122 results on '"P. Houssel-Debry"'
Search Results
2. Inevitability of disease recurrence after liver transplantation for NAFLD cirrhosis
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François Villeret, Sébastien Dharancy, Domitille Erard, Armand Abergel, Louise Barbier, Camille Besch, Olivier Boillot, Karim Boudjema, Audrey Coilly, Filomena Conti, Christophe Corpechot, Christophe Duvoux, François Faitot, Stéphanie Faure, Claire Francoz, Emiliano Giostra, Jean Gugenheim, Jean Hardwigsen, Marie-Noëlle Hilleret, Jean-Baptiste Hiriart, Pauline Houssel-Debry, Nassim Kamar, Guillaume Lassailly, Marianne Latournerie, Georges-Philippe Pageaux, Didier Samuel, Claire Vanlemmens, Faouzi Saliba, and Jérôme Dumortier
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liver transplantation ,NASH ,metabolic syndrome ,NAFLD recurrence ,Bariatric surgery ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Liver transplantation (LT) is the only available treatment for end-stage non-alcoholic fatty liver disease (NAFLD) (related decompensated cirrhosis and/or hepatocellular carcinoma). The aim of our study was to evaluate the risk of disease recurrence after LT and the factors influencing it. Method: This retrospective multicenter study included adults transplanted for NAFLD cirrhosis between 2000 and 2019 in 20 participating French-speaking centers. Disease recurrence (steatosis, steatohepatitis and fibrosis) was diagnosed from liver graft biopsies. Results: We analyzed 150 patients with at least one graft liver biopsy available ≥6 months after transplantation, among 361 patients transplanted for NAFLD. The median (IQR) age at LT was 61.3 (54.4-64.6) years. The median follow-up after LT was 4.7 (2.8-8.1) years. The cumulative recurrence rates of steatosis and steatohepatitis at 5 years were 80.0% and 60.3%, respectively. Significant risk factors for steatohepatitis recurrence in multivariate analysis were recipient age at LT
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- 2023
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3. AFP score and metroticket 2.0 perform similarly and could be used in a 'within-ALL' clinical decision tool
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Federico Piñero, Charlotte Costentin, Helena Degroote, Andrea Notarpaolo, Ilka FSF. Boin, Karim Boudjema, Cinzia Baccaro, Aline Chagas, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poniachik, Fabrice Muscari, Fabrizio Dibenedetto, Sergio Hoyos Duque, Ephrem Salame, Umberto Cillo, Sebastián Marciano, Claire Vanlemmens, Stefano Fagiuoli, Flair Carrilho, Daniel Cherqui, Patrizia Burra, Hans Van Vlierberghe, Quirino Lai, Marcelo Silva, Fernando Rubinstein, Christophe Duvoux, Filomena Conti, Olivier Scatton, Pierre Henri Bernard, Claire Francoz, Francois Durand, Sébastien Dharancy, Marie-lorraine Woehl, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Louise Barbier, Pauline Houssel-Debry, Georges Philippe Pageaux, Laurence Chiche, Victor Deledinghen, Jean Hardwigsen, J. Gugenheim, M. altieri, Marie Noelle Hilleret, Thomas Decaens, Paulo Costa, Elaine Cristina de Ataide, Emilio Quiñones, Margarita Anders, Adriana Varón, Alina Zerega, Alejandro Soza, Martín Padilla Machaca, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatoba, Linda Muñoz, Ricardo Chong Menéndez, Martín Maraschio, Luis G. Podestá, Lucas McCormack, Juan Mattera, Adrian Gadano, Jose Huygens Parente García, Giulia Magini, Lucia Miglioresi, Martina Gambato, Cecilia D’Ambrosio, Alessandro Vitale, Michele Colledan, Domenico Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, Valerio Giannelli, Adriano Pellicelli, Callebout Eduard, Iesari Samuele, Dekervel Jeroen, Schreiber Jonas, Pirenne Jacques, Verslype Chris, Ysebaert Dirk, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Delwaide Jean, Troisi Roberto, and Lerut Jan Paul
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Prediction ,reclassification ,recurrence ,transplantation ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Two recently developed composite models, the alpha-fetoprotein (AFP) score and Metroticket 2.0, could be used to select patients with hepatocellular carcinoma (HCC) who are candidates for liver transplantation (LT). The aim of this study was to compare the predictive performance of both models and to evaluate the net risk reclassification of post-LT recurrence between them using each model’s original thresholds. Methods: This multicenter cohort study included 2,444 adult patients who underwent LT for HCC in 47 centers from Europe and Latin America. A competing risk regression analysis estimating sub-distribution hazard ratios (SHRs) and 95% CIs for recurrence was used (Fine and Gray method). Harrell’s adapted c-statistics were estimated. The net reclassification index for recurrence was compared based on each model’s original thresholds. Results: During a median follow-up of 3.8 years, there were 310 recurrences and 496 competing events (20.3%). Both models predicted recurrence, HCC survival and survival better than Milan criteria (p
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- 2023
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4. Involvement of circulating soluble HLA-G after liver transplantation in the low immunogenicity of hepatic allograft.
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Bastien Le Floc'h, Nathalie Costet, Nicolas Vu, Pénélope Bernabeu-Gentey, Charlotte Pronier, Pauline Houssel-Debry, Karim Boudjéma, Virginie Renac, Michel Samson, and Laurence Amiot
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Medicine ,Science - Abstract
Graft rejection is a critical risk in solid-organ transplantation. To decrease such risk, an understanding of the factors involved in low immunogenicity of liver allografts could potentially make it possible to transfer this tolerogenic property to other transplanted organs. HLA-G, a natural physiological molecule belonging to the Human Leukocyte Antigen class (HLA) Ib family that induces tolerance, is associated with fewer rejections in solid-organ transplantation. In contrast to HLA-G, HLA antigen incompatibilities between donor and recipient can lead to rejection, except in liver transplantation. We compared HLA-G plasma levels and the presence of anti-HLA antibodies before and after LT to understand the low immunogenicity of the liver. We conducted a large prospective study that included 118 patients on HLA-G plasma levels during a 12-month follow-up and compared them to the status of anti-HLA antibodies. HLA-G plasma levels were evaluated by ELISA at seven defined pre- and post-LT time points. HLA-G plasma levels were stable over time pre-LT and were not associated with patient characteristics. The level increased until the third month post-LT, before decreasing to a level comparable to that of the pre-LT period at one year of follow-up. Such evolution was independent of biological markers and immunosuppressive treatment, except with glucocorticoids. An HLA-G plasma level ≤ 50 ng/ml on day 8 after LT was significantly associated with a higher rejection risk. We also observed a higher percentage of rejection in the presence of donor specific anti-HLA antibodies (DSA) and an association between the increase in HLA-G plasma levels at three months and the absence of DSA. The low immunogenicity of liver allografts could be related to early elevated levels of HLA-G, which lead, in turn, to a decrease in anti-HLA antibodies, opening potential new therapeutic strategies using synthetic HLA-G proteins.
