9 results on '"Broeders N."'
Search Results
2. Does Loss to Follow-Up Affects Outcomes of Renal Transplantation? A Retrospective Study of 849 Patients.
- Author
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Kianda, M. N., Wissing, M. K., Maddhoun, P., Hougardy, J.-M., Broeders, N. E., Benhamed, A., Massart, A., Vereerstraeten, P., Hoang, A. D., Racapé, J., and Abramowicz, D.
- Published
- 2012
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3. CONVERSION FROM PROGRAFT® TO ADVAGRAF® AMONG KIDNEY TRANSPLANT RECIPIENTS RESULTS IN SUSTAINED DECREASE IN TACROLIMUS EXPOSURE.
- Author
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Hougardy, J., Kianda, M., Massart, A., Hoang, A. D., Mikhalski, D., Wissing, M., Broeders, N., and Abramowicz, D.
- Published
- 2010
- Full Text
- View/download PDF
4. Conversion from Prograf to Advagraf among kidney transplant recipients results in sustained decrease in tacrolimus exposure.
- Author
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Hougardy JM, Broeders N, Kianda M, Massart A, Madhoun P, Le Moine A, Hoang AD, Mikhalski D, Wissing KM, and Abramowicz D
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- Adult, Aged, Chemistry, Pharmaceutical, Creatinine blood, Cross-Sectional Studies, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Graft Rejection immunology, Humans, Immunosuppressive Agents blood, Immunosuppressive Agents therapeutic use, Kidney physiology, Male, Middle Aged, Monitoring, Physiologic, Retrospective Studies, Tacrolimus blood, Tacrolimus therapeutic use, Graft Rejection prevention & control, Immunosuppressive Agents administration & dosage, Kidney Transplantation immunology, Tacrolimus administration & dosage
- Abstract
Background: Advagraf is a slow release form of tacrolimus with once-daily formulation. The potential advantages of Advagraf are better adherence and a safer profile by avoiding toxic peak concentrations. In this study, we evaluated the required daily doses of tacrolimus and subsequent blood levels on conversion from Prograf to Advagraf among kidney transplant recipients., Methods: We retrospectively reviewed data from 55 patients for whom a switch from Prograf to Advagraf was identified. Tacrolimus daily doses and concomitant blood levels were analyzed at several time points ranging from 3 months before to 6 months after conversion., Results: We observed a significant increase in tacrolimus daily doses, starting with a dose of 0.063 mg/kg of Prograf, increasing up to 0.081 mg/kg of Advagraf at 6 months (P<0.0001). After conversion, we observed a quick and sustained decrease in trough tacrolimus levels, decreasing from 8.05 ng/mL at day 0 to 6.30 ng/mL at day 180 (P=0.0009). At 6 months, 35% of patients experienced a decrease in trough levels of more than 30%. Creatinine values remained stable over time, and no patient experienced an acute rejection episode., Conclusions: Contrary to the manufacturer instructions, we found a significant decrease in tacrolimus exposure after switching to Advagraf. Therefore, the switch from Prograf to Advagraf should be performed under close medical supervision.
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- 2011
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5. Cold ischemia is a major determinant of acute rejection and renal graft survival in the modern era of immunosuppression.
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Mikhalski D, Wissing KM, Ghisdal L, Broeders N, Touly M, Hoang AD, Loi P, Mboti F, Donckier V, Vereerstraeten P, and Abramowicz D
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- Adult, Cohort Studies, Cyclosporine therapeutic use, Delayed Graft Function physiopathology, Female, Graft Rejection physiopathology, Graft Survival drug effects, Humans, Immunosuppressive Agents therapeutic use, Male, Middle Aged, Multivariate Analysis, Retrospective Studies, Risk Factors, Tacrolimus therapeutic use, Cold Ischemia methods, Graft Rejection prevention & control, Graft Survival physiology, Immunosuppression Therapy, Kidney Transplantation immunology, Kidney Transplantation physiology
- Abstract
Background: The aim of our study was to examine, in a recent cohort of kidney transplant recipients who have received modern immunosuppressive therapy, the respective role of cold ischemia time (CIT) and delayed graft function (DGF) on acute rejection (AR) rates and long-term graft survival., Methods: We retrospectively reviewed the charts of 611 renal transplantations between 1996 and 2005. Most patients received a calcineurin inhibitor as maintenance therapy, either cyclosporine (43%) or tacrolimus (52%) and 76% of the patients received an antilymphocyte induction therapy. Study endpoints were DGF, first-year AR, and long-term graft survival. Uni- and multivariate analyses were performed to determine factors that may have influenced the study outcomes., Results: DGF was observed in 16.2% of patients. Both older donor age and longer CIT were significant risk factors for DGF. DGF rates were similar whether patients received a calcineurin inhibitor before transplantation or not. AR occurred in 16.5% of grafts during the first year. Independent predictors of AR by multivariate analysis were duration of dialysis, CIT, current panel-reactive lymphocytotoxic antibody more than 5%, and the number of human leukocyte antigen-A, B, and DR mismatches. Each hour of cold ischemia increases the risk of rejection by 4%. With respect to death-censored graft survival, three pretransplant parameters emerged as independent predictors of graft loss: younger recipient age, peak panel-reactive lymphocytotoxic antibody more than 5% and longer CIT. The detrimental effect of CIT on graft survival was entirely because of its propensity to trigger AR. When AR was added to the multivariate Cox model, CIT was no longer significant whereas first-year AR became the most important predictor of graft loss (Hazards ratio, 4.6)., Conclusion: Shortening CIT will help to decrease not only DGF rates but also AR incidence and hence graft loss. Patients with prolonged CIT should receive adequate immunosuppression, possibly with antilymphocyte preparations, to prevent AR occurrence.
