,chemistry ,Cyclosporine ,Drug Therapy, Combination ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Since the introduction of cyclosporine (CyA) in our center in February 1983, 1267 kidney transplant patients have received an immunosuppressive regimen based on CyA, usually in association with azathioprine and steroids and following an induction therapy in three quarters of patients. The aim of this study was to retrospectively analyze our 20-year experience with CyA and examine the evolution of therapy during this period. Induction treatment has been less commonly used during the past 5 years. Even in the early years of our experience, CyA doses were low (under 6 mg/kg per day at 3 months after transplantation). Acute tubular necrosis was observed in 39.4% of patients. The incidence of acute rejection episodes has dramatically decreased since 1984, but the frequency of steroid-resistant rejection has remained constant (around 20%). The first year of transplantation, 32.7% of patients had arterial hypertension. De novo diabetes mellitus occurred in 2.5% of patients. An incidence of 11.8% of malignancies was observed. Skin cancer and lymphomas accounted for 50% and 12% of neoplasms. Five-year graft and patient survivals were 70% and 87%, respectively. Renal function remained remarkably constant during the first 10 years of follow-up with a mean creatinine of 150 micromol/L. Chronic allograft nephropathy resulted in 43% graft losses. In conclusion, CyA has been well tolerated in our patients. However, the occurrence of chronic allograft nephropathy was a major concern in our cohort.
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- 2004
16. AGU5 Les thromboses vasculaires precoces de la transplantation renale : resultats de l’echo-Doppler, apport du scanner multibarrette
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Laurence Rocher, A. Lesavre, Y. Menu, A. Miquel, T. Guedj, A-S Rangheard, R. Snanoudj, and Bertrand Bessoud
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Radiological and Ultrasound Technology ,Radiology, Nuclear Medicine and imaging - Abstract
Objectifs Optimiser la realisation de l’echo-Doppler du greffon renal dans les premiers jours : astuces techniques, reglages, signes positifs de thrombose arterielle et veineuse, faux positifs. Determiner les indications du scanner. Materiels et methodes Trois cents transplantations renales ont ete realisees depuis 3 ans. L’echo-Doppler etait realise pour eliminer une thrombose vasculaire en particulier quand il n’y avait pas de reprise de la diurese. En cas de doute sur la perfusion renale, un scanner mul-tibarrette et/ou une angiographie etaient pratiques. Resultats Six patients (2 %) ont presente une thrombose confirmee chirurgicalement. Le signe du « flux de va et vient » dans l’artere peut traduire une thrombose veineuse, mais il n’est pas specifique car il s’observe aussi en cas de necrose tubulaire severe, de rejet vasculaire. Le scanner au temps arteriel, nephrographique et tardif peut aider au diagnostic. L’angiographie peut etre prise en defaut pour diagnostiquer une thrombose veineuse. Conclusion L’echo-Doppler precoce du greffon renal peut presenter des difficultes techniques et des doutes diagnostiques, alors que les consequences therapeutiques sont majeures. Une bonne technique echographique et l’utilisation ciblee du scanner aident a evaluer la perfusion du greffon et a decider d’une eventuelle reprise chirurgicale.
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- 2005
17. PRIMARY BRAIN LYMPHOMAS AFTER KIDNEY TRANSPLANTATION: PRESENTATION AND OUTCOME
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R Snanoudj, A Durrbach, V Leblond, B Moulin, B hurault de ligny, E Rondeau, and B Charpentier
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Transplantation - Published
- 2004
18. A case report of Paracetamol related pyroglutamic acidosis: mind the gap in a malnourished patient.
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Eid R, Zamparini E, Ouchrif Y, Snanoudj R, Ottolenghi C, and Zaidan M
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- Humans, Aged, Male, Pyrrolidonecarboxylic Acid, Acid-Base Equilibrium, Acetaminophen adverse effects, Acidosis chemically induced, Malnutrition complications, Analgesics, Non-Narcotic adverse effects
- Abstract
Background: Pyroglutamic acidosis is a rare cause of high anion gap metabolic acidosis. Most cases of paracetamol related pyroglutamic acidosis are described in malnourished women and patients with kidney/liver failure, alcohol use or severe sepsis. In this report, we describe how pyroglutamic acidosis could be related to the use of chronic therapeutic paracetamol with only malnutrition as an associated risk factor., Case Presentation: We report a case of a 67-year-old male patient developing a pyroglutamic acidosis. The patient was initially admitted to hospital for infectious osteoarthritis and developed a metabolic acidosis during his hospital stay. Analgesics included daily therapeutic doses of paracetamol. What makes our case unusual is that our malnourished male patient did not have renal or hepatic failure. The diagnosis of paracetamol related pyroglutamic acidosis was made after ruling out the main causes of metabolic acidosis. It was further confirmed by urine organic acids measurement showing a markedly elevated level of pyroglutamic aciduria. Paracetamol was discontinued allowing a prompt correction of the anion gap., Conclusion: This case is a representative of pyroglutamic acidosis related to chronic therapeutic paracetamol with only malnutrition as an associated risk factor. Physicians should be aware of such unusual cause of metabolic acidosis, which may be more common than expected in hospitalized patients. A high clinical suspicion is needed when urine organic acids analysis is not available., (© 2024. The Author(s).)
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- 2024
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19. Antibody Mediated Rejection and T-cell Mediated Rejection Molecular Signatures Using Next-Generation Sequencing in Kidney Transplant Biopsies.
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Cortes Garcia E, Giarraputo A, Racapé M, Goutaudier V, Ursule-Dufait C, de la Grange P, Adoux L, Raynaud M, Couderau C, Mezine F, Dagobert J, Bestard O, Moreso F, Villard J, Halleck F, Giral M, Brouard S, Danger R, Gourraud PA, Rabant M, Couzi L, Le Quintrec M, Kamar N, Morelon E, Vrtovsnik F, Taupin JL, Snanoudj R, Legendre C, Anglicheau D, Budde K, Lefaucheur C, Loupy A, and Aubert O
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- Humans, Biopsy, Male, Female, Middle Aged, Adult, Gene Expression Profiling, Transcriptome, Kidney pathology, Sequence Analysis, RNA, Aged, Kidney Transplantation, Graft Rejection genetics, Graft Rejection immunology, High-Throughput Nucleotide Sequencing, T-Lymphocytes immunology
- Abstract
Recently, interest in transcriptomic assessment of kidney biopsies has been growing. This study investigates the use of NGS to identify gene expression changes and analyse the pathways involved in rejection. An Illumina bulk RNA sequencing on the polyadenylated RNA of 770 kidney biopsies was conducted. Differentially-expressed genes (DEGs) were determined for AMR and TCMR using DESeq2. Genes were segregated according to their previous descriptions in known panels (microarray or the Banff Human Organ Transplant (B-HOT) panel) to obtain NGS-specific genes. Pathway enrichment analysis was performed using the Reactome and Kyoto Encyclopaedia of Genes and Genomes (KEGG) public repositories. The differential gene expression using NGS analysis identified 6,141 and 8,478 transcripts associated with AMR and TCMR. While most of the genes identified were included in the microarray and the B-HOT panels, NGS analysis identified 603 (9.8%) and 1,186 (14%) new specific genes. Pathways analysis showed that the B-HOT panel was associated with the main immunological processes involved during AMR and TCMR. The microarrays specifically integrated metabolic functions and cell cycle progression processes. Novel NGS-specific based transcripts associated with AMR and TCMR were discovered, which might represent a novel source of targets for drug designing and repurposing., Competing Interests: Author PG was employed by GenoSplice. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Cortes Garcia, Giarraputo, Racapé, Goutaudier, Ursule-Dufait, de la Grange, Adoux, Raynaud, Couderau, Mezine, Dagobert, Bestard, Moreso, Villard, Halleck, Giral, Brouard, Danger, Gourraud, Rabant, Couzi, Le Quintrec, Kamar, Morelon, Vrtovsnik, Taupin, Snanoudj, Legendre, Anglicheau, Budde, Lefaucheur, Loupy and Aubert.)
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- 2024
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20. Kidney Biopsy Findings After Lung Transplantation.
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de Saint Gilles D, Rabant M, Sannier A, Mussini C, Hertig A, Roux A, Karras A, Daugas E, Bunel V, Le Pavec J, and Snanoudj R
- Abstract
Introduction: The early diagnosis of histological kidney damage after lung transplantation (LT) is of paramount importance given the negative prognostic implications of kidney disease., Methods: Three pathologists analyzed all kidney biopsies (KBs) (N = 100) performed from 2010 to 2021 on lung transplant patients in 4 Paris transplantation centers., Results: The main indication for biopsy was chronic renal dysfunction (72% of patients). Biopsies were performed at a median of 26.3 months after transplantation and 15 months after a decline in estimated glomerular filtration rate (eGFR) or the onset of proteinuria. Biopsies revealed a wide spectrum of chronic lesions involving the glomerular, vascular, and tubulointerstitial compartments. The 4 most frequent final diagnoses, observed in 18% to 49% of biopsies, were arteriosclerosis, acute calcineurin inhibitor (CNI) toxicity, thrombotic microangiopathy (TMA) and acute tubular necrosis (ATN). TMA was significantly associated with a combination of mTOR inhibitors (mTORi) or CNIs with biological signs present in only 50% of patients. The eGFR was poorly correlated with most lesions, particularly percent glomerulosclerosis, and with the risk of end-stage renal disease (ESRD). Thirty-four patients progressed to ESRD at an average of 20.1 months after biopsy. Three factors were independently associated with the risk of ESRD: postoperative dialysis, proteinuria >3 g/g and percent glomerulosclerosis >4%., Conclusion: Given the great diversity of renal lesions observed in lung transplant recipients, early referral to nephrologists for KB should be considered for these patients when they present with signs of kidney disease., (© 2024 International Society of Nephrology. Published by Elsevier Inc.)
