16 results on '"Gabriela Gautier-Vargas"'
Search Results
2. SARS-Cov-2 Seroprevalence in a French Kidney Transplant Center Located Within a 'High-risk' Zone
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Gabriela Gautier Vargas, Vanessa Jegou, Karima Kedjam, Jonas Martzloff, Bruno Moulin, Ilies Benotmane, Céline Meidinger, Audrey Desmarquets, Laura Braun, Lucille Steinmetz, Sophie Caillard, Sandra Ludwiller, Francoise Heibel, Noëlle Cognard, Murielle Morvan, Xavier Bassand, Dominique Schmitt, Danielle Roy, Amandine Bigot, Peggy Perrin, Anne Rihon, Jérôme Olagne, David Marx, and Samira Fafi Kremer
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Transplantation ,medicine.medical_specialty ,SARS-CoV-2 ,Transmission (medicine) ,business.industry ,COVID-19 ,Outbreak ,Seroepidemiologic Studies ,Antibodies, Viral ,medicine.disease ,Kidney Transplantation ,Asymptomatic ,Covid ,Serology ,Internal medicine ,Cohort ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,medicine ,Humans ,Seroprevalence ,France ,medicine.symptom ,business ,Kidney transplantation - Abstract
Supplemental Digital Content is available in the text., Background. Data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in kidney transplant recipients (KTRs) remain rare. We sought to shed further light on this issue by conducting a single-center study in a kidney transplant center located in one of the France’s highest risk zone (Grand Est) for coronavirus disease 2019 (Covid-19) during the initial disease outbreak. Methods. To this aim, we used a survey approach coupled with systematic investigation of SARS-CoV-2 serology in a cohort of 1390 KTRs. Results. SARS-CoV-2 serologies were available for 780 survey respondents, among whom 48 had anti-SARS-CoV-2 antibodies (total seroprevalence: 6.2%). Thirty-five of the 48 seropositive KTRs had previously received a diagnosis of Covid-19, whereas the remaining 13 patients were not known to be infected (8 asymptomatic cases). Specifically, 18.7% of seropositive KTRs and 1.1% of the entire cohort were asymptomatic. Household exposure was found to markedly increase the risk of SARS-CoV-2 transmission. Conclusions. Our findings demonstrate that the overall SARS-CoV-2 seroprevalence in KTRs living in one of the France’s highest risk zone for Covid-19 during the first French lockdown was as low as 6.3%. Rapid and strict implementation of protective measures could have significantly mitigated virus spread even in an area of high virus circulation.
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- 2021
3. Persistence of SARS-CoV-2 antibodies in kidney transplant recipients
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Peggy Perrin, Sophie Caillard, Ilies Benotmane, Samira Fafi-Kremer, Marie-José Wendling, Aurélie Velay, and Gabriela Gautier Vargas
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Transplantation ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,biology ,SARS-CoV-2 ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,Kidney Transplantation ,Kidney transplant ,Virology ,Transplant Recipients ,Infectious disease (medical specialty) ,biology.protein ,Humans ,Immunology and Allergy ,Medicine ,Pharmacology (medical) ,Antibody ,business ,Immunosuppressive Agents - Published
- 2021
4. A rapid decline in the anti-receptor-binding domain of the SARS-CoV-2 spike protein IgG titer in kidney transplant recipients after tixagevimab-cilgavimab administration
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Ilies Benotmane, Aurélie Velay, Gabriela-Gautier Vargas, Jérôme Olagne, Noëlle Cognard, Françoise Heibel, Laura Braun-Parvez, Jonas Martzloff, Peggy Perrin, Romain Pszczolinski, Bruno Moulin, Samira Fafi-Kremer, and Sophie Caillard
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Nephrology ,SARS-CoV-2 ,Immunoglobulin G ,Spike Glycoprotein, Coronavirus ,Humans ,COVID-19 ,Kidney Transplantation - Published
- 2022
5. Breakthrough COVID-19 cases despite prophylaxis with 150 mg of tixagevimab and 150 mg of cilgavimab in kidney transplant recipients
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Ilies Benotmane, Aurélie Velay, Gabriela Gautier-Vargas, Jérôme Olagne, Augustin Obrecht, Noëlle Cognard, Françoise Heibel, Laura Braun-Parvez, Nicolas Keller, Jonas Martzloff, Peggy Perrin, Romain Pszczolinski, Bruno Moulin, Samira Fafi-Kremer, Olivier Thaunat, and Sophie Caillard
