86 results on '"Federico Sallusto"'
Search Results
2. ABO-Incompatible Robotic-Assisted Kidney Transplantation in the Obese Recipient
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Thomas Prudhomme, Arnaud Del Bello, Federico Sallusto, Marine Lesourd, Nassim Kamar, and Nicolas Doumerc
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robotic-assisted kidney transplantation ,ABO-incompatible ,open kidney transplantation ,desensitization protocols ,delayed graft function ,Surgery ,RD1-811 - Abstract
Objective: The objective of this preliminary study was to report and compare the peri-operative and functional results of ABO-incompatible (ABOi) living-donor robotic-assisted kidney transplantation (RAKT), ABO-compatible (ABOc) living-donor RAKT, and ABOi living-donor open kidney transplantation (OKT).Materials and Methods: For the present retrospective study, we analyzed data of consecutive patients who underwent ABOi or ABOc-RAKT and ABOi-OKT, from January 2015 to December 2019, in one French academic center. Patients' baseline characteristics, operative, and functional outcomes were compared between ABOi-RAKT, ABOc-RAKT, and ABOi-OKT.Results: 29 RAKT, including 7 ABOi-RAKT, and 56 ABOi-OKT were performed in our center. Median follow-up was 2.0 years. Median recipient age, pre-emptive kidney transplantation rate, sex ratio and desensitization procedures were similar in ABOi-RAKT, ABOc-RAKT, and ABOi-OKT groups. Recipient BMI at transplantation was statistically higher in ABOi and ABOc-RAKT groups compared to ABOi-OKT. The surgical site complication (principally infection-related) rate was lower in ABOi-RAKT, without statistical differences (0 vs. 8.9%, respectively, in ABOi-RAKT and ABOi-OKT, p = 0.7). The delayed graft function rate was 0% in ABOi-RAKT, 13.6% in ABOc-RAKT, and 10.7% in ABOi-OKT (p = 0.6). The post-transplantation blood transfusion rate was statistically higher in the ABOi-OKT group (14.3 vs. 13.6 vs. 57.1% in ABOi-RAKT, ABOc-RAKT, and ABOi-OKT, respectively, p = 0.001). The kidney graft survival at 1 month and at last follow-up was not different between ABOi-RAKT and ABOi-OKT.Conclusion: Our data support the use of ABOi-RAKT to restore accessibility to kidney transplantation for obese patients to the greatest extent possible. Large series are required to confirm these encouraging data from a single center.
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- 2020
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3. Long-term outcomes after ABO-incompatible kidney transplantation; a single-center French study
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Zhiyar Abdulrahman, Hamza Bennani Naciri, Asma Allal, Federico Sallusto, Bénédicte Debiol, Laure Esposito, Céline Guilbeau-Frugier, Nassim Kamar, and Lionel Rostaing
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abo-incompatible ,abo-compatible ,living-kidney transplantation ,outcomes ,Pathology ,RB1-214 ,Internal medicine ,RC31-1245 ,Other systems of medicine ,RZ201-999 - Abstract
Background: ABO-incompatible (ABOi) is as efficient as ABO-compatible (ABOc) kidneytransplantation in the setting of live-donation. Objectives: To evaluate the long-term outcomes (i.e. >6 months) of 44 consecutive ABOi living-donor kidney-transplants (KTx). The results were compared to those from 44 ABOc KTx that were matched with ABOi-patients on age, gender, and date of transplantation. Patients and Methods: With regards to immunosuppression (IS) only ABOi-patients received pre-transplant IS, that included rituximab. Induction therapy relied significantly more frequently on basiliximab in ABOc- than in ABOi-patients 77.2% vs. 38.6% (P = 0.0002). Post-transplant IS relied only on tacrolimus/mycophenolic acid and steroids in ABOipatients, whereas some ABOc-patients were alternatively on cyclosporine (13.6%)/everolimus (11.3%) and no steroids (7%), respectively (P = 0.05). Results: In ABOi-patients there was no isoagglutinin titer rebound posttransplant. At last follow-up patient and graft survival was similar in the two groups, as well as kidneyallograft function. Acute rejection rates (cellular, humoral, or mixed) were similar across both groups (ABOi: 22.7%; ABOc: 20.4%). With regards to bacterial and viral infections the only significant difference between the two groups was that at month three there were significantly more BKV viruria in ABOi (25%) vs. 6.8% in ABOc (P = 0.03). De novo donor-specific alloantibody were detected in 13.6% ABOi and 4.5% ABOc patients (ns). Readmission rates in our department for less than two days were more frequent for ABOi conversely readmission rates for more than two days was similar across the groups. Conclusions: ABOi-kidney transplantation after desensitization provides in the long-term same results as those observed in live-donor ABOc-kidney transplantation.
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- 2017
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4. Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates
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Lionel Rostaing, Asma Allal, Arnaud del Bello, Federico Sallusto, Laure Esposito, Nicolas Doumerc, Bénédicte Debiol, Audrey Delas, Xavier Game, and Nassim Kamar
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abo-incompatible kidney transplantation ,specific immunoadsorption ,glycosorb® ,large plasma volumes ,Pathology ,RB1-214 ,Internal medicine ,RC31-1245 ,Other systems of medicine ,RZ201-999 - Abstract
Background: ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression. Objectives: To assess the efficacy of a single, pretransplant (Day –1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L). Patients and Methods: Prospective single-center study evaluating 12 consecutive patients (6 males), aged 40 (23–59) years. Incompatibilities were A into 0 (8), B into 0 (3), and AB into 0 (1). Pretransplant desensitization relied on rituximab (D–30), tacrolimus, mycophenolic acid, and steroids (all started on D–13), and a single session of specific immunoadsorption on D–1. Immunoadsorption was coupled in tandem with a hemodialysis session. Results: Overall, 15 L (11–18) of plasma were treated per patient, i.e., 0.2 (0.11–0.36 L/kg). Isoagglutinin titers were 1/16 (1/5–1/64) before the procedure, decreasing after 6 hours to 1/5 (1/1–1/16 P = 0.008), and to 1/2 (1/1–1/8; P = 0.05) at completion of the session. The next day, i.e., the day of transplantation, there was no rebound of isoagglutinins [1/4 (1/1–1/5); P = ns]. The procedure was well tolerated with no side-effects and no significant changes in hemoglobin level, platelet counts, fibrinogen, or albumin levels. Conclusions: For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound. These results should be confirmed when isoagglutinin titers are higher (≥120).
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- 2016
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5. Early post-transplant complications following ABO-incompatible kidney transplantation
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Hamza Naciri Bennani, Zhyiar Abdulrahman, Asma Allal, Federico Sallusto, Antoine Delarche, Xavier Game, Laure Esposito, Nicolas Doumerc, Bénédicte Debiol, Nassim Kamar, and Lionel Rostaing
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kidney transplantation ,bleeding ,surgical complications ,bk virus ,blood transfusion ,fibrinogen ,Pathology ,RB1-214 ,Internal medicine ,RC31-1245 ,Other systems of medicine ,RZ201-999 - Abstract
Background: Living-kidney transplantation is increasing because of the scarcity of kidneys from deceased donors and the increasing numbers of patients on waiting lists for a kidney transplant. Living-kidney transplantation is now associated with increased long-term patient- and allograft-survival rates. Objectives: The purpose of this retrospective study was to identify, in a cohort of 44 ABO-incompatible (ABOi) live-kidney transplant patients, the main complications that occurred within 6 months post-transplantation, and to compare these findings with those from 44 matched ABO-compatible (ABOc) live-kidney transplant patients who were also from our center. Patients and Methods: This single-center retrospective study assessed post-transplantation complications in 44 ABO-i versus 44 matched ABO-c patients. All patients were comparable at baseline except that ABO-i patients had greater immunological risks. Results: During the 6-month post-transplant period, more ABO-i patients presented with postoperative bleeds, thus requiring significantly more blood transfusions. Bleeds were associated with significantly lower values of fibrinogen, platelets, prothrombin time, and hemoglobin levels. Surgical complications, patient- and graft-survival rates, and kidney-function statuses were similar between both groups at 6 months post-transplantation. Conclusions: We conclude that impairment of hemostatic factors at pre-transplant explained the increased risk of a post-transplant bleed in ABO-i patients.
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- 2016
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6. Hepatitis E Virus Infection without Reactivation in Solid-Organ Transplant Recipients, France
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Florence Legrand-Abravanel, Nassim Kamar, Karine Sandres-Saune, Sebastien Lhomme, Jean-Michel Mansuy, Fabrice Muscari, Federico Sallusto, Lionel Rostaing, and Jacques Izopet
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Hepatitis E virus ,viruses ,incidence ,reactivation ,solid-organ transplant recipients ,France ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Infections with hepatitis E virus (HEV) in solid-organ transplant recipients can lead to chronic hepatitis. However, the incidence of de novo HEV infections after transplantation and risk for reactivation in patients with antibodies against HEV before transplantation are unknown. Pretransplant prevalence of these antibodies in 700 solid-organ transplant recipients at Toulouse University Hospital in France was 14.1%. We found no HEV reactivation among patients with antibodies against HEV at the first annual checkup or by measuring liver enzyme activities and HEV RNA. In contrast, we found 34 locally acquired HEV infections among patients with no antibodies against HEV, 47% of whom had a chronic infection, resulting in an incidence of 3.2/100 person-years. Independent risk factors for HEV infection were an age
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- 2011
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7. Impact of newly diagnosed prostate cancer at time of evaluation for renal transplantation
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Florence Poinard, Thomas Bessede, Benoit Barrou, Sarah Drouin, Georges Karam, Julien Branchereau, Eric Alezra, Rodolphe Thuret, Gregory Verhoest, Anna Goujon, Clementine Millet, Romain Boissier, Veronique Delaporte, Federico Sallusto, Thomas Prudhomme, Jean‐Michel Boutin, Thibaut Culty, and Marc‐Olivier Timsit
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Transplantation - Published
- 2023
8. Robotic-assisted kidney transplantation in obese recipients compared to non-obese recipients : the European experience
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Nicolas Doumerc, Jean Baptiste Beauval, Alberto Breda, Nassim Kamar, Mathieu Roumiguié, Antonio Alcaraz, Mireia Musquera, Selcuk Sahin, Volkan Tugcu, Paolo Fornara, Marine Lesourd, Thomas Prudhomme, L. Gausa, Sergio Serni, Karel Decaestecker, Nasreldin Mohammed, Angelo Territo, Arnaud Del Bello, Martin Janssen, Graziano Vignolini, Riccardo Campi, Federico Sallusto, and Michael Stöckle
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Nephrology ,Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Robotic assisted ,Urology ,030232 urology & nephrology ,Renal function ,Overweight ,Kidney transplantation ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Robotic Surgical Procedures ,Internal medicine ,medicine ,Humans ,Robotic surgery ,Obesity ,Retrospective Studies ,business.industry ,nutritional and metabolic diseases ,Retrospective cohort study ,Robot-assisted kidney transplantation ,Middle Aged ,medicine.disease ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,business ,Obese patients ,Vascular anastomosis - Abstract
Purpose The main objective was to compare minor (Clavien I-II) and major (Clavien >= III) intra- and postoperative complications of living donor robotic assisted kidney transplantation (RAKT) in obese (>= 30 kg/m(2)BMI), overweight (< 30/ >= 25 kg/m(2)BMI) and non-overweight recipients (< 25 kg/m(2)BMI). Methods For the present retrospective study, we reviewed the multi-institutional ERUS-RAKT database to select consecutive living donor RAKT recipients. Functional outcomes, intra- and postoperative complications were compared between obese, overweight and non-overweight recipients. Results 169 living donor RAKTs were performed, by 10 surgeons, from July 2015 to September 2018 in the 8 European centers. 32 (18.9%) recipients were obese, 66 (39.1%) were overweight and 71 (42.0%) were non-overweight. Mean follow-up was 1.2 years. There were no major intra-operative complications in either study group. Conversion to open surgery occurred in 1 obese recipient, in 2 overweight recipients and no conversion occurred in non-overweight recipients (p = 0.3). Minor and major postoperative complications rates were similar in the 3 groups. At one-year of follow-up, median eGFR was similar in all groups [54 (45-60) versus 57 (46-70) versus 63 (49-78) ml/min/1.73 m(2)in obese, overweight and non-overweight recipient groups, respectively,p = 0.5]. Delayed graft function rate was similar in the 3 groups. Only the number of arteries was an independent predictive factor of suboptimal renal function at post-operative day 30 in the multivariate analysis. Conclusion RAKT in obese recipients is safe, compared to non-overweight recipients and yields very good function, when it performed at high-volume referral centers by highly trained transplant teams.
