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1. Antireflux surgery for prevention of chronic lung allograft dysfunction (CLAD) onset after lung transplantation: The earlier the better before CLAD onset? A single-center series of 284 patients

Author

Abdulmonem Hamid, Alexandre Vallée, Sophie Rong, Olivier Boche, Sandra De Miranda, Laurence Beaumont-Azuar, Sylvie Colin de Verdière, Dominique Grenet, Marc Stern, Benjamin Zuber, Jerôme Devaquet, Julien Fessler, Julien De Wolf, Ciprian Pricopi, Matthieu Glorion, Edouard Sage, Jonathan Messika, Antoine Magnan, François Parquin, Clément Picard, Antoine Roux, and Olivier Brugière

Subjects
graft dysfunction, lung transplantation, gastroesophageal reflux, antireflux surgery, DSA, Surgery, RD1-811, Specialties of internal medicine, RC581-951
Abstract

Background: Gastroesophageal reflux disease (GERD) is highly prevalent after lung transplantation (LTx) and is suspected to favor the development of chronic lung allograft dysfunction (CLAD), almost of bronchiolitis obliterans syndrome (BOS) phenotype. The preventive effect of antireflux surgery (ARS) on BOS/CLAD onset in patients with GERD still remains debated. We compared the outcome (freedom from CLAD and graft survival) of patients with GERD with or without performed ARS (GERD-ARS and GERD-noARS groups) and those without GERD (noGERD group) in our LTx cohort. Methods: Data from 284 LTx recipients with available post-LTx pHmetry findings were reviewed (2001-2014). We focused on the outcome of 244 patients without CLAD at the date of pHmetry. Results: Among 244 stable patients at the date of pHmetry, 78 patients did not have GERD and 166 patients had GERD [41 with and 125 without ARS performed]). The mean DeMeester score was higher in the GERD-ARS group than GERD-noARS group (p = 0.03). An increase in donor-specific antibodies' mean fluorescence intensity values was observed only in GERD after LTx (M6 vs day 0, p

Published
2024
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2. Protocol for venoarterial ExtraCorporeal Membrane Oxygenation to reduce morbidity and mortality following bilateral lung TransPlantation: the ECMOToP randomised controlled trial

Author

Richard Galliot, Jonathan Messika, Jérôme Devaquet, Jérome Ridolfo, Hervé Mal, Séverine Feuillet, François Tronc, Pascal-Alexandre Thomas, Edouard Sage, Philippe Montravers, Jacques Jougon, Elodie Blanchard, Enora Atchade, Philippine Eloy, Bruno Pastene, Nassima Si Mohammed, Pierre Gazengel, Charles Cerf, David Boulate, Justin Issard, Elie Fadel, Olaf Mercier, Brice Lortat-Jacob, Sylvain Jean-Baptiste, Aurelie Snauwaert, Yves Castier, Elie Kantor, Sandrine Boudinet, Pierre Mordant, Antoine Girault, Arnaud Roussel, Aude Charvet, Julien Fessler, Philippe Lacoste, Philippe Portran, Hadrien Roze, Jacques Thes, Mickael Vourc'h, Pierre Cerceau, Vincent Bunel, Isabelle Pavlakovic, Delphine Chesnel, Léa Didier, Matthias Jacquet Lagreze, Eva Chatron, Claire Merveilleux Du Vignaux, Gabrielle Drevet, Jean Michel Maury, Valentin Soldea, Xavier Demant, Julie Macey, Christelle Pellerin, Clément Boisselier, Claire Bon, Benjamin Chevalier, Eloïse Gallo, Benjamin Repusseau, Arnaud Rodriguez, Regisse Seramondi, Matthieu Thumerel, Gaelle Dauriat, Amélie Delaporte, Samuel Dolidon, Jerome Estephan, Sylvain Diop, Dominique Fabre, Avit Guirimand, Iolanda Ion, Christian Ionescu, Jérome Le Pavec, Chahine Medraoui, Jean-Baptiste Menager, Delphine Mitilian, Andy Musat, Marwan Nader, Geoffrey Brioude, Xavier Djourno, Ambroise Labarriere, Pierre Mora, Adrien Rivory, Julien Cadiet, Nicolas Groleau, Thierry Lepoivre, Antoine Roux, Sandra de Miranda, Clément Picard, Laurence Beaumont, Olivier Brugière, Sylvie Colin de Verdière, Abdul-Momen Hamid, François Parquin, Amer Hamdan, Benjamin Zuber, Guillaume Tachon, Nicolas Mayenco-Cardenal, Mathilde Phillips-Houlbracq, David Cortier, Johanna Cohen, Alexis Paternot, Ciprian Pricopi, Francesco Cassiano, Matthieu Glorion, Julien De Wolf, Chloé Mimbimi, Morgan Le Guen, Virginie Dumans, Sébastien Jacqmin, Michael Finet, Sindia Goncalves, Louis Grosz, Charles Hickel, Julien Josserand, Julien Richard, and Gaëlle Weisenburger