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Transplantation ,SARS-CoV-2 ,Immunology and Allergy ,Humans ,COVID-19 ,Pharmacology (medical) ,Sciences du Vivant [q-bio]/Médecine humaine et pathologie ,Antibodies, Viral ,Kidney Transplantation ,Antibodies, Neutralizing - Abstract
The cilgavimab-tixagevimab combination retains a partial in vitro neutralizing activity against the current SARS-CoV-2 variants of concern (omicron BA.1, BA.1.1, and BA.2). Here, we examined whether preexposure prophylaxis with cilgavimab-tixagevimab can effectively protect kidney transplant recipients (KTRs) against the omicron variant. Of the 416 KTRs who received intramuscular prophylactic injections of 150 mg tixagevimab and 150 mg cilgavimab, 39 (9.4%) developed COVID-19. With the exception of one case, all patients were symptomatic. Hospitalization and admission to an intensive care unit were required for 14 (35.9%) and three patients (7.7%), respectively. Two KTRs died of COVID-19-related acute respiratory distress syndrome. SARS-CoV-2 sequencing was carried out in 15 cases (BA.1, n = 5; BA.1.1, n = 9; BA.2, n = 1). Viral neutralizing activity of the serum against the BA.1 variant was negative in the 12 tested patients, suggesting that this prophylactic strategy does not provide sufficient protection against this variant of concern. In summary, preexposure prophylaxis with cilgavimab-tixagevimab at the dose of 150 mg of each antibody does not adequately protect KTRs against omicron. Further clarification of the optimal dosing can assist in our understanding of how best to harness its protective potential.
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- 2022
6. Infection or a third dose of mRNA vaccine elicits neutralizing antibody responses against SARS-CoV-2 in kidney transplant recipients
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Xavier Charmetant, Maxime Espi, Ilies Benotmane, Véronique Barateau, Francoise Heibel, Fanny Buron, Gabriela Gautier-Vargas, Marion Delafosse, Peggy Perrin, Alice Koenig, Noëlle Cognard, Charlène Levi, Floriane Gallais, Louis Manière, Paola Rossolillo, Eric Soulier, Florian Pierre, Anne Ovize, Emmanuel Morelon, Thierry Defrance, Samira Fafi-Kremer, Sophie Caillard, and Olivier Thaunat
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Vaccines, Synthetic ,COVID-19 Vaccines ,SARS-CoV-2 ,COVID-19 ,Humans ,Prospective Studies ,mRNA Vaccines ,General Medicine ,Antibodies, Viral ,Antibodies, Neutralizing ,Kidney Transplantation ,BNT162 Vaccine ,Transplant Recipients - Abstract
Transplant recipients, who receive therapeutic immunosuppression to prevent graft rejection, are characterized by high coronavirus disease 2019 (COVID-19)–related mortality and defective response to vaccines. We observed that previous infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but not the standard two-dose regimen of vaccination, provided protection against symptomatic COVID-19 in kidney transplant recipients. We therefore compared the cellular and humoral immune responses of these two groups of patients. Neutralizing anti–receptor-binding domain (RBD) immunoglobulin G (IgG) antibodies were identified as the primary correlate of protection for transplant recipients. Analysis of virus-specific B and T cell responses suggested that the generation of neutralizing anti-RBD IgG may have depended on cognate T-B cell interactions that took place in germinal center, potentially acting as a limiting checkpoint. High-dose mycophenolate mofetil, an immunosuppressive drug, was associated with fewer antigen-specific B and T follicular helper (TFH) cells after vaccination; this was not observed in patients recently infected with SARS-CoV-2. Last, we observed that, in two independent prospective cohorts, administration of a third dose of SARS-CoV-2 mRNA vaccine restored neutralizing titers of anti-RBD IgG in about 40% of individuals who had not previously responded to two doses of vaccine. Together, these findings suggest that a third dose of SARS-CoV-2 mRNA vaccine improves the RBD-specific responses of transplant patients treated with immunosuppressive drugs.