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- 2022
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9. Updated National Study of Functional Graft Renal Cell Carcinomas: Are They a Different Entity?
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Nicolas Szabla, Xavier Matillon, Jehanne Calves, Julien Branchereau, Cécile Champy, Yann Neuzillet, Thomas Bessede, Sébastien Bouhié, Jean-Marie Boutin, Kevin Caillet, Noelle Cognard, Thibaut Culty, Guillaume De Fortescu, Sarah Drouin, Imad Bentellis, Jacques Hubert, Romain Boissier, Federico Sallusto, Cédric Sénéchal, Nicolas Terrier, Rodolphe Thuret, Gregory Verhoest, Thibaut Waeckel, and Xavier Tillou
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Urology - Abstract
To analyze de novo graft carcinoma characteristics from our updated national multicentric retrospective cohort.Thirty-two transplant centers have retrospectively completed the database. This database concerns all kidney graft tumors including urothelial, and others type but excludes renal lymphomas over 31 years.One hundred and fifty twokidney graft carcinomas were diagnosed in functional grafts. Among them 130 tumors were Renal Cell Carcinomas. The calculated incidence was 0.18%. Median age of the allograft at diagnosis was 45.4 years old. The median time between transplantation and diagnosis was 147.1 months. 60 tumors were papillary carcinomas and 64 were clear cell carcinomas. Median tumor size was 25 mm. 18, 64, 21 and 1 tumors were respectively Fuhrman grade 1, 2, 3 and 4. Nephron sparing surgery (NSS) was performed on 68 (52.3%) recipients. Ablative therapy was performed in 23 cases (17.7%). Specific survival rate was 96.8%.This study confirmed that renal graft carcinomas are a different entity: with a younger age of diagnosis; a lower stage at diagnosis; a higher incidence of papillary subtypes.
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- 2022
10. Extracción y trasplante renal en el donante vivo por laparoscopia asistida por robot
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M Roumiguié, N. Doumerc, Thomas Prudhomme, and Federico Sallusto
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03 medical and health sciences ,0302 clinical medicine ,030232 urology & nephrology ,030230 surgery - Abstract
Resumen El trasplante renal con donante vivo se considera el mejor tratamiento de la insuficiencia renal cronica. La supervivencia de los trasplantes procedentes de un donante vivo es significativamente mejor que la de los trasplantes realizados a partir de un donante cadaver. En 2009, Giulianotti et al realizaron el primer trasplante renal laparoscopico asistido por robot en Chicago. Despues, varios centros han desarrollado esta tecnica proponiendo diferentes vias de acceso (vaginal, supraumbilical), ademas de dirigirse a una poblacion de receptores obesos (indice de masa corporal mayor de 30 kg/m2), pacientes que tienen complicaciones postoperatorias con mas frecuencia. En este articulo, se describe la extraccion renal por laparoscopia asistida por robot, asi como la tecnica estandarizada de trasplante renal por laparoscopia asistida por robot. En una epoca en la que la cirugia asistida por robot, gracias a la tecnologia EndoWrist y a la vision tridimensional (3D) ha demostrado sus ventajas en muchas intervenciones quirurgicas, el desarrollo del trasplante renal laparoscopico asistido por robot permite disminuir las complicaciones postoperatorias, en particular parietales, a la vez que garantiza unos resultados funcionales comparables a los de la via abierta.
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- 2020
11. Benign Prostatic Hyperplasia Endoscopic Surgical Procedures in Kidney Transplant Recipients: A Comparison Between Holmium Laser Enucleation of the Prostate, GreenLight Photoselective Vaporization of the Prostate, and Transurethral Resection of the Prostate
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Jérôme Rigaud, P.M. Patard, T. Marquette, Julien Branchereau, Grégoire Robert, P. Glemain, Federico Sallusto, Clément Michiels, Michel Soulié, Morgane Pere, Georges Karam, Pascal Rischmann, Xavier Gamé, Gilles Blancho, Thomas Prudhomme, and Nassim Kamar
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Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Enucleation ,Prostatic Hyperplasia ,030232 urology & nephrology ,Holmium laser ,Pilot Projects ,Lasers, Solid-State ,Holmium ,03 medical and health sciences ,0302 clinical medicine ,Prostate ,medicine ,Humans ,Postoperative Period ,Kidney transplantation ,Aged ,Retrospective Studies ,Transurethral resection of the prostate ,Prostatectomy ,business.industry ,Transurethral Resection of Prostate ,Endoscopy ,Middle Aged ,Prostate-Specific Antigen ,Urinary Retention ,Surgical procedures ,Hyperplasia ,medicine.disease ,Kidney Transplantation ,Transplant Recipients ,humanities ,Treatment Outcome ,medicine.anatomical_structure ,Creatinine ,030220 oncology & carcinogenesis ,Kallikreins ,Photoselective vaporization ,France ,Laser Therapy ,Volatilization ,business ,Immunosuppressive Agents ,Follow-Up Studies - Abstract
Purpose: The main objective of this multicentric retrospective pilot study was to evaluate the 1-year follow-up safety (i.e., minor [Clavien–Dindo I–II] and major [Clavien–Dindo ≥III] complications...
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- 2020
12. Kidney transplantation during the COVID‐19 pandemic: Potential long‐term consequences of an early post‐transplant infection
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Audrey Delas, L. Esposito, Nicolas Doumerc, Federico Sallusto, Olivier Marion, Arnaud Del Bello, Nassim Kamar, CHU Toulouse [Toulouse], Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital de Rangueil, Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM)
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living-donor kidney transplantation ,safety ,Pediatrics ,medicine.medical_specialty ,MESH: Pandemics ,Coronavirus disease 2019 (COVID-19) ,Disease ,030230 surgery ,medicine.disease_cause ,Organ transplantation ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Pandemic ,MESH: COVID-19 ,Medicine ,MESH: SARS-CoV-2 ,Kidney transplantation ,Coronavirus ,Transplantation ,MESH: Humans ,business.industry ,organ transplantation ,nosocomial transmission ,Outbreak ,COVID-19 ,MESH: Kidney Transplantation* / adverse effects ,medicine.disease ,3. Good health ,Infectious Diseases ,surgical procedures, operative ,030211 gastroenterology & hepatology ,MESH: Postoperative Complications / epidemiology ,business - Abstract
International audience; Recently, Akalin et al.1 reported a 28% mortality among kidney‐transplant patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2). Two of the 10 patients who died had been transplanted within the previous 5 weeks. During the coronavirus disease (COVID)‐19 outbreak, kidney transplant programs were suspended in several countries2. Although the pandemic is still ongoing, the stop of lockdown has prompted several transplant centers to restart kidney transplantation programs. It is recommended to consider that donors and recipients are screened for SARS‐CoV‐2 before transplantation by means of nuclear acid tests with or without chest CT scans.
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- 2021
13. ABO-Incompatible Robotic-Assisted Kidney Transplantation in the Obese Recipient
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Nassim Kamar, Thomas Prudhomme, Marine Lesourd, Arnaud Del Bello, Nicolas Doumerc, and Federico Sallusto
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medicine.medical_specialty ,Blood transfusion ,medicine.medical_treatment ,lcsh:Surgery ,Single Center ,03 medical and health sciences ,desensitization protocols ,0302 clinical medicine ,delayed graft function ,ABO blood group system ,medicine ,Kidney transplantation ,Original Research ,Kidney ,business.industry ,robotic-assisted kidney transplantation ,Retrospective cohort study ,open kidney transplantation ,lcsh:RD1-811 ,medicine.disease ,Surgery ,Transplantation ,medicine.anatomical_structure ,ABO-incompatible ,030220 oncology & carcinogenesis ,Complication ,business ,030217 neurology & neurosurgery - Abstract
Objective: The objective of this preliminary study was to report and compare the peri-operative and functional results of ABO-incompatible (ABOi) living-donor robotic-assisted kidney transplantation (RAKT), ABO-compatible (ABOc) living-donor RAKT, and ABOi living-donor open kidney transplantation (OKT). Materials and Methods: For the present retrospective study, we analyzed data of consecutive patients who underwent ABOi or ABOc-RAKT and ABOi-OKT, from January 2015 to December 2019, in one French academic center. Patients' baseline characteristics, operative, and functional outcomes were compared between ABOi-RAKT, ABOc-RAKT, and ABOi-OKT. Results: 29 RAKT, including 7 ABOi-RAKT, and 56 ABOi-OKT were performed in our center. Median follow-up was 2.0 years. Median recipient age, pre-emptive kidney transplantation rate, sex ratio and desensitization procedures were similar in ABOi-RAKT, ABOc-RAKT, and ABOi-OKT groups. Recipient BMI at transplantation was statistically higher in ABOi and ABOc-RAKT groups compared to ABOi-OKT. The surgical site complication (principally infection-related) rate was lower in ABOi-RAKT, without statistical differences (0 vs. 8.9%, respectively, in ABOi-RAKT and ABOi-OKT, p = 0.7). The delayed graft function rate was 0% in ABOi-RAKT, 13.6% in ABOc-RAKT, and 10.7% in ABOi-OKT (p = 0.6). The post-transplantation blood transfusion rate was statistically higher in the ABOi-OKT group (14.3 vs. 13.6 vs. 57.1% in ABOi-RAKT, ABOc-RAKT, and ABOi-OKT, respectively, p = 0.001). The kidney graft survival at 1 month and at last follow-up was not different between ABOi-RAKT and ABOi-OKT. Conclusion: Our data support the use of ABOi-RAKT to restore accessibility to kidney transplantation for obese patients to the greatest extent possible. Large series are required to confirm these encouraging data from a single center.