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- 2023
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5. Poor Patient and Graft Outcome After Induction Treatment by Antithymocyte Globulin in Recipients of a Kidney Graft After Nonrenal Organ Transplantation.
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Mai, Hoa Le, Treilhaud, Michèle, Ben-Arye, Shani Leviatan, Yu, Hai, Perreault, Hélène, Ang, Evelyn, Trébern-Launay, Katy, Laurent, Julie, Malard-Castagnet, Stéphanie, Cesbron, Anne, Nguyen, Thi Van Ha, Brouard, Sophie, Rostaing, Lionel, Houssel-Debry, Pauline, Legendre, Christophe, Girerd, Sophie, Kessler, Michèle, Morelon, Emmanuel, Sicard, Antoine, Garrigue, Valérie, Karam, Georges, Chen, Xi, Giral, Magali, Padler-Karavani, Vered, and Soulillou, Jean Paul
- Abstract
Background:End-stage renal failure occurs in a substantial number of patients having received a nonrenal transplantation (NRT), for whom a kidney transplantation is needed. The medical strategy regarding the use of immunosuppression (IS) for a kidney graft in patients after an NRT is not well established. The prekidney grafts long-term IS advocates for a mild induction, such as using anti-IL-2R antibodies, whereas addition of new incompatibilities and anti-HLA preimmunization may suggest using stronger IS such as induction by polyclonal antithymocyte globulins (ATG). Methods:We performed Cox multivariate and propensity score analysis of our validated transplant database to study the impact of the type of induction therapy on kidney graft survival of recipients of a kidney graft after NRT. Results:We report here that kidney transplantation after NRT treated with an ATG induction has a poorer outcome (kidney and recipient survival) than that with an anti-IL-2R induction. After accounting for potential baseline differences with a multivariate Cox model, or by adjusting on a propensity score, we found that despite patients having received ATG cumulate more risk factors, ATG appears independently involved. As animal-derived biotherapeutics induce antiglycan antibodies and particularly anti-N-glycolylneuraminic acid (Neu5Gc) IgGs which may activate endothelial cells in patients and grafts, we also investigated the magnitude and the nature of the anti-Neu5Gc elicited by the induction and showed that induction was associated with a shift in anti-Neu5Gc IgG repertoire. Possible reasons and mechanisms of a deleterious ATG usage in these patients are discussed. Conclusions:Our study suggests that ATG induction after a kidney transplantation in recipients already under maintenance IS for a NRT should be used cautiously.
- Published
- 2018
6. R3-AFP score is a new composite tool to refine prediction of hepatocellular carcinoma recurrence after liver transplantation
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Charlotte Costentin, Federico Piñero, Helena Degroote, Andrea Notarpaolo, Ilka F. Boin, Karim Boudjema, Cinzia Baccaro, Luis G. Podestá, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poniachik, Fabrice Muscari, Fabrizio Dibenedetto, Sergio Hoyos Duque, Ephrem Salame, Umberto Cillo, Sebastian Marciano, Claire Vanlemmens, Stefano Fagiuoli, Patrizia Burra, Hans Van Vlierberghe, Daniel Cherqui, Quirino Lai, Marcelo Silva, Fernando Rubinstein, Christophe Duvoux, Filomena Conti, Olivier Scatton, Pierre Henri Bernard, Claire Francoz, Francois Durand, Sébastien Dharancy, Marie-lorraine Woehl, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Louise Barbier, Pauline Houssel-Debry, Georges Philippe Pageaux, Laurence Chiche, Victor Deledinghen, Jean Hardwigsen, J. Gugenheim, M. Altieri, Marie Noelle Hilleret, Thomas Decaens, Aline Chagas, Paulo Costa, Elaine Cristina de Ataide, Emilio Quiñones, Sebastián Marciano, Margarita Anders, Adriana Varón, Alina Zerega, Alejandro Soza, Martín Padilla Machaca, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatoba, Linda Muñoz, Ricardo Chong Menéndez, Martín Maraschio, Lucas McCormack, Juan Mattera, Adrian Gadano, Ilka S.F. Fatima Boin, Jose Huygens Parente García, Flair Carrilho, Giulia Magini, Lucia Miglioresi, Martina Gambato, Fabrizio Di Benedetto, Cecilia D’Ambrosio, Alessandro Vitale, Michele Colledan, Domenico Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, Valerio Giannelli, Adriano Pellicelli, Cizia Baccaro, Callebout Eduard, Iesari Samuele, Dekervel Jeroen, Schreiber Jonas, Pirenne Jacques, Verslype Chris, Ysebaert Dirk, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Delwaide Jean, Troisi Roberto, and Lerut Jan Paul
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Liver transplantation ,Liver cancer ,Recurrence ,Explants pathology ,Prediction ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Patients with hepatocellular carcinoma (HCC) are selected for liver transplantation (LT) based on pre-LT imaging ± alpha-foetoprotein (AFP) level, but discrepancies between pre-LT tumour assessment and explant are frequent. Our aim was to design an explant-based recurrence risk reassessment score to refine prediction of recurrence after LT and provide a framework to guide post-LT management. Methods: Adult patients who underwent transplantation between 2000 and 2018 for HCC in 47 centres were included. A prediction model for recurrence was developed using competing-risk regression analysis in a European training cohort (TC; n = 1,359) and tested in a Latin American validation cohort (VC; n=1,085). Results: In the TC, 76.4% of patients with HCC met the Milan criteria, and 89.9% had an AFP score of ≤2 points. The recurrence risk reassessment (R3)-AFP model was designed based on variables independently associated with recurrence in the TC (with associated weights): ≥4 nodules (sub-distribution of hazard ratio [SHR] = 1.88, 1 point), size of largest nodule (3–6 cm: SHR = 1.83, 1 point; >6 cm: SHR = 5.82, 5 points), presence of microvascular invasion (MVI; SHR = 2.69, 2 points), nuclear grade >II (SHR = 1.20, 1 point), and last pre-LT AFP value (101–1,000 ng/ml: SHR = 1.57, 1 point; >1,000 ng/ml: SHR = 2.83, 2 points). Wolber’s c-index was 0.76 (95% CI 0.72–0.80), significantly superior to an R3 model without AFP (0.75; 95% CI 0.72–0.79; p = 0.01). Four 5-year recurrence risk categories were identified: very low (score = 0; 5.5%), low (1–2 points; 15.1%), high (3–6 points; 39.1%), and very high (>6 points; 73.9%). The R3-AFP score performed well in the VC (Wolber’s c-index of 0.78; 95% CI 0.73–0.83). Conclusions: The R3 score including the last pre-LT AFP value (R3-AFP score) provides a user-friendly, standardised framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials for HCC not limited to the Milan criteria. Clinical Trials Registration: NCT03775863. Lay summary: Considering discrepancies between pre-LT tumour assessment and explant are frequent, reassessing the risk of recurrence after LT is critical to further refine the management of patients with HCC. In a large and international cohort of patients who underwent transplantation for HCC, we designed and validated the R3-AFP model based on variables independently associated with recurrence post-LT (number of nodules, size of largest nodule, presence of MVI, nuclear grade, and last pre-LT AFP value). The R3-AFP model including last available pre-LT AFP value outperformed the original R3 model only based on explant features. The final R3-AFP scoring system provides a robust framework to design post-LT surveillance strategies, protocols, or adjuvant therapy trials, irrespective of criteria used to select patients with HCC for LT.