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- 2024
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21. Use of a Belatacept-based Immunosuppression for Kidney Transplantation From Donors After Circulatory Death: A Paired Kidney Analysis.
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Eid R, Scemla A, Giral M, Arzouk N, Bertrand D, Peraldi MN, Mesnard L, Longuet H, Maanaoui M, Desbuissons G, Lefevre E, and Snanoudj R
- Abstract
Background: Efficacy and safety of belatacept have not been specifically reported for kidney transplantations from donors after circulatory death., Methods: In this retrospective multicenter paired kidney study, we compared the outcome of kidney transplantations with a belatacept-based to a calcineurin inhibitor (CNI)-based immunosuppression. We included all kidney transplant recipients from donors after uncontrolled or controlled circulatory death performed in our center between February 2015 and October 2020 and treated with belatacept (n = 31). The control group included the recipients of the contralateral kidney that were treated with CNI in 8 other centers (tacrolimus n = 29, cyclosporine n = 2)., Results: There was no difference in the rate of delayed graft function. A higher incidence of biopsy-proven rejections was noted in the belatacept group (24 versus 6 episodes). Estimated glomerular filtration rate (eGFR) was significantly higher in the belatacept group at 3-, 12-, and 36-mo posttransplant, but the slope of eGFR was similar in the 2 groups. During a mean follow-up of 4.1 y, 12 patients discontinued belatacept and 2 patients were switched from CNI to belatacept. For patients who remained on belatacept, eGFR mean value and slope were significantly higher during the whole follow-up. At 5 y, eGFR was 80.7 ± 18.5 with belatacept versus 56.3 ± 22.0 mL/min/1.73 m
2 with CNI ( P = 0.003). No significant difference in graft and patient survival was observed., Conclusions: The use of belatacept for kidney transplants from either uncontrolled or controlled donors after circulatory death resulted in a better medium-term renal function for patients remaining on belatacept despite similar rates of delayed graft function and higher rates of cellular rejection., (Copyright © 2024 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)- Published
- 2024
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22. Pathological spectrum of hereditary transthyretin renal amyloidosis and clinicopathologic correlation: a French observational study.
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Dang J, Ferlicot S, Misrahi M, Mussini C, Kounis I, Rémy P, Samuel D, Planté-Bordeneuve V, Adams D, Funalot B, Snanoudj R, Damy T, Moktefi A, Audard V, and Zaidan M
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- Humans, Retrospective Studies, Prealbumin genetics, Plaque, Amyloid pathology, Kidney, Proteinuria pathology, Amyloid Neuropathies, Familial pathology, Kidney Diseases pathology, Immunoglobulin Light-chain Amyloidosis
- Abstract
Background: Cardiac and neurological involvements are the main clinical features of hereditary transthyretin (ATTRv) amyloidosis. Few data are available about ATTRv amyloid nephropathy (ATTRvN)., Methods: We retrospectively included 30 patients with biopsy-proven ATTRvN [V30M (26/30) including two domino liver recipients, S77Y (2/30), V122I (1/30) and S50R (1/30) variants] from two French reference centers. We described the pathological features by comparing amyloid deposits distribution to patients with AL or AA amyloidosis, and sought to determine clinicopathological correlation with known disease-modifying factors such as TTR variant, gender and age at diagnosis., Results: In comparison with AL and AA amyloidosis, ATTRv patients had similar glomerular, arteriolar and arterial amyloid deposits, but more cortical and medullary tubulointerstitial (33%, 44%, 77%, P = .03) involvement. While the presence of glomerular deposits is associated with the range of proteinuria, some patients with abundant glomerular ATTRv amyloidosis had no significant proteinuria. V30M patients had more glomerular (100% and 25%, odds ratio = 114, 95% confidence interval 3.85-3395.00, P = .001) deposits, and higher estimated glomerular filtration rate [50 (interquartile range 44-82) and 27 (interquartile range 6-31) mL/min/1.73 m², P = .004] than non-V30M patients. We did not find difference in amyloid deposition according to gender or age at diagnosis., Conclusion: ATTRvN affects all kidney compartments, but compared with AL/AA amyloidosis, ATTRvN seems to involve more frequently tubulointerstitial areas. V30M patients represents the dominant face of the disease with a higher risk of glomerular/arteriolar involvement. ATTRvN should thus be considered in patients, and potential relatives, with ATTRv amyloidosis and kidney dysfunction, regardless of proteinuria level., (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)
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- 2023
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23. Invasive bacillary angiomatosis in a kidney transplant recipient: A challenging case on belatacept immunosuppression.
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Eid R, Assayag M, Lefevre E, Escaut L, Laifi M, Brodin-Sartorius A, Zaidan M, and Snanoudj R
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- Humans, Female, Abatacept, Immunosuppression Therapy adverse effects, Angiomatosis, Bacillary diagnosis, Angiomatosis, Bacillary drug therapy, HIV Infections complications, Kidney Transplantation adverse effects
- Abstract
Bacillary angiomatosis is a disseminated vascular proliferative disease caused by aerobic gram-negative bacilli Bartonella henselae or Bartonella quintana. Bacillary angiomatosis is mostly described in immunosuppressed patients with HIV infection and organ transplant recipients. We describe the case of a female aged 75 years who is a kidney transplant recipient who was admitted for a 3-month history of intermittent fever, chills, vomiting, and a 12-kg weight loss. The maintenance immunosuppression was based on prednisone, mycophenolate, and monthly infusions of belatacept. Physical examination was unremarkable. Laboratory investigations revealed elevated blood acute phase proteins but all blood cultures were negative. Serological tests for Bartonella were negative. Thoracoabdominal computed tomography scan and transesophageal echocardiography were normal. A Positron Emission Tomography scan showed a hypermetabolic mass in the duodenopancreatic region, with multiple hepatic and splenic lesions. Histological findings of spleen and pancreatic biopsies were not conclusive. The histopathological examination of a celiac lymph node biopsy finally demonstrated bacillary angiomatosis. The diagnosis of bacillary angiomatosis in immunocompromised patients is most often delayed in the absence of skin involvement. A high index of clinical suspicion is needed when interpreting negative results., Competing Interests: Declarations of competing interest The authors have no competing interests to declare., (Copyright © 2023. Published by Elsevier Ltd.)
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- 2023
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24. Clinical and Prognostic Factors in Patients with IgG4-Related Kidney Disease.
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Chaba A, Devresse A, Audard V, Boffa JJ, Karras A, Cartery C, Deltombe C, Chemouny J, Contamin C, Courivaud C, Duquennoy S, Garcia H, Joly D, Goumri N, Hanouna G, Halimi JM, Plaisier E, Hamidou M, Landron C, Launay D, Lebas C, Legendre M, Masseau A, Mathian A, Mercadal L, Morel N, Mutinelli-Szymanski P, Palat S, Pennaforte JL, Peraldi MN, Pozdzik A, Schleinitz N, Thaunat O, Titeca-Beauport D, Mussini C, Touati S, Prinz E, Faller AL, Richter S, Vilaine E, Ferlicot S, Von-Kotze C, Belliere J, Olagne J, Mesbah R, Snanoudj R, Nouvier M, Ebbo M, and Zaidan M
- Subjects
- Adult, Middle Aged, Humans, Male, Aged, Female, Rituximab adverse effects, Cohort Studies, Prognosis, Kidney pathology, Immunoglobulin G, Recurrence, Retrospective Studies, Immunoglobulin G4-Related Disease complications, Immunoglobulin G4-Related Disease diagnosis, Immunoglobulin G4-Related Disease drug therapy, Nephritis, Interstitial pathology
- Abstract
Background: IgG4-related kidney disease is a major manifestation of IgG4-related disease, a systemic fibroinflammatory disorder. However, the clinical and prognostic kidney-related factors in patients with IgG4-related kidney disease are insufficiently defined., Methods: We conducted an observational cohort study using data from 35 sites in two European countries. Clinical, biologic, imaging, and histopathologic data; treatment modalities; and outcomes were collected from medical records. Logistic regression was performed to identify the possible factors related to an eGFR ≤30 ml/min per 1.73 m 2 at the last follow-up. Cox proportional hazards model was performed to assess the factors associated with the risk of relapse., Results: We studied 101 adult patients with IgG4-related disease with a median follow-up of 24 (11-58) months. Of these, 87 (86%) patients were male, and the median age was 68 (57-76) years. Eighty-three (82%) patients had IgG4-related kidney disease confirmed by kidney biopsy, with all biopsies showing tubulointerstitial involvement and 16 showing glomerular lesions. Ninety (89%) patients were treated with corticosteroids, and 18 (18%) patients received rituximab as first-line therapy. At the last follow-up, the eGFR was below 30 ml/min per 1.73 m 2 in 32% of patients; 34 (34%) patients experienced a relapse, while 12 (13%) patients had died. By Cox survival analysis, the number of organs involved (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.01 to 1.55) and low C3 and C4 concentrations (HR, 2.31; 95% CI, 1.10 to 4.85) were independently associated with a higher risk of relapse, whereas first-line therapy with rituximab was protective (HR, 0.22; 95% CI, 0.06 to 0.78). At their last follow-up, 19 (19%) patients had an eGFR ≤30 ml/min per 1.73 m 2 . Age (odd ratio [OR], 1.11; 95% CI, 1.03 to 1.20), peak serum creatinine (OR, 2.74; 95% CI, 1.71 to 5.47), and serum IgG4 level ≥5 g/L (OR, 4.46; 95% CI, 1.23 to 19.40) were independently predictive for severe CKD., Conclusions: IgG4-related kidney disease predominantly affected middle-aged men and manifested as tubulointerstitial nephritis with potential glomerular involvement. Complement consumption and the number of organs involved were associated with a higher relapse rate, whereas first-line therapy with rituximab was associated with lower relapse rate. Patients with high serum IgG4 concentrations (≥5 g/L) had more severe kidney disease., (Copyright © 2023 by the American Society of Nephrology.)
