First World Consensus Conference on pancreas transplantation: Part II - recommendations.

Funder: Fondazione Pisa, Pisa, Italy; Id: http://dx.doi.org/10.13039/100007368Funder: Tuscany Region, Italy; Id: http://dx.doi.org/10.13039/501100009888Funder: Pisa University Hospital, Pisa, ItalyFunder: University of Pisa, Pisa, Italy; Id: http://dx.doi.org/10.13039/501100007514The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246

Retransplantation de pancréas (survie du patient, survie du greffon pancréatique et impact sur le greffon rénal)

LYON1-BU Santé (693882101) / SudocSudocFranceF

A joint model for longitudinal and time-to-event data to better assess the specific role of donor and recipient factors on long-term kidney transplantation outcomes

International audienceIn renal transplantation, serum creatinine (SCr) is the main biomarker routinely measured to assess patient’s health, with chronic increases being strongly associated with long-term graft failure risk (death with a functioning graft or return to dialysis). Joint modeling may be useful to identify the specific role of risk factors on chronic evolution of kidney transplant recipients: some can be related to the SCr evolution, finally leading to graft failure, whereas others can be associated with graft failure without any modification of SCr. Sample data for 2749 patients transplanted between 2000 and 2013 with a functioning kidney at 1-year post-transplantation were obtained from the DIVAT cohort. A shared random effect joint model for longitudinal SCr values and time to graft failure was performed. We show that graft failure risk depended on both the current value and slope of the SCr. Deceased donor graft patient seemed to have a higher SCr increase, similar to patient with diabetes history, while no significant association of these two features with graft failure risk was found. Patient with a second graft was at higher risk of graft failure, independent of changes in SCr values. Anti-HLA immunization was associated with both processes simultaneously. Joint models for repeated and time-to-event data bring new opportunities to improve the epidemiological knowledge of chronic diseases. For instance in renal transplantation, several features should receive additional attention as we demonstrated their correlation with graft failure risk was independent of the SCr evolutio

Clinicopathological Findings of Chronic Rejection in a Face Grafted Patient

International audienceBACKGROUND: Skin chronic rejection (CR) in vascularized composite allotransplantation has not been included in the Banff classification yet. We report a face-transplant patient who developed cutaneous clinicopathologic changes suggestive of CR. METHODS: The recipient was a 27-year-old man with severe disfigurement of the lower face due to a pyrotechnic explosion. He received a facial allograft, including mandible, cheeks, lips, and chin, in November 2009. Immunosuppression included antithymocyte globulins and bone-marrow infusion then steroids, tacrolimus, and mycophenolate mofetil. RESULTS: During the first posttransplant year the acute rejection episodes were characterized by reversible oedema and erythema of the graft. Subsequently, the patient developed primary asymptomatic Epstein-Barr virus (EBV) infection, followed by EBV+ B-cell lymphoma and hepatic EBV-associated posttransplant smooth muscle tumors; therefore, the immunosuppressive treatment was greatly reduced. Since the second posttransplant year, the allografted facial skin became progressively sclerotic and presented pigmented macules on a background of hypopigmentation and teleangiectasias, resulting in a poikilodermatous aspect. Skin biopsies showed epidermal atrophy, basal cell vacuolization, and diffuse dermal sclerosis in the absence of significant dermal cell infiltration. The dermal capillaries showed thickened walls and narrowed lumina, whereas the large vessels did not show significant alterations. Neither donor-specific antibodies nor vascular Cd4 deposits were detected.A dysfunction of the graft functions occurred. It was evidenced by a decrease in mouth opening and modification of some phonemes although lip closure was still possible allowing food intake. CONCLUSIONS: This is the first report suggestive of CR in a face allotransplantation after immunosuppression minimization

Chronic rejection in vascularized composite allotransplantation

International audienc

Chronic rejection in vascularized composite allotransplantation

International audienc

Pancreas retransplantation: a second chance for diabetic patients?