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- 2020
14. MP52-14 ROBOT-ASSISTED KIDNEY TRANSPLANTATION IN THE OBESE: UPDATE OF A MONOCENTRIC STUDY WITH 28 PATIENTS
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Nicolas Doumerc, Lesourd Marine, Michel Soulié, Mathieu Roumiguié, Nassim Kamar, Jean Baptiste Beauval, Pascal Rischmann, Xavier Gamé, and Federico Sallusto
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medicine.medical_specialty ,business.industry ,Urology ,Medicine ,Robot ,business ,medicine.disease ,Kidney transplantation ,Surgery - Published
- 2020
15. Living-donor kidney transplantation: comparison of sequential and simultaneous surgical organizations
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Nicolas Doumerc, Julien Branchereau, Mathieu Roumiguié, Georges Karam, François Iborra, Michel Soulié, Delphine Kervella, L. Broudeur, B. Mesnard, Shruti Mittal, Federico Sallusto, Rodolphe Thuret, Gilles Blancho, M. Binhazzaa, Thibaut Benoit, Xavier Gamé, Nassim Kamar, Thomas Prudhomme, Le Bihan, Sylvie, Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Nuffield Department of Surgical Sciences, University of Oxford, National Institute for Health Research (NHS), Département d'Urologie et de Transplantation Rénale [CHU Montpellier], Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], and University of Oxford [Oxford]
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Nephrology ,Male ,medicine.medical_specialty ,Multivariate analysis ,Time Factors ,Urology ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,030232 urology & nephrology ,Living-donor kidney transplantation ,030204 cardiovascular system & hematology ,Living donor ,Nephrectomy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Living Donors ,Humans ,Kidney transplantation ,Retrospective Studies ,Kidney ,Univariate analysis ,business.industry ,Cold Ischemia ,Delayed graft function ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Delayed Graft Function ,Sequential ,3. Good health ,[SDV] Life Sciences [q-bio] ,medicine.anatomical_structure ,Female ,business ,Simultaneous - Abstract
International audience; PURPOSE: The objective of this study was to compare living-donor kidney transplantation (LDKT) performed either sequentially, in one operating room, leading to extended cold ischemia time (CIT) or simultaneously, in two different operating room, with shorter CIT.METHODS: We retrospectively included all living-donor nephrectomies and kidney transplantations, performed from March 2010 to March 2014, in three French university centers. In the first one (C1), LDKTs were performed in sequential manner (Sequential group) and in C2 and C3, LDKTs were performed in simultaneous manner (Simultaneous group).RESULTS: A total of 324 LDKT were performed: 176 LDKT in Sequential group and 148 LDKT in Simultaneous group. Patients characteristics were equivalent between groups, except nephrectomy side, ABO mismatch rate and previous kidney transplantation rate. CIT, rewarming time, transfusion and delayed graft function (DGF) were significantly higher in Sequential group. Overall survival and graft survival of kidney transplant recipients were similar in the Sequential and Simultaneous groups. 5-year eGFR was similar between groups. In univariate analysis, number of graft arteries, recipient BMI, previous kidney transplantation status and CIT were significant predictors of DGF. Only previous kidney transplantation status was an independent predictive factor of DGF in the multivariate analysis.CONCLUSIONS: Sequential surgical organization results in the same functional results as simultaneous surgical organization. DGF was higher for LDKT performed sequentially but at 5-year overall survival, graft survival and eGFR were similar between these two types of transplant organizations.
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- 2020
16. Outcomes of solid organ transplant recipients with invasive aspergillosis and other mold infections
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Laurence Lavayssière, Cédric Farges, Federico Sallusto, Joelle Guitard, Eléna Charpentier, Fabrice Muscari, Nassim Kamar, Xavier Iriart, Marie-Béatrice Nogier, Shérazade Lakhdar-Ghazal, Laure Esposito, M. Murris, Camille Dambrin, Arnaud Del Bello, Sophie Cassaing, Olivier Cointault, L. Porte, Anne-Laure Hebral, Stanislas Faguer, Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation, CHU Toulouse [Toulouse]-Hôpital de Rangueil, Service de pneumologie [Toulouse], CHU Toulouse [Toulouse]-Hôpital Larrey [Toulouse], Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service d'Urologie - Transplantation Rénale - Andrologie, Hôpital de Rangueil, Service des maladies infectieuses et tropicales [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Fédératif de Biologie (IFB) - Hôpital Purpan, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3)
- Subjects
Male ,medicine.medical_treatment ,Hemodynamics ,MESH: Transplant Recipients ,030230 surgery ,MESH: Female Humans ,Aspergillosis ,Logistic regression ,outcomes ,0302 clinical medicine ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Cumulative incidence ,MESH: Incidence ,solid organ transplantation ,MESH: Treatment Outcome ,Heart transplantation ,MESH: Aged ,Kidney ,MESH: Middle Aged ,Incidence ,Middle Aged ,3. Good health ,Infectious Diseases ,medicine.anatomical_structure ,Treatment Outcome ,Aspergillus ,non-Aspergillus molds ,030211 gastroenterology & hepatology ,Female ,MESH: Invasive Fungal Infections / mortality ,medicine.medical_specialty ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Renal replacement therapy ,Aged ,Retrospective Studies ,Mechanical ventilation ,Transplantation ,invasive aspergillosis ,business.industry ,MESH: Retrospective Studies ,Organ Transplantation ,medicine.disease ,Transplant Recipients ,MESH: Male ,MESH: Aspergillosis / epidemiology ,MESH: Organ Transplantation ,MESH: Invasive Fungal Infections / epidemiology ,business ,Invasive Fungal Infections - Abstract
International audience; Objectives: To characterize the clinical presentation and outcomes of invasive mold infections (IMI) in solid organ transplant (SOT) recipients.Methods: Inclusion of all SOT recipients with IMI diagnosed between 2008 and 2016 at a referral center for SOT. Univariable analyses identified factors associated with death at one year, and logistic regression models retained independent predictors.Results: Of the 1739 patients that received a SOT during this period, 68 developed IMI (invasive aspergillosis [IA] in 58). Cumulative incidence of IMI at 1 year ranged from 1.2% to 18.8% (kidney and heart transplantation, respectively). At baseline, compared with other IMI, the need for vasoactive drugs was more frequent in patients with IA. During follow-up, 35 patients (51%) were admitted to the ICU and required mechanical ventilation (n = 27), vasoactive drugs (n = 31), or renal replacement therapy (n = 31). The need for vasoactive drugs (OR 7.34; P = .003) and a positive direct examination (OR 10.1; P = .004) were independently associated with the risk of death at 1 year in patients with IA (n = 33; 57%) CONCLUSIONS: Characteristics of IMI at presentation varied according to the underlying transplanted organ and the mold species. Following IA, one-year mortality may be predicted by the need for hemodynamic support and initial fungal load
- Published
- 2019
17. Total intracorporeal robotic renal auto-transplantation: A new minimally invasive approach to preserve the kidney after major ureteral injuries
- Author
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Nicolas Doumerc, Xavier Gamé, Federico Sallusto, Jean-Baptiste Beauval, Mathieu Roumiguié, Michel Soulié, Florian Laclergerie, Clément Biscans, and P. Roulette
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,030230 surgery ,Article ,03 medical and health sciences ,0302 clinical medicine ,Blood loss ,Laparotomy ,Autotransplantation ,medicine ,Robotic surgery ,Renal auto-transplantation ,Totally intracorporeal ,Kidney transplantation ,Kidney ,business.industry ,technology, industry, and agriculture ,medicine.disease ,Surgery ,Transplantation ,surgical procedures, operative ,medicine.anatomical_structure ,business ,human activities ,Robotic arm - Abstract
Highlights • RATx is a suitable option for managing patients with major ureteric injury. • The procedure was performed via a transperitoneal approach, with the robotic assistance. • The kidney was perfused intracorporealy with a ice-cold Ringer solution. • This is the first case successfully performed as a total robotic approach outside of North America., Background Renal auto-transplantation is a suitable option for managing patients with major ureteric injury. Conventional Renal auto-transplantation is however, underutilized because of its invasiveness. Completely intra-corporeal robotic renal auto-transplantation is a suitable option to decrease the morbidity. In this case, we report the first use of total intra-corporeal robotic renal auto-transplantation outside of North America. Case report A 30-year-old woman presented with an extensive upper left ureter defect, following a high kinetic energy trauma. She underwent 2 median laparotomies, with extensive resection of small intestine, and 1 transverse laparotomy to repair a massive rupture of abdominal muscles. The procedure was performed via a transperitoneal approach, with the assistance of the da Vinci Si robot (Intuitive Surgical Inc. Sunnyvale, CA, USA). The renal auto-transplantation was conducted entirely robotically, in 2 separate stages, using a 4 robotic arm approach. Total operative time was 300 min: 150 min to harvest the kidney including adhesiolysis, 20 min to reposition the patient, and 130 min for the robot assisted kidney transplantation (RAKT). The total ischemia time was 96 min (3 min of warm ischemia, no cold ischemia, 93 min of rewarming time). The estimated blood loss was 150 mL. Conclusion To our knowledge, this is the first case successfully performed as a total robotic approach outside of North America.
- Published
- 2018
18. Long-term outcomes after ABO-incompatible kidney transplantation; a single-center French study
- Author
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Federico Sallusto, Laure Esposito, Asma Allal, Bénédicte Debiol, Nassim Kamar, Hamza Bennani Naciri, Lionel Rostaing, Zhiyar Abdulrahman, and Céline Guilbeau-Frugier
- Subjects
medicine.medical_specialty ,business.industry ,Living kidney transplantation ,030232 urology & nephrology ,030230 surgery ,medicine.disease ,Single Center ,03 medical and health sciences ,0302 clinical medicine ,Nephrology ,Internal medicine ,ABO blood group system ,Long term outcomes ,Medicine ,business ,Kidney transplantation - Abstract
Background: ABO-incompatible (ABOi) is as efficient as ABO-compatible (ABOc) kidneytransplantation in the setting of live-donation. significantly more BKV viruria in ABOi (25%) vs. 6.8% in ABOc (P = 0.03). De novo donor-specific alloantibody were detected in 13.6% ABOi and 4.5% ABOc patients (ns). Readmission rates in our department for less than two days were more frequent for ABOi conversely readmission rates for more than two days was similar across the groups.
- Published
- 2017
19. Laparoscopy for living donor left nephrectomy: Comparison of three-dimensional and two-dimensional vision
- Author
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Federico Sallusto, Mathieu Roumiguié, Jean Baptiste Beauval, Xavier Gamé, Michel Soulié, Nassim Kamar, Thomas Prudhomme, Nicolas Doumerc, Thibaut Benoit, and Marine Lesourd
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,No conversion ,030230 surgery ,Living donor ,Nephrectomy ,03 medical and health sciences ,0302 clinical medicine ,Living Donors ,Medicine ,Humans ,Warm Ischemia ,Laparoscopy ,Retrospective Studies ,Transplantation ,medicine.diagnostic_test ,business.industry ,Open surgery ,Length of Stay ,Middle Aged ,Warm ischemia ,Prognosis ,Kidney Transplantation ,Surgery ,Tissue and Organ Harvesting ,Operative time ,030211 gastroenterology & hepatology ,Female ,business ,Hospital stay ,Follow-Up Studies - Abstract
The main objective of this preliminary study was to evaluate the feasibility and safety of 3-D laparoscopic living donor left nephrectomy (LDLN). The secondary objective was to compare intraoperative and postoperative outcomes between 3-D and 2-D laparoscopic LDLN. All patients who underwent a laparoscopic LDLN from January 2015 to April 2018 in a university center were included. All surgeries were performed by three experienced surgeons. Seventy three patients were included the following: 16 underwent a 3-D laparoscopic LDLN (3-D group), and 57 underwent a 2-D laparoscopic LDLN (2-D group). Operative time and warm ischemia time (WIT) were significantly lower in the 3-D group (operative time: 80.9 ± 10.2 vs 114.1 ± 32.3 minutes in the 3-D and 2-D groups, P = .0002) (WIT: 1.7 ± 0.6 vs 2.3 ± 0.9 minutes in the 3-D and 2-D groups, P = .02). No conversion to open surgery occurred in both groups. Length of hospital stay was significantly shorter in the 3-D group. No major postoperative complications (Clavien ≥ III) occurred. One-year postoperative GFR was similar to 3-D and 2-D groups. Our preliminary study demonstrates that 3-D laparoscopic LDLN is a feasible and safe surgical procedure. Intraoperative and postoperative outcomes were similar in both 2-D and 3-D vision systems, but 3-D vision systems allow reduction in WIT and operative time.