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- 2023
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25. Natural Antibodies Are Associated With Rejection and Long-term Renal Allograft Loss in a Multicenter International Cohort.
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See SB, Yang X, Burger C, Lamarthée B, Snanoudj R, Shihab R, Tsapepas DS, Roy P, Larivière-Beaudoin S, Hamelin K, Mendoza Rojas A, van Besouw NM, Bartosic A, Daniel N, Rodica VE, Mohan S, Cohen D, Ratner L, Baan CC, Bromberg JS, Cardinal H, Anglicheau D, Sun Y, and Zorn E
- Subjects
- Humans, Retrospective Studies, Transplantation, Homologous, Immunoglobulin G, HLA Antigens, Allografts, Graft Rejection, Graft Survival, Kidney Transplantation adverse effects
- Abstract
Background: Potentially harmful nonhuman leukocyte antigen antibodies have been identified in renal transplantation, including natural immunoglobulin G antibodies (Nabs) reactive to varied antigenic structures, including apoptotic cells., Methods: In this retrospective, multicenter study, we assessed Nabs by reactivity to apoptotic cells in sera collected from 980 kidney transplant recipients across 4 centers to determine their association with graft outcomes., Results: Elevated pretransplant Nabs were associated with graft loss (hazard ratio [HR] 2.71; 95% confidence interval [CI], 1.15-6.39; P = 0.0232), the composite endpoint of graft loss or severe graft dysfunction (HR 2.40; 95% CI, 1.13-5.10; P = 0.0232), and T cell-mediated rejection (odds ratio [OR] 1.77; 95% CI, 1.07-3.02; P = 0.0310). High pretransplant Nabs together with donor-specific antibodies (DSAs) were associated with increased risk of composite outcomes (HR 6.31; 95% CI, 1.81-22.0; P = 0.0039). In patients with high pretransplant Nabs, the subsequent development of posttransplant Nabs was associated with both T cell-mediated rejection (OR 3.64; 95% CI, 1.61-8.36; P = 0.0021) and mixed rejection (OR 3.10; 95% CI, 1.02-9.75; P = 0.0473). Finally, elevated pre- and posttransplant Nabs combined with DSAs were associated with increased risk of composite outcomes (HR 3.97; 95% CI, 1.51-10.43; P = 0.0052) and T cell-mediated rejection (OR 7.28; 95% CI, 2.16-25.96; P = 0.0016)., Conclusions: The presence of pre- and posttransplant Nabs, together with DSAs, was associated with increased risk of poor graft outcomes and rejection after renal transplantation., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2023
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26. Microbiology and outcomes of polymicrobial peritonitis associated with peritoneal dialysis: a register-based cohort study from the French Language Peritoneal Dialysis Registry.
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Forté V, Novelli S, Zaidan M, Snanoudj R, Verger C, and Beaudreuil S
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- Humans, Cohort Studies, Renal Dialysis, Retrospective Studies, Registries, Language, Risk Factors, Kidney Failure, Chronic complications, Kidney Failure, Chronic therapy, Peritoneal Dialysis adverse effects, Peritonitis epidemiology, Peritonitis etiology
- Abstract
Background: Previous studies have reported that polymicrobial peritonitis in peritoneal dialysis (PD) is associated with poor outcomes, but recent data from European cohorts are scarce., Methods: We included from the French Language Peritoneal Dialysis Registry all patients ≥18 years of age who started PD between January 2014 and November 2020. We compared microbiology and patient characteristics associated with mono- and polymicrobial peritonitis. We assessed patient outcomes after a first polymicrobial peritonitis using survival analysis with competing events. We differentiated microorganisms isolated from dialysis effluent as enteric or non-enteric pathogens., Results: A total of 8848 patients contributed 13 023 patient-years of follow-up and 3348 culture-positive peritonitis episodes, including 251 polymicrobial ones. This corresponded to rates of 0.32 and 0.02 episodes/patient-year, respectively. For most patients (72%) who experienced polymicrobial peritonitis, this was their first peritonitis episode. Enteric pathogens were more frequently isolated in polymicrobial than in monomicrobial peritonitis (57 versus 44%; P < .001). In both cases of peritonitis with and without enteric pathogens, the polymicrobial versus monomicrobial character of the peritonitis was not associated with mortality in patients who did not switch to haemodialysis {adjusted cause-specific hazard ratio [acsHR] 1.2 [95% confidence interval (CI) 0.3-5.0], P = .78 and 1.1 [95% CI 0.7-1.8], P = .73, respectively}. However, the risks of death and switch to haemodialysis were higher for monomicrobial peritonitis with enteric pathogens compared with those without [acsHR 1.3 (95% CI 1.1-1.7), P = .02 and 1.9 (95% CI 1.5-2.4), P < .0001, respectively]., Conclusion: Isolation of enteric pathogens, rather than the polymicrobial character of the peritonitis, is associated with poorer outcomes., (© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.)
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- 2023
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27. Absence of Mortality Differences Between the First and Second COVID-19 Waves in Kidney Transplant Recipients.
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Berger B, Hazzan M, Kamar N, Francois H, Matignon M, Greze C, Gatault P, Frimat L, Westeel PF, Goutaudier V, Snanoudj R, Colosio C, Sicard A, Bertrand D, Mousson C, Bamoulid J, Thierry A, Anglicheau D, Couzi L, Chemouny JM, Duveau A, Moal V, Le Meur Y, Blancho G, Tourret J, Malvezzi P, Mariat C, Rerolle JP, Bouvier N, Caillard S, and Thaunat O
- Abstract
Introduction: SARS-CoV-2 pandemic evolved in 2 consecutive waves during 2020. Improvements in the management of COVID-19 led to a reduction in mortality rates among hospitalized patients during the second wave. Whether this progress benefited kidney transplant recipients (KTRs), a population particularly vulnerable to severe COVID-19, remained unclear., Methods: In France, 957 KTRs were hospitalized for COVID-19 in 2020 and their data were prospectively collected into the French Solid Organ Transplant (SOT) COVID registry. The presentation, management, and outcomes of the 359 KTRs diagnosed during the first wave were compared to those of the 598 of the second wave., Results: Baseline comorbidities were similar between KTRs of the 2 waves. Maintenance immunosuppression was reduced in most patients but withdrawal of antimetabolite (73.7% vs. 58.4%, P < 0.001) or calcineurin inhibitor (32.1% vs. 16.6%, P < 0.001) was less frequent during the second wave. Hydroxychloroquine and azithromycin that were commonly used during the first wave (21.7% and 30.9%, respectively) but were almost abandoned during the second wave. In contrast, the use of high dose corticosteroids doubled (19.5% vs. 41.6%, P < 0.001). Despite these changing trends in COVID-19 management, 60-day mortality was not statistically different between the 2 waves (25.3% vs. 23.9%; Log Rank, P = 0.48) and COVID-19 hospitalization period was not associated with death due to COVID-19 in multivariate analysis (Hazard ratio 0.89, 95% confidence interval 0.67-1.17, P = 0.4)., Conclusion: We conclude that changing of therapeutic trends during 2020 did not reduce COVID-19 related mortality among KTRs. Our data indirectly support the importance of vaccination and neutralizing monoclonal anti-SARS-CoV-2 antibodies to protect KTRS from severe COVID-19., (© 2022 International Society of Nephrology. Published by Elsevier Inc.)
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- 2022
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28. Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade.
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Bedin A, Carbonnel M, Snanoudj R, Roux A, Vanlieferinghen S, Marchiori C, Hertig A, Racowsky C, and Ayoubi JM
- Abstract
In recent years, solid organ transplantations, such as kidney or lung grafts, have been performed worldwide with an improvement of quality of life under immunosuppressive therapy and an increase in life expectancy, allowing young women to consider childbearing. In the current study, we conduct a retrospective study in two French centers for kidney and lung transplantations to evaluate the rate and outcomes of pregnancies, contraception and gynecological monitoring for women under 40 years old who underwent solid organ transplantation. Among 210 women, progestin was the most widely used contraceptive method. Of the 210 women, 24 (11.4%) conceived 33 pregnancies of which 25 (75.8%) were planned with an immunosuppressant therapy switch. Of the 33 pregnancies, 7 miscarried (21.2%) and 21 (63.7%) resulted in a live birth with a high rate of pre-eclampsia (50%). No graft rejections were observed during pregnancies. Among the deliveries, 19 were premature (90.5%, mostly due to induced delivery) and the C-section rate was high (52.4%). No particular pathology was identified among newborns. We conclude that pregnancies following solid organ transplantation are feasible, and while they are at an increased risk of pre-eclampsia and prematurity, they should still be permitted with close surveillance by a multidisciplinary care team., Competing Interests: The authors declare no conflicts of interest.
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- 2022
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29. Case Report: Post-Partum SARS-CoV-2 Infection After the First French Uterus Transplantation.
