Utilisation du Rituximab dans le syndrome néphrotique à lésions glomérulaires minimes de l'adulte

TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Specific organization for in‐hospital belatacept infusion to avoid nosocomial transmission during the SARS‐CoV‐2 pandemic

International audienceThe first cases of Severe Acute Respiratory Syndrome coronavirus 2 (SARS‐CoV‐2) occurred in France in early February and in our region (Southwest France) in early March 2020

Tacrolimus Intrapatient Variability After Switching From Immediate or Prolonged-Release to Extended-Release Formulation, After an Organ Transplantation

International audienceBackground and Purpose: Several formulations of tacrolimus are available, but evidence of the benefit of changing to the most recent formulations is lacking. Tacrolimus intrapatient variability (tacrolimus IPV) is an emerging risk factor associated with poor graft outcomes after solid organ transplantations. Here, we examined the modifications of tacrolimus IPV after switching to a different formulation of tacrolimus. Experimental Approach: We identified 353 solid organ transplant recipients that were switched in our center from immediate-release (IR-tacrolimus) or prolonged-release tacrolimus (PR-tacrolimus) to extended-release, LCP-tacrolimus (LCP-tacrolimus). Among them, 54 patients underwent at least 3 available tacrolimus blood concentrations before and after the switch, allowing us to investigate tacrolimus IPV

Safety and Immunogenicity of Anti–SARS-CoV-2 Messenger RNA Vaccines in Recipients of Solid Organ Transplants

International audienceBackground: Recipients of solid organ transplant (SOT) are a high-risk group for severe SARS-CoV-2 infection. The mortality rate of patients with SOT during the COVID-19 pandemic has been reported to be approximately 20% (1). The anti–SARS-CoV-2 vaccines represent a hope to protect this population against this life-threatening infection.Objective: To assess the humoral response to messenger RNA (mRNA)–based vaccination in recipients of SOT.Methods: All patients with heart, kidney, liver, or pancreas transplants from the Midi-Pyrénées region (southwest France) are followed in our department. When the vaccination campaign started (7 January 2021), these patients were invited via text message, e-mail, or transplant patients' associations to be vaccinated. Patients were asked to register via a dedicated telephone number or website. They were vaccinated consecutively according to their registration date. According to the recommendations of the Francophone Society of Transplantation, anti–SARS-CoV-2 spike protein antibodies were monitored before and after vaccination. We used the SARS-CoV-2 total antibodies enzyme-linked immunosorbent assay test (Beijing Wantai Biological Pharmacy Enterprise) (80% of patients) or another validated anti–SARS-CoV-2 spike protein assay. According to French law (loi Jardé), anonymous retrospective studies do not require institutional review board approval.Findings: By 16 April 2021, 950 patients of the 2666 from our cohort had received at least 1 dose of an mRNA vaccine (BNT162b2 vaccine [Pfizer-BioNTech], n = 942; mRNA-1273 vaccine [Moderna], n = 8) and had anti–SARS-CoV-2 antibodies monitored. Fifty patients had vaccination without monitoring of antibodies, 80 patients are planned to be vaccinated within the next month, and 257 patients declined the vaccine. We had no feedback from the remaining 1329 patients

Do anti‐IL‐6R blockers have a beneficial effect in the treatment of antibody‐mediated rejection resistant to standard therapy after kidney transplantation?

International audienceAntibody‐mediated rejection (AMR) that resists to standard of care (SOC) therapy remains a major challenge after kidney transplantation and leads to graft failure in a majority of cases. The use of anti‐IL6 receptor antibodies was suggested to treat chronic antibody‐mediated rejection (cAMR) after failure of classical treatments. We treated nine patients with AMR resistant to apheresis, rituximab, and intravenous immunoglobulins, with a monthly infusion of tocilizumab and compared them with a historical cohort of 37 patients with similar clinical, immunological, and histological characteristics. The 1‐year graft survival and the decline in renal function did not differ between patients who received tocilizumab and those who did not. Histological follow‐up showed that despite a decrease in inflammation and tubulitis scores after tocilizumab, the course of antibody‐mediated lesions and chronic glomerulopathy were similar in both groups. In our study, the addition of monthly infusions of tocilizumab did not alter the course of AMR that resist to SOC therapy. Large randomized studies are urgently needed to assess the effect of tocilizumab in this context

Outcomes of kidney transplant recipients admitted to the intensive care unit: a retrospective study of 200 patients

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A Randomized Prospective Study Comparing Anti–T-Lymphocyte Igs to Basiliximab in Highly Sensitized Kidney Transplant Patients

International audienceBackground:Two prospective studies that were performed before the era of highly sensitive solid-phaseassays have shown a lower incidence of acute rejection in highly sensitized kidney-transplant patientsgiven polyclonal antibodies compared with those given anti-CD25 monoclonal antibodies.Methods:This prospective pilot randomized French multicenter study aimed to compare anti–T-lympho-cyte Ig (ATLG) (n¼32) and basiliximab (n¼27) in highly sensitized kidney-transplant patients withoutpreformed donor-specific antibodies (pDSAs) as assessed by a Luminex Single-Antigenflow bead assay.Only patients with a calculated panel reactive antibody$50$5000 and without a historical pDSA and without a pDSA on the day of trans-plantation were included.Results:Treatment failure as defined by biopsy-proven acute rejection, patient lost to follow-up, graft loss,and death was observed in 18.8% (95% confidence interval [CI], 8.9%–37.1%) and 18.8% (95% CI, 8.9%–37.1%) in patients who received ATLG and 14.8% (95% CI, 5.8%–34.8%) and 28.2% (95% CI, 14.2%–51.2%) ofpatients who received basiliximab, respectively at 6 (P¼0.66) and 12 (P¼0.62) months post-transplantation.One T cell–mediated rejection was observed in ATLG-treated patients (3.1%). One antibody-mediatedrejection due to ade novodonor-specific antibody (DSA) occurred in basiliximab-treated patients (3.7%).Patient survival, graft survival, kidney parameters, and infection rate were similar in the 2 groups.Conclusion:This pilot study indicates that in highly sensitized kidney-transplant patients without pDSAs,both ATLG and basiliximab can be used efficiently and safely. However, because of the lack of power,these results should be interpreted with cautio

Ribavirin for Hepatitis E Virus Infection After Organ Transplantation: A Large European Retrospective Multicenter Study

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