- Published
- 2019
20. MP76-12 ROBOT-ASSISTED KIDNEY TRANSPLANTATION IN THE OBESE: RESULT AT 2 YEARS OF THE FIRST FRENCH SERIES
- Author
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Mathieu Roumiguié, Nicolas Doumerc, Pascal Rischmann, Michel Soulié, Nassim Kamar, Jean-Baptiste Beauval, Xavier Gamé, Marine Lesourd, and Federico Sallusto
- Subjects
Series (stratigraphy) ,medicine.medical_specialty ,business.industry ,Urology ,medicine ,Robot ,medicine.disease ,business ,Kidney transplantation ,Surgery - Published
- 2019
21. Successful Transplantation in ABO- and HLA-Incompatible Living Kidney Transplant Patients: A Report on 12 Cases
- Author
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Federico Sallusto, Béatrice Karam, Nicolas Congy-Jolivet, Nicolas Doumerc, Valérie Hage, Xavier Gamé, Asma Allal, Laure Esposito, Céline Guilbeau-Frugier, Bénédicte Debiol, Lionel Rostaing, and Nassim Kamar
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,Immunosuppression ,Hematology ,030230 surgery ,medicine.disease ,Gastroenterology ,Tacrolimus ,Histocompatibility ,Surgery ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Nephrology ,Internal medicine ,medicine ,Rituximab ,Plasmapheresis ,Immunoadsorption ,business ,Kidney transplantation ,medicine.drug - Abstract
Few studies have assessed the outcomes of ABOi/HLAi living-kidney transplantation. We report a single-center experience of 12 ABOi/HLAi living-kidney recipients. Twenty-seven donor-specific alloantibodies (DSAs) (1-6 per patient) were found with fluorescence intensities of 1500-15 000. Desensitization was based on IVIg, two doses of rituximab (375 mg/m2 ), tacrolimus-based (0.2 mg/kg) immunosuppression (started on day-10 pretransplant), and 11 (6-27) pretransplant apheresis sessions (plasmapheresis, specific or semi-specific immunoadsorption). By day 0, 17 of the 27 DSAs had become undetectable. After 19 (3-51) months, patient- and graft-survival rates were 100% and 91.6%, respectively. One patient had an acute humoral rejection whereas three had a chronic antibody-mediated rejection (CAMR). At the last follow-up, kidney biopsies were nearly normal in seven cases (58.3%) and renal function was excellent except for the three cases of CAMR. Four patients had a BK virus infection. We conclude that ABOi/HLAi living-kidney transplantation is a reasonable option for highly sensitized patients.
- Published
- 2016
22. Renal transplantation in obese recipients: Could robot-assisted surgery become a real alternative?
- Author
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Jean-Baptiste Beauval, Federico Sallusto, Nicolas Doumerc, Mathieu Roumiguié, M. Soulié, Pascal Rischmann, X. Gamé, M. Binhazzaa, Benjamin Pradere, and Marine Lesourd
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,Urology ,Medicine ,Robot ,business ,Surgery - Published
- 2017
23. Three-dimensional laparoscopy for living-donor nephrectomy with vaginal extraction: The first case
- Author
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Federico Sallusto, Nassim Kamar, M. Binhazzaa, Xavier Gamé, Michel Soulié, Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, and CHU Toulouse [Toulouse]
- Subjects
Living-donor ,medicine.medical_specialty ,Standard of care ,[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,Case Report ,Warm Ischemic Time ,Nephrectomy ,Living donor nephrectomy ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Laparoscopy ,ComputingMilieux_MISCELLANEOUS ,medicine.diagnostic_test ,business.industry ,3-dimensional ,Kidney donation ,3. Good health ,Surgery ,Dissection ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Vagina ,030211 gastroenterology & hepatology ,business - Abstract
Introduction Two-dimensional laparoscopy for living donor nephrectomy is the current standard of care. We report the first case of three-dimensional laparoscopy for living-donor nephrectomy with vaginal extraction. Presentation of case The procedure was performed in a 66-year-old woman donating his left kidney to her son with the HD S 3D column (Karl Storz, Tuttlingen, Germany). Preoperative computed tomography showed one left renal artery. The warm ischemic time was 2 min 20 s and the operative time was 200 min. There was no loss of blood and no intraoperative or postoperative complications. Discussion This report demonstrates the feasibility of using 3D laparoscopy which allows for a more in-depth vision, greater overall definition of planes, better accuracy of dissection and reduced operative times, for nephrectomy with vaginal extraction for kidney donation. Conclusion Three-dimensional laparoscopy for living-donor nephrectomy with vaginal extraction is feasible and could become a new standard.
- Published
- 2017
24. Robot-assisted laparoscopic partial nephrectomy with renal artery clamping using an endovascular balloon catheter for an allograft kidney tumor: A new perspective to manage renal vascular control?
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Marie-Charlotte Delchier, Michel Soulié, B. Covin, Xavier Gamé, Mathieu Roumiguié, Nassim Kamar, Florian Laclergerie, Federico Sallusto, Jean-Baptiste Beauval, and Nicolas Doumerc
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,Balloon catheter ,030230 surgery ,Nephrectomy ,Clamping ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Immunology and Allergy ,Medicine ,Pharmacology (medical) ,Renal artery ,business ,Allograft kidney - Published
- 2019
25. Interference of therapeutic antibodies used in desensitization protocols on lymphocytotoxicity crossmatch results
- Author
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David Milongo, Guillaume Vieu, Sarah Blavy, Nicolas Congy-Jolivet, Lionel Rostaing, Arnaud Del Bello, Federico Sallusto, and Nassim Kamar
- Subjects
Globulin ,Basiliximab ,Recombinant Fusion Proteins ,medicine.medical_treatment ,Immunology ,Human leukocyte antigen ,Antibodies, Monoclonal, Humanized ,ABO Blood-Group System ,HLA Antigens ,Isoantibodies ,medicine ,Animals ,Humans ,Immunology and Allergy ,Diagnostic Errors ,Complement Activation ,Antilymphocyte Serum ,Desensitization (medicine) ,Transplantation ,biology ,business.industry ,Antibody-Dependent Cell Cytotoxicity ,Antibodies, Monoclonal ,Immunoglobulins, Intravenous ,Eculizumab ,Complement system ,Blood Grouping and Crossmatching ,biology.protein ,Rituximab ,Rabbits ,Antibody ,business ,medicine.drug - Abstract
Background Therapeutic antibodies used to desensitize patients awaiting a human leukocyte antigen (HLA) or ABO-mismatched graft are suspected to interfere with the lymphocytotoxicity crossmatch (LCT-XM) test when they are present in the tested sera because of their potential ability to activate or inhibit the complement. Methods The most frequent therapeutic antibodies (Abs) used in desensitization protocols (intravenous immunoglobulins, rituximab, basiliximab, eculizumab, antithymocyte globulin) were added to a negative- or a positive-control serum at various concentrations, and tested in vitro in a LCT-XM test. Results Rituximab turned the LCT-XM positive on B cells at 0.2 μg/mL and antithymocyte globulin turned the LCT-XM positive with T and B cells at 20 μg/mL and 200 μg/mL, respectively. Treatment with dithiothreitol sera, supplemented with rituximab (0.2 and 2 μg/mL) and antithymocyte globulins (20 and 200 μg/mL), partially or totally reduced this positive interference. Intravenous immunoglobulin, eculizumab, and basiliximab did not trigger any interference with the negative control serum. In a positive LCT-XM, eculizumab did not annihilate activation of the rabbit complement. Intravenous immunoglobulins (25 g/L) could partially or totally reduced lysis score of positive crossmatch with weak lysis scores. Conclusion If eculizumab within the serum did not annihilate rabbit complement activation and basiliximab did not interfere with the crossmatch reaction, treatments based on rituximab, antithymocyte globulin and intravenous immunoglobulins need to be taken into account when interpreting a positive or negative crossmatch test.
