The early decline in renal function in patients with type 1 diabetes and proteinuria predicts the risk of end stage renal disease

The risk of end-stage renal disease (ESRD) remains high in patients with type 1diabetes and proteinuria; however, little is known about the rate of decline in their renal function. To help determine this we enrolled patients with 1 diabetes and proteinuria whose estimated glomerular filtration rate (eGFR) was normal (equal to or above 60 ml/min/1.73$m^2$). Using a minimum of 5 serial measurements of serum creatinine for 161 patients, we determined individual trajectories of eGFR change and the occurrence of ESRD during 5–18 years of follow-up. The rates were linear for 110 patients, for 24 the non-linear rate was mild enough to satisfy a linear model, and the rates were clearly non-linear for only 27 patients. Overall, in more than one third of patients, the eGFR decline was less than 3.5 ml/min/1.73$m^2$ per year and the lifetime risk of ESRD could be considered negligible. In the remainder of patients, eGFR declined with widely different slopes and ESRD developed within 2 to 18 years. Based on up to five years observation when renal function was within the normal range, the estimates of early eGFR slope predicted the risk of ESRD during subsequent follow-up better than the baseline clinical characteristics of glycated hemoglobin, blood pressure, or the albumin to creatinine ratio. Thus, the early slope of eGFR decline in patients with type 1diabetes and proteinuria can be used to predict the risk of ESRD

Etude des facteurs de risques d'échec après transplantation pancréatique (analyse rétrospective chez 141 patients transplantés au CHU de Nantes de 1999 à 2005)

Entre le mois de novembre 1999 et le mois de décembre 2005, 141 greffes pancréatiques ont été réalisées au CHU de Nantes. Vingt deux (15,6%) greffons ont été perdus. Trois facteurs prédictifs d'échec ont été individualisés : un index de masse corporelle >= 25 chez le donneur, un index de masse corporelle >= 25 chez le receveur et le sexe masculin du donneur. D'autres facteurs moins significatifs suggèrent également une tendance : les prélèvements d'organes non locaux, un long temps d'ischémie froide, les causes non vasculaires du décès du donneur, la non utilisation des glucocorticoïdes et le besoin en insuline exogène pendant plus de 24 heures après la greffe. Les valeurs moyennes du peptide C plasmatique durant les premiers jours de la greffe ne semblent pas corréler avec les complications médico-chirurgicales. Nos résultats peuvent avoir une implication clinique dans la future sélection des donneurs et des receveurs, ainsi que dans le suivi des patients greffés. Néanmoins dans le contexte actuel de pénurie d'organes, et en raison de l'importante morbidité et mortalité du patient diabétique en attente de greffe, le choix d'accepter ou de refuser un greffon doit être évalué de façon individuelle en tenant compte des bénéfices et des risques de cette thérapeutique.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Le rejet vasculaire aigu en transplantation rénale (diagnostic et traitement à propos de vingt six cas)

Le rejet vasculaire aigu est une forme rare, particulière et très grave de rejet. Il survient dans le premiers mois qui suit la transplantation et dans la majorité des cas est irréversible malgré un traitement anti-rejet. Ce type de rejet touche particulièrement les sujets ayant un taux élevé d'allo-anticorps cytotoxiques dans le sang et plus rarement des patients sans aucun facteur prédisposant..... Une étude rétrospective, descriptive à été réalisée dans le centre de transplantation nantais, elle s'est intéressée aux patients ayant présenté un rejet vasculaire aigu entre 1994 et 2001, date à laquelle un traitement prospectif de ces rejets a été mis en place. Ce traitement était constitué par l'association d'échanges plasmatiques et d'OKT3. Contrairement à notre expérience passée avec ce type de rejets et d'autres modalités de traitement, soixante quinze pour cent des patients ayant bénéficié de la double thérapeutique ont présenté un rejet vasculaire aigu réversible.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

XENOGREFFE D'ILOTS PANCREATIQUES PORCINS ET TRAITEMENT IMMUNOSUPPRESSEUR SANS CORTICOSTEROIDES AVEC DU SERUM ANTITHYMOCYTAIRE APRES TRANSPLANTATION RENALE ET PANCREATIQUE (DOCTORAT IMMUNOLOGIE)

NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

IgGκ light and heavy chain amyloidosis secondary to a B‐cell lymphoproliferative disorder, whole picture on a renal biopsy

International audienceno abstrac

Pancreas allograft rejection occurring after ChAdOx1 nCoV-19 vaccine

International audienceNo abstract availabl

Aortic Dissection and Severe Renal Failure 6 Years After Kidney Transplantation

Abstract. We report the case of a patient with long-term history of hypertension, presenting with transient neurological disorders and severe graft failure several years after kidney transplantation. Cause of end-stage renal disease was hypertensive nephrosclerosis. Chronic hemodialysis lasted for 1 year. After transplantation and throughout follow-up, serum creatinine ranged from 200 to 230 μmol/L and maintenance immunosuppression included sirolimus and low-dose steroids. Six years after transplantation, the patient presented with right hip pain radiating to the lower back, transient aphasia, confusion, and hemiparesis. Surprisingly, progressive anuria was established requiring dialysis. After numerous nonconclusive investigations including renal histology, a contrast computed tomography scan discovered a Stanford B aortic dissection from the left common carotid artery and left subclavian artery to bilateral internal and external iliac arteries, including the right femoral artery. No surgical treatment was opted and hemodialysis, tight control of blood pressure and oral anticoagulation were established. Immunosuppression was lightened to low-dose steroids alone. After 8 months, chronic dialysis was stopped, and today, 22 months after the diagnosis of aortic dissection, the patient is doing well with a still functioning graft (creatinine, 377 μmol/L; modification of diet in renal disease-glomerular filtration rate, 15 mL/min), and without any other immunosuppression than low-dose steroids

A fourth SARS-CoV-2 mRNA vaccine in strictly seronegative kidney transplant recipients

International audienceSince January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active

Hypothermic pulsatile perfusion of human pancreas: Preliminary technical feasibility study based on histology

International audienceBackground: There are currently two approaches to hypothermic preservation for most solid organs: static or dynamic. Cold storage is the main method used for static storage (SS), while hypothermic pulsatile perfusion (HPP) and other machine perfusion-based methods, such as normothermic machine perfusion and oxygen persufflation, are the methods used for dynamic preservation. HPP is currently approved for kidney trans-plantation.Methods: We evaluated, for the first time, the feasibility of HPP on 11 human pancreases contraindicated for clinical transplantation because of advanced age and/or history of severe alcoholism and/or abnormal laboratory tests. Two pancreases were used as SS controls, pancreas splitting was performed on 2 other pancreases for SS and HPP and 7 pancreases were tested for HPP. HPP preservation lasted 24 h at 25 mmHg. Resistance index was continuously monitored and pancreas and duodenum histology was evaluated every 6 h.Results: The main finding was the complete absence of edema of the pancreas and duodenum at all time-points during HPP. Insulin, glucagon and somatostatin staining was normal. Resistance index decreased during the first 12 h and remained stable thereafter.Conclusion: 24 h hypothermic pulsatile perfusion of marginal human pancreas-duodenum organs was feasible with no deleterious parenchymal effect. These observations encourage us to further develop this technique and evaluate the safety of HPP after clinical transplantation