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Ayoubi JM, Carbonnel M, Kvarnström N, Revaux A, Poulain M, Vanlieferinghen S, Coatantiec Y, Le Marchand M, Tourne M, Pirtea P, Snanoudj R, Le Guen M, Dahm-Kähler P, Racowsky C, and Brännström M
- Abstract
Absolute uterus factor infertility, whether congenital or acquired, renders the woman unable to carry a child. Although uterus transplantation (UTx) is being increasingly performed as a non-vital procedure to address this unfortunate condition, the immunosuppression required presents risks that are further compounded by pregnancy and during the puerperium period. These vulnerabilities require avoidance of SARS-CoV-2 infection in pregnant UTx recipients especially during the third trimester, as accumulating evidence reveals increased risks of morbidity and mortality. Here we describe a successful UTx case with delivery of a healthy child, but in which both mother and neonate developed asymptomatic SARS-CoV-2 infection seven days after RNA vaccination, on day 35 post-partum. Although the patient was successfully treated with a combination therapy comprised of two monoclonal antibodies, this case highlights the challenges associated with performing UTx in the era of Covid-19. More broadly, the risks of performing non-vital organ transplantation during a pandemic should be discussed among team members and prospective patients, weighing the risks against the benefits in improving the quality of life, which were considerable for our patient who achieved motherhood with the birth of a healthy child., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ayoubi, Carbonnel, Kvarnström, Revaux, Poulain, Vanlieferinghen, Coatantiec, Le Marchand, Tourne, Pirtea, Snanoudj, Le Guen, Dahm-Kähler, Racowsky and Brännström.)
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- 2022
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30. Cryptococcal Meningitis in Kidney Transplant Recipients: A Two-Decade Cohort Study in France.
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Tardieu L, Divard G, Lortholary O, Scemla A, Rondeau É, Accoceberry I, Agbonon R, Alanio A, Angoulvant A, Albano L, Attias P, Bellanger AP, Bertrand D, Bonhomme J, Botterel F, Bouvier N, Buchler M, Chouaki T, Crépin T, Durieux MF, Desoubeaux G, Doppelt G, Favennec L, Fekkar A, Fourdinier O, Frimat M, Gangneux JP, Garandeau C, Hasseine L, Hennequin C, Iriart X, Kamar N, Kaminski H, Kormann R, Lachaud L, Legendre C, Le Quintrec Donnette M, Leroy J, Levi C, Machouart M, Marx D, Menotti J, Moal V, Morio F, Mrozek N, Nicolas M, Poirier P, Peraldi MN, Poussot B, Ranque S, Rerolle JP, Sendid B, Snanoudj R, Tourret J, Vasse M, Vigneau C, Villard O, Mesnard L, Lanternier F, and Rafat C
- 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.
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- 2022
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31. Long-term survival benefit from dual kidney transplantation using kidneys from donors with very extended criteria-a French cohort between 2002 and 2014.
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Savoye E, Legendre C, Neuzillet Y, Peraldi MN, Grimbert P, Ouali N, Durand M, Badet L, Kerbaul F, Pastural M, Legeai C, Macher MA, and Snanoudj R
- Subjects
- Graft Survival, Humans, Kidney, Retrospective Studies, Tissue Donors, Treatment Outcome, Kidney Transplantation
- Abstract
Background: This national multicentre retrospective cohort study aimed to assess the long-term outcomes of dual kidney transplantation (DKT) and compare them with those obtained from single kidney transplantation (SKT)., Methods: Our first analysis concerned all first transplants performed between May 2002 and December 2014, from marginal donors, defined as brain death donors older than 65 years, with an estimated glomerular filtration rate (eGFR) lower than 90 mL/min/1.73 m2. The second analysis was restricted to transplants adequately allocated according to the French DKT program based on donor eGFR: DKT for eGFR between 30 and 60, SKT for eGFR between 60 and 90 mL/min/1.73 m2. Recipients younger than 65 years or with a panel-reactive antibody percentage ≥25% were excluded., Results: The first analysis included 461 DKT and 1131 SKT. DKT donors were significantly older (77.6 versus 74 years), had a more frequent history of hypertension and a lower eGFR (55.1 versus 63.6 mL/min/1.73 m2). While primary nonfunction and delayed graft function did not differ between SKT and DKT, 1-year eGFR was lower in SKT recipients (39 versus 49 mL/min/1.73 m2, P < 0.001). Graft survival was significantly better in DKT, even after adjustment for recipient and donor risk factors. Nevertheless, patient survival did not differ between these groups. The second analysis included 293 DKT and 687 SKT adequately allocated with donor eGFR and displayed similar results but with a smaller benefit in terms of graft survival., Conclusions: In a context of organ shortage, DKT is a good option for optimizing the use of kidneys from very expanded criteria donors., (© The Author(s) 2021. Published by Oxford University Press on behalf of the ERA.)
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- 2022
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32. CRISPR/Cas9-Engineered HLA-Deleted Glomerular Endothelial Cells as a Tool to Predict Pathogenic Non-HLA Antibodies in Kidney Transplant Recipients.
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Lamarthée B, Burger C, Leclaire C, Lebraud E, Zablocki A, Morin L, Lebreton X, Charreau B, Snanoudj R, Charbonnier S, Blein T, Hardy M, Zuber J, Satchell S, Gallazzini M, Terzi F, Legendre C, Taupin JL, Rabant M, Tinel C, and Anglicheau D
- Subjects
- Adult, Aged, Cells, Cultured, Endothelial Cells immunology, Female, Gene Deletion, HLA Antigens genetics, Humans, Male, Middle Aged, Nuclear Proteins genetics, Reoperation, Retrospective Studies, Trans-Activators genetics, beta 2-Microglobulin genetics, CRISPR-Cas Systems genetics, Graft Rejection etiology, HLA Antigens immunology, Isoantibodies immunology, Kidney Glomerulus immunology, Kidney Transplantation adverse effects, Tissue Donors
- Abstract
Background: After kidney transplantation, donor-specific antibodies against human leukocyte antigen donor-specific antibodies (HLA-DSAs) drive antibody-mediated rejection (ABMR) and are associated with poor transplant outcomes. However, ABMR histology (ABMRh) is increasingly reported in kidney transplant recipients (KTRs) without HLA-DSAs, highlighting the emerging role of non-HLA antibodies (Abs)., Methods: W e designed a non-HLA Ab detection immunoassay (NHADIA) using HLA class I and II-deficient glomerular endothelial cells (CiGEnC Δ HLA) that had been previously generated through CRISPR/Cas9-induced B2M and CIITA gene disruption. Flow cytometry assessed the reactivity to non-HLA antigens of pretransplantation serum samples from 389 consecutive KTRs. The intensity of the signal observed with the NHADIA was associated with post-transplant graft histology assessed in 951 adequate biopsy specimens., Results: W e sequentially applied CRISPR/Cas9 to delete the B2M and CIITA genes to obtain a CiGEnC Δ HLA clone. CiGEnC Δ HLA cells remained indistinguishable from the parental cell line, CiGEnC, in terms of morphology and phenotype. Previous transplantation was the main determinant of the pretransplantation NHADIA result ( P <0.001). Stratification of 3-month allograft biopsy specimens ( n =298) according to pretransplantation NHADIA tertiles demonstrated that higher levels of non-HLA Abs positively correlated with increased glomerulitis ( P =0.002), microvascular inflammation ( P =0.003), and ABMRh ( P =0.03). A pretransplantation NHADIA threshold of 1.87 strongly discriminated the KTRs with the highest risk of ABMRh ( P =0.005, log-rank test). A multivariate Cox model confirmed that NHADIA status and HLA-DSAs were independent, yet synergistic, predictors of ABMRh., Conclusion: The NHADIA identifies non-HLA Abs and strongly predicts graft endothelial injury independent of HLA-DSAs., (Copyright © 2021 by the American Society of Nephrology.)
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- 2021
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33. Clinical Utility of Biochemical Markers for the Prediction of COVID-19-Related Mortality in Kidney Transplant Recipients.
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Caillard S, Chavarot N, Francois H, Matignon M, Snanoudj R, Tourret J, Greze C, Thaunat O, Frimat L, Westeel PF, Gatault P, Masset C, Blancho G, Legris T, Moal V, Kamar N, Jdidou M, Colosio C, Mousson C, Goutadier V, Sicard A, Bertrand D, Bamoulid J, Malvezzi P, Couzi L, Chemouny JM, Duveau A, Mariat C, Rerolle JP, Thierry A, Bouvier N, Anglicheau D, Le Meur Y, and Hazzan M
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- 2021
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34. [Kidney transplantation in the elderly: A benefit for all patients?]
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Snanoudj R
- Subjects
- Aged, Comorbidity, Humans, Tissue Donors, Waiting Lists, Kidney Transplantation
- Abstract
Age per se should not be a contraindication to kidney transplantation. The first studies have shown a benefit for the survival of elderly eligible patients getting a kidney transplant compared to be maintained on the waiting list. However, more recent data suggest that this benefit is not as constant, notably with a significant early mortality period. The eligibility of elderly patients for transplantation must be based on the usual consideration of co-morbidities, but should also include, for some patients, a geriatric evaluation to detect clinical symptoms of frailty. The decision to transplant an elderly recipient must also integrate the characteristics of the donors, since the use of donors with increasingly expanding criteria can have a negative impact on the survival of these patients., (Copyright © 2020 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)
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- 2021
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35. Is COVID-19 infection more severe in kidney transplant recipients?