- Published
- 2015
26. Predictive model of 1-year postoperative renal function after living donor nephrectomy
- Author
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Mathieu Roumiguié, Jean Baptiste Beauval, Michel Soulié, Bernard Malavaud, Nicolas Doumerc, Thibaut Benoit, Pascal Rischmann, Xavier Gamé, Federico Sallusto, Nassim Kamar, Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, and CHU Toulouse [Toulouse]
- Subjects
Nephrology ,Male ,Time Factors ,Databases, Factual ,[SDV]Life Sciences [q-bio] ,030232 urology & nephrology ,Kidney Function Tests ,Nephrectomy ,Cohort Studies ,0302 clinical medicine ,Postoperative Complications ,Living Donors ,030212 general & internal medicine ,Laparoscopy ,Kidney transplantation ,ComputingMilieux_MISCELLANEOUS ,education.field_of_study ,medicine.diagnostic_test ,Middle Aged ,Female ,Glomerular Filtration Rate ,Adult ,medicine.medical_specialty ,Urology ,Population ,Renal function ,Transplant Donor Site ,Living donor nephrectomy ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,Preoperative Care ,medicine ,Humans ,Internal validation ,education ,Retrospective Studies ,Receiver operating characteristic ,business.industry ,medicine.disease ,Kidney Transplantation ,Surgery ,ROC Curve ,Multivariate Analysis ,Linear Models ,Kidney Failure, Chronic ,business ,Follow-Up Studies - Abstract
Kidney transplantation from a living donor nephrectomy (LDN) is the best treatment for end-stage renal disease, but decrease in donor renal function is often revealed. The aim of this study was to evaluate the association between preoperative factors and postoperative estimated glomerular filtration rate (eGFR) and test a predictive model to estimate postoperative eGFR, 1 year after LDN. We reviewed 226 records of consecutive patients who underwent laparoscopic live donor nephrectomy between 2006 and 2014 in a single tertiary center. Of these, complete data on 202 patients were analyzed. A training (2/3 of the whole population) and a validation set (1/3) were randomized. A multivariate regression model was used to identify predictors and a formula to estimate of 1-year postoperative eGFR in the training set, using the CKD-EPI formula. Then, the formula was subjected to internal validation using the validation set using receiver operating characteristic (ROC) curves. Two hundred and two LLDN were evaluated with a mean preoperative eGFR of 94.1 ± 15.5 ml/min/1.73 m2 and postoperative eGFR of 64.6 ± 14.5 ml/min/1.73 m2 (p
- Published
- 2017
27. Three-dimensional laparoscopy for living-donor nephrectomy
- Author
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M. Soulié, Nassim Kamar, Federico Sallusto, X. Gamé, M. Binhazzaa, Département d'urologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], and Service d'Urologie - Transplantation Rénale - Andrologie
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Urology ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Living donor ,Living donor nephrectomy ,Nephrectomy ,Surgery ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,business ,Laparoscopy ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
- Published
- 2017
28. Successful treatment of fibrosing cholestatic hepatitis with pegylated interferon, ribavirin and sofosbuvir after a combined kidney-liver transplantation
- Author
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Laurence Lavayssière, Jacques Izopet, Jean-Marie Peron, Federico Sallusto, Christophe Bureau, Lionel Rostaing, Nassim Kamar, Gaëlle Dörr, Fabrice Muscari, Marie Danjoux, and Cyrielle Delabaudière
- Subjects
Male ,medicine.medical_specialty ,Sofosbuvir ,medicine.medical_treatment ,Hepatitis C virus ,Liver transplantation ,medicine.disease_cause ,Antiviral Agents ,Gastroenterology ,Virus ,Polyethylene Glycols ,chemistry.chemical_compound ,Recurrence ,Pegylated interferon ,Internal medicine ,Ribavirin ,medicine ,Humans ,Kidney transplantation ,Aged ,Transplantation ,business.industry ,Interferon-alpha ,virus diseases ,medicine.disease ,Hepatitis C ,Kidney Transplantation ,Recombinant Proteins ,digestive system diseases ,Liver Transplantation ,Drug Combinations ,chemistry ,Uridine Monophosphate ,business ,medicine.drug - Abstract
Summary Fibrosing cholestatic hepatitis (FCH) is a classical but rare and severe form of recurrent hepatitis C virus (HCV) after liver transplantation. Classical anti-HCV therapy, that is pegylated-interferon (peg-interferon) and ribavirin, has been shown to have limited efficacy in treating FCH. Herein, we report on the first case of successful use of peg-interferon, ribavirin, plus sofosbuvir to treat HCV-induced FCH in a combined liver–kidney transplant patient. Antiviral therapy was given for 24 weeks. HCV clearance occurred within 4 weeks after starting therapy and was maintained until 4 weeks after the end of therapy. Antiviral tolerance was good. We conclude that the use of sofosbuvir-based anti-HCV therapy can be successfully used to treat FCH after a liver or combined kidney–liver transplantation.
- Published
- 2014
29. Pregnancy after kidney transplantation: outcome and anti-human leucocyte antigen alloimmunization risk
- Author
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Nassim Kamar, Isabelle Cardeau-Desangles, X. Gamé, Laurence Lavayssière, Nicolas Congy-Jolivet, David Ribes, Joelle Guitard, Lionel Rostaing, Olivier Parant, Federico Sallusto, Arnaud Del Bello, Marie Béatrice Nogier, Anne Laure Hebral, Olivier Cointault, Alain Berrebi, Laure Esposito, and Laure Connan
- Subjects
Adult ,Graft Rejection ,medicine.medical_specialty ,Adolescent ,Birth weight ,Renal function ,Tacrolimus ,Young Adult ,Pre-Eclampsia ,Glomerular Filtration Barrier ,HLA Antigens ,Pregnancy ,Humans ,Transplantation, Homologous ,Medicine ,Kidney transplantation ,Transplantation ,business.industry ,Obstetrics ,Graft Survival ,Infant, Newborn ,Pregnancy Outcome ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Pregnancy Complications ,Gestational diabetes ,Nephrology ,Kidney Failure, Chronic ,Female ,business ,Live birth ,Immunosuppressive Agents ,Kidney disease - Abstract
BACKGROUND: Kidney transplantation increases the chances for pregnancy and live birth for women with end-stage kidney disease. The aims of this study were to describe the outcomes of pregnancies in women with a kidney transplant and to evaluate the impact on anti-human leucocyte antigen (HLA) alloimmunization. METHODS: We analysed 61 pregnancies that occurred in 46 patients after having excluded 10 miscarriages during the first trimester and 10 other pregnancies from which important data were missing. Anti-HLA antibodies were screened using the Luminex assay. RESULTS: Overall, the live birth rate was 83% (94% after exclusion of miscarriages during the first trimester). Pre-eclampsia and gestational diabetes occurred in 26 and 21% of cases, respectively. The use of tacrolimus was an independent predictive factor for gestational diabetes. Twenty-four newborns (42%) were premature (
- Published
- 2014
30. Comparison of the exposure of mycophenolate mofetil and enteric-coated mycophenolate sodium in recipients of kidney-pancreas transplantation
- Author
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Isabelle Cardeau-Desangles, Nassim Kamar, Federico Sallusto, Julie Belliere, Laure Esposito, Peggy Gandia, Lionel Rostaing, Arnaud Del Bello, and Jean Pierre Duffas
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Gastroparesis ,medicine.medical_treatment ,Pancreas transplantation ,Mycophenolate ,Gastroenterology ,Mycophenolic acid ,Young Adult ,Pharmacokinetics ,Internal medicine ,medicine ,Humans ,Diabetic Nephropathies ,Kidney transplantation ,Retrospective Studies ,Transplantation ,business.industry ,Area under the curve ,Mycophenolate Sodium ,General Medicine ,Middle Aged ,Mycophenolic Acid ,medicine.disease ,Kidney Transplantation ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Female ,Pancreas Transplantation ,Tablets, Enteric-Coated ,business ,Immunosuppressive Agents ,Follow-Up Studies ,medicine.drug - Abstract
BACKGROUND Patients with a simultaneous pancreas-kidney transplant (SPKT), especially those with gastroparesis, often have gastro-intestinal (GI) disorders that can modify immunosuppressant pharmacokinetics. We compared the MPA 12-hours area under the curve (AUC(0-12)) in SKPT patients with severe gastroparesis receiving mycophenolate mofetil (MMF) or enteric-coated mycophenolate sodium (EC-MPS). MATERIAL/METHODS Fifteen SKPT patients having a severe gastroparesis were switched, at 182 (69-1523) days post-transplantation, from MMF to EC-MPS because of GI disorders. MPA AUC(0-12) values were obtained before and after the switch, ie, under MMF (500 mg b.i.d.) at 169 (51-1522) days post-transplantation and EC-MPS (360 mg b.i.d.) at 102 (26-355) days after the switch. RESULTS Mean MPA AUC(0-12) h did not differ significantly under MMF and EC-MPS, ie, 40.13±14 and 38.24±15.5 mg*h/L, respectively. Trough and maximal MPA concentrations were similar with both MPA formulations. Although all patients had GI disorders under MMF (100%), only 3 had persistent GI disorders under EC-MPS (20%) (p
- Published
- 2014
31. Robotic Kidney Transplantation for Morbidly Obese Patients Excluded from Traditional Transplantation
- Author
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Federico Sallusto, Mathieu Roumiguié, Nicolas Doumerc, M. Soulié, Nassim Kamar, Jean-Baptiste Beauval, Pascal Rischmann, Service d'Urologie - Transplantation Rénale - Andrologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, and CHU Toulouse [Toulouse]
- Subjects
medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Endocrinology, Diabetes and Metabolism ,[SDV]Life Sciences [q-bio] ,030232 urology & nephrology ,MEDLINE ,030230 surgery ,Morbidly obese ,medicine.disease ,3. Good health ,Surgery ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,business ,Kidney transplantation ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
- Published
- 2016
32. Place de la transplantectomie après échec de greffe rénale
- Author
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Lionel Rostaing, Federico Sallusto, Xavier Gamé, Nicolas Congy-Jolivet, Arnaud Del Bello, and Nassim Kamar
- Subjects
Local pain ,medicine.medical_specialty ,Kidney ,business.industry ,medicine.medical_treatment ,Immunosuppression ,medicine.disease ,Nephrectomy ,Peripheral blood ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Nephrology ,Chronic dialysis ,medicine ,business ,Prospective cohort study ,Kidney transplantation - Abstract
The number of kidney-transplant patients that return to dialysis therapy after a failed kidney allograft is increasing sharply. These patients differ from patients treated with chronic dialysis, but who have never received a transplant; i.e., former transplanted patients display a higher risk of morbidity-mortality, particularly from cardiovascular and infectious complications. The management of immunosuppression has not been codified for patients with a failed kidney allograft: immunosuppressive therapy can be either abruptly stopped or progressively reduced. In addition, nephrectomy of the failed allograft is debatable. Some advocate this procedure only when there is intolerance, e.g., gross hematuria, local pain, or unexplained inflammatory syndrome. In contrast, others propose a systematic nephrectomy, mainly to reveal anti-HLA antibodies within peripheral blood that may have been adsorbed within the failed allograft, and are not detected, even using sensitive techniques. Prospective studies are warranted to answer these issues.
- Published
- 2013
33. Systematic Kidney Biopsies After Acute Allograft Pyelonephritis
- Author
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Federico Sallusto, Céline Guilbeau-Frugier, Olivier Cointault, Claire Cartery, Joelle Guitard, Nassim Kamar, Xavier Gamé, Laure Esposito, Isabelle Cardeau-Desangles, and Lionel Rostaing
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Time Factors ,Biopsy ,Urology ,Renal function ,Kidney ,Kidney transplant ,Young Adult ,Kidney histology ,Predictive Value of Tests ,medicine ,Humans ,In patient ,Aged ,Transplantation ,Pyelonephritis ,Graft rejection ,medicine.diagnostic_test ,urogenital system ,business.industry ,Graft Survival ,Immunosuppressive regimen ,Recovery of Function ,Middle Aged ,Prognosis ,Kidney Transplantation ,surgical procedures, operative ,medicine.anatomical_structure ,Case-Control Studies ,Acute Disease ,Female ,business ,Glomerular Filtration Rate - Abstract
OBJECTIVES Scarce data exist regarding the effect of acute graft pyelonephritis on kidney histology after a kidney transplant. This study sought to assess the kidney histology at 1 month, and kidney function at 1 year, after acute graft pyelonephritis in kidney transplant patients. MATERIALS AND METHODS All kidney transplant patients with acute graft pyelonephritis between October 2006, and December 2008, underwent a kidney biopsy 1 month later (n=28). Histologic findings were compared with those observed in a control group (n=28) who underwent a protocol kidney biopsy at 1 year posttransplant and did not present with acute graft pyelonephritis. Patients were matched according to age, sex, and immunosuppressive regimen. RESULTS Kidney function was impaired by the acute graft pyelonephritis episodes at the time of biopsy. In 40% of patients, the estimated glomerular filtration rate did not return to baseline by 1 month after acute graft pyelonephritis and remained impaired thereafter. Three patients had features of acute rejection. Tubulitis was seen more frequently in the acute graft pyelonephritis group, especially in patients in whom estimated glomerular filtration rate did not completely recover by 1 month after acute graft pyelonephritis. Patients with acute graft pyelonephritis who had inflammatory infiltrate of > 20% 1 month after acute graft pyelonephritis had worse kidney function 1 year later. CONCLUSIONS After transplant, when kidney function remains impaired 1 month after acute graft pyelonephritis, kidney biopsies allowed graft rejection diagnosis and predicted kidney function recovery.