If pancreas transplantation is a validated alternative for type 1 diabetic patients with end-stage renal disease, the management of patients who have lost their primary graft is poorly defined. This study aims at evaluating pancreas retransplantation outcome

Performances of creatinine-based glomerular filtration rate estimating equations in simultaneous pancreas-kidney transplant recipients: a single center cohort study

International audienceEstimating glomerular filtration rate (GFR) is important for clinical management and research studies in simultaneous pancreas-kidney transplantation (SPK) recipients. No study has specifically investigated the reliability of recent creatinine-based GFR estimating equations in this singular population. We assessed the performances of CKD-EPI, MDRD, Schwartz-2009, Schwartz-Lyon, Lund-Malmo and Full Age Spectrum equations for estimating GFR after SPK. 126 patients were included. GFR was measured by a reference method (mGFR) one year after SPK and estimated with the different equations from a standardized measure of serum creatinine. Relative bias, precisions, 10% and 30% accuracies (P30) were used to determine equations reliability. Ages ranged from 29 to 58. Mean mGFR was 56.3 \textpm 13.3 [23.6-92.5] ml/min/1.73 m2 . In the whole population, P30 of the CKD-EPI and MDRD equations were 42% (38.0; 46.0) and 65% (61.5; 69) respectively. As compared to the other equations, the Schwartz-Lyon equation was significantly more accurate (P30 = 86.0% [83.5-88.0], P \textless 0.01) and less biased (1.13 [1.06-1.19], P \textless 0.01). Conclusions were similar whatever the age class (\textless40 or >=40) and mGFR level (\textless60 or >=60 ml/min/1.73 m2 ). This study suggests that the CKD-EPI and MDRD equations have poor performances in SPK recipients and that the Schwartz-Lyon equation is a reliable alternative

Le duc de Mercœur

Ce volume propose une enquête sur la fonction de la culture littéraire dans les pratiques et dans la représentation d’un grand seigneur à la fin du XVIe et au début du XVIIe siècles. Philippe-Emmanuel de Lorraine, duc de Mercœur, a été le beau-frère d’Henri III, mais il rejoint la Ligue dans la dernière phase des guerres de religion : dans sa province bretonne, il mène le combat contre les armées royales, et il sera le dernier des ligueurs à se rallier à Henri IV. C’est en partie pour occulter ce passé de rebelle qu’après sa mort, survenue quelques années plus tard, ses thuriféraires élaborent le portrait d’un gentilhomme cultivé, possesseur d’une énorme bibliothèque et protecteur des lettrés. Il s’agit toutefois de faire la part de l’idéalisation dans cette construction rétrospective, et d’interroger la place effective qu’ont occupée les lettres dans cette vie largement consacrée aux armes. Cet ouvrage réunit des contributions d’historiens et de littéraires, qui analysent d’abord la carrière, les ambitions et les moyens politiques et militaires du duc, puis la réalité de la protection qu’il a accordée aux lettrés, la représentation de Mercœur que les écrivains qu’il a protégés ont élaborée au cours de son existence et les idéaux qu’ils ont associés à sa cause ; enfin le contenu de la bibliothèque ducale à partir d’un inventaire après décès

Induction Therapy in Elderly Kidney Transplant Recipients with Low Immunological Risk

International audienceBACKGROUND: In nonimmunized patients, similar rejection rates are observed for patients who have undergone Thymoglobulin (ATG) or Basiliximab (BSX) therapy. Whilst ATG may improve Delayed Graft Function (DGF), it may also be associated with higher infection rates and malignancy risk. We compared survival and clinical outcomes in elderly recipients with low immunological risk according to their induction therapy. METHODS: We conducted a multicentric study on nonimmunized ≥q 65 years patients receiving a first kidney transplant between 2010 and 2017. The principal outcome was patient and graft survival. Secondary outcomes were cumulative probabilities of infection, first acute rejection episode, malignancy, de novo DSA, Post Transplant Diabetes (PTD), cardiac complications, eGFR, occurrence of DGF. Cox, logistic or linear statistical models were used depending on the outcome studied, and models were weighted on the propensity scores. RESULTS: 204 patients were included in the BSX group and 179 in the ATG group, with the average age 71.0 and 70.5 years respectively. Patient and graft survival at 3 years posttransplantation were 74% (95%CI from 65% to 84%) and 68% (95%CI from 60% to 78%) in ATG and BSX group respectively, without significant difference. Occurrence of PTD was significatively higher in BSX group (23% vs 15%, p = 0.04) due to higher trough levels of Tacrolimus on month 3 (9.48 vs 7.30 ng/ml, p = 0.023). There was no difference in other evaluated outcomes. CONCLUSION: In elderly recipients, ATG does not lead to poorer outcomes compared to BSX and could permit lower trough levels of Tacrolimus, thus reducing occurrence of PTD