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Caillard S, Chavarot N, Francois H, Matignon M, Greze C, Kamar N, Gatault P, Thaunat O, Legris T, Frimat L, Westeel PF, Goutaudier V, Jdidou M, Snanoudj R, Colosio C, Sicard A, Bertrand D, Mousson C, Bamoulid J, Masset C, Thierry A, Couzi L, Chemouny JM, Duveau A, Moal V, Blancho G, Grimbert P, Durrbach A, Moulin B, Anglicheau D, Ruch Y, Kaeuffer C, Benotmane I, Solis M, LeMeur Y, Hazzan M, and Danion F
- Subjects
- Aged, COVID-19 epidemiology, Comorbidity, Female, France epidemiology, Graft Rejection prevention & control, Humans, Immunosuppression Therapy methods, Immunosuppressive Agents therapeutic use, Incidence, Intensive Care Units, Male, Middle Aged, Retrospective Studies, Risk Factors, SARS-CoV-2, Severity of Illness Index, COVID-19 diagnosis, Graft Rejection epidemiology, Kidney Transplantation, Pandemics, Propensity Score, Registries, Transplant Recipients statistics & numerical data
- Abstract
There are no studies which have compared the risk of severe COVID-19 and related mortality between transplant recipients and nontransplant patients. We enrolled two groups of patients hospitalized for COVID-19, that is, kidney transplant recipients (KTR) from the French Registry of Solid Organ Transplant (n = 306) and a single-center cohort of nontransplant patients (n = 795). An analysis was performed among subgroups matched for age and risk factors for severe COVID-19 or mortality. Severe COVID-19 was defined as admission (or transfer) to an intensive care unit, need for mechanical ventilation, or death. Transplant recipients were younger and had more comorbidities compared to nontransplant patients. They presented with higher creatinine levels and developed more episodes of acute kidney injury. After matching, the 30-day cumulative incidence of severe COVID-19 did not differ between KTR and nontransplant patients; however, 30-day COVID-19-related mortality was significantly higher in KTR (17.9% vs 11.4%, respectively, p = .038). Age >60 years, cardiovascular disease, dyspnea, fever, lymphopenia, and C-reactive protein (CRP) were associated with severe COVID-19 in univariate analysis, whereas transplant status and serum creatinine levels were not. Age >60 years, hypertension, cardiovascular disease, diabetes, CRP >60 mg/L, lymphopenia, kidney transplant status (HR = 1.55), and creatinine level >115 µmol/L (HR = 2.32) were associated with COVID-19-related mortality in univariate analysis. In multivariable analysis, cardiovascular disease, dyspnea, and fever were associated with severe disease, whereas age >60 years, cardiovascular disease, dyspnea, fever, and creatinine level>115 µmol/L retained their independent associations with mortality. KTR had a higher COVID-19-related mortality compared to nontransplant hospitalized patients., (© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)
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- 2021
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36. COVID-19 severity in kidney transplant recipients is similar to nontransplant patients with similar comorbidities.
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Chavarot N, Gueguen J, Bonnet G, Jdidou M, Trimaille A, Burger C, Amrouche L, Weizman O, Pommier T, Aubert O, Celier J, Sberro-Soussan R, Geneste L, Panagides V, Delahousse M, Marsou W, Aguilar C, Deney A, Zuber J, Fauvel C, Legendre C, Mika D, Pezel T, Anglicheau D, Sutter W, Zaidan M, Snanoudj R, Cohen A, and Scemla A
- Subjects
- Aged, Comorbidity, Female, Humans, Intensive Care Units statistics & numerical data, Male, Middle Aged, Pandemics, Retrospective Studies, COVID-19 epidemiology, Immunocompromised Host, Kidney Transplantation, SARS-CoV-2, Transplant Recipients
- Abstract
Higher rates of severe COVID-19 have been reported in kidney transplant recipients (KTRs) compared to nontransplant patients. We aimed to determine if poorer outcomes were specifically related to chronic immunosuppression or underlying comorbidities. We used a 1:1 propensity score-matching method to compare survival and severe disease-free survival (defined as death and/or need for intensive care unit [ICU]) incidence in hospitalized KTRs and nontransplant control patients between February 26 and May 22, 2020. Patients were matched for risk factors of severe COVID-19: age, sex, body mass index, diabetes mellitus, preexisting cardiopathy, chronic lung disease, and basal renal function. We included 100 KTRs (median age [interquartile range (IQR)]) 64.7 years (55.3-73.1) in three French transplant centers. After a median follow-up of 13 days (7-30), transfer to ICU was required for 34 patients (34%) and death occurred in 26 patients (26%). Overall, 43 patients (43%) developed a severe disease during a median follow-up of 8.5 days (2-14). Propensity score matching to a large French cohort of 2017 patients hospitalized in 24 centers, revealed that survival was similar between KTRs and matched nontransplant patients with respective 30-day survival of 62.9% and 71% (p = .38) and severe disease-free 30-day survival of 50.6% and 47.5% (p = .91). These findings suggest that severity of COVID-19 in KTRs is related to their associated comorbidities and not to chronic immunosuppression., (© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)
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- 2021
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37. The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury, and/or proteinuria.
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Ferlicot S, Jamme M, Gaillard F, Oniszczuk J, Couturier A, May O, Grünenwald A, Sannier A, Moktefi A, Le Monnier O, Petit-Hoang C, Maroun N, Brodin-Sartorius A, Michon A, Dobosziewicz H, Andreelli F, Guillet M, Izzedine H, Richard C, Dekeyser M, Arrestier R, Sthelé T, Lefèvre E, Mathian A, Legendre C, Mussini C, Verpont MC, Pallet N, Amoura Z, Essig M, Snanoudj R, Brocheriou-Spelle I, François H, Belenfant X, Geri G, Daugas E, Audard V, Buob D, Massy ZA, and Zaidan M
- Abstract
We report a multicentric retrospective case series of patients with COVID-19 who developed acute kidney injury and/or proteinuria and underwent a kidney biopsy in the Paris and its metropolitan area. Forty-seven patients (80.9% men) with COVID-19 who underwent a kidney biopsy between March 08 and May 19, 2020 were included. Median age was 63 years IQR [52-69]. Comorbidities included hypertension (66.0%), diabetes mellitus (27.7%), obesity (27.7%), history of chronic kidney (25.5%), cardiac (38.6%) and respiratory (27.3%) diseases. Initial symptoms were fever (85.1%), cough (63.8%), shortness of breath (55.3%), and diarrhea (23.4%). Almost all patients developed acute kidney injury (97.9%) and 63.8% required renal replacement therapy. Kidney biopsy showed two main histopathological patterns, including acute tubular injury in 20 (42.6%) patients, and glomerular injury consisting of collapsing glomerulopathy and focal segmental glomerulosclerosis in 17 (36.2%) patients. Two (4.3%) patients had acute vascular nephropathy, while eight (17%) had alternative diagnosis most likely unrelated to COVID-19. Acute tubular injury occurred almost invariably in the setting of severe forms of COVID-19, whereas patients with glomerular injury had various profiles of COVID-19 severity and collapsing glomerulopathy was only observed in patients harboring a combination of APOL1 risk variants. At last follow-up, 16 of the 30 patients who initially required dialysis were still on dialysis, and 9 died. The present study describes the spectrum of kidney lesions in patients with COVID-19. While acute tubular injury is correlated with COVID-19 severity, the pattern of glomerular injury is intimately associated with the expression of APOL1 risk variants., (© The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
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- 2021
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38. Higher mortality risk among kidney transplant recipients than among estimated glomerular filtration rate-matched patients with CKD-preliminary results.
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Cheddani L, Liabeuf S, Essig M, Snanoudj R, Jacquelinet C, Kerleau C, Metzger M, Balkau B, Drüeke TB, Hourmant M, and Massy ZA
- Subjects
- Aged, Cardiovascular Diseases etiology, Cardiovascular Diseases pathology, Case-Control Studies, Female, Humans, Kidney Transplantation adverse effects, Male, Middle Aged, Prognosis, Prospective Studies, Renal Insufficiency, Chronic pathology, Renal Insufficiency, Chronic surgery, Risk Factors, Survival Rate, Cardiovascular Diseases mortality, Glomerular Filtration Rate, Kidney Transplantation mortality, Renal Insufficiency, Chronic mortality, Transplant Recipients statistics & numerical data
- Abstract
Background: Although kidney transplantation prolongs survival relative to dialysis, it is associated with a higher death rate than in the general population. The objective of the present study was to assess and compare the risk of mortality and frequency of non-lethal cardiovascular (CV) events in kidney transplant recipients (KTRs) beyond 1 year after successful transplantation versus patients with chronic kidney disease (CKD) using propensity score-matched analysis of estimated glomerular filtration rate (eGFR) and other parameters., Methods: After propensity score matching, we studied 340 KTRs from the French Données Informatisées et Validées en Transplantation cohort and 605 non-transplant patients with CKD (CKDps) from the French Chronic Kidney Disease-Renal Epidemiology and Information Network cohort. The mean ± standard deviation eGFR was 42 ± 13 and 41 ± 12 mL/min/ 1.73 m2, respectively (P = 0.649). Descriptive data were completed by a survival analysis with Cox regression models., Results: After a median follow-up period of 2.8 years (KTRs 2.0 years, CKDp 2.9 years), 71 deaths were recorded (31 and 40 in the KTR and CKD groups, respectively). Univariate analysis showed that KTRs had a significantly greater risk of mortality than CKDps. In multivariable analysis, KTRs were found to have a 2.7-fold greater risk of mortality [hazard ratio 2.7 (95% confidence interval 1.6-4.7); P = 0.005]. There was no between-group difference concerning the risk of CV events (P = 0.448). CV death rates in KTRs (29.0%) approximated those of CKDps (22.5%), whereas death rates due to infections were higher in KTRs (19.4% versus 10.0%)., Conclusion: Beyond 1 year after transplantation, KTRs, who possibly had a longer CKD history, had a significantly greater mortality risk than eGFR-matched CKDps. The excess risk was not associated with CV events., (© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
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- 2021
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39. Deciphering the Prognostic and Predictive Value of Urinary CXCL10 in Kidney Recipients With BK Virus Reactivation.