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- 2008
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6. HLA mismatches remain risk factors for acute kidney allograft rejection in patients receiving quadruple immunosuppression with anti-interleukin-2 receptor antibodies.
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Wissing KM, Fomegné G, Broeders N, Ghisdal L, Hoang AD, Mikhalski D, Donckier V, Vereerstraeten P, and Abramowicz D
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- Acute Disease, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Risk Factors, Transplantation, Homologous immunology, Antibodies immunology, Antibodies therapeutic use, Graft Rejection immunology, HLA Antigens immunology, Immunosuppressive Agents therapeutic use, Receptors, Interleukin-2 immunology
- Abstract
Background: New immunosuppressive drugs such as anti-interleukin-2 receptor antibodies (aIL2R) and mycophenolate mofetil (MMF) have reduced the incidence of acute rejection after renal transplantation. Whether matching donor and recipient human leukocyte antigen (HLA) antigens is still relevant in patients receiving modern immunosuppression has been questioned., Methods: We retrospectively analyzed the incidence and risk factors of acute rejection during the first posttransplant year and the impact of acute rejection on long-term graft survival in a cohort of 208 renal transplant patients treated with aIL2R (basiliximab, n=166; daclizumab, n=42), calcineurin inhibitors (tacrolimus, n=180; cyclosporin, n=28), mycophenolate mofetil, and steroids. Graft and patient survival were calculated by the Kaplan-Meier method. Risk factors for acute rejection were analyzed by logistic regression modeling., Results: Twenty-seven patients were treated for acute rejection (26 biopsy-proven) during the first posttransplant year. The Kaplan-Meier estimate of first-year acute rejection was 13.2%. The number of HLA mismatches (odds ratio [OR] 1.65 per HLA mismatch) and long periods of dialysis before transplantation (OR 3.1 for more than 4 years of dialysis) were the only independent risk factors for first-year acute rejection. First-year acute rejection was associated with a significant reduction in overall and death-censored graft survival at 5 years after transplantation., Conclusions: Although infrequent in patients receiving modern immunosuppressive drugs, acute rejection remains an important risk factor for graft loss after renal transplantation. Our results suggest that better HLA matching and shorter periods of dialysis before transplantation could reduce acute rejection rates and further improve outcomes under current immunosuppressive regimens.
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- 2008
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7. Effect of atorvastatin therapy and conversion to tacrolimus on hypercholesterolemia and endothelial dysfunction after renal transplantation.
- Author
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Wissing KM, Unger P, Ghisdal L, Broeders N, Berkenboom G, Carpentier Y, and Abramowicz D
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- Adult, Apolipoproteins blood, Atorvastatin, Body Mass Index, Creatinine blood, Cross-Over Studies, Drug Therapy, Combination, Endothelium, Vascular drug effects, Female, Follow-Up Studies, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Hypercholesterolemia epidemiology, Immunosuppressive Agents therapeutic use, Kidney Transplantation immunology, Lipids blood, Male, Middle Aged, Triglycerides blood, Endothelium, Vascular physiopathology, Heptanoic Acids therapeutic use, Hypercholesterolemia drug therapy, Kidney Transplantation physiology, Pyrroles therapeutic use, Tacrolimus therapeutic use
- Abstract
Background: Hypercholesterolemia is a frequent complication in renal transplant patients treated with cyclosporine A (CsA). Whether it is preferable to treat hypercholesterolemia with statins or to switch patients from CsA to tacrolimus (TRL) has not been investigated., Methods: Twelve CsA-treated kidney transplant recipients with hypercholesterolemia were successively crossed over from CsA alone to: CsA plus atorvastatin; TRL alone; and TRL plus atorvastatin. Total cholesterol (C), Low density lipoprotein (LDL)-C, high density lipoprotein (HDL)-C, LDL and HDL alpha-tocopherol content, lag-time of LDL oxidation, plasma levels of oxidized LDL and the percentage of small dense LDL were assayed at the end of each treatment period. Endothelial function was assessed by high resolution ultrasound measurement of flow-mediated brachial artery vasodilatation (FMD)., Results: Atorvastatin therapy was more efficient in reducing total cholesterol and LDL-C levels than conversion from CsA to TRL. Combining TRL with atorvastatin further reduced LDL-C levels as compared to TRL alone, but was no more efficient than the CsA-statin combination. Neither atorvastatin therapy nor conversion to TRL significantly changed the proportion of dense LDL, lipoprotein alpha-tocopherol contents or the lag time of LDL oxidation. Addition of atorvastatin to CsA increased FMD from 4.0+/-1.8% to 6.5+/-4.0% (P<0.05 vs. CsA). Conversion from CsA to TRL caused a slight improvement in FMD (5.1+/-2.1%, P<0.05 vs. CsA). Adding atorvastatin to TRL had no detectable effect on FMD (5.5+/-2.3%, P=NS vs. TRL)., Conclusions: Atorvastatin was more efficient in reducing total and LDL cholesterol levels of CsA-treated renal transplant patients than conversion to TRL and significantly improved endothelial dysfunction.
