Pretransplant renal function according to CKD-EPI cystatin C equation is a prognostic factor of death after liver transplantation

International audienceBackground & aims - In patients with cirrhosis, cystatin C (CystC) based equations may be more accurate indicators of glomerular filtration rate (GFR) than creatinine (Pcr) based equations. Renal function before liver transplantation (LT) is thought to impact survival after LT. We aimed at assessing pretransplant creatinine and CystC based equations with respect to their predictive value on long-term survival after LT. Methods - From 2001 to 2011, CystC was determined at pre-LT evaluation in 682 patients together with GFR assessed using MDRD-4, MDRD-6, CKD-EPI-cystatin C, CKD-EPI-creatinine and CKD-EPI-creatinine-cystatin C equations. Patients were classified according to the Kidney Disease Outcomes Quality Initiative classification (KDOQI). Results - Median age at LT was 55 [49-60] years with a median MELD score of 13.5 [8.3-19.2] and a median post-transplant follow-up of 60 [26-89] months. Using CKD-EPI Cystatin C and the KDOQI classification, 21.1% of patients were stage 1, 43.1% stage 2, 29.1% stage 3 and 6.5% stage 4. Kaplan-Meier survival estimates were significantly different between KDOQI stages when determined using the CKD-EPI-CystatinC equation. This was not the case when using the other equations. At multivariate analysis, GFR and KDOQI estimated using the CKD-EPI-CystatinC equation were significantly associated with death (HR: 0.992; CI95%: 0.986-0.999 and 1.24; CI95%: 1.02-1.50 respectively). When assessed using the MDRD-4, MDRD-6, CKD-EPI-Creatinine-CystatinC and CKD-EPI-Creatinine equations GFR was not significantly associated with death. Conclusions - Estimated pre-LT renal function is predictive of post-LT survival only when assessed using the CKD-EPI cystatin C equation. This supports the use of Cystatine C and of its related equation for the assessment of renal function before liver transplantation

Hépatosidérose dysmétabolique: une maladie générale ?[Dysmetabolic iron overload syndrome: a systemic disease?]

National audienceno abstrac

Iron absorption in Nonalcoholic Steatohepatitis (NASH) and Dysmetabolic iron overload syndrome (DIOS)

International audienceCorrespondenc

Diagnostic d'une hépatopathie stéatosique métabolique

National audienceLa stéatose hépatique est définie par un contenu du foie en triglycérides > 5 %. Le plus souvent cette lésion est secondaire à un état d'insulinorésistance, survenant chez des sujets présentant des traits du syndrome métabolique (obésité, dyslipidémie, diabète, hypertension artérielle) et non consommateurs excessifs d'alcool, ce qui fait de plus en plus préférer le terme d'hépatopathie stéatosique métabolique (HSM) à celui initialement usité d'hépatopathie stéatosique non alcoolique. Son incidence augmente parallèlement à l'augmentation d'incidence du surpoids et de ses complications, particulièrement le diabète de type 2, et elle est devenue la principale cause de perturbations chroniques du bilan hépatique

Reply to: Reduced mortality due to phlebotomy in moderately iron-loaded HFE Haemochromatosis? The need for clinical trials.

International audienceReply to: Reduced mortality due to phlebotomy in moderately iron-loaded HFE Haemochromatosis? The need for clinical trials. 10.1016/j.jhep.2015.03.028Original article: Decreased cardiovascular and extrahepatic cancer-related mortality in treated patients with mild HFE hemochromatosis (10.1016/j.jhep.2014.10.025) https://hal-univ-rennes1.archives-ouvertes.fr/hal-01091479

Is room temperature susceptometer really an accurate method to assess hepatocellular iron?

International audienceWe read with interest the study by Mueller et al. describing the use of room temperature susceptometer (RTS) to assess hepatic iron content (HIC).1 This is an interesting clinical application of the methods described by Avrin et al.2,3 This topic is relevant as there is still a need for a cost-effective and efficient iron quantification method in liver disease.However, we think that several points could benefit from clarification and that a more cautious conclusion should be drawn from these results. Overall, as a study of diagnostic accuracy, it would have been beneficial to follow the STARD statement to avoid some pitfall

Structure, diversity and density of the protocatechuate-degrading bacterial community - Impact of long-term organic amendments

International audienc

Low doses of fludrocortisone and hydrocortisone, alone or in combination, on vascular responsiveness to phenylephrine in healthy volunteers.

International audienceAIMS: A single administration of hydrocortisone has been shown to enhance the pressor response to phenylephrine in healthy volunteers and to norepinephrine in septic shock patients. Similar data do not exist for fludrocortisone. Since there continues to be disagreement about the utility of fludrocortisone in septic shock, we assessed the effects of a single administration of low doses of hydrocortisone (50 mg intravenously) and fludrocortisone (50 μg orally), given either alone or in combination, on phenylephrine mean arterial pressure and cardiac systolic and diastolic function dose-response relationships in 12 healthy male volunteers with hypo-aldosteronism induced by intravenous sodium loading. METHODS: This was a placebo-controlled, randomized, double-blind, crossover study performed according to a 2 × 2 factorial design. Subjects received first a 2000 ml infusion of NaCl 0.9% during 2 h. Then fludrocortisone 50 μg (or its placebo) was administered orally and hydrocortisone 50 mg (or its placebo) was injected intravenously. At 1.5 h after treatment administration, incremental doses of phenylephrine were infused (from 0.01 to 3 μg kg(-1) min(-1)), each dose being infused during 5 min. RESULTS: Both fludrocortisone (P < 0.001) and hydrocortisone (P = 0.002) induced a significant decrease in pressor response to phenylephrine, their effects being additive (fludrocortisone × hydrocortisone interaction, P = 0.792). The two drugs did not induce any detectable cardiac effect. CONCLUSIONS: Single administrations of fludrocortisone and hydrocortisone decreased the pressor response to phenylephrine in healthy volunteers with hypo-aldosteronism. These similar effects of hydrocortisone and fludrocortisone probably express a rapid non-genomic vasodilating effect of the two steroids in the context of acute volume loading

Protecting Mixed-­Signal Technologies Against Electrostatic Discharges: Challenges and Protection Strategies from Component to System

International audienceMixed-­signal technologies such as smart power technologies are used in demanding applications such as the automotive one. In this application, one of the very stringent requirements concerns the robustness to electrostatic discharges (ESD) that still constitutes one of the major causes of re-­design and field returns. In this chapter, we review the challenges that have to be tackled both at chip and system levels. With the help of simple examples, we demonstrate that a global ESD protection strategy approach based on efficient predictive modeling is key to reach the goal of zero ppm failure