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Tinel C, Vermorel A, Picciotto D, Morin L, Devresse A, Sauvaget V, Lebreton X, Aouni L, Prié D, Brabant S, Avettand-Fenoel V, Scemla A, Timsit MO, Snanoudj R, Legendre C, Terzi F, Rabant M, and Anglicheau D
- Subjects
- Adult, Biomarkers urine, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Polyomavirus Infections urine, Polyomavirus Infections virology, Predictive Value of Tests, Retrospective Studies, Time Factors, Treatment Outcome, Tumor Virus Infections urine, Tumor Virus Infections virology, Urinalysis, Viral Load, BK Virus pathogenicity, Chemokine CXCL10 urine, Kidney Transplantation adverse effects, Polyomavirus Infections diagnosis, Tumor Virus Infections diagnosis, Virus Activation
- Abstract
BK virus (BKV) replication increases urinary chemokine C-X-C motif ligand 10 (uCXCL10) levels in kidney transplant recipients (KTRs). Here, we investigated uCXCL10 levels across different stages of BKV replication as a prognostic and predictive marker for functional decline in KTRs after BKV-DNAemia. uCXCL10 was assessed in a cross-sectional study (474 paired urine/blood/biopsy samples and a longitudinal study (1,184 samples from 60 KTRs with BKV-DNAemia). uCXCL10 levels gradually increased with urine (P-value < 0.0001) and blood BKV viral load (P < 0.05) but were similar in the viruria and no BKV groups (P > 0.99). In viremic patients, uCXCL10 at biopsy was associated with graft functional decline [HR = 1.65, 95% CI (1.08-2.51), P = 0.02], irrespective of baseline eGFR, blood viral load, or BKVN diagnosis. uCXL10/cr (threshold: 12.86 ng/mmol) discriminated patients with a low risk of graft function decline from high-risk patients (P = 0.01). In the longitudinal study, the uCXCL10 and BKV-DNAemia trajectories were superimposable. Stratification using the same uCXCL10/cr threshold at first viremia predicted the subsequent inflammatory response, assessed by time-adjusted uCXCL10/cr AUC (P < 0.001), and graft functional decline (P = 0.03). In KTRs, uCXCL10 increases in BKV-DNAemia but not in isolated viruria. uCXCL10/cr is a prognostic biomarker of eGFR decrease, and a 12.86 ng/ml threshold predicts higher inflammatory burdens and poor renal outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Tinel, Vermorel, Picciotto, Morin, Devresse, Sauvaget, Lebreton, Aouni, Prié, Brabant, Avettand-Fenoel, Scemla, Timsit, Snanoudj, Legendre, Terzi, Rabant and Anglicheau.)
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- 2020
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40. An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants.
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Caillard S, Anglicheau D, Matignon M, Durrbach A, Greze C, Frimat L, Thaunat O, Legris T, Moal V, Westeel PF, Kamar N, Gatault P, Snanoudj R, Sicard A, Bertrand D, Colosio C, Couzi L, Chemouny JM, Masset C, Blancho G, Bamoulid J, Duveau A, Bouvier N, Chavarot N, Grimbert P, Moulin B, Le Meur Y, and Hazzan M
- Subjects
- Adult, Aged, Aged, 80 and over, COVID-19 complications, COVID-19 therapy, Deprescriptions, Female, France epidemiology, Humans, Immunosuppression Therapy, Male, Middle Aged, Pandemics statistics & numerical data, Postoperative Complications virology, Retrospective Studies, Risk Factors, Young Adult, COVID-19 mortality, Kidney Transplantation mortality, Postoperative Complications mortality, Registries
- Abstract
Notwithstanding the ongoing coronavirus disease-2019 (Covid-19) pandemic, information on its clinical presentation and prognosis in recipients of a kidney transplant remain scanty. The aim of this registry-based observational study was to explore characteristics and clinical outcomes of recipients of kidney transplants included in the French nationwide Registry of Solid Organ Transplant Recipients with Covid-19. Covid-19 was diagnosed in symptomatic patients who had a positive PCR assay for SARS-CoV-2 or having typical lung lesions on imaging. Clinical and laboratory characteristics, management of immunosuppression, treatment for Covid-19, and clinical outcomes (hospitalization, admission to intensive care unit, mechanical ventilation, or death) were recorded. Risk factors for severe disease or death were determined. Of the 279 patients, 243 were admitted to hospital and 36 were managed at home. The median age of hospitalized patients was 61.6 years; most had comorbidities (hypertension, 90.1%; overweight, 63.8%; diabetes, 41.3%; cardiovascular disease, 36.2%). Fever, cough, dyspnea, and diarrhea were the most common symptoms on admission. Laboratory findings revealed mild inflammation frequently accompanied by lymphopenia. Immunosuppressive drugs were generally withdrawn (calcineurin inhibitors: 28.7%; antimetabolites: 70.8%). Treatment was mainly based on hydroxychloroquine (24.7%), antiviral drugs (7.8%), and tocilizumab (5.3%). Severe Covid-19 occurred in 106 patients (46%). Forty-three hospitalized patients died (30-day mortality 22.8%). Multivariable analysis identified overweight, fever, and dyspnea as independent risk factors for severe disease, whereas age over 60 years, cardiovascular disease, and dyspnea were independently associated with mortality. Thus, Covid-19 in recipients of kidney transplants portends a high mortality rate. Proper management of immunosuppression and tailored treatment of this population remain challenging., (Copyright © 2020 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
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- 2020
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41. Development and validation of an optimized integrative model using urinary chemokines for noninvasive diagnosis of acute allograft rejection.
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Tinel C, Devresse A, Vermorel A, Sauvaget V, Marx D, Avettand-Fenoel V, Amrouche L, Timsit MO, Snanoudj R, Caillard S, Moulin B, Olagne J, Essig M, Gwinner W, Naesens M, Marquet P, Legendre C, Terzi F, Rabant M, and Anglicheau D
- Subjects
- Allografts, Chemokine CXCL10, Chemokine CXCL9, Graft Rejection diagnosis, Graft Rejection etiology, Humans, BK Virus, Kidney Transplantation adverse effects, Polyomavirus Infections diagnosis, Tumor Virus Infections
- Abstract
The urinary chemokines CXCL9 and CXCL10 are promising noninvasive diagnostic markers of acute rejection (AR) in kidney recipients, but their levels might be confounded by urinary tract infection (UTI) and BK virus (BKV) reactivation. Multiparametric model development and validation addressed these confounding factors in a training set of 391 samples, optimizing the diagnostic performance of urinary chemokines. CXCL9/creatinine increased in UTI and BKV viremia with or without nephropathy (BKVN) (no UTI/leukocyturia/UTI: -0.10/1.61/2.09, P = .0001 and no BKV/viremia/BKVN: -0.10/1.90/2.29, P < .001) as well as CXCL10/creatinine (1.17/2.09/1.98, P < .0001 and 1.13/2.21/2.51, P < .001, respectively). An optimized 8-parameter model (recipient age, sex, estimated glomerular filtration rate, donor specific antibodies, UTI, BKV blood viral load, CXCL9, and CXCL10) diagnosed AR with high accuracy (area under the curve [AUC]: 0.85, 95% confidence interval [CI]: 0.80-0.89) and remained highly accurate at the time of screening (AUC: 0.81, 95% CI: 0.48-1) or indication biopsies (AUC: 0.85, 95% CI: 0.81-0.90) and within the first year (AUC: 0.86, 95% CI: 0.80-0.91) or later (AUC: 0.90, 95% CI: 0.84-0.96), achieving AR diagnosis with an AUC of 0.85 and 0.92 (P < .0001) in 2 external validation cohorts. Decision curve analyses demonstrated the clinical utility of the model. Considering confounding factors rather than excluding them, we optimized a noninvasive multiparametric diagnostic model for AR of kidney allografts with unprecedented accuracy., (© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)
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- 2020
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42. COVID-19 in Patients on Maintenance Dialysis in the Paris Region.