- Published
- 2013
34. Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates
- Author
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Nicolas Doumerc, Lionel Rostaing, Asma Allal, Nassim Kamar, Laure Esposito, Xavier Gamé, Bénédicte Debiol, Arnaud Del Bello, Federico Sallusto, and Audrey Delas
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Urology ,Glycosorb® ,030230 surgery ,Large plasma volumes ,Mycophenolic acid ,03 medical and health sciences ,0302 clinical medicine ,ABO-incompatible kidney transplantation ,ABO blood group system ,medicine ,Immunoadsorption ,business.industry ,Specific immunoadsorption ,Immunosuppression ,Tacrolimus ,Surgery ,Transplantation ,Nephrology ,Rituximab ,Original Article ,Hemodialysis ,business ,medicine.drug - Abstract
Background: ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression. Objectives: To assess the efficacy of a single, pretransplant (Day –1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L). Patients and Methods: Prospective single-center study evaluating 12 consecutive patients (6 males), aged 40 (23–59) years. Incompatibilities were A into 0 (8), B into 0 (3), and AB into 0 (1). Pretransplant desensitization relied on rituximab (D–30), tacrolimus, mycophenolic acid, and steroids (all started on D–13), and a single session of specific immunoadsorption on D–1. Immunoadsorption was coupled in tandem with a hemodialysis session. Results: Overall, 15 L (11–18) of plasma were treated per patient, i.e., 0.2 (0.11–0.36 L/kg). Isoagglutinin titers were 1/16 (1/5–1/64) before the procedure, decreasing after 6 hours to 1/5 (1/1–1/16 P = 0.008), and to 1/2 (1/1–1/8; P = 0.05) at completion of the session. The next day, i.e., the day of transplantation, there was no rebound of isoagglutinins [1/4 (1/1–1/5); P = ns]. The procedure was well tolerated with no side-effects and no significant changes in hemoglobin level, platelet counts, fibrinogen, or albumin levels. Conclusions: For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound. These results should be confirmed when isoagglutinin titers are higher (≥120).
- Published
- 2016
35. Allelic and Epitopic Characterization of Intra-Kidney Allograft Anti-HLA Antibodies at Allograft Nephrectomy
- Author
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David Milongo, Gaëlle Dörr, L. Esposito, Antoine Blancher, Nicolas Congy-Jolivet, Nassim Kamar, Federico Sallusto, A. Del Bello, and Céline Guilbeau-Frugier
- Subjects
Adult ,Graft Rejection ,Male ,Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,030230 surgery ,Nephrectomy ,Epitope ,Isoantibodies ,03 medical and health sciences ,Epitopes ,0302 clinical medicine ,Antigen ,HLA Antigens ,medicine ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,Kidney transplantation ,Alleles ,Transplantation ,Kidney ,biology ,business.industry ,Graft Survival ,medicine.disease ,Allografts ,Kidney Transplantation ,Tissue Donors ,Histocompatibility ,surgical procedures, operative ,medicine.anatomical_structure ,Immunology ,biology.protein ,Female ,Antibody ,business - Abstract
The reasons for the increased incidence of de novo anti-human leukocyte antibody (HLA) donor-specific antibodies (DSAs) observed after kidney allograft nephrectomy are not fully understood. One advocated mechanism suggests that at graft loss, DSAs are not detected in the serum because they are fixed on the nonfunctional transplant; removal of the kidney allows DSAs to then appear in the blood circulation. The aim of our study was to compare anti-HLA antibodies present in the serum and in the graft at the time of an allograft nephrectomy. Using solid-phase assays, anti-HLA antibodies were searched for in the sera of 17 kidney transplant patients undergoing allograft nephrectomy. No anti-HLA antibodies were detected in the graft if they were not also detected in the serum. Eleven of the 12 patients who had DSAs detected in their sera also had DSAs detected in the grafts. Epitopic analysis revealed that most anti-HLA antibodies detected in removed grafts were directed against the donor. In summary, our data show that all anti-HLA antibodies that were detected in grafts were also detected in the sera. These intragraft anti-HLA antibodies are mostly directed against the donor at an epitopic level but not always at an antigenic level.
- Published
- 2016
36. Donor-Specific Antibodies after Ceasing Immunosuppressive Therapy, with or without an Allograft Nephrectomy
- Author
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Laure Esposito, Laurence Lavayssière, Isabelle Cardeau-Desangles, Olivier Cointault, Lionel Rostaing, Marylise Fort, Nicolas Congy-Jolivet, Federico Sallusto, Arnaud Del Bello, Antoine Blancher, Joelle Guitard, Nassim Kamar, Marie Béatrice Nogier, and Céline Guilbeau-Frugier
- Subjects
Adult ,Reoperation ,Graft Rejection ,Male ,medicine.medical_specialty ,Time Factors ,Epidemiology ,Biopsy ,medicine.medical_treatment ,Urology ,Histocompatibility Testing ,Human leukocyte antigen ,Critical Care and Intensive Care Medicine ,Risk Assessment ,Nephrectomy ,Drug Administration Schedule ,Isoantibodies ,Young Adult ,Risk Factors ,HLA Antigens ,Humans ,Medicine ,Kidney transplantation ,Transplantation ,Kidney ,medicine.diagnostic_test ,business.industry ,Graft Survival ,Original Articles ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Histocompatibility ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Nephrology ,Multivariate Analysis ,Female ,France ,business ,Immunosuppressive Agents - Abstract
Within the last few years, anti-human leukocyte antigen detection assays have significantly improved. This study asked, using the Luminex single-antigen assay, whether an allograft nephrectomy allowed donor-specific alloantibodies to appear that were not previously detected in the serum when the failed kidney was still in place.After losing the kidney allograft and stopping immunosuppressive therapy, the proportions of donor-specific alloantibodies and nondonor-specific alloantibodies were compared in patients who had (n=48; group I) and had not (n=21; group II) undergone an allograft nephrectomy. Allograft nephrectomies were performed at 150 days after kidney allograft loss, and the time between allograft nephrectomy and last follow-up was 538 ± 347 days.At kidney allograft loss, donor-specific alloantibodies were detected in three group II patients (14.2%) and six group I patients (12.5%). At last follow-up, donor-specific alloantibodies were detected in 11 patients (52.4%) without and 39 patients (81%) with an allograft nephrectomy (P=0.02). Anti-human leukocyte antigen class I donor-specific alloantibodies were positive in 23.8% of group II and 77% of group I patients (P0.001); anti-human leukocyte antigen class II donor-specific alloantibodies were positive in 42.8% of group II and 62.5% of group I patients. Independent predictive factors for developing donor-specific alloantibodies after losing kidney allograft and stopping immunosuppressants were number of anti-human leukocyte antigen A/B mismatches at transplantation (zero versus one or more) and allograft nephrectomy.The development of donor-specific alloantibodies was significantly greater in patients with a failed kidney who had undergone an allograft nephrectomy compared with those patients who had not undergone allograft nephrectomy.
- Published
- 2012
37. Early post-transplant complications following ABO-incompatible kidney transplantation
- Author
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Lionel Rostaing, Nicolas Doumerc, Xavier Gamé, Laure Esposito, Asma Allal, Bénédicte Debiol, Hamza Naciri Bennani, Nassim Kamar, Federico Sallusto, Zhyiar Abdulrahman, and Antoine Delarche
- Subjects
Prothrombin time ,medicine.medical_specialty ,Blood transfusion ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Surgical complications ,Bleeding ,Fibrinogen ,Retrospective cohort study ,Bleed ,medicine.disease ,Surgery ,Transplantation ,Kidney transplantation ,surgical procedures, operative ,BK virus ,Nephrology ,ABO blood group system ,Cohort ,medicine ,Original Article ,business - Abstract
Background: Living-kidney transplantation is increasing because of the scarcity of kidneys from deceased donors and the increasing numbers of patients on waiting lists for a kidney transplant. Living-kidney transplantation is now associated with increased long-term patient- and allograft-survival rates. Objectives: The purpose of this retrospective study was to identify, in a cohort of 44 ABO-incompatible (ABOi) live-kidney transplant patients, the main complications that occurred within 6 months post-transplantation, and to compare these findings with those from 44 matched ABO-compatible (ABOc) live-kidney transplant patients who were also from our center. Patients and Methods: This single-center retrospective study assessed post-transplantation complications in 44 ABO-i versus 44 matched ABO-c patients. All patients were comparable at baseline except that ABO-i patients had greater immunological risks. Results: During the 6-month post-transplant period, more ABO-i patients presented with postoperative bleeds, thus requiring significantly more blood transfusions. Bleeds were associated with significantly lower values of fibrinogen, platelets, prothrombin time, and hemoglobin levels. Surgical complications, patient- and graft-survival rates, and kidney-function statuses were similar between both groups at 6 months post-transplantation. Conclusions: We conclude that impairment of hemostatic factors at pre-transplant explained the increased risk of a post-transplant bleed in ABO-i patients.
- Published
- 2015
38. Prostatectomie laparoscopique robot-assistée : une technique d’aide opératoire et une instrumentation standardisées
- Author
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Bernard Malavaud, Mathieu Roumiguié, Nicolas Doumerc, Federico Sallusto, Phillip D. Stricker, B. Bordier, Pascal Rischmann, Xavier Gamé, and Nicolas Mingat
- Subjects
Urology - Abstract
Resume L’introduction de la robotique dans une equipe chirurgicale ne peut se concevoir qu’au mieux comme un projet d’equipe ambitieux a meme d’assurer le transfert et l’integration d’une expertise acquise dans un centre de reference. Nous presentons dans cet article les roles de l’assistant et de l’instrumentiste lors de la prostatectomie totale laparoscopique robot-assistee. La technique chirurgicale que nous utilisons est directement inspiree de VR. Patel. Ses principales particularites sont la conservation retrograde des bandelettes neurovasculaires, le point de suspension uretral et la reconstruction du plan posterieur. Nous insisterons particulierement sur le role de l’assistant et de l’instrumentiste, en sachant que leur performance a des repercussions directes sur celle du chirurgien a sa console. Une technique inspiree de centres de reference, standardisee a la fois pour l’operateur et son assistant, est indispensable a la mise en place d’un programme de robotique sur et ambitieux.
- Published
- 2011
39. Anurie par obstacle de la voie excrétrice
- Author
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Federico Sallusto, G Fournier, Charles Deruelle, A Valeri, and V Joulin
- Subjects
business.industry ,Medicine ,business - Published
- 2011
40. Anuria por obstáculo en la vía excretora
- Author
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A Valeri, Georges Fournier, Charles Deruelle, Vincent Joulin, and Federico Sallusto
- Subjects
General Medicine - Abstract
La anuria por obstaculo en la via excretora se define como la detencion total o casi total de la diuresis con vejiga vacia, causada por una obstruccion a cualquier nivel de la via excretora superior, incluidos los meatos ureterales. Para provocar una anuria, el obstaculo debe ser bilateral o situarse del lado de un rinon anatomica o funcionalmente unico. Se trata de una urgencia urologica, puesto que la anuria obstructiva lleva a una insuficiencia renal aguda con riesgo para la vida del paciente. Cuando existe anuria, se empieza por descartar un origen obstructivo. En la mayoria de los casos se consigue diagnosticar la obstruccion mediante la ecografia del aparato urinario. Las causas mas frecuentes son las litiasis, las neoplasias y la fibrosis retroperitoneal. El tratamiento de las anurias obstructivas consta de tres etapas, segun el grado de urgencia: el tratamiento de los trastornos metabolicos provocados por la insuficiencia renal aguda, el drenaje de la via excretora obstruida y el tratamiento de la causa del obstaculo.