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- 2022
7. Strong antibody response after a first dose of a SARS-CoV-2 mRNA-based vaccine in kidney transplant recipients with a previous history of COVID-19
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Aurélie Velay, Noëlle Cognard, Gabriela Gautier-Vargas, Pierre Gantner, Peggy Perrin, Floriane Gallais, Ilies Benotmane, Sophie Caillard, Francoise Heibel, Samira Fafi-Kremer, Jonas Martzloff, Laura Braun-Parvez, Jérôme Olagne, Bruno Moulin, univOAK, Archive ouverte, Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Strasbourg, LabEx Transplantex [Strasbourg], Université de Strasbourg (UNISTRA), and Fédération de Médecine Translationnelle de Strasbourg (FMTS)
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2019-20 coronavirus outbreak ,COVID-19 Vaccines ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Kidney transplant ,Letter to the Editors ,Immunology and Allergy ,Medicine ,Humans ,Pharmacology (medical) ,RNA, Messenger ,Letter to the Editor ,Transplantation ,Messenger RNA ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,business.industry ,SARS-CoV-2 ,COVID-19 ,Kidney Transplantation ,Transplant Recipients ,Past history ,Antibody response ,Immunization ,Immunology ,Antibody Formation ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
A recent study demonstrated that a single dose of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA-based vaccine is sufficient to mount a robust immunological response in immunocompetent subjects with a previous history of coronavirus disease 2019 (COVID-19).1,2 While research has suggested that immunocompromised kidney transplant recipients (KTRs) who received mRNA-based vaccines show low immunization rates,3-5 the question as to whether this also applies to KTRs with a past history of COVID-19 remains unanswered. The aim of this study was to describe the results of immunization after one dose of the mRNA-1273 SARS-CoV-2 vaccine in KTRs who were already seropositive at baseline because of previous exposure to SARS-CoV-2.
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- 2021
8. COVID-19 in a kidney transplant recipient treated with eculizumab for atypical hemolytic uremic syndrome: a case report
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Gabriela Gautier-Vargas, Noëlle Cognard, Ilies Benotmane, Sophie Caillard, and Peggy Perrin
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,SARS-CoV-2 ,business.industry ,COVID-19 ,Eculizumab ,Antibodies, Monoclonal, Humanized ,medicine.disease ,Gastroenterology ,Kidney transplantation ,Kidney transplant recipient ,Nephrology ,Internal medicine ,Case report ,Atypical hemolytic uremic syndrome ,Lessons for the Clinical Nephrologist ,medicine ,Humans ,business ,Atypical Hemolytic Uremic Syndrome ,medicine.drug - Published
- 2021
9. SARS‐CoV‐2 viral dynamics in immunocompromised patients
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Peggy Perrin, Gabriela Gautier Vargas, Ilies Benotmane, Sophie Caillard, and Samira Fafi-Kremer
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Male ,Saliva ,Coronavirus disease 2019 (COVID-19) ,viruses ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,030230 surgery ,Letter to the Editors ,03 medical and health sciences ,Immunocompromised Host ,0302 clinical medicine ,Medicine ,Humans ,Immunology and Allergy ,Viral rna ,Pharmacology (medical) ,Respiratory system ,skin and connective tissue diseases ,Letter to the Editor ,Aged ,Transplantation ,business.industry ,SARS-CoV-2 ,RNA ,COVID-19 ,Middle Aged ,Virology ,Viral dynamics ,Female ,business ,Viral load - Abstract
While the median duration of SARS-CoV-2 viral RNA detection in nasopharyngeal swabs collected from immunocompetent subjects is approximately 18 days,1 data for immunocompromised patients are not yet available. Here, we prospectively monitored the dynamic changes of SARS-CoV-2 RNA viral loads in serial nasopharyngeal swab, saliva, and respiratory specimens collected from kidney transplant recipients (KTR) hospitalized with a confirmed diagnosis of Covid-19.
