Humoral Response to the Influenza A H1N1/09 Monovalent AS03-Adjuvanted Vaccine in Immunocompromised Patients

In this observational study, safety and immunogenicity after one dose of the AS03-adjuvanted influenza H1N1/09 vaccine was overall appropriate in HIV-infected patients and solid-organ transplant recipients. A second dose of the vaccine only moderately improved the antibody respons

Efficacy and safety of universal valganciclovir prophylaxis combined with a tacrolimus/mycophenolate-based regimen in kidney transplantation

Immunosuppressive and antiviral prophylactic drugs are needed to prevent acute rejection and infection after transplantation. We assessed the efficacy and safety of the introduction of universal valganciclovir prophylaxis in combination with a tacrolimus/mycophenolate-based regimen in kidney transplantation at our centr

Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence?

Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients. This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20). Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20). Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study. Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics

Infectious complications and graft outcome following treatment of acute antibody-mediated rejection after kidney transplantation: A nationwide cohort study.

Acute antibody-mediated rejection (AMR) remains a challenge after kidney transplantation (KT). As there is no clear-cut treatment recommendation, accurate information on current therapeutic strategies in real-life practice is needed. KT recipients from the multicenter Swiss Transplant Cohort Study treated for acute AMR during the first post-transplant year were included retrospectively. We aimed at describing the anti-rejection protocols used routinely, as well as patient and graft outcomes, with focus on infectious complications. Overall, 65/1669 (3.9%) KT recipients were treated for 75 episodes of acute AMR. In addition to corticosteroid boluses, most common therapies included plasmapheresis (56.0%), intravenous immunoglobulins (IVIg) (38.7%), rituximab (25.3%), and antithymocyte globulin (22.7%). At least one infectious complication occurred within 6 months from AMR treatment in 63.6% of patients. Plasmapheresis increased the risk of overall (hazard ratio [HR]: 2.89; P-value = 0.002) and opportunistic infection (HR: 5.32; P-value = 0.033). IVIg exerted a protective effect for bacterial infection (HR: 0.29; P-value = 0.053). The recovery of renal function was complete at 3 months after AMR treatment in 67% of episodes. One-year death-censored graft survival was 90.9%. Four patients (6.2%) died during the first year (two due to severe infection). In this nationwide cohort we found significant heterogeneity in therapeutic approaches for acute AMR. Infectious complications were common, particularly among KT recipients receiving plasmapheresis

Variable viral clearance despite adequate ganciclovir plasma levels during valganciclovir treatment for cytomegalovirus disease in D+/R- transplant recipients

ABSTRACT: BACKGROUND: Valganciclovir, the oral prodrug of ganciclovir, has been demonstrated equivalent to iv ganciclovir for CMV disease treatment in solid organ transplant recipients. Variability in ganciclovir exposure achieved with valganciclovir could be implicated as a contributing factor for explaining variations in the therapeutic response. This prospective observational study aimed to correlate clinical and cytomegalovirus (CMV) viral load response (DNAemia) with ganciclovir plasma concentrations in patients treated with valganciclovir for CMV infection/disease. METHODS: Seven CMV D+/R- transplant recipients (4 kidney, 2 liver and 1 heart) were treated with valganciclovir (initial dose was 900-1800 mg/day for 3-6.5 weeks, followed by 450-900 mg/day for 2-9 weeks). DNAemia was monitored by real time quantitative PCR and ganciclovir plasma concentration was measured at trough (Ctrough) and 3 h after drug administration (C3h) by HPLC. RESULTS: Four patients presented with CMV syndrome, two had CMV tissue-invasive disease after prophylaxis discontinuation, and one liver recipient was treated pre-emptively for asymptomatic rising CMV viral load 5 weeks post-transplantation in the absence of prophylaxis. CMV DNAemia decreased during the first week of treatment in all recipients except in one patient (median decrease: -1.2 log copies/mL, range: -1.8 to 0) despite satisfactory ganciclovir exposure (AUC0-12 = 48 mg.h/L, range for the 7 patients: 40-118 mg.h/L). Viral clearance was obtained in five patients after a median of time of 34 days (range: 28-82 days). Two patients had recurrent CMV disease despite adequate ganciclovir exposure (65 mg.h/L, range: 44-118 mg.h/L). CONCLUSIONS: Valganciclovir treatment for CMV infection/disease in D+/R- transplant recipients can thus result in variable viral clearance despite adequate ganciclovir plasma concentrations, probably correlating inversely with anti-CMV immune responses after primary infection