- Published
- 2011
41. Characteristics of Autochthonous Hepatitis E Virus Infection in Solid‐Organ Transplant Recipients in France
- Author
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Federico Sallusto, Jacques Izopet, Lionel Rostaing, Martine Dubois, Fabrice Muscari, Jean-Michel Mansuy, Karine Sandres-Sauné, Florence Legrand-Abravanel, Cyril Garrouste, and Nassim Kamar
- Subjects
medicine.medical_specialty ,education.field_of_study ,viruses ,Population ,virus diseases ,Biology ,Chronic liver disease ,medicine.disease ,Hepatitis E ,medicine.disease_cause ,Virus ,Serology ,Chronic infection ,Infectious Diseases ,Hepatitis E virus ,Internal medicine ,Immunology ,medicine ,Immunology and Allergy ,Viral disease ,education - Abstract
Background. Hepatitis E virus (HEV) infections can lead to chronic hepatitis in immunocompromised patients. We have investigated the risk factors for HEV infection among solid-organ transplant recipients and the characteristics of these infections. Methods. We performed serological tests, quantified the virus, and genotyped the virus in plasma samples. We performed a case-control study with HEV-infected patients and control participants matched for sex and age who were recruited from a population of solid-organ transplant recipients with no markers of HEV infection. Results. We investigated 38 consecutive cases of HEV genotype 3 infection. Twenty-two (58%) of these 38 patients developed a chronic infection. The acute-phase aminotransferase levels were higher in the patients who cleared the virus than in those who developed chronic infections. The anti-HEV immunoglobulin G and immunoglobulin M profiles and HEV RNA concentration in patients who cleared the virus were similar to those in patients who developed a chronic infection. A logistic regression analysis of 37 case patients and 148 control participants indicated that the only factor independently associated with HEV infection was the consumption of game meat (68% of case patients vs 47% of control participants; odds ratio, 2.32; 95% confidence interval, 1.04-5.15). Conclusion. Immunocompromised patients should avoid eating insufficiently cooked game meat or pork products so as to reduce the risk of HEV infection and chronic liver disease.
- Published
- 2010
42. HLA Class I Antibodies Provoke Graft Arteriosclerosis in Human Arteries Transplanted into SCID/Beige Mice
- Author
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Nassim Kamar, Lionel Rostaing, Sylvain Galvani, Mogens Thomsen, Jean-Claude Thiers, Y. Zou, Torsten Böhler, Michel Abbal, P. Stastny, Anne Nègre-Salvayre, Nathalie Augé, Cindy Canivet, Robert Salvayre, Federico Sallusto, Denis Calise, Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Néphrologie et Transplantation d'organes [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service Médecine Interne et immunologie clinique [CHU Toulouse], Pôle Maladies de l'appareil digestif [CHU Toulouse], University of Texas Southwestern Medical Center [Dallas], Simon, Marie Francoise, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Faculté de Médecine [Rangueil], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse], Department of Multiorgan Transplantation, CHU Toulouse [Toulouse], and Department of Clinical Immunology
- Subjects
Graft Rejection ,Cellular immunity ,Arteriosclerosis ,[SDV]Life Sciences [q-bio] ,MESH: Mesenteric Arteries ,Mice, SCID ,030230 surgery ,Muscle, Smooth, Vascular ,MESH: Histocompatibility Antigens Class I ,Mice ,0302 clinical medicine ,Immunology and Allergy ,MESH: Animals ,Pharmacology (medical) ,MESH: Mice, SCID ,Mesenteric arteries ,ComputingMilieux_MISCELLANEOUS ,biology ,MESH: Muscle, Smooth, Vascular ,Mesenteric Arteries ,3. Good health ,medicine.anatomical_structure ,MESH: Cell Division ,Antibody ,Cell Division ,Blood vessel ,medicine.drug_class ,Transplantation, Heterologous ,Antibodies, Heterophile ,MESH: Graft Rejection ,Human leukocyte antigen ,Monoclonal antibody ,03 medical and health sciences ,medicine ,Animals ,Humans ,MESH: Transplantation, Heterologous ,MESH: Mice ,Transplantation ,MESH: Humans ,business.industry ,Histocompatibility Antigens Class I ,MESH: Tunica Intima ,medicine.disease ,MESH: Arteriosclerosis ,Immunology ,biology.protein ,Tunica Intima ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,MESH: Antibodies, Heterophile ,030215 immunology - Abstract
International audience; Antibodies toward HLA class I and/or MICA are commonly observed in transplanted patients suffering from allograft arteriosclerosis, also called chronic vascular rejection (CVR). The relative importance of cellular versus humoral alloreactivity for CVR is still disputed. We demonstrate that antibodies toward HLA class I provoke lesions typical for CVR in human arteries in vivo in the absence of cellular immunity. To show this, we grafted segments of human mesenteric arteries from 8 deceased organ donors into 36 immunodeficient SCID/beige mice in the infrarenal aortic position. Three mice died postoperatively. The remaining 33 mice received weekly i.v. injections of either a monoclonal antibody toward HLA class I, toward MICA or an irrelevant monoclonal antibody. At sacrifice after 6 weeks, mice receiving the HLA antibody showed a significant neointimal thickening in the grafted artery due to smooth muscle cell (SMC) proliferation while control mice receiving anti-MICA or irrelevant antibody showed little or no thickening. Whereas antibodies toward HLA class I were mitogenic to SMC in vitro, those directed toward MICA did not have any effect. Humoral alloreactivity toward HLA may thus play a causal role for the development of CVR and this opens new possibilities for the treatment of CVR.
- Published
- 2009
43. Alpha-interferon therapy for chronic hepatitis C may induce acute allograft rejection in kidney transplant patients with failed allografts
- Author
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Jacques Izopet, Mehrenberger M, Céline Guilbeau-Frugier, Federico Sallusto, Anne Modesto, Lionel Rostaing, Hugo Wéclawiack, David Ribes, and Nassim Kamar
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hepatitis C virus ,Alpha interferon ,Kidney ,medicine.disease_cause ,Antiviral Agents ,Gastroenterology ,Renal Dialysis ,Risk Factors ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Interferon alfa ,Kidney transplantation ,Transplantation ,business.industry ,Interferon-alpha ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Surgery ,Transplant rejection ,Nephrology ,Kidney Diseases ,Hemodialysis ,business ,Kidney disease ,medicine.drug - Abstract
BACKGROUND In hepatitis C virus (HCV) positive kidney transplant (KT) patients, the use of alpha-interferon (alphaIFN) is contraindicated due to the risk of acute rejection (AR). Conversely, if these HCV(+) KT patients lose their allograft, re-transplantation might be contemplated provided alphaIFN therapy has been attempted. METHODS Between 01/01/1989 and 31/12/1994, 261 kidney transplantations were performed; of these 174 were HCV(-) (group I) and 87 were HCV(+) (group II). RESULTS At last follow-up (2006), in group I, the number of patients with a functioning graft, the number of patients who died with a functioning graft, and the number of patients who lost their graft before or after month (M) 12 were 92 (52.8%), 14 (8%), 20 (11.5%) and 48 (27.7%), respectively. In group II, the corresponding figures were 22 (25.3%; P < 0.0001), 8 (9.1%; ns), 9 (10.3%; ns) and 48 (55.3%; P < 0.0001). In group I, 19 of 48 (39.5%) patients with failed allografts after M12 underwent transplantectomy (TX) compared to 14 of 48 (29%; ns) in group II. In group II, 11 of 48 (23%) patients were offered alphaIFN therapy after their allograft failed: of these, four (36.3%) developed AR during alphaIFN therapy leading to TX. Histology, in addition to chronic allograft lesions, showed acute cellular and vascular lesions. In patients who were not offered alphaIFN therapy, TX was performed less frequently, i.e. in only six cases (16.2%). CONCLUSIONS We conclude that even alphaIFN-treated KT patients with a failed allograft can experience acute allograft rejection that requires transplantectomy during therapy.
- Published
- 2007
44. Successful Transplantation in ABO- and HLA-Incompatible Living Kidney Transplant Patients: A Report on 12 Cases
- Author
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Lionel, Rostaing, Béatrice, Karam, Nicolas, Congy-Jolivet, Valérie, Hage, Federico, Sallusto, Laure, Esposito, Nicolas, Doumerc, Bénédicte, Debiol, Céline, Guilbeau-Frugier, Xavier, Game, Asma, Allal, and Nassim, Kamar
- Subjects
Adult ,Graft Rejection ,Male ,Time Factors ,Graft Survival ,Plasmapheresis ,Middle Aged ,Kidney Transplantation ,Tacrolimus ,ABO Blood-Group System ,Desensitization, Immunologic ,HLA Antigens ,Isoantibodies ,Blood Group Incompatibility ,Histocompatibility ,Blood Component Removal ,Humans ,Female ,Rituximab ,Immunosorbent Techniques ,Immunosuppressive Agents ,Aged ,Follow-Up Studies - Abstract
Few studies have assessed the outcomes of ABOi/HLAi living-kidney transplantation. We report a single-center experience of 12 ABOi/HLAi living-kidney recipients. Twenty-seven donor-specific alloantibodies (DSAs) (1-6 per patient) were found with fluorescence intensities of 1500-15 000. Desensitization was based on IVIg, two doses of rituximab (375 mg/m
- Published
- 2015
45. Role of Sphingosine-1-Phosphate in Transplant Vasculopathy Evoked by Anti-HLA Antibody
- Author
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Federico Sallusto, Elodie Mucher, Magali Trayssac, Roger A. Sabbadini, Denis Calise, Mogens Thomsen, Nathalie Augé, Sylvain Galvani, Anne Nègre-Salvayre, Robert Salvayre, Institut de médecine moléculaire de Rangueil (I2MR), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)- Institut Fédératif de Recherche Bio-médicale Institution (IFR150)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de biologie intégrative des adaptations à l'exercice (UBIAE), Université d'Évry-Val-d'Essonne (UEVE)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'Urologie-Andrologie et Transplantation Rénale [CHU Toulouse], Pôle Urologie - Néphrologie - Dialyse - Transplantations - Brûlés - Chirurgie plastique - Explorations fonctionnelles et physiologiques [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'urologie, CHU Toulouse [Toulouse]-Hôpital de Rangueil, and CHU Toulouse [Toulouse]
- Subjects
medicine.medical_specialty ,Intimal hyperplasia ,Vascular smooth muscle ,[SDV]Life Sciences [q-bio] ,Mice, SCID ,Mice ,chemistry.chemical_compound ,Immune system ,Cell Movement ,HLA Antigens ,Sphingosine ,Internal medicine ,medicine ,Animals ,Humans ,Immunology and Allergy ,Pharmacology (medical) ,Vascular Diseases ,Sphingosine-1-phosphate ,Cells, Cultured ,S1PR1 ,ComputingMilieux_MISCELLANEOUS ,Cell Proliferation ,S1PR3 ,Transplantation ,biology ,business.industry ,Antibodies, Monoclonal ,Organ Transplantation ,medicine.disease ,3. Good health ,Endocrinology ,chemistry ,Cancer research ,biology.protein ,Endothelium, Vascular ,Lysophospholipids ,Antibody ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Transplant vasculopathy (TV) represents the main cause of late graft failure and limits the long-term success of organ transplantation. Cellular and humoral immune responses contribute to the pathogenesis of the concentric and diffuse intimal hyperplasia of arteries of the grafted organ. We recently reported that the mitogenic signaling, evoked in human vascular smooth muscle cells (hmSMC) by the anti-HLA class I monoclonal antibody W6/32, implicates neutral sphingomyelinase-2, suggesting a role for sphingolipids in intimal hyperplasia of TV. Here, we investigated whether the mitogenic sphingolipid, sphingosine-1-phosphate (S1P), is involved in intimal hyperplasia elicited by W6/32. Studies were done on cultured hmSMC and on an in vivo model of TV, consisting of human mesenteric arteries grafted into SCID/beige mice, injected weekly with W6/32. hmSMC migration and DNA synthesis elicited by W6/32 were inhibited by the sphingosine kinase-1 (SK1) inhibitor dimethylsphingosine, the anti-S1P antibody Sphingomab and the S1PR1/R3 inhibitor VPC23019. W6/32 stimulated SK1 activity, while siRNA silencing SK1, S1PR1 and S1PR3 inhibited hmSMC migration. In vivo, Sphingomab significantly reduced the intimal thickening induced by W6/32. These data emphasize the role of S1P in intimal hyperplasia elicited by the humoral immune response, and open perspectives for preventing TV with S1P inhibitors.