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- 2020
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10. Cytokine release syndrome‐associated encephalopathy in patients with COVID‐19
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Gabriela Gautier-Vargas, Seyyid Baloglu, Sophie Caillard, Bruno Moulin, Nicolas Keller, Dimitri Bedo, Nicolas Collongues, Thomas Lavaux, Ilies Benotmane, Xavier Bassand, Stéphane Kremer, Samira Fafi-Kremer, and Peggy Perrin
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Male ,encephalitis ,neurological disorders ,Brain Edema ,Gastroenterology ,corticosteroids ,0302 clinical medicine ,Cerebrospinal fluid ,Adrenal Cortex Hormones ,intravenous immunoglobulin ,cytokine ,Longitudinal Studies ,030212 general & internal medicine ,Brain Diseases ,medicine.diagnostic_test ,Brain ,Middle Aged ,Magnetic Resonance Imaging ,Cytokine release syndrome ,Treatment Outcome ,Neurology ,Blood-Brain Barrier ,Original Article ,Female ,medicine.symptom ,kidney ,medicine.medical_specialty ,Encephalopathy ,Clinical Neurology ,Immunoglobulins ,intravenous immunoglobulins ,03 medical and health sciences ,COVID‐19 ,Internal medicine ,medicine ,Humans ,Aged ,Ischemic Stroke ,Coma ,Cerebellar ataxia ,business.industry ,COVID-19 ,Dysautonomia ,cytokine release syndrome ,Magnetic resonance imaging ,Original Articles ,medicine.disease ,Uremia ,neurological manifestations ,Neurology (clinical) ,Nervous System Diseases ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND AND PURPOSE: Neurological manifestations in coronavirus disease (COVID)-2019 may adversely affect clinical outcomes. Severe COVID-19 and uremia are risk factors for neurological complications. However, the lack of insight into their pathogenesis, particularly with respect to the role of the cytokine release syndrome (CRS), is currently hampering effective therapeutic interventions. The aims of this study were to describe the neurological manifestations of patients with COVID-19 and to gain pathophysiological insights with respect to CRS. METHODS: In this longitudinal study, we performed extensive clinical, laboratory and imaging phenotyping in five patients admitted to our renal unit. RESULTS: Neurological presentation included confusion, tremor, cerebellar ataxia, behavioral alterations, aphasia, pyramidal syndrome, coma, cranial nerve palsy, dysautonomia, and central hypothyroidism. Notably, neurological disturbances were accompanied by laboratory evidence of CRS. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was undetectable in the cerebrospinal fluid (CSF). Hyperalbuminorrachia and increased levels of the astroglial protein S100B were suggestive of blood-brain barrier (BBB) dysfunction. Brain magnetic resonance imaging findings comprised evidence of acute leukoencephalitis (n = 3, one of whom had a hemorrhagic form), cytotoxic edema mimicking ischaemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted, resulting in rapid recovery from neurological disturbances in two cases. SARS-CoV2 was undetectable in 88 of the 90 patients with COVID-19 who underwent Reverse Transcription-PCR testing of CSF. CONCLUSIONS: Patients with COVID-19 can develop neurological manifestations that share clinical, laboratory and imaging similarities with those of chimeric antigen receptor T-cell-related encephalopathy. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune-mediated mechanisms.
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- 2020
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11. Biomarkers of Cytokine Release Syndrome Predict Disease Severity and Mortality From COVID-19 in Kidney Transplant Recipients
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Francoise Heibel, Ilies Benotmane, Samira Fafi Kremer, Thomas Lavaux, Gabriela Gautier Vargas, Clement Baldacini, Mylene Sagnard, Heloise Delagreverie, Jérôme Olagne, David Marx, Bruno Moulin, Sophie Caillard, Mickaël Ohana, Nicolas Keller, Margaux Della Chiesa, Noëlle Cognard, Xavier Bassand, Laura Braun, Dimitri Bedo, Dogan-Firat Bozman, and Peggy Perrin
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Male ,medicine.medical_specialty ,Population ,030230 surgery ,Severity of Illness Index ,Fibrin Fibrinogen Degradation Products ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Severity of illness ,medicine ,Coagulopathy ,Humans ,education ,Kidney transplantation ,Aged ,education.field_of_study ,Transplantation ,biology ,business.industry ,Interleukin-6 ,SARS-CoV-2 ,Mortality rate ,C-reactive protein ,Troponin I ,COVID-19 ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Hospitalization ,Cytokine release syndrome ,C-Reactive Protein ,biology.protein ,030211 gastroenterology & hepatology ,Female ,business ,Cytokine Release Syndrome ,Biomarkers ,Cohort study - Abstract
BACKGROUND Data on coronavirus disease 2019 (COVID-19) in immunocompromised kidney transplant recipients (KTR) remain scanty. Although markers of inflammation, cardiac injury, and coagulopathy have been previously associated with mortality in the general population of patients with COVID-19, their prognostic impact amongst KTR with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has not been specifically investigated. METHODS We conducted a cohort study of 49 KTR who presented with COVID-19. Clinical and laboratory risk factors for severe disease and mortality were prospectively collected and analyzed with respect to outcomes. The study participants were divided into 3 groups: (1) mild disease manageable in an outpatient setting (n = 8), (2) nonsevere disease requiring hospitalization (n = 21), and (3) severe disease (n = 20). RESULTS Gastrointestinal manifestations were common at diagnosis. The 30-day mortality rate in hospitalized patients was 19.5%. Early elevations of C-reactive protein (>100 mg/L) and interleukin-6 (>65 ng/L) followed by increases in high-sensitivity troponin I (>30 ng/L) and D-dimer (>960 ng/mL) were significantly associated with severe disease and mortality. Viral load did not have prognostic significance in our sample, suggesting that outcomes were chiefly driven by a cytokine release syndrome (CRS). CONCLUSIONS Regular monitoring of CRS biomarkers in KTR with COVID-19 is paramount to improve clinical outcomes.