Subjects
Medicine
Abstract

Introduction Lung transplantation (LTx) aims at improving survival and quality of life for patients with end-stage lung diseases. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used as intraoperative support for LTx, despite no precise guidelines for its initiation. We aim to evaluate two strategies of VA-ECMO initiation in the perioperative period in patients with obstructive or restrictive lung disease requiring bilateral LTx. In the control ‘on-demand’ arm, high haemodynamic and respiratory needs will dictate VA-ECMO initiation; in the experimental ‘systematic’ arm, VA-ECMO will be pre-emptively initiated. We hypothesise a ‘systematic’ strategy will increase the number of ventilatory-free days at day 28.Methods and analysis We designed a multicentre randomised controlled trial in parallel groups. Adult patients with obstructive or restrictive lung disease requiring bilateral LTx, without a formal indication for pre-emptive VA-ECMO before LTx, will be included. Patients with preoperative pulmonary hypertension with haemodynamic collapse, ECMO as a bridge to transplantation, severe hypoxaemia or hypercarbia will be secondarily excluded. In the systematic group, VA-ECMO will be systematically implanted before the first pulmonary artery cross-clamp. In the on-demand group, VA-ECMO will be implanted intraoperatively if haemodynamic or respiratory indices meet preplanned criteria. Non-inclusion, secondary exclusion and VA-ECMO initiation criteria were validated by a Delphi process among investigators. Postoperative weaning of ECMO and mechanical ventilation will be managed according to best practice guidelines. The number of ventilator-free days at 28 days (primary endpoint) will be compared between the two groups in the intention-to-treat population. Secondary endpoints encompass organ failure occurrence, day 28, day 90 and year 1 vital status, and adverse events.Ethics and dissemination The sponsor is the Assistance Publique–Hôpitaux de Paris. The ECMOToP protocol version 2.1 was approved by Comité de Protection des Personnes Ile de France VIII. Results will be published in international peer-reviewed medical journals.Trial registration number NCT05664204.

Published
2024
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3. Conversion to belatacept after lung transplantation: Report of 10 cases.

Author

Olivier Brugière, Alexandre Vallée, Quentin Raimbourg, Marie-Noelle Peraldi, Sylvie Colin de Verdière, Laurence Beaumont, Abdulmonem Hamid, Mathilde Zrounba, Antoine Roux, Clément Picard, François Parquin, Matthieu Glorion, Julie Oniszczuk, Alexandre Hertig, Hervé Mal, and Vincent Bunel