- Published
- 2015
46. Pilot conversion trial from mycophenolic acid to everolimus in ABO-incompatible kidney-transplant recipients with BK viruria and/or viremia
- Author
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Lionel Rostaing, Laure Esposito, Julie Belliere, Nicolas Congy-Jolivet, Nassim Kamar, Catherine Mengelle, Bénédicte Debiol, Federico Sallusto, Xavier Gamé, Nicolas Doumerc, and Asma Allal
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Pilot Projects ,030230 surgery ,Pharmacology ,medicine.disease_cause ,Kidney Function Tests ,Gastroenterology ,Mycophenolic acid ,Tacrolimus ,ABO Blood-Group System ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,BK Virus Infection ,medicine ,Humans ,Everolimus ,Viremia ,Kidney transplantation ,Aged ,Retrospective Studies ,Immunosuppression Therapy ,Transplantation ,Polyomavirus Infections ,business.industry ,Immunosuppression ,Middle Aged ,Mycophenolic Acid ,medicine.disease ,Kidney Transplantation ,BK virus ,stomatognathic diseases ,Tumor Virus Infections ,BK Virus ,Female ,business ,Viral load ,Immunosuppressive Agents ,medicine.drug - Abstract
Immunosuppression using everolimus (EVR) plus low-dose tacrolimus (Tac) is commonly used in organ transplantation. EVR has potential antiviral effects. Herein, the long-term outcomes and impacts of Tac-EVR on the BK virus are reported in ABO-incompatible kidney-transplant recipients. The initial immunosuppressive regimen combined steroids, Tac, and mycophenolic acid (MPA). At a median of 141 (34-529) days post-transplantation, seven stable ABO-incompatible kidney-transplant recipients were converted from MPA to EVR because of active BK replication, and compared with a reference group of fourteen ABO-incompatible patients receiving classical Tac plus MPA. At 1 month before conversion, at 1, 3 months after, and at last follow-up, clinical and biological parameters were monitored. The median time from conversion to the last follow-up was 784 (398-866) days. Conversion to EVR caused no change to rejection episodes or immunological status (isoagglutinin titers, anti-HLA antibodies). At last follow-up, median eGFR was similar in the Tac-MPA versus Tac-EVR group (40 [range: 14-56] vs. 54.5 ml/min/1.73 m(2) [range: 0-128], P = 0.07). The major adverse event was dyslipidemia. Interestingly, conversion from MPA to EVR decreased BK viral load in five patients. ABO-incompatible kidney-transplant recipients with an active BK virus infection may benefit from conversion to EVR.
- Published
- 2015
47. Efficacy and safety of tandem hemodialysis and immunoadsorption to desensitize kidney transplant candidates
- Author
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Lionel, Rostaing, Sébastien, Maggioni, Corinne, Hecht, Martine, Hermelin, Eric, Faudel, Nassim, Kamar, Federico, Sallusto, Nicolas, Doumerc, and Asma, Allal
- Subjects
Graft Rejection ,Time Factors ,Histocompatibility Testing ,Graft Survival ,Kidney Transplantation ,ABO Blood-Group System ,Treatment Outcome ,Desensitization, Immunologic ,HLA Antigens ,Isoantibodies ,Renal Dialysis ,Risk Factors ,Blood Group Incompatibility ,Histocompatibility ,Blood Component Removal ,Humans ,Kidney Failure, Chronic ,Immunosorbents ,Program Evaluation - Abstract
We conducted a desensitization program in our center in patients undergoing kidney transplant for end-stage renal disease. These patients had a living-donor either ABO incompatible and/or human-leukocyte antigen-incompatible. The safety and efficacy of this program were evaluated.A pretransplant desensitization program relies on immunosuppressants and apheresis to remove detrimental antibodies. We chose immunoadsorption as the apheresis technique, and coupled this with hemodialysis in a tandem procedure.We report on the efficacy of this new method in 120 procedures performed in 20 patients (14 ABO incompatible, 6 ABO incompatible/human leukocyte antigen-incompatible). The tandem procedure was well tolerated, and saved time compared with conducting sequential immunoadsorption and hemodialysis (6 h vs 10 h). The tandem procedure was associated with significantly decreased isoagglutinin titers and donor-specific alloantibodies (assessed by mean fluorescence intensity). Dialysance was effective (183, 102-264). The biochemical and hematologic parameters were similar to those observed after a conventional hemodialysis session, with the exception of protidemia; this might be related to some degree of albumin loss during the immunoadsoprtion procedure. The posttransplant events included 1) one ABO incompatible / human leukocyte antigenincompatible patient with vein thrombosis and ultimate kidney loss; 2) two patients with steroidsensitive cellular acute rejection; and 3) two patients with acute antibody-mediated rejection, which was successfully treated with apheresis and steroid pulses, plus rituximab in one and eculizumab in the other.We conclude that the tandem immunoadsorption-hemodialysis procedure is efficient at desensitizing patients with end-stage renal disease who are candidates for a living ABO incompatible and/or human leukocyte antigenincompatible donor-kidney transplant.
- Published
- 2015
48. Efficacy of immunoadsorption to reduce donor-specific alloantibodies in kidney-transplant candidates
- Author
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Lionel, Rostaing, Nicolas, Congy, Alice, Aarnink, Sébastien, Maggioni, Asma, Allal, Federico, Sallusto, Xavier, Game, and Nassim, Kamar
- Subjects
Adult ,Graft Rejection ,Male ,Time Factors ,Histocompatibility Testing ,Graft Survival ,Middle Aged ,Kidney Transplantation ,Treatment Outcome ,Desensitization, Immunologic ,HLA Antigens ,Isoantibodies ,Risk Factors ,Histocompatibility ,Blood Component Removal ,Living Donors ,Humans ,Female ,Prospective Studies ,Immunosorbents ,Biomarkers ,Immunosuppressive Agents - Abstract
We implemented a desensitization program at our center to enable transplant in kidney-transplant candidates who have a living human-leukocyte antigen-incompatible (HLAi) donor. We report on the efficacy of semispecific immunoadsorption to allow HLAi kidney transplant in 6 highly sensitized patients.We chose immunoadsorption as the apheresis technique coupled to hemodialysis as a means to decrease donor-specific alloantibodies in kidney transplant candidates submitted to a pretransplant desensitization program to remove detrimental antibodies.Six highly sensitized kidney-transplant patients (5 females), awaiting their first (n = 1) or second (n = 5) kidney transplant from a living donor, were enrolled in this desensitization program. They had 1 (n = 2), 2 (n = 1), 3 (n = 2), or 4 (n = 1) donor-specific alloantibodies; their mean fluorescent intensities at predesensitization ranged from 1200 to 19 000. Each patient underwent between 10 and 16 immunoadsorption sessions. At the time of transplant, donor-specific alloantibodies were undetectable in 2 patients (A24, DR3); donorspecific alloantibodies decreased by50% in 8 patients (A11, B44, DR3, DR11, DQ3 thrice, DQ5); donor-specific alloantibodies remained unchanged in 2 patients (B50, DR13); and mean fluorescent intensities were slightly increased in 2 patients (Cw6, DQ8). In the analysis of final outcomes, 2 patients experienced no rejection (1 experienced donor-specific alloantibody elimination, and 1 experienced a50% decrease in donor-specific alloantibodies). One patient presented with acute antibody-mediated rejection, which required immunoadsorption sessions and eculizumab therapy (donor-specific alloantibodies between 5000 and 19 000). Two patients presented with subacute antibody-mediated rejection; 1 was treated by plasmapheresis/rituximab therapy, and the other was treated with plasmapheresis/ methylprednisolone pulses. Another patient presented with chronic antibody-mediated rejection, which was treated unsuccessfully with plasmapheresis/rituximab; a tentative of rescue therapy with eculizumab was attempted without success.Desensitization of the humanleukocyte antigen using this immunoadsorption procedure effectively reduced or eliminated donorspecific alloantibodies in 71% of patients undergoing kidney transplant, at the time of transplant.
- Published
- 2015
49. Totally Robotic Approach with Transvaginal Insertion for Kidney Transplantation
- Author
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Nicolas Doumerc, Mathieu Roumiguié, Pascal Rischmann, and Federico Sallusto
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,Cosmesis ,medicine.disease ,Graft function ,Living donor ,Surgery ,Retractor ,Dissection ,Lymphocele ,surgical procedures, operative ,medicine ,business ,Kidney transplantation ,Kidney disease - Abstract
We report the first totally robotic procedure for kidney transplantation with transvaginal insertion. The initial results suggested reduced pain and improved cosmesis and the absence of lymphocele formation without compromising graft function or patient outcome. The patient was a 50-yr-old woman who received a living donor transplant for end-stage chronic kidney disease. We used a 4-arm Si HD da Vinci robot (Intuitive Surgical Inc., Sunnyvale, CA, USA) with standard port placement. The following procedural steps were performed sequentially: transperitoneal dissection of the external vessels, uterine mobilisation with transparietal stitching to allow full visualisation of the posterior vaginal wall to be used for graft insertion (through an Alexis retractor [Applied Medical
- Published
- 2015
50. Feasibility and perioperative outcomes of robot-assisted renal transplantation: An initial experience
- Author
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Nicolas Doumerc, M. Soulié, Benjamin Pradere, Mathieu Roumiguié, Federico Sallusto, Nassim Kamar, Jean-Baptiste Beauval, M. Binhazzaa, X. Gamé, Marine Lesourd, and Pascal Rischmann
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,Urology ,Medicine ,Robot ,Perioperative ,business ,Surgery - Published
- 2017
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