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- 2020
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12. In‐depth virological assessment of kidney transplant recipients with COVID‐19
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Aurélie Velay, Clement Baldacini, Noëlle Cognard, Ilies Benotmane, Louise Gontard, Margaux Della-Chiesa, Samira Fafi-Kremer, Dogan Firat Bozman, Floriane Gallais, Marie Josée Wendling, Heloise Delagreverie, Dimitri Bedo, Sophie Caillard, Gabriela Gautier-Vargas, Bruno Moulin, Francoise Heibel, Laura Braun-Parvez, Morgane Solis, Mylene Sagnard, Jérôme Olagne, David Marx, Xavier Bassand, Baptiste Panaget, and Peggy Perrin
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Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,viruses ,Enzyme-Linked Immunosorbent Assay ,Comorbidity ,030230 surgery ,Brief Communication ,Antibodies, Viral ,Gastroenterology ,Kidney transplant ,Serology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Nasopharynx ,medicine ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Viral shedding ,Pandemics ,Aged ,Transplantation ,biology ,business.industry ,SARS-CoV-2 ,COVID-19 ,Middle Aged ,Viral Load ,Kidney Transplantation ,Survival Rate ,medicine.anatomical_structure ,biology.protein ,Female ,France ,Antibody ,business ,Viral load ,Respiratory tract - Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread widely, causing coronavirus disease 2019 (COVID-19) and significant mortality. However, data on viral loads and antibody kinetics in immunocompromised populations are lacking. We aimed to determine nasopharyngeal and plasma viral loads via reverse transcription-polymerase chain reaction and SARS-CoV-2 serology via enzyme-linked immunosorbent assay and study their association with severe forms of COVID-19 and death in kidney transplant recipients. In this study, we examined hospitalized kidney transplant recipients with nonsevere (n = 21) and severe (n = 19) COVID-19. SARS-CoV-2 nasopharyngeal and plasma viral load and serological response were evaluated based on outcomes and disease severity. Ten recipients (25%) displayed persistent viral shedding 30 days after symptom onset. The SARS-CoV-2 viral load of the upper respiratory tract was not associated with severe COVID-19, whereas the plasma viral load was associated with COVID-19 severity (P = .010) and mortality (P = .010). All patients harbored antibodies during the second week after symptom onset that persisted for 2 months. We conclude that plasma viral load is associated with COVID-19 morbidity and mortality, whereas nasopharyngeal viral load is not. SARS-CoV-2 shedding is prolonged in kidney transplant recipients and the humoral response to SARS-CoV-2 does not show significant impairment in this series of transplant recipients.