Subjects
Medicine, Science
Abstract

BackgroundCalcineurin inhibitors (CNIs) remain the cornerstone of maintenance immunosuppression (IS) after lung transplantation (LTx), although CNI-related life-threatening toxic effects may occur. Belatacept, a novel immunosuppressant that blocks a T-cell co-stimulation pathway, is a non-nephrotoxic drug indicated as an alternative to CNIs in kidney Tx. In LTx, there are only a few reports of belatacept conversion as a CNI-free or CNI-sparing IS treatment.MethodsWe reviewed a series of 10 LTx recipients with conversion to a CNI-free belatacept IS regimen within the first year post-LTx (n = 7) or a belatacept/low-dose CNI combination after the first year (n = 3).ResultsUse of belatacept was triggered by severe renal failure in 9 patients and under-IS with previous other IS-related toxicities in 1 patient. Mean estimated glomerular filtration rate after starting belatacept significantly improved at 6 months after initiation and at the last-follow-up (p = 0.006, and p = 0.002 respectively). The incidence of recurrent and/or severe acute cellular rejection (ACR) episodes was high in patients with CNI-free belatacept-based IS (n = 4/7). Chronic graft allograft dysfunction developed in 2 of 9 recipients under belatacept IS. Belatacept was stopped in 6 patients because of recurrent/severe ACR (n = 3), recurrent opportunistic infections (n = 1), center modified policy (n = 1), or other cause (n = 1).ConclusionEarly conversion to CNI-free belatacept-based IS improved renal function in this series but was counterbalanced by a high incidence of recurrent ACR, including life-threatening episodes. Other studies are needed to better determine the indications for its use after LTx, possibly with lower immunological risk IS regimens, such as CNI-sparing belatacept.

Published
2023
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4. Distribution of

Author

Thomas, Garrigos, Manon, Dollat, Arnaud, Magallon, Anaïs, Folletet, Julien, Bador, Maryam, Abid, Marlène, Amara, Clémence, Beauruelle, Olivier, Belmonte, Pierre, Boyer, Emilie, Cardot-Martin, Anne-Gaëlle, Cauchie, Sylvie, Colin de Verdière, Claire, Daurel, Cécile, Gaudru, Farida, Hamdad, Geneviève, Héry-Arnaud, Baptiste, Hoellinger, Claudie, Lamoureux, Marie-Frédérique, Lartigue, Damasie, Malandain, Océane, Marchand, Caroline, Piau, Sandrine, Picot, Hélène, Revillet, Zeina, Sabouni, Catherine, Neuwirth, and Lucie, Amoureux

Subjects
Cystic Fibrosis, Epidemiology, Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization, Spectrum Analysis, Humans, Achromobacter, Gram-Negative Bacterial Infections, Retrospective Studies
Abstract

Achromobacter spp. are nonfermenting Gram-negative bacilli mainly studied among cystic fibrosis (CF) patients. The identification of the 19 species within the genus is time-consuming (nrdA-sequencing), thus data concerning the distribution of the species are limited to specific studies. Recently, we built a database using MALDI-TOF mass spectrometry (MS) (Bruker) that allows rapid and accurate species identification and detection of the multiresistant epidemic clones: A. xylosoxidans ST137 spreading among CF patients in various French and Belgium centers, and A. ruhlandii DES in Denmark. Here, we first assessed whether species identification could be achieved with our database solely by analysis of MS spectra without availability of isolates. Then, we conducted a multicentric study describing the distribution of Achromobacter species and of the clone ST137 among French CF centers. We collected and analyzed with our local database the spectra of Achromobacter isolates from 193 patients (528 samples) from 12 centers during 2020. In total, our approach enabled to conclude for 502/528 samples (95.1%), corresponding to 181 patients. Eleven species were detected, only five being involved in chronic colonization, A. xylosoxidans (86.4%), A. insuavis (9.1%), A. mucicolens (2.3%), A. marplatensis (1.1%) and A. genogroup 3 (1.1%). This study confirmed the high prevalence of A. xylosoxidans in chronic colonizations and the circulation of the clone A. xylosoxidans ST137 in France: four patients in two centers. The present study is the first to report the distribution of Achromobacter species from CF patients samples using retrospective MALDI-TOF/MS data. This easy approach could enable future large-scale epidemiological studies.