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- 2022
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7. Mortality after Transplantation for Hepatocellular Carcinoma: A Study from the European Liver Transplant Registry
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Hans-Christian Pommergaard, Andreas Arendtsen Rostved, René Adam, Mauro Salizzoni, Miguel Angel Gómez Bravo, Daniel Cherqui, Paolo De Simone, Pauline Houssel-Debry, Vincenzo Mazzaferro, Olivier Soubrane, Juan Carlos García-Valdecasas, Joan Fabregat Prous, Antonio D. Pinna, John O’Grady, Vincent Karam, Christophe Duvoux, and Lau Caspar Thygesen
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hepatocellular carcinoma ,liver transplantation ,prognosis ,propensity score calibration ,unmeasured confounding ,non-cirrhotic liver ,cirrhosis ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background and Aims: Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. Methods: We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. Results: We included 22,787 patients, of whom 96.5% had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.23–1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95% CI 0.99–1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95% CI 2.21–3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95% CI 1.31–2.00). Conclusions: Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.
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- 2020
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8. International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria
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Helena Degroote, Federico Piñero, Charlotte Costentin, Andrea Notarpaolo, Ilka F. Boin, Karim Boudjema, Cinzia Baccaro, Aline Lopes Chagas, Philippe Bachellier, Giuseppe Maria Ettorre, Jaime Poniachik, Fabrice Muscari, Fabrio Di Benedetto, Sergio Hoyos Duque, Ephrem Salame, Umberto Cillo, Adrián Gadano, Claire Vanlemmens, Stefano Fagiuoli, Fernando Rubinstein, Patrizia Burra, Daniel Cherqui, Marcelo Silva, Hans Van Vlierberghe, Christophe Duvoux, Filomena Conti, Olivier Scatton, Pierre Henri Bernard, Claire Francoz, Francois Durand, Sébastien Dharancy, Marie-lorraine Woehl, Alexis Laurent, Sylvie Radenne, Jérôme Dumortier, Armand Abergel, Louise Barbier, Pauline Houssel-Debry, Georges Philippe Pageaux, Laurence Chiche, Victor Deledinghen, Jean Hardwigsen, J. Gugenheim, M. Altieri, Marie Noelle Hilleret, Thomas Decaens, Aline Chagas, Paulo Costa, Elaine Cristina de Ataide, Emilio Quiñones, Sebastián Marciano, Margarita Anders, Adriana Varón, Alina Zerega, Alejandro Soza, Martín Padilla Machaca, Diego Arufe, Josemaría Menéndez, Rodrigo Zapata, Mario Vilatoba, Linda Muñoz, Ricardo Chong Menéndez, Martín Maraschio, Luis G. Podestá, M. Fauda, A. Gonzalez Campaña, Lucas McCormack, Juan Mattera, Adrian Gadano, Ilka S.F. Fatima Boin, Jose Huygens Parente García, Flair Carrilho, Giulia Magini, Lucia Miglioresi, Martina Gambato, Fabrizio Di Benedetto, Cecilia D’Ambrosio, Alessandro Vitale, Michele Colledan, Domenico Pinelli, Paolo Magistri, Giovanni Vennarecci, Marco Colasanti, Valerio Giannelli, Adriano Pellicelli, Cizia Baccaro, Callebout Eduard, Iesari Samuele, Dekervel Jeroen, Schreiber Jonas, Pirenne Jacques, Verslype Chris, Ysebaert Dirk, Michielsen Peter, Lucidi Valerio, Moreno Christophe, Detry Olivier, Delwaide Jean, Troisi Roberto, and Lerut Jan Paul
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Hepatocellular carcinoma ,Downstaging ,UCSF downstaging protocol ,All-comers ,Alpha-foetoprotein ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Good outcomes after liver transplantation (LT) have been reported after successfully downstaging to Milan criteria in more advanced hepatocellular carcinoma (HCC). We aimed to compare post-LT outcomes in patients receiving locoregional therapies (LRT) before LT according to Milan criteria and University of California San Francisco downstaging (UCSF-DS) protocol and ‘all-comers’. Methods: This multicentre cohort study included patients who received any LRT before LT from Europe and Latin America (2000–2018). We excluded patients with alpha-foetoprotein (AFP) above 1,000 ng/ml. Competing risk regression analysis for HCC recurrence was conducted, estimating subdistribution hazard ratios (SHRs) and corresponding 95% CIs. Results: From 2,441 LT patients, 70.1% received LRT before LT (n = 1,711). Of these, 80.6% were within Milan, 12.0% within UCSF-DS, and 7.4% all-comers. Successful downstaging was achieved in 45.2% (CI 34.8–55.8) and 38.2% (CI 25.4–52.3) of the UCSF-DS group and all-comers, respectively. The risk of recurrence was higher for all-comers (SHR 6.01 [p
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- 2021
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9. Patients Treated for HCV Infection and Listed for Liver Transplantation in a French Multicenter Study: What Happens at Five Years?