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- 2020
13. Does a Useful Test Exist to Properly Evaluate the Pathogenicity of Donor-specific Antibodies? Lessons From a Comprehensive Analysis in a Well-studied Single-center Kidney Transplant Cohort
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Mélanie Joly, Nadine Froelich, Peggy Perrin, Philippe Guntz, Jérôme Olagne, Gabriela Gautier Vargas, Christian Gachet, Noëlle Cognard, Bruno Moulin, Sophie Caillard, and A. Parissiadis
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Graft Rejection ,Male ,Time Factors ,Biopsy ,030230 surgery ,Single Center ,Gastroenterology ,0302 clinical medicine ,HLA Antigens ,Isoantibodies ,Child ,Kidney ,medicine.diagnostic_test ,biology ,Complement Fixation Tests ,Graft Survival ,Middle Aged ,medicine.anatomical_structure ,Treatment Outcome ,Complement C3d ,Child, Preschool ,Cohort ,030211 gastroenterology & hepatology ,Female ,Antibody ,Adult ,medicine.medical_specialty ,Adolescent ,Renal function ,03 medical and health sciences ,Young Adult ,Monitoring, Immunologic ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Clinical significance ,Aged ,Retrospective Studies ,Transplantation ,business.industry ,Donor specific antibodies ,Complement C1q ,Reproducibility of Results ,Kidney Transplantation ,body regions ,biology.protein ,business ,Biomarkers - Abstract
Background Donor-specific antibodies (DSA) play a major role in antibody-mediated rejection (AMR) and graft dysfunction. However, the clinical relevance of complement-binding anti-HLA antibodies remains unclear. Methods Here, we analyzed DSA detected in the serum (sDSA) using single antigen bead, C1q, and C3d assays combined with the study of intragraft DSA (gDSA) in 86 patients who had DSA and underwent a kidney biopsy for cause (n = 58) or without evidence of kidney dysfunction (n = 28). DSA characteristics were collected and related to the presence of AMR, graft histological features, and allograft survival. Results Forty-five patients (52%) had C1q DSA, and 42 (51%) had C3d DSA. Allograft biopsies revealed AMR in 63 cases (73%), regardless of kidney function. gDSA were identified in 74% of biopsies. We observed a strong correlation among single antigen bead mean fluorescence intensity and complement assays positivity, presence of gDSA, and AMR occurrence. Conclusions Complement-binding DSA per se were not significantly associated with allograft survival in the entire study sample. Finally, gDSA predicted subsequent graft loss in patients who showed a stable renal function at the day of biopsy. Our data suggest that DSA mean fluorescence intensity and presence of gDSA might provide prognostic information during posttransplant monitoring.
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- 2020
14. Recent Changes in Chronic Kidney Disease-Mineral and Bone Disorders and Associated Fractures After Kidney Transplantation
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C. Muller, Francoise Heibel, Bruno Moulin, Noëlle Cognard, Sophie Ohlmann, Gabriela Gautier-Vargas, Laura Braun, Clotilde Kiener, Rose-Marie Javier, Peggy Perrin, and Jérôme Olagne
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,030232 urology & nephrology ,Urology ,030230 surgery ,03 medical and health sciences ,Fractures, Bone ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Young adult ,Vitamin D ,Kidney transplantation ,Aged ,Retrospective Studies ,Aged, 80 and over ,Chronic Kidney Disease-Mineral and Bone Disorder ,Transplantation ,Kidney ,Bone Density Conservation Agents ,urogenital system ,business.industry ,Incidence (epidemiology) ,Incidence ,Follow up studies ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Surgery ,medicine.anatomical_structure ,Female ,France ,business ,Kidney disease ,Follow-Up Studies - Abstract
The management of chronic kidney disease-mineral and bone disorders has recently changed. We investigated the modifications of chronic kidney disease-mineral and bone disorder with a special focus on the incidence of fractures in the first year after kidney transplantation (KT).We retrospectively compared 2 groups of patients who consecutively underwent transplantation at our center 5 years from each other. Group 1 consisted of patients (n = 152) transplanted between 2004 and 2006, whereas patients in group 2 (n = 137) underwent KT between 2009 and 2011.During the end-stage renal disease phase at the time of transplant, cinacalcet, and native vitamin D were used significantly more frequently in group 2. Median intact parathyroid hormone levels were lower and severe hyperparathyroidism decreased significantly. Vitamin D deficiency dropped from 64% to 20%. After transplantation, persistent hyperparathyroidism (parathyroid hormone130 ng/L) and bone turnover markers were significantly reduced in group 2. Native vitamin D supplementation increased over time, whereas the use of active vitamin D was unchanged. The 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were significantly higher. The fracture incidence at 1 year decreased significantly (3.1% vs 9.1%; P = 0.047). No steroid sparing was observed in group 2. Bisphosphonates after KT were more frequently used in group 2.Recent changes in clinical practice are associated with reductions in pretransplant and posttransplant hyperparathyroidism, vitamin D deficiency, and fracture risk after KT.