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Tortonese S, Scriabine I, Anjou L, Loens C, Michon A, Benabdelhak M, Ouali S, Morin G, Laifi M, Dobosziewicz H, Guillet M, Dekeyser M, Luong Nguyen LB, Grünenwald A, Dang J, Desbuissons G, Becquemont L, Snanoudj R, Legendre C, Hebibi H, Lefèvre E, Beaudreuil S, and Zaidan M
- Abstract
Introduction: Coronavirus disease 2019 (COVID-19) represents a serious threat to patients on maintenance dialysis. The clinical setting, mortality rate, and prognostic factors in these patients have not been well established., Methods: We included all dialyzed patients with COVID-19 referred to our dialysis center between March 11 and April 11, 2020. Data were obtained through the review of the medical records and were censored at the time of data cutoff, on May 11, 2020., Results: Forty-four patients on maintenance dialysis with COVID-19 were referred to our dialysis unit during the COVID-19 epidemic. Median age was 61 years (interquartile range [IQR]: 51.5-72.5); 65.9% were men. Comorbidities included hypertension (97.7%), diabetes mellitus (50%), and chronic cardiac (38.6%) and respiratory (27.3%) diseases. Initial symptoms were fever (79.5%), shortness of breath (29.5%), cough (43.2%), and diarrhea (13.6%). Three profiles of severity were distinguished based on the World Health Organization (WHO) progression scale. Forty-one (93.2%) were hospitalized and only 3 were maintained on outpatient hemodialysis. Thirty-three (75%) patients required oxygen therapy, including 15 (45.5%) who were referred to the intensive care unit. Overall, 27.3% of patients died, and 58.5% were discharged from hospital, including only 2 (13.3%) of those admitted to the intensive care unit. By multivariate analysis, cough, thrombopenia <120 g/l, lactate dehydrogenase (LDH) level greater than 2 times the upper limit of normal, and blood C-reactive protein (CRP) >175 mg/l were significantly associated with death., Conclusion: A major outbreak of COVID-19 occurred in the Paris region, and spread among dialyzed patients. Our study underscores the severity of COVID-19 in these patients and identified prognostic markers., (© 2020 International Society of Nephrology. Published by Elsevier Inc.)
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- 2020
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43. Predictive value of mixed antigen screen beads in pre-transplant assessment of HLA immunization in solid organ transplant recipients.
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Snanoudj R, Siemowski J, Amankwa E, Kheav VD, Arzouk N, Galichon P, Matignon M, Legendre C, Delahousse M, Caillat-Zucman S, and Taupin JL
- Subjects
- Graft Rejection diagnosis, Graft Rejection etiology, HLA Antigens, Histocompatibility Testing, Humans, Immunization, Isoantibodies, Organ Transplantation
- Abstract
Pre-transplant serum screening of anti-HLA antibodies is recommended for solid organ transplantations. Many laboratories use the less expensive bead-based screening assay as the main technique and, if positive, turn to single-antigen beads (SAB). We studied the correlations between these two immunoassays. We re-analyzed the raw data of the two assays in 3030 first organ transplant recipients, explored with the two tests. We performed a ROC curve analysis of the screening ratio to predict a positive SAB assay. The AUC were 0.72 and 0.64 for class I and class II. The optimal thresholds of screening ratios were 3.28 (class I) and 2.11 (class II). Whatever the class, the negative predictive value was low, around 40%, with 36% of discordant sera, as defined by negative screening and positive SAB. Testing class I discordant sera on acid-treated SAB showed that 54% of antibodies reacted against denatured HLA molecules. However, these screening-negative sera may contain donor-specific antibodies in 13.9% and 28.7% of cases for class I and class II, respectively, involved in antibody-mediated rejection with the same frequency as non-discordant sera. Given the low predictive value of screening, both assays should be performed at least once on the same serum before transplantation., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2020
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44. Kidney transplantation improves the clinical outcomes of Acute Intermittent Porphyria.
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Lazareth H, Talbi N, Kamar N, Levi C, Moulin B, Caillard S, Frimat L, Chemouny J, Chatelet V, Vachey C, Snanoudj R, Lefebvre T, Karras A, Gouya L, Schmitt C, Puy H, and Pallet N
- Subjects
- Adult, Female, Heme biosynthesis, Heme genetics, Humans, Kidney Failure, Chronic complications, Kidney Failure, Chronic genetics, Kidney Failure, Chronic pathology, Male, Middle Aged, Porphyria, Acute Intermittent complications, Porphyria, Acute Intermittent genetics, Porphyria, Acute Intermittent pathology, Treatment Outcome, Young Adult, Kidney pathology, Kidney Failure, Chronic therapy, Kidney Transplantation, Porphyria, Acute Intermittent therapy
- Abstract
Background: Acute Intermittent Porphyria (AIP) is a rare inherited autosomal dominant disorder of heme biosynthesis. Porphyria-associated kidney disease occurs in more than 50% of the patients with AIP, and end stage renal disease (ESRD) can be a devastating complication for AIP patients. The outcomes of AIP patients after kidney transplantation are poorly known., Methods: We examined the outcomes of 11 individuals with AIP, identified as kidney transplant recipients in the French Porphyria Center Registry., Results: AIP had been diagnosed on average 19 years before the diagnosis of ESRD except for one patient in whom the diagnosis of AIP had been made 5 years after the initiation of dialysis. Median follow-up after transplantation was 9 years. A patient died 2 months after transplantation from a cardiac arrest and a patient who received a donation after cardiac death experienced a primary non-function. No rejection episode and no noticeable adverse event occurred after transplantation. Serum creatinine was on average 117 μmol/l, and proteinuria <0.5 g/l in all patients at last follow up. All usually prescribed drugs after transplantation are authorized except for trimethoprim/sulfamethoxazole. Critically, acute porphyria attacks almost disappeared after kidney transplantation, and skin lesions resolved in all patients., Conclusion: Kidney transplantation is the treatment of choice for AIP patients with ESRD and dramatically reduces the disease activity., Competing Interests: Declaration of Competing Interest This research was unfunded and the authors have no conflicts of interest to declare., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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45. Uterus Transplantation with Live Donors: Screening Candidates in One French Center.
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Carbonnel M, Revaux A, Menzhulina E, Karpel L, Snanoudj R, Le Guen M, De Ziegler D, and Ayoubi JM
- Abstract
We report our experience regarding the profile and screening process of potential recipients (R) and their live donors (D) in our Uterus transplantation (UTx) trial from 2014 to 2020. The initial screening was performed using medical questionnaires and consultations. The second step of the screening consisted of two individual interviews with an independent multidisciplinary committee. Then, a complete medical, biological and imaging assessment of the directed living D, the R, and her partner was performed over a two-day hospitalization. A total of 239 women contacted our department: 165 potentials R and 74 potentials D. During the first step of screening, 141 R and 45 D were excluded. Only 12 R/D pairs were pursued. During inclusion, 10 R/D pairs were excluded. One R/D pair is still under evaluation. Finally, only 1 R/D pair was definitively included (0.6%), which led us to perform the first French UTx in March 2019 with a successful graft. The primary limiting factors of inclusion were due to very strict criteria and difficulty of having a suitable directed living D. The International Society of UTx (ISUTx) guidelines based on worldwide results of trials can help ease our inclusion criteria in the future while remaining safe for patients.
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- 2020
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46. Trends and Outcomes with Kidney Failure from Antineoplastic Treatments and Urinary Tract Cancer in France.
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Mansouri I, Alencar de Pinho N, Snanoudj R, Jacquelinet C, Lassalle M, Béchade C, Vigneau C, de Vathaire F, Haddy N, and Stengel B
- Subjects
- Adult, Age Factors, Aged, Case-Control Studies, Comorbidity, Female, France epidemiology, Humans, Incidence, Kidney Failure, Chronic chemically induced, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic mortality, Kidney Transplantation adverse effects, Kidney Transplantation mortality, Male, Middle Aged, Registries, Renal Dialysis adverse effects, Renal Dialysis mortality, Risk Assessment, Risk Factors, Sex Factors, Time Factors, Treatment Outcome, Urologic Neoplasms diagnosis, Urologic Neoplasms mortality, Waiting Lists, Antineoplastic Agents adverse effects, Kidney Failure, Chronic therapy, Kidney Transplantation trends, Renal Dialysis trends, Urologic Neoplasms drug therapy
- Abstract
Background and Objectives: Cancer survival is improving along with an increase in the potential for adverse kidney effects from antineoplastic treatments or nephrectomy. We sought to describe recent trends in the incidence of kidney failure related to antineoplastic treatments and urinary tract cancers and evaluate patient survival and kidney transplantation access., Design, Setting, Participants, & Measurements: We used the French Renal Epidemiology and Information Network registry to identify patients with kidney failure related to antineoplastic treatments or urinary tract cancer from 2003 to 2015. We identified 287 and 1157 cases with nephrotoxin- and urinary tract cancer-related kidney failure, respectively. The main study outcomes were death and kidney transplantation. After matching cases to two to ten controls ( n =11,678) with other kidney failure causes for age, sex, year of dialysis initiation, and diabetes status, we estimated subdistribution hazard ratios (SHR) of each outcome separately for patients with and without active malignancy., Results: The mean age- and sex-adjusted incidence of nephrotoxin-related kidney failure was 0.43 (95% CI, 0.38 to 0.49) per million inhabitants and 1.80 (95% CI, 1.68 to 1.90) for urinary tract cancer-related kidney failure; they increased significantly by 5% and 2% annually, respectively, during 2006-2015. Compared with matched controls, age-, sex-, and comorbidity-adjusted SHRs for mortality in patients with nephrotoxin-related kidney failure were 4.2 (95% CI, 3.2 to 5.5) and 1.4 (95% CI, 1.0 to 2.0) for those with and without active malignancy, respectively; for those with urinary tract cancer, SHRs were 2.0 (95% CI, 1.7 to 2.2) and 1.1 (95% CI, 0.9 to 1.2). The corresponding SHRs for transplant wait-listing were 0.19 (95% CI, 0.11 to 0.32) and 0.62 (95% CI, 0.43 to 0.88) for nephrotoxin-related kidney failure cases and 0.28 (95% CI, 0.21 to 0.37) and 0.47 (95% CI, 0.36 to 0.60) for urinary tract cancer cases. Once on the waiting list, access to transplantation did not differ significantly between cases and controls., Conclusions: Cancer-related kidney failure is slowly but steadily increasing. Mortality does not appear to be increased among patients without active malignancy at dialysis start, but their access to kidney transplant remains limited., (Copyright © 2020 by the American Society of Nephrology.)