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Lucy Meunier, Mohamed Belkacemi, George Philippe Pageaux, Sylvie Radenne, Anaïs Vallet-Pichard, Pauline Houssel-Debry, Christophe Duvoux, Danielle Botta-Fridlund, Victor de Ledinghen, Filomena Conti, Rodolphe Anty, Vincent Di Martino, Marilyne Debette-Gratien, Vincent Leroy, Theophile Gerster, Pascal Lebray, Laurent Alric, Armand Abergel, Jérôme Dumortier, Camille Besch, Helene Montialoux, Didier Samuel, Jean-Charles Duclos-Vallée, and Audrey Coilly
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anti HCV therapy ,DAAs ,liver transplantation ,decompensated cirrhosis ,hepatocellular carcinoma ,waiting list ,Microbiology ,QR1-502 - Abstract
Background: Direct-acting antiviral (DAA) agents for the treatment of hepatitis C virus (HCV) infection have been proven safe and effective in cirrhotic patients awaiting liver transplantation (LT). However, in the long term, data remain minimal regarding the clinical impact of viral eradication on patients listed for decompensated cirrhosis or hepatocellular carcinoma (HCC). We aimed to elucidate the clinical outcomes of patients regarding delisting and the evolution of HCC during the long-term follow-up. Methods: An observational, multicenter, retrospective analysis was carried out on prospectively collected data from HCV-positive patients treated with an interferon-free regimen while awaiting LT in 18 French hospitals. Results: A total of 179 patients were included in the study. The indication for LT was HCC in 104 (58.1%) patients and cirrhosis in 75 (41.9%) patients. The sustained virological response was 84.4% and the treatment was well tolerated. At five years, among 75 patients with cirrhosis treated for HCV, 19 (25.3%) were delisted following improvement after treatment. Predictive factors for delisting highlighted an absence of ascites, MELD score ≤ 15, and Child–Pugh score ≤ 7. No patients with refractory ascites were delisted. Among patients with HCC, 82 (78.9%) were transplanted. The drop-out rate was low (6.7%) and few recurrences of HCC after LT were observed. Conclusions: DAAs are safe and effective in patients awaiting LT for cirrhosis or HCC. A quarter of patients with cirrhosis can be delisted because of clinical improvement. Predictive factors for delisting, as a result of improvement, may assist prescribers, before initiating HCV infection therapy in the long-term perspective.
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- 2022
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10. Comparison of the effect of direct-acting antiviral with and without ribavirin on cyclosporine and tacrolimus clearance values: results from the ANRS CO23 CUPILT cohort
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Barrail-Tran, Aurélie, Goldwirt, Lauriane, Gelé, Thibaut, Laforest, Claire, Lavenu, Audrey, Danjou, Hélène, Radenne, Sylvie, Leroy, Vincent, Houssel-Debry, Pauline, Duvoux, Christophe, Kamar, Nassim, De Ledinghen, Victor, Canva, Valérie, Conti, Filomena, Durand, François, D’Alteroche, Louis, Botta-Fridlund, Danielle, Moreno, Christophe, Cagnot, Carole, Samuel, Didier, Fougerou-Leurent, Claire, Pageaux, Georges-Philippe, Duclos-Vallée, Jean-Charles, Taburet, Anne-Marie, and Coilly, Audrey
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- 2019
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11. Pharmacogenetic-Whole blood and intracellular pharmacokinetic-Pharmacodynamic (PG-PK2-PD) relationship of tacrolimus in liver transplant recipients.
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Camille Tron, Jean-Baptiste Woillard, Pauline Houssel-Debry, Véronique David, Caroline Jezequel, Michel Rayar, David Balakirouchenane, Benoit Blanchet, Jean Debord, Antoine Petitcollin, Mickaël Roussel, Marie-Clémence Verdier, Eric Bellissant, and Florian Lemaitre
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Medicine ,Science - Abstract
Tacrolimus (TAC) is the cornerstone of immunosuppressive therapy in liver transplantation. This study aimed at elucidating the interplay between pharmacogenetic determinants of TAC whole blood and intracellular exposures as well as the pharmacokinetic-pharmacodynamic relationship of TAC in both compartments. Complete pharmacokinetic profiles (Predose, and 20 min, 40 min, 1h, 2h, 3h, 4h, 6h, 8h, 12h post drug intake) of twice daily TAC in whole blood and peripheral blood mononuclear cells (PBMC) were collected in 32 liver transplanted patients in the first ten days post transplantation. A non-parametric population pharmacokinetic model was applied to explore TAC pharmacokinetics in blood and PBMC. Concurrently, calcineurin activity was measured in PBMC. Influence of donor and recipient genetic polymorphisms of ABCB1, CYP3A4 and CYP3A5 on TAC exposure was assessed. Recipient ABCB1 polymorphisms 1199G>A could influence TAC whole blood and intracellular exposure (p
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- 2020
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12. Localisation hépatique isolée d’une histiocytose langerhansienne : à propos d’un cas
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Allaume, Pierre, Meneyrol, Eric, Bernard, Gontran, Houssel-Debry, Pauline, Emile, Jean-François, and Turlin, Bruno
- Abstract
L’histiocytose langerhansienne (LCH) est une maladie de physiopathologie encore incertaine, impliquant à la fois des processus inflammatoires et une prolifération clonale. Elle est observable à tout âge, bien que dix fois plus fréquente chez les enfants que chez les adultes. Une atteinte hépatique n’est pas rare, s’intégrant le plus souvent dans une maladie systémique, et considérée péjorative. Nous rapportons ici un cas d’histiocytose langerhansienne de localisation hépatique exclusive chez un patient de 74ans. Ce cas présentait une anomalie moléculaire de la voie des MAPK, BRAFN486_P490del. À travers cette observation, nous préciserons les aspects épidémiologiques et histologiques ainsi que la démarche diagnostique à effectuer devant ce type de pathologie rare.
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- 2024
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13. Poor Patient and Graft Outcome After Induction Treatment by Antithymocyte Globulin in Recipients of a Kidney Graft After Nonrenal Organ Transplantation
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Hoa Le Mai, PhD, Michèle Treilhaud, MD, Shani Leviatan Ben-Arye, PhD, Hai Yu, PhD, Hélène Perreault, PhD, Evelyn Ang, PhD, Katy Trébern-Launay, PhD, Julie Laurent, PhD, Stéphanie Malard-Castagnet, PhD, Anne Cesbron, MD, Thi Van Ha Nguyen, PhD, Sophie Brouard, PhD, Lionel Rostaing, MD, Pauline Houssel-Debry, MD, Christophe Legendre, MD, Sophie Girerd, MD, Michèle Kessler, MD, Emmanuel Morelon, MD, Antoine Sicard, MD, Valérie Garrigue, MD, Georges Karam, MD, Xi Chen, PhD, Magali Giral, MD, Vered Padler-Karavani, PhD, and Jean Paul Soulillou, MD
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Surgery ,RD1-811 - Abstract
Background. End-stage renal failure occurs in a substantial number of patients having received a nonrenal transplantation (NRT), for whom a kidney transplantation is needed. The medical strategy regarding the use of immunosuppression (IS) for a kidney graft in patients after an NRT is not well established. The prekidney grafts long-term IS advocates for a mild induction, such as using anti-IL-2R antibodies, whereas addition of new incompatibilities and anti-HLA preimmunization may suggest using stronger IS such as induction by polyclonal antithymocyte globulins (ATG). Methods. We performed Cox multivariate and propensity score analysis of our validated transplant database to study the impact of the type of induction therapy on kidney graft survival of recipients of a kidney graft after NRT. Results. We report here that kidney transplantation after NRT treated with an ATG induction has a poorer outcome (kidney and recipient survival) than that with an anti–IL-2R induction. After accounting for potential baseline differences with a multivariate Cox model, or by adjusting on a propensity score, we found that despite patients having received ATG cumulate more risk factors, ATG appears independently involved. As animal-derived biotherapeutics induce antiglycan antibodies and particularly anti–N-glycolylneuraminic acid (Neu5Gc) IgGs which may activate endothelial cells in patients and grafts, we also investigated the magnitude and the nature of the anti-Neu5Gc elicited by the induction and showed that induction was associated with a shift in anti-Neu5Gc IgG repertoire. Possible reasons and mechanisms of a deleterious ATG usage in these patients are discussed. Conclusions. Our study suggests that ATG induction after a kidney transplantation in recipients already under maintenance IS for a NRT should be used cautiously.