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- 2016
15. Pre-existing donor-specific antibodies are detrimental to kidney allograft only when persistent after transplantation
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Christian Gachet, Bruno Moulin, Francoise Heibel, C. Muller, Gabriela Gautier-Vargas, Veronique Renner, A. Parissiadis, Francois Lefebre, Sophie Caillard, Jérôme Olagne, Laura Braun, Camille Becmeur, Peggy Perrin, and Noëlle Cognard
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,030232 urology & nephrology ,Urology ,030230 surgery ,Kidney ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Antigen ,HLA Antigens ,Isoantibodies ,Risk Factors ,medicine ,Humans ,Renal Insufficiency ,Kidney transplantation ,Retrospective Studies ,Immunosuppression Therapy ,Transplantation ,biology ,business.industry ,Donor specific antibodies ,Histocompatibility Testing ,Graft Survival ,Middle Aged ,medicine.disease ,Allografts ,Kidney Transplantation ,Tissue Donors ,Surgery ,body regions ,surgical procedures, operative ,medicine.anatomical_structure ,Allograft rejection ,Area Under Curve ,Multivariate Analysis ,biology.protein ,Graft survival ,Female ,Antibody ,business ,Immunosuppressive Agents ,Glomerular Filtration Rate - Abstract
Donor-specific antibodies (DSA) increase the risk of allograft rejection and graft failure. They may be present before transplant or develop de novo after transplantation. Here, we studied the evolution of preformed DSA and their impact on graft outcome in kidney transplant recipients. Using the Luminex Single Antigen assay, we analyzed the sera on the day of transplantation of 239 patients who received a kidney transplant. Thirty-seven patients (15.5%) had pre-existing DSA detected the day of transplantation. After 5 years, the pre-existing DSA disappeared in 22 patients whereas they persisted in 12. Variables associated with DSA persistence were age50 years (P = 0.009), a history of previous transplantation (P = 0.039), the presence of class II DSA (P = 0.009), an MFI of preformed DSA3500 (P 0.001), and the presence of two or more DSA (P 0.001). DSA persistence was associated with a higher risk of graft loss and antibody-mediated rejection. Previously undetected preformed DSA are deleterious to graft survival only when they persist after transplantation.
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- 2016
16. Impaired P2Y12 inhibition by clopidogrel in kidney transplant recipients: results from a cohort study
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Sophie Caillard, Nathan Messas, Gabriela Gautier-Vargas, Olivier Morel, Jérôme Olagne, C. Muller, Bruno Moulin, Noëlle Cognard, and Peggy Perrin
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Nephrology ,Male ,medicine.medical_specialty ,Ticlopidine ,medicine.medical_treatment ,030232 urology & nephrology ,macromolecular substances ,030204 cardiovascular system & hematology ,Gastroenterology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,P2Y12 ,Maintenance therapy ,Internal medicine ,medicine ,Humans ,Platelet aggregation ,Registries ,Renal Insufficiency, Chronic ,Kidney transplantation ,Aged ,Retrospective Studies ,business.industry ,Immunosuppression ,Odds ratio ,Middle Aged ,medicine.disease ,Clopidogrel ,Cardiovascular disease ,Platelet Activation ,Kidney Transplantation ,Cardiology ,Purinergic P2Y Receptor Antagonists ,Female ,business ,Platelet Aggregation Inhibitors ,Kidney disease ,medicine.drug ,Research Article - Abstract
Background Cardiovascular complications represent a major cause of morbidity and mortality for patients who received kidney transplantation (KT). However, the impact of KT and chronic immunosuppression on platelet response to clopidogrel in patients undergoing coronary or peripheral revascularization procedures remains unclear. This cohort study compares platelet responsiveness to clopidogrel as assessed byvasodilator-stimulated phosphoprotein (VASP) phosphorylation. Methods The study population was divided between chronic kidney disease (CKD) patients who underwent KT (n = 36) and non-transplanted CKD patients (control group, n = 126). Patients were on maintenance antiplatelet therapy with clopidogrel 75 mg daily for at least 8 days. The mean platelet reactivity index (PRI) VASP values and the prevalence of high on-treatment platelet reactivity (HPR, defined as PRI VASP ≥61 %) were compared. Results The mean PRI VASP value was significantly higher in the transplant group (60.1 ± 3 vs 51.2 ± 1.6 %; p=0.014). HPR was significantly more common in the transplant group on clopidogrel maintenance therapy (58 vs. 31 %; p = 0.011). KT was the only independent predictor of HPR (odds ratio: 2.6; 95 % confidence interval: 1.03–6.27, p = 0.03). The effect of treatment with calcineurin inhibitors on clopidogrel response could not be analyzed separately from the kidney transplant status. Conclusions KT is associated with an increased prevalence of HPR. Our results suggest that plateletfunction tests may be clinically useful for the management of this specific population.
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