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- 2020
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47. Central nervous system complications in adult cystinosis patients.
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Servais A, Saitovitch A, Hummel A, Boisgontier J, Scemla A, Sberro-Soussan R, Snanoudj R, Lemaitre H, Legendre C, Pontoizeau C, Antignac C, Anglicheau D, Funalot B, and Boddaert N
- Subjects
- Adolescent, Adult, Aged, Case-Control Studies, Central Nervous System Diseases diagnostic imaging, Cerebrovascular Circulation, Cystine blood, Cystinosis complications, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Young Adult, Central Nervous System Diseases etiology, Cysteamine administration & dosage, Cystinosis drug therapy, Fanconi Syndrome complications, Gray Matter pathology
- Abstract
Little is known about the long-term progression of adult nephropathic cystinosis patients. Our objective was to study central nervous system complications in cystinosis patients in the era of early cysteamine treatment, using advanced neuroimaging techniques. Neurological examination and multimodal brain 3 Tesla MRI were performed in 21 adult cystinosis patients, including 18 infantile cystinosis patients, 20 controls matched for age and renal function, and 12 healthy controls. Differences in gray matter volume and rest cerebral blood flow (CBF) using arterial spin labeling sequence were investigated using whole-brain voxel-based approach. Median age was 33.8 years (18.7-65.8). Seven patients (38.9%) presented with at least one central nervous system clinical abnormality: two (11.1%) with seizures, three (16.7%) with memory defects, five (27.8%) with cognitive defect, and one (5.5%) with stroke-like episode. These patients had a worse compliance to treatment (compliance score 2 vs 1, P = .03) and received a lower median cysteamine dose (0.9 g/day vs 2.1 g/day, P = .02). Among patients with infantile cystinosis, 13 (72.2%) showed cortical atrophy, which was absent in controls, but it was not correlated with symptoms. Cystinosis patients showed a significant gray matter decrease in the middle frontal gyrus compared with healthy controls and a significant negative correlation between the cystine blood level and rest CBF was observed in the right superior frontal gyrus, a region associated with executive function. Compliance to cysteamine treatment is a major concern in these adult patients and could have an impact on the development of neurological and cognitive complications., (© 2019 SSIEM.)
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- 2020
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48. [Renal transplantation: Procedure and early follow-up].
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Anglicheau D, Tinel C, Canaud G, Loupy A, Zuber J, Delville M, Rabaté C, Scemla A, Snanoudj R, Sberro-Soussan R, Mamzer-Bruneel MF, Bererhi L, Martinez F, Timsit MO, Rabant M, Correas JM, Bienaimé F, Duong JP, Hélénon O, Prié D, Méjean A, and Legendre C
- Subjects
- Aftercare, Biopsy methods, Contraindications, Procedure, Delayed Graft Function, Follow-Up Studies, Glomerular Filtration Rate, Graft Rejection prevention & control, Humans, Immunosuppressive Agents adverse effects, Immunosuppressive Agents therapeutic use, Informed Consent, Kidney pathology, Kidney Failure, Chronic surgery, Postoperative Complications, Practice Guidelines as Topic, Preoperative Care, Tissue Donors, Tissue and Organ Procurement, Transplants pathology, Kidney Transplantation methods
- Abstract
More than fifty years after the success of the two first renal transplantations in Boston and in Necker hospital in Paris, renal transplantation became the treatment of choice of end stage renal failure, because it improves not only the quality of life of the patients but also their long-term survival. In France, more than 3,700 kidney transplantations are performed every year and more than 40,000 patients are living with a functioning kidney allograft. This treatment of end stage renal disease requires a fine-tuned pre-transplant evaluation and a multidisciplinary post-transplant care in order to prevent, to detect and to treat comorbidities and complications of immunosuppression. The ambition of this manuscript is not to describe in an exhaustive way all the aspects of renal transplantation but starting from the experience of a team, recently published data, and national and international guidelines, to try to provide a synthetic and chronological view of the early post-transplant monitoring., (Copyright © 2019. Published by Elsevier Masson SAS.)
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- 2019
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49. Conversion From Calcineurin Inhibitors to Belatacept in HLA-sensitized Kidney Transplant Recipients With Low-level Donor-specific Antibodies.
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Ulloa CE, Anglicheau D, Snanoudj R, Scemla A, Martinez F, Timsit MO, Legendre C, and Sberro-Soussan R
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- Adult, Aged, Allografts drug effects, Allografts immunology, Allografts pathology, Biopsy, Calcineurin Inhibitors administration & dosage, Drug Substitution, Female, Glomerular Filtration Rate drug effects, Glomerular Filtration Rate immunology, Graft Rejection blood, Graft Rejection immunology, Graft Rejection pathology, HLA Antigens immunology, Humans, Isoantibodies immunology, Isoantigens immunology, Kidney drug effects, Kidney immunology, Kidney pathology, Male, Middle Aged, Renal Insufficiency chemically induced, Treatment Outcome, Abatacept administration & dosage, Calcineurin Inhibitors adverse effects, Graft Rejection drug therapy, Isoantibodies blood, Kidney Transplantation adverse effects, Renal Insufficiency prevention & control
- Abstract
Background: Belatacept could be the treatment of choice in renal-transplant recipients with renal dysfunction attributed to calcineurin inhibitor (CNI) nephrotoxicity. Few studies have described its use in patients with donor-specific antibody (DSA)., Methods: We retrospectively evaluated conversion from CNIs to belatacept in 29 human leukocyte antigen-immunized renal-transplant recipients. Data about acute rejection, DSA, and renal function were collected. These patients were compared with 42 nonimmunized patients treated with belatacept., Results: Patients were converted from CNIs to belatacept a median of 444 days (interquartile range, 85-1200) after transplantation and were followed up after belatacept conversion, for a median of 308 days (interquartile range, 125-511). At conversion, 16 patients had DSA. Nineteen DSA were observed in these 16 patients, of which 11/19 were <1000 mean fluorescence intensity (MFI), 7/19 were between 1000 and 3000 MFI, and one was >3000 MFI. At last follow-up, preexisting DSA had decreased or stabilized. Seven patients still had DSA with a mean MFI of 1298 ± 930 at the last follow-up. No patient developed a de novo DSA in the DSA-positive group. In the nonimmunized group, one patient developed de novo DSA (A24-MFI 970; biopsy for cause did not show biopsy-proven acute rejection or microinflammation score). After belatacept conversion, one antibody-mediated rejection was diagnosed. The mean estimated glomerular filtration rate improved from 31.7 ± 14.2 mL/min/1.73 m to 40.7 ± 12.3 mL/min/1.73 m (P < 0.0001) at 12 months after conversion. We did not find any significant difference between groups in terms of renal function, proteinuria, or biopsy-proven acute rejection., Conclusions: We report on a safe conversion to belatacept in human leukocyte antigen-immunized patients with low DSA levels.
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- 2019
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50. Baseline graft status is a critical predictor of kidney graft failure after diarrhoea.
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Devresse A, Morin L, Aulagnon F, Taupin JL, Scemla A, Lanternier F, Aubert O, Aidoud AA, Lebreton X, Sberro-Soussan R, Snanoudj R, Amrouche L, Tinel C, Martinez F, Bererhi L, Anglicheau D, Lortholary O, Legendre C, Avettand-Fenoel V, and Zuber J
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- Adult, Diarrhea pathology, Female, France epidemiology, Glomerular Filtration Rate, Graft Rejection etiology, Graft Survival, Humans, Incidence, Kidney Failure, Chronic etiology, Male, Middle Aged, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Time Factors, Diarrhea epidemiology, Graft Rejection diagnosis, Kidney Failure, Chronic diagnosis, Kidney Transplantation adverse effects, Postoperative Complications diagnosis
- Abstract
Background: Diarrhoea is one of the most frequent complications after kidney transplantation (KT). Non-infectious diarrhoea has been associated with reduced graft survival in kidney transplant recipients. However, the risk factors for renal allograft loss following diarrhoea remain largely unknown., Methods: Between January 2010 and August 2011, 195 consecutive KT recipients who underwent standardized microbiological workups for diarrhoea at a single centre were enrolled in this retrospective study., Results: An enteric pathogen was readily identified in 91 patients (47%), while extensive microbiological investigations failed to find any pathogen in the other 104. Norovirus was the leading cause of diarrhoea in these patients, accounting for 30% of the total diarrhoea episodes. The baseline characteristics were remarkably similar between non-infectious and infectious diarrhoea patients, with the exception that the non-infectious group had significantly lower graft function before diarrhoea (P = 0.039). Infectious diarrhoea was associated with a longer duration of symptoms (P = 0.001) and higher rates of acute kidney injury (P = 0.029) and hospitalization (P < 0.001) than non-infectious diarrhoea. However, the non-infectious group had lower death-censored graft survival than the infectious group (Gehan-Wilcoxon test, P = 0.038). Multivariate analysis retained three independent predictors of graft failure after diarrhoea: diarrhoea occurring ≥5 years after KT [hazard ratio (HR) 4.82; P < 0.001], re-transplantation (HR 2.38; P = 0.001) and baseline estimated glomerular filtration rate <30 mL/min/1.73 m2 (HR 11.02; P < 0.001)., Conclusion: Our study shows that pre-existing conditions (re-transplantation, chronic graft dysfunction and late occurrence) determine the primary functional long-term consequences of post-transplant diarrhoea., (© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
- Published
- 2019
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