- Published
- 2018
- Full Text
- View/download PDF
14. Development of an organ failure score in acute liver failure for transplant selection and identification of patients at high risk of futility.
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Francesco Figorilli, Antonella Putignano, Olivier Roux, Pauline Houssel-Debry, Claire Francoz, Catherine Paugam-Burtz, Olivier Soubrane, Banwari Agarwal, François Durand, and Rajiv Jalan
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Medicine ,Science - Abstract
King's College Hospital criteria are currently used to select liver transplant candidates in acetaminophen-related acute liver failure (ALF). Although widely accepted, they show a poor sensitivity in predicting pre-transplant mortality and cannot predict the outcome after surgery. In this study we aimed to develop a new prognostic score that can allow patient selection for liver transplantation more appropriately and identify patients at high risk of futile transplantation.We analysed consecutive patients admitted to the Royal Free and Beaujon Hospitals between 1990 and 2015. Clinical and laboratory data at admission were collected. Predictors of 3-month mortality in the non-transplanted patients admitted to the Royal Free Hospital were used to develop the new score, which was then validated against the Beaujon cohort. The Beaujon-transplanted group was also used to assess the ability of the new score in identifying patients at high risk of transplant futility.152 patients were included of who 44 were transplanted. SOFA, CLIF-C OF and CLIF-ACLF scores were the best predictors of 3-month mortality among non-transplanted patients. CLIF-C OF score and high dosages of norepinephrine requirement were the only significant predictors of 3-month mortality in the non-transplanted patients, and therefore were included in the ALF-OFs score. In non-transplanted patients, ALF-OFs showed good performance in both exploratory (AUC = 0.89; sensitivity = 82.6%; specificity = 89.5%) and the validation cohort (AUC = 0.988; sensitivity = 100%; specificity = 92.3%). ALF-OFs score was also able to identify patients at high risk of transplant futility (AUC = 0.917; sensitivity = 100%; specificity = 79.2%).ALF-OFs is a new prognostic score in acetaminophen-related ALF that can predict both the need for liver transplant and high risk of transplant futility, improving candidate selection for liver transplantation.
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- 2017
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15. Influence de 4 solutions de préservation sur la durée de réanimation, la survie du greffon et du patient après transplantation hépatique
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Astrid Herrero, Laurence Chiche, L. Barbier, Emmanuel Boleslawski, M. Rayar, K. Mohkam, R. Brustia, François-René Pruvot, Jean-Christophe Vaillant, C. Chardot, C B Lim, M. Chirica, Oriana Ciacio, Francis Navarro, Emilie Gregoire, J.-L. Golmard, Samir Jaber, Pietro Addeo, Christian Letoublon, René Adam, Bertrand Suc, J. Abba, Olivier Soubrane, E. Salame, A. Sepulveda, Jean-Yves Mabrut, Emmanuel Buc, Philippe Bachellier, F. Jeune, Eric Savier, K. Boudjema, Gabriella Pittau, C. Maulat, François Faitot, Philippe Compagnon, O. Boilot, B. Heyd, Y.P. Le Treut, A. Mallet, P. Houssel-Debry, Christophe Laurent, C. Salloum, F. Perdigao, A. Merdignac, T. Dao, Safi Dokmak, Jean Gugenheim, B. Trechot, G. Rousseau, S. Branchereau, Daniel Cherqui, Jean Hardwigsen, Olivier Scatton, F. Dondero, A. Mulliri, Jean-Michel Siksik, and G.-P. Pageaux
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Surgery - Abstract
Resume But de l’etude Le but de l’etude etait d’evaluer le role pronostique de 4 solutions de conservation en transplantation hepatique (TH). Patients et methodes Il s’agit d’une etude retrospective a partir de toutes les TH de tous les centres francais (n = 22) enregistrees dans la base de donnees prospective de l’Agence de la Biomedecine (Cristal) entre 2008 et 2013. Les solutions de preservation utilisees etaient : Celsior, IGL-1, SCOT 15 ou UW. Les criteres d’exclusion etaient : solution inconnue ou inhomogene ou solution HTK (3 % seulement des TH). Le critere principal de jugement etait la survie des patients. Les criteres secondaires etaient la survie des greffons et la duree de reanimation. Resultats Parmi 6347 TH realisees, 4928 ont ete incluses pour lesquelles la solution de preservation utilisee etaient Celsior (30 %), IGL-1 (44 %), SCOT 15 (10 %) et UW (16 %). La survie des patients etait de 86 %, 80 % et 74 % a 1, 3 et 5 ans, respectivement, sans difference entre les 4 solutions (p = 0,78). La survie des greffons etait respectivement de 82 %, 75 % et 69 % a 1, 3 et 5 ans, sans difference entre les 4 solutions (p = 0,80). Le sejour en reanimation etait different selon la solution utilisee en analyse univariee (p Conclusion Le type de solution de conservation utilisee (Celsior, IGL-1, SCOT 15 ou UW) n’a pas d’influence sur la survie des patients ou des greffons apres TH.