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- 2006
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8. A controlled study of vitamin D3 to prevent bone loss in renal-transplant patients receiving low doses of steroids.
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Wissing KM, Broeders N, Moreno-Reyes R, Gervy C, Stallenberg B, and Abramowicz D
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- Adult, Aged, Bone Density, Calcium blood, Female, Graft Rejection, Humans, Male, Middle Aged, Osteoporosis etiology, Parathyroid Hormone blood, Prospective Studies, Risk Factors, Cholecalciferol therapeutic use, Kidney Transplantation adverse effects, Osteoporosis prevention & control, Prednisolone adverse effects
- Abstract
Background: New and potent immunosuppressive regimens allow for reduced doses of corticosteroids after renal transplantation. The aims of our study were to investigate whether the use of low-dose corticosteroids is associated with a reduction in posttransplant bone loss and to assess the ability of cholecalciferol supplementation to further decrease bone loss in this setting., Methods: Ninety patients admitted for renal transplantation and scheduled to be treated per protocol with low doses of prednisolone were randomized to receive either 400 mg daily oral calcium (Ca group, n=44) or the same dose of calcium in association with a monthly dose of 25,000 IU of vitamin D3 (CaVitD group, n=46). Bone mineral density (BMD) was measured by dual energy absorptiometry at baseline and at 1 year., Results: The overall population experienced a moderate but significant -2.3+/-0.9% loss of lumbar spine BMD (P<0.01) but no bone loss at the femoral neck and shaft during the first posttransplant year. Bone loss tended to be slightly higher in the CaVitD group, but the difference did not reach statistical significance. Patients in the CaVitD group had significantly higher 25(OH) but not 1,25(OH)2 vitamin D levels. We observed a highly significant negative correlation between 25(OH) vitamin D and intact parathyroid hormone (iPTH) serum levels., Conclusions: Kidney-transplant recipients receiving modern immunosuppressive regimens with low doses of corticosteroids experience only minimal loss of BMD during the first posttransplant year. Cholecalciferol supplementation did not prevent posttransplant bone loss but contributed to the normalization of iPTH levels after renal transplantation.
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- 2005
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9. Hypercholesterolemia is associated with increased kidney graft loss caused by chronic rejection in male patients with previous acute rejection.
- Author
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Wissing KM, Abramowicz D, Broeders N, and Vereerstraeten P
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- Acute Disease, Adult, Cholesterol blood, Chronic Disease, Female, Humans, Hypercholesterolemia blood, Male, Middle Aged, Retrospective Studies, Risk Factors, Sex Factors, Graft Rejection etiology, Hypercholesterolemia complications, Kidney Transplantation adverse effects
- Abstract
Background: Whereas acute rejection is the main risk factor for the occurrence of chronic rejection, mechanisms in addition to the donor-specific immune response probably contribute to late allograft failure. In this study, we investigated the possible role of hypercholesterolemia in the incidence of chronic kidney graft loss., Methods: By using the actuarial method, we retrospectively analyzed the long-term loss of cadaveric kidney grafts in patients who had a functioning graft at 1 year and had received a transplant and undergone cyclosporin A therapy in our center between 1983 and 1997., Results: As observed previously, patients with acute rejection during the 1st posttransplant year (n=198) had significantly higher actuarial graft loss at 10 years compared with those free of acute rejection (n=244). In patients free of acute rejection at 1 year, hypercholesterolemia (> or =250 mg/dl) had no impact on graft loss at 10 years. On the contrary, in patients with previous acute rejection, those with hypercholesterolemia (n=59) had a higher immunological (36.0% vs. 19.2%; P<0.01) and overall (50.0% vs. 25.3%; P<0.01) graft loss at 10 years compared with patients with serum cholesterol <250 mg/dl (n=139). Among patients with 1st year acute rejection, hypercholesterolemia was associated with a significant increase in graft loss in male but not in female recipients. Multivariate analysis confirmed that hypercholesterolemia was an independent risk factor for chronic graft loss in male patients (P<0.05)., Conclusion: Hypercholesterolemia is an independent risk factor for kidney graft loss from chronic rejection in male patients with previous acute rejection. Correction of hypercholesterolemia could help to reduce kidney graft loss caused by chronic rejection in this category of patients.
- Published
- 2000
- Full Text
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