Published
2022

5. Distribution of Achromobacter species in 12 French cystic fibrosis centers in 2020 by a retrospective MALDI-TOF MS spectrum analysis

Author

Thomas Garrigos, Manon Dollat, Arnaud Magallon, Anaïs Folletet, Julien Bador, Maryam Abid, Marlène Amara, Clémence Beauruelle, Olivier Belmonte, Pierre Boyer, Emilie Cardot-Martin, Anne-Gaëlle Cauchie, Sylvie Colin de Verdière, Claire Daurel, Cécile Gaudru, Farida Hamdad, Geneviève Héry-Arnaud, Baptiste Hoellinger, Claudie Lamoureux, Marie-Frédérique Lartigue, Damasie Malandain, Océane Marchand, Caroline Piau, Sandrine Picot, Hélène Revillet, Zeina Sabouni, Catherine Neuwirth, Lucie Amoureux, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de bactériologie-virologie [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau, Service de bactériologie et d'hygiène hospitalière [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier de Versailles André Mignot (CHV), Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) (GGB), EFS-Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion], Virulence bactérienne précoce : fonctions cellulaires et contrôle de l'infection aiguë et subaiguë, Université de Strasbourg (UNISTRA), Pathogénie des Staphylocoques – Staphylococcal Pathogenesis (StaPath), Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Versailles, 78000 Le Chesnay, France, parent, Hôpital Foch [Suresnes], Service de Microbiologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Institut de Recherche en Santé Digestive (IRSD ), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Amiens-Picardie, Laboratoire Universitaire de Biodiversité et Ecologie Microbienne (LUBEM), CHU Strasbourg, Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Infectiologie et Santé Publique (UMR ISP), Université de Tours (UT)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse, Hôpital Sud [CHU Rennes], CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Faculté de Médecine Purpan, CHU Toulouse [Toulouse], Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Toulouse (UT)-Université de Toulouse (UT)-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)

Subjects
Microbiology (medical), [SDV.BIO]Life Sciences [q-bio]/Biotechnology, Achromobacter, ST137, DES, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Maldi-TOF, cystic fibrosis, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], identification, epidemiology, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, mass spectrometry
Abstract

International audience; Achromobacter spp. are nonfermenting Gram-negative bacilli mainly studied among cystic fibrosis (CF) patients. The identification of the 19 species within the genus is time-consuming (nrdA-sequencing), thus data concerning the distribution of the species are limited to specific studies. Recently, we built a database using MALDI-TOF mass spectrometry (MS) (Bruker) that allows rapid and accurate species identification and detection of the multiresistant epidemic clones: A xylosoxidans ST137 spreading among CF patients in various French and Belgium centers, and A. ruhlandii DES in Denmark. Here, we first assessed whether species identification could be achieved with our database solely by analysis of MS spectra without availability of isolates. Then, we conducted a multicentric study describing the distribution of Achromobacter species and of the clone ST137 among French CF centers. We collected and analyzed with our local database the spectra of Achromobacter isolates from 193 patients (528 samples) from 12 centers during 2020. In total, our approach enabled to conclude for 502/528 samples (95.1%), corresponding to 181 patients. Eleven species were detected, only five being involved in chronic colonization, A. xylosoxidans (86.4%), A. insuavis (9.1%), A. mucicolens (2.3%), A. marplatensis (1.1%) and A. genogroup 3 (1.1%). This study confirmed the high prevalence of A. xylosoxidans in chronic colonizations and the circulation of the clone A. xylosoxidans ST137 in France: four patients in two centers. The present study is the first to report the distribution of Achromobacter species from CF patients samples using retrospective MALDI-TOF/MS data. This easy approach could enable future large-scale epidemiological studies.

Published
2022

6. Refractory Microascus Bronchopulmonary Infection Treated with Olorofim, France

Author

Emmanuel Faure, Olivier Brugière, Sylvie Colin de Verdiere, Fanny Vuotto, Lucie Limousin, Emilie Cardot, Camille Cordier, Pauline Coulon, Dea Garcia-Hermoso, Olivier Lortholary, and Fanny Lanternier

Subjects
Microascus, olorofim, Microascus melanosporus, M. cirrosus pneumonia, respiratory infections, fungi, Medicine, Infectious and parasitic diseases, RC109-216
Abstract

We report 3 cases of successful treatment of Microascus spp. bronchopulmonary infection in a multiple-traumatized patient and 2 lung transplant recipients in France. We emphasize the promising use of olorofim antifungal therapy in a rising context of intrinsically less-susceptible respiratory infections caused by mold.

Published
2023
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