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- 2020
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16. Influence of 4 preservation solutions on ICU stay, graft and patient survival following liver transplantation
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L. Barbier, Emmanuel Boleslawski, J.-M. Siksik, E. Savier, A. Mulliri, K. Boudjema, Gabriella Pittau, René Adam, O. Boilot, Jean-Yves Mabrut, A. Sepulveda, Astrid Herrero, G.-P. Pageaux, J.-L. Golmard, Christophe Laurent, Philippe Bachellier, F. Dondero, François Faitot, Emilie Gregoire, C. Salloum, E. Salame, Laurence Chiche, Jean Hardwigsen, Christian Letoublon, M. Rayar, R. Brustia, Philippe Compagnon, F. Jeune, Y.P. Le Treut, Jean Gugenheim, Samir Jaber, Bertrand Suc, Olivier Scatton, A. Mallet, J. Abba, P. Houssel-Debry, C. Maulat, E. Buc, C B Lim, F. Perdigao, Safi Dokmak, François-René Pruvot, M. Chirica, Oriana Ciacio, B. Trechot, G. Rousseau, S. Branchereau, C. Chardot, Pietro Addeo, K. Mohkam, Jean-Christophe Vaillant, Francis Navarro, A. Merdignac, T. Dao, Olivier Soubrane, Daniel Cherqui, B. Heyd, MORNET, Dominique, Service de Chirurgie Digestive, Hépato-Bilio-pancréatique et Transplantation Hépatique [CHU Pitié-Salpétrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Département de Biostatistiques [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Paul Brousse, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Service d’Hépatologie [Hôpital Beaujon], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital de Hautepierre [Strasbourg], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Département d'Hépato-Gastroentérologie et de Transplantation Hépatique [CHU Saint-Eloi], Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM), Hôpital de la Timone [CHU - APHM] (TIMONE), Service de pédiatrie médicale et médecine de l'adolescent [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Hôpital Henri Mondor, Centre Hospitalier Universitaire [Grenoble] (CHU), Département de chirurgie digestive et de l'urgence, CHU Grenoble-Hôpital Michallon, Hôpital Claude Huriez [Lille], CHU Lille, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Université Pierre et Marie Curie - Paris 6 (UPMC), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Centre Hospitalier Universitaire de Nice (CHU Nice), Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte (M2iSH), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Bicêtre, CHU Necker - Enfants Malades [AP-HP], Agence de la Biomédecine, Service de chirurgie digestive et hépato-bilio-pancréatique [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], CHU Pitié Salpêtrière, CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Unité de Transplantation, CHU Cochin [AP-HP], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, CHU Saint-Eloi-Université de Montpellier (UM), Department of Hepatobiliary Surgery, Hôpital Conception, Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Hôpital de Rangueil, CHU Toulouse [Toulouse], UPMC Université Paris 06, 75012 Paris, France., Université Nice Sophia Antipolis (... - 2019) (UNS), Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Mère Enfant Edouard Herriot, 69677 Bron, France. 2, Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte - Clermont Auvergne (M2iSH), Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA)-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne), Université Clermont Auvergne, and Hôpital Bicêtre, AP-HP, 94275 Le Kremlin-Bicêtre, France.
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Male ,Adenosine ,[SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Liver transplantation ,Disaccharides ,Electrolytes ,0302 clinical medicine ,Glutamates ,Preservation solutions ,Insulin ,Mannitol ,Registries ,ComputingMilieux_MISCELLANEOUS ,Univariate analysis ,Graft Survival ,General Medicine ,Prognosis ,Glutathione ,Multicenter study ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,Human ,medicine.medical_specialty ,Critical Care ,Allopurinol ,Organ Preservation Solutions ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,03 medical and health sciences ,Raffinose ,Intensive care ,medicine ,Humans ,Icu stay ,Histidine ,Retrospective Studies ,business.industry ,Significant difference ,Retrospective cohort study ,Patient survival ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Length of Stay ,Survival Analysis ,Preservation solution ,[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Surgery ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,Follow-Up Studies - Abstract
International audience; Objective - The goal of this study was to evaluate the prognostic role of four preservation solutions in liver transplantation (LT). Patients and methods - This is a retrospective study originating from 22 French centers performing LT, registered in the prospective databank of the Cristal Biomedicine Agency between 2008 and 2013. The preservation solutions used were Celsior (CS), Institut Georges Lopez (IGL)-1, Solution de Conservation des Organes et des Tissus (SCOT) 15 and University of Wisconsin (UW) solutions. Exclusion criteria were preservation with unknown or inhomogeneous solutions, or Histidine-tryptophan-ketoglutarate (HTK) solution (representing only 3% of LT). Patient survival was the main endpoint. Secondary endpoints were graft survival and duration of stay in intensive care. Results - Of 6347 LT performed, 4928 were included in this study, for which the distribution of preservation solution was CS (30%), IGL-1 (44%), SCOT 15 (10%) and UW (16%). Patient survival was 86%, 80% and 74% at 1, 3 and 5 years after LT, respectively, without any statistically significant difference between the four solutions (P=0.78). Graft survival was 82%, 75% and 69% at 1, 3 and 5 years after LT, respectively, without any statistically significant difference between the four solutions (P=0.80). Duration of intensive care was different according to the solution used in univariate analysis (P
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- 2020
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17. Morbid obesity increases death and dropout from the liver transplantation waiting list: A prospective cohort study
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Delacôte, Claire, Favre, Mathilde, Amrani, Medhi, Ningarhari, Massih, Lemaitre, Elise, Ntandja‐Wandji, Line Carolle, Bauvin, Pierre, Boleslawski, Emmanuel, Millet, Guillaume, Truant, Stephanie, Mathurin, Philippe, Louvet, Alexandre, Canva, Valérie, Lebuffe, Gilles, Pruvot, François René, Dharancy, Sébastien, Lassailly, Guillaume, Di Martino, Vincent, Turco, Célia, Doussot, Alexandre, Chiche, Laurence, Laurent, Christophe, Chermak, Faiza, Hiriart, Jean‐Baptiste, Buchard, Benjamin, Buc, Emmanuel, Dondero, Federica, Sepulveda, Ailton, Roux, Olivier, Francoz, Claire, Bout, Hélène, Holleville, Mathilde, Duvoux, Christophe, Jost, Paul‐Henri, Girard, Edouard, Abba, Julio, Chirica, Mircea, Decaens, Thomas, Mabrut, Jean‐Yves, Lesurtel, Mickael, Antonini, Teresa, Lebosse, Fanny, Poinsot, Domitille, Lambert, Dominique, Gregoire, Emilie, Chopinet, Sophie, Decoster, Claire, Panaro, Fabrizio, Pageaux, Georges‐Philippe, Vachiery‐Lahaye, Florence, Herrero, Astrid, Ursic‐Bedoya, José, Anty, Rodolphe, Gugenheim, Jean, Goumard, Claire, Savier, Eric, Scatton, Olivier, Mazzola, Alessandra, Mallet, Maxime, Conti, Filomena, Boudjema, Karim, Sulpice, Laurent, Bardou Jacquet, Edouard, Jezequel, Caroline, Houssel‐Debry, Pauline, Bergeat, Damien, Bachellier, Philippe, Besch, Camille, Faitot, François, Addeo, Pietro, Michard, Baptiste, Maulat, Charlotte, Muscari, Fabrice, Kamar, Nassim, Venhard, Jean‐Christophe, Salame, Ephrem, Barbier, Louise, Bucur, Petru, Tabchouri, Nicolas, Brunault, Paul, Cherqui, Daniel, Saliba, Faouzi, Coilly, Audrey, Vibert, Eric, Samuel, Didier, and Adam, René
- Abstract
Liver transplant (LT) candidates with a body mass index (BMI) over 40 kg/m2have lower access to a liver graft without clear explanation. Thus, we studied the impact of obesity on the waiting list (WL) and aimed to explore graft proposals and refusal. Data between January 2007 and December 2017 were extracted from the French prospective national database: CRISTAL. Competing risk analyses were performed to evaluate predictors of receiving LT. Competitive events were (1) death/WL removal for disease aggravation or (2) improvement. The link between grade obesity, grafts propositions, and reason for refusal was studied. 15,184 patients were analysed: 10,813 transplant, 2847 death/dropout for aggravation, 748 redirected for improvement, and 776 censored. Mortality/dropout were higher in BMI over 35 (18% vs. 14% 1 year after listing) than in other candidates. In multivariate analysis, BMI>35, age, hepatic encephalopathy, and ascites were independent predictors of death/dropout. Candidates with a BMI ≥ 35 kg/m2had reduced access to LT, without differences in graft proposals. However, grafts refusal was more frequent especially for ‘morphological incompatibility’ (14.9% vs. 12.7% p< 0.01). BMI over 35 kg/m2reduces access to LT with increased risk of dropout and mortality. Increased mortality and dropout could be due to a lower access to liver graft secondary to increased graft refusal for morphological incompatibility.
