Evolution de l'hyperparathyroïdie secondaire et de la densité minérale osseuse aprés transplantation rénale

Malgré la restauration d une fonction rénale satisfaisante, un certain nombre de patients présente une hyperparathyroïdie (HPT) persistante après transplantation rénale (TR). Celle-ci peut avoir des conséquences métaboliques et osseuses importantes. Le but de ce travail est d identifier les facteurs prédictifs de l HPT après TR. Nous avons également étudié l évolution de la calcémie, de la phosphatémie et de la masse osseuse au cours de la première année après TR et tenté de déterminer les facteurs qui y étaient associés. Il s agit d une étude rétrospective concernant 227 patients transplantés rénaux au CHU d Amiens, entre le 1er janvier 2003 et le 31 août 2006. Deux tiers des patients présentaient une HPT à M6 et M12. Le taux de PTH à distance de la greffe était positivement corrélé à la durée de dialyse (r=0,17, p=0,001), aux valeurs de PTH avant greffe (r=0,38, p<0,001), et négativement à la fonction rénale (r=-0,28, p=0,002) et au taux plasmatique de 25OHD3 (r=-0,23, p=0,002). Plus de 10% des patients présentaient une hypercalcémie à M6. Le pourcentage de patients hypophosphatémiques à J14 et M1 était respectivement de 40% et 54 %. La phosphaturie à M1 était positivement corrélée à la dose de corticoïdes utilisée à J14 (r=0,24, p=0,02) et à la PTH plasmatique à M1 (r=0,20, p=0,02). A 12 mois, la densité minérale osseuse (DMO) au poignet, aux vertèbres et au col fémoral, n avait pas varié par rapport aux mesures réalisées à M1. L évolution de la DMO au rachis était négativement corrélée au taux de PTH à M12 (r=-0,15, p=0,005) et à la dose cumulée de corticoïdes de J0 à M12 (r=-0,32, p=0,001). Les anomalies du métabolisme minéral et osseux, telles que l HPT ou l hypophosphatémie, sont fréquentes après TR et participent à l ODR. Il est important de comprendre les mécanismes qui les déterminent, afin de mettre en place les mesures thérapeutiques appropriées et espérer améliorer le pronostic des patients transplantés rénauxAMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Opportunistic Infections and Efficacy Following Conversion to Belatacept-Based Therapy after Kidney Transplantation: A French Multicenter Cohort

Conversion from calcineurin-inhibitors (CNIs) to belatacept can help kidney-transplant (KT) recipients avoid CNI-related nephrotoxicity. The risk of associated opportunistic infections (OPIs) is ill-defined. We conducted a multicentric cohort study across 15 French KT-centers in a real-life setting. Between 07-2010 and 07-2019, 453 KT recipients were converted from CNI- to belatacept-based therapy at 19 [0.13&ndash;431] months post-transplantation. Most patients, i.e., 332 (79.3%), were converted after 6-months post-transplantation. Follow-up time after conversion was 20.1 +/&minus; 13 months. OPIs developed in 42(9.3%) patients after 14 +/&minus; 12 months post-conversion. Eight patients (19%) had two OPI episodes during follow-up. Incidences of CMV DNAemia and CMV disease were significantly higher in patients converted before 6-months post-KT compared to those converted later (i.e., 31.6% vs. 11.5%; p &lt; 0.001; and 11.6% vs. 2.4%, p &lt; 0.001, respectively). Cumulative incidence of OPIs was 6.5 OPIs/100 person&ndash;years. Incidence of CMV disease was 2.8/100 person&ndash;years, of pneumocystis pneumonia 1.6/100 person&ndash;years, and of aspergillosis 0.2/100 person&ndash;years. Multivariate analyses showed that estimated glomerular filtration (eGFR) &lt; 25 mL/min/1.73 m2 at conversion was independently associated with OPIs (HR = 4.7 (2.2 &minus; 10.3), p &lt; 0.001). The incidence of EBV DNAemia was 17.3 events /100 person&ndash;years. At 1-year post-conversion, mean eGFR had significantly increased from 32.0 +/&minus; 18 mL/min/1.73 m2 to 42.2 +/&minus; 18 mL/min/1.73 m2 (p &lt; 0.0001). Conversion to belatacept is an effective strategy with a low infectious risk

IMPact of the COVID-19 epidemic on the moRTAlity of kidney transplant recipients and candidates in a French Nationwide registry sTudy (IMPORTANT)

International audienceEnd stage kidney disease increase the risk of COVID-19 related death but how the kidney replacement strategy should be adapted during the pandemic is unknown. Chronic hemodialysis makes social distancing difficult to achieve. Alternatively, kidney transplantation could increase the severity of COVID-19 due to therapeutic immunosuppression and contribute to saturation of intensive care units. For these reasons, kidney transplantation was suspended in France during the first epidemic wave. Here, we retrospectively evaluated this strategy by comparing the overall and COVID-19 related mortality in kidney transplant recipients and candidates over the last three years. Cross-interrogation of two national registries for the period 1 March and 1 June 2020, identified 275 deaths among the 42812 kidney transplant recipients and 144 deaths among the 16210 candidates. This represents an excess of deaths for both populations, as compared with the same period the two previous years (mean of two previous years: 253 in recipients and 112 in candidates). This difference was integrally explained by COVID-19, which accounted for 44% (122) and 42% (60) of the deaths in recipients and candidates, respectively. Taking into account the size of the two populations and the geographical heterogeneity of virus circulation, we found that the excess of risk of death due to COVID-19 was similar for recipients and candidates in high viral risk area but four-fold higher for candidates in the low viral risk area. Thus, in case of a second epidemic wave, kidney transplantation should be suspended in high viral risk areas but maintained outside those areas, both to reduce the excess of deaths of candidates and avoid wasting precious resources