PTX3 Polymorphisms and Invasive Mold Infections After Solid Organ Transplant

Donor PTX3 polymorphisms were shown to influence the risk of invasive aspergillosis among hematopoietic stem cell transplant recipients. Here, we show that PTX3 polymorphisms are independent risk factors for invasive mold infections among 1101 solid organ transplant recipients, thereby strengthening their role in mold infection pathogenesis and patients' risk stratificatio

Variations et anomalies néphrologiques, vasculaires et urologiques chez les candidats au don vivant rénal

Titre Variations et anomalies néphrologiques, vasculaires et urologiques chez les candidats au don vivant rénal. Introduction Cette étude consiste à déterminer I.a prévalence des variations anatomiques (rénales, vasculaires et urologiques) ainsi que des pathologies rénales acquises dans une population de candidats au don vivant de rein (CDVR). Matériel et méthodes Il s'agit d'une étude rétrospective de tous les CDVR référés dans notre centre en vue d'une transplantation rénale entre avril 2003 et se pt embre· 2014. Sur les 491 CDVR, 189 ont été initialement exclus pour des raisons médicales (n=140) ou autres (n=49), sans avoir effectué de bilan radiologique. 302 ont bénéficié d'un bilan radiologique (angio-CT ou IRM) en prévision du don et 226/302 (73.5%) ont pu donner un rein. Résultats Une ou plusieurs variations anatomiques et/ou anomalies acquises ont été constatées chez 178/302 (58.9%) des CDVR, dont les plus fréquentes concernaient les anomalies et variations artérielles (artères multiples, fibrodysplasie, anévrisme, sténose 70%), présentes chez . 39.3% des CDVR, suivies par les variations veineuses (27.8%). Des calculs ont été observés chez 5.6% des C:DVR et les anomalies des voies urinaires (duplicité/bifidité urétérale) ont concerné 3.0% des CDVR. Aucune tumeur maligne n'a été diagnostiquée alors que 4 tumeurs bénignes (1.3%) ont été identifiées, dont un cas nécessitant des investigations supplémentaires. Conclusion Nous constatons une haute prévalence de variations anatomiques et anomalies acquises dans une population de CDVR. Cependant, ces variantes et anomalies constatées ont conduit à exclure seulement 4 % des candidats. Ceci soit parce que les anomalies ne contre­ indiquaient pas le prélèvement, soit parce que dans la majorité des cas le. rein controlatéral a pu être utilisé

Symptomatologie et qualité de vie de patients transplantés rénaux de Suisse francophone ::une étude descriptive corrélationnelle

Introduction : Après une greffe rénale, les patients continuent à vivre avec des symptômes, pourtant peu étudiés jusqu’à présent en Suisse francophone. Méthode : Un devis descriptif corrélationnel transversal a été utilisé, afin d’explorer les relations entre les symptômes et le niveau de qualité de vie (QDV) de patients transplantés rénaux suivis au Centre de Transplantation d’Organes (CTO) du Centre Hospitalier Universitaire Vaudois (CHUV). Résultats : En moyenne, les symptômes les plus prévalents chez les participants (n = 76) étaient : manque d’énergie, sécheresse de la peau, difficultés d’endormissement, irritabilité, nervosité. Quatre-vingts pour cent des participants ont évalué leur QDV comme étant bonne, voire très bonne. Toutes les corrélations entre les symptômes et le niveau de QDV des participants étaient significatives et négatives. Les régressions ont révélé un lien persistant entre les symptômes et la dimension sociale de la QDV des participants. Conclusion : Malgré la transplantation, les patients expérimentent de nombreux symptômes, pouvant affecter leur QDV.Introduction : After a kidney transplant, patients continue to live with symptoms, although little studied so far in French-speaking Switzerland. Method : A cross-sectional correlational description of work was used to explore the relationship between symptoms and quality of life (QOL) of kidney transplant patients followed at the Organ Transplant Center of the Lausanne University Hospital. Results : On average, the most prevalent symptoms among participants (N = 76) were lack of energy, dry skin, difficulty falling asleep, irritability, nervousness. Eighty per cent of participants rated their QOL as good or very good. All correlations between symptoms and QOL level of participants were significant and negative. Regressions revealed a persistent link between symptoms and the social dimension of participants’ QOL. Conclusion : Despite transplantation, patients experience many symptoms, which can affect their QOL