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- 2022
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18. Tacrolimus Concentrations Measured in Excreted Bile in Liver Transplant Recipients The STABILE Study
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Eric Bellissant, Laurent Sulpice, Jean-Marie Beaurepaire, Karim Boudjema, Alexandre Chebaro, C. Cusumano, Edouard Bardou-Jacquet, Camille Tron, Antoine Petitcollin, P. Houssel-Debry, Véronique Desfourneaux, Bernard Meunier, Marc Blondeau, Michel Rayar, Clara Locher, M. Lakehal, Florian Lemaitre, Marie Clémence Verdier, Christophe Camus, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Comité de la Recherche Clinique et Translationnelle, Rennes University Hospital, and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,chemical and pharmacologic phenomena ,Liver transplantation ,030226 pharmacology & pharmacy ,01 natural sciences ,Gastroenterology ,Peripheral blood mononuclear cell ,03 medical and health sciences ,0302 clinical medicine ,Therapeutic index ,stomatognathic system ,Internal medicine ,medicine ,Bile ,Humans ,bile quantification ,Pharmacology (medical) ,neurologic toxicity ,tacrolimus ,Whole blood ,Aged ,Pharmacology ,medicine.diagnostic_test ,liver transplantation ,Surrogate endpoint ,business.industry ,010401 analytical chemistry ,Middle Aged ,Tacrolimus ,0104 chemical sciences ,3. Good health ,Hepatobiliary Elimination ,stomatognathic diseases ,Immunosuppressive drug ,Liver ,Therapeutic drug monitoring ,Leukocytes, Mononuclear ,Female ,Drug Monitoring ,business ,Immunosuppressive Agents - Abstract
International audience; Purpose - Tacrolimus (TAC) is the main immunosuppressive drug in liver transplantation. Despite intensive therapeutic drug monitoring (TDM) that relies on whole blood trough concentration (TAC), patients still present with acute cellular rejection or TAC-related toxic effects with concentrations within the therapeutic range. TAC concentration in peripheral blood mononuclear cells (TAC) is considered as an efficient surrogate marker of TAC efficacy. However, it is still not applicable in daily practice. New TDM methods are therefore needed, especially during the early postoperative period. TAC is metabolized in the liver and eliminated through biliary excretion. We therefore hypothesised that TAC concentration measured in excreted bile (TAC) could be a relevant surrogate marker of its efficacy. Methods - The Therapeutic Drug Monitoring of Tacrolimus Biliary Concentrations for Liver-Transplanted Patients (STABILE) study is a prospective monocentric trial. During the 7 first days after TAC therapy initiation, TAC was measured. The correlation between TAC and TAC as well as between TAC and TAC was assessed. The correlations between TAC and liver graft function parameter or with occurrence of neurologic toxic effects were also evaluated. Findings - Between May 2016 and April 2017, 41 patients were analyzed. TAC was significantly correlated with TAC (r = 0.25, P = 0.007). However, a better correlation was found between TAC and TAC (r = 0.53, P
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- 2018
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19. Long term results of liver transplantation for alpha-1 antitrypsin deficiency.
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Guillaud, Olivier, Jacquemin, Emmanuel, Couchonnal, Eduardo, Vanlemmens, Claire, Francoz, Claire, Chouik, Yasmina, Conti, Filomena, Duvoux, Christophe, Hilleret, Marie-Noëlle, Kamar, Nassim, Houssel-Debry, Pauline, Neau-Cransac, Martine, Pageaux, Georges-Philippe, Gonzales, Emmanuel, Ackermann, Oanez, Gugenheim, Jean, Lachaux, Alain, Ruiz, Mathias, Radenne, Sylvie, and Debray, Dominique
- Abstract
Liver transplantation (LT) is the therapeutic option for end-stage liver disease associated with alpha1 antitrypsin (A1AT) deficiency. The aim of the present retrospective study was to report on long-term outcomes following LT for A1AT deficiency. The medical records of 90 pediatric and adult patients transplanted between 1982 and 2017 in France and Geneva (Switzerland) were reviewed. The study population consisted of 32 adults and 58 children; median age at transplant was 13.0 years (range: 0.2–65.1), and 65 were male (72.2%). Eighty-two patients (94.8% of children and 84.4% of adults) had the PI*ZZ genotype/phenotype and eight patients (8.9%) had the Pi*SZ genotype/phenotype. Eighty-four patients (93.3%) were transplanted for end-stage liver disease and six (all Pi*ZZ adults) for HCC. Median follow-up after LT was 13.6 years (0.1–31.7). The overall cumulative patient survival rates post-transplant were 97.8% at 1 year, and 95.5%, 95.5%, 92.0%, 89.1% at 5, 10, 15, 20 years respectively. The overall cumulative graft survival rates were 92.2% at 1 year, and 89.9%, 89.9%, 84.4%, 81.5% at 5, 10, 15 and 20 years, respectively. In a representative cohort of patients having presented with end-stage-liver disease or HCC secondary to A1AT, liver transplantation offered very good patient and graft survival rates. [ABSTRACT FROM AUTHOR]
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- 2021
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20. Therapeutic anticoagulation after liver transplantation is not useful among patients with pre‐transplant Yerdel‐grade I/II portal vein thrombosis: A two‐center retrospective study
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Bos, Isabel, Blondeau, Marc, Wouters, Dune, Camus, Christophe, Houssel‐Debry, Pauline, van der Plas, Willemijn S., Nieuwenhuis, Lianne M., Bardou‐Jacquet, Edouard, Lisman, Ton, de Meijer, Vincent E., Porte, Robert J., and Rayar, Michel
- Abstract
Portal vein thrombosis (PVT) is no longer a contraindication for liver transplantation (LT). While therapeutic anticoagulation (tAC) is recommended during the waiting period, there is no evidence for its usefulness in the prevention of PVT recurrence after LT.
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- 2021
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21. Baseline serum ferritin is an independent predictive factor of mortality in patients with chronic hepatitis C after long term follow-up
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Romain Moirand, L. Legros, Charlotte Pronier, I. Renard, Z. B. Ali, Valérie Thibault, Dominique Guyader, Caroline Jezequel, Edouard Bardou-Jacquet, Thomas Uguen, Caroline Le Lan, A F Rabot, Christian Michelet, P. Houssel-Debry, CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], Service de virologie [CHU Pitié-Salpêtrière], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service des maladies du foie, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Centre Hospitalier Universitaire [Rennes], Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service des maladies du foie [CHU Rennes], and Centre Hospitalier Universitaire [Rennes]
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medicine.medical_specialty ,Long term follow up ,health care facilities, manpower, and services ,education ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Chronic hepatitis ,Internal medicine ,Medicine ,In patient ,Baseline (configuration management) ,Serum ferritin ,health care economics and organizations ,030304 developmental biology ,0303 health sciences ,Hepatology ,business.industry ,social sciences ,[SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism ,3. Good health ,Predictive factor ,030211 gastroenterology & hepatology ,business ,[SDV.AEN]Life Sciences [q-bio]/Food and Nutrition - Abstract
International audience; International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver, Amsterdam, Netherland, April 2014
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- 2017
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22. P217 Usefulness of systematic liver biopsy during a surgery for inflammatory bowel disease for the diagnosis of primary sclerosing cholangitis
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Y Harnoy, Véronique Desfourneaux, Guillaume Bouguen, C Bendavid, P Houssel-Debry, Marie Dewitte, Céline Miard, and Laurent Siproudhis
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Internal medicine ,Liver biopsy ,Gastroenterology ,medicine ,General Medicine ,medicine.disease ,business ,Inflammatory bowel disease ,Primary sclerosing cholangitis - Published
- 2018
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23. Characteristics, management, and outcome of tuberculosis after liver transplant: A case series and literature review
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Nguyen Van, Rémi, Houssel-Debry, Pauline, Erard, Domitille, Dumortier, Jérôme, Pouvaret, Anne, Bergez, Guillaume, Danion, François, Surgers, Laure, Le Moing, Vincent, Kamar, Nassim, Lanternier, Fanny, and Tattevin, Pierre
- Abstract
•Tuberculosis is a severe disease in liver transplant recipients, difficult to diagnose and difficult to treat.•As in other immunocompromised populations, most patients in this case series (20/23, 87%), had extra-pulmonary tuberculosis.•Median time from liver transplant to tuberculosis diagnosis was 10 months [5–40.5]; median time from first symptoms to diagnosis was 38 days [26–60]•Even though most patients had pre-transplant risk factors for tuberculosis, screening by IFN-gamma release assay was performed in only three patients.
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- 2024
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24. Risk analysis of ischemic-type biliary lesions after liver transplant using octogenarian donors
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Laurent Sulpice, G.B. Levi Sandri, P. Houssel-Debry, C. Cusumano, Véronique Desfourneaux, Bernard Meunier, Karim Boudjema, M. Lakehal, Christophe Camus, Michel Rayar, Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Jonchère, Laurent
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medicine.medical_specialty ,[SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery ,medicine.medical_treatment ,Biliary Tract Diseases ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,030230 surgery ,Liver transplantation ,Inferior vena cava ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Aged, 80 and over ,Transplantation ,Hepatology ,business.industry ,Graft Survival ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,[SDV.MHEP.HEG] Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Tissue Donors ,3. Good health ,Surgery ,Liver Transplantation ,medicine.vein ,Porto caval shunt ,030211 gastroenterology & hepatology ,business - Abstract
International audience; We read with great interest the study of Ghinolfi et al. entitled: “Risk Analysis of Ischemic-Type Biliary Lesions After Liver Transplant using Octogenarian Donor”. The authors reported their series of 123 liver transplantations (LT), performed with the retro-hepatic inferior vena cava (IVC) replacement technique and veno-venous bypass, using octogenarian grafts and found that donor hemodynamic instability, diabetes mellitus and D-MELD were predictive of higher incidence of ischemic-type biliary lesions (ITBL) incidence in multivariate analysis. In our center, we routinely perform LT with retro-hepatic IVC preservation and side-to-side cavo-caval anastomosis. According to surgeon preference, a temporary porto-caval shunt (TPCS) is performed or not. Since January 2007 to December 2014, 816 transplantations were performed in our institution and, using the same selection criteria as Ghinolfi et al., we identified 48 LT performed using octogenarian donors. TPCS was performed in 31 cases and absent in 17 cases. We found that octogenarian graft survival was significantly improved when a TPCS was performed (p=0.02) (figure 1-A). We also observed a significant reduction of alkaline phosphatase and gamma-glutamyl transferase level in the early postoperative days (POD), while bilirubin levels were similar.
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- 2016
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25. A high performance liquid chromatography tandem mass spectrometry for the quantification of tacrolimus in human bile in liver transplant recipients
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Jean-Marie Beaurepaire, Florian Lemaitre, Antoine Petitcollin, Marie-Clémence Verdier, P. Houssel-Debry, Eric Bellissant, Karim Boudjema, C. Cusumano, Camille Tron, Michel Rayar, Christophe Camus, CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], Faculté de médecine, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Foie, métabolismes et cancer, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), The study was partially funded by the COmité de la REcherche Clinique Translationnelle (CORECT) of the Rennes University Hospital, France., Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes - Faculté de Médecine (UR Médecine), Université de Rennes (UR), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Jonchère, Laurent, and Université de Rennes 1 - Faculté de Médecine (UR1 Médecine)
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Cost effectiveness ,Tandem mass spectrometry ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Liver transplantation ,030226 pharmacology & pharmacy ,01 natural sciences ,Biochemistry ,High-performance liquid chromatography ,Analytical Chemistry ,0302 clinical medicine ,Liquid chromatography–mass spectrometry ,High pressure liquid chromatography ,Bile ,Chromatography, High Pressure Liquid ,Patient monitoring ,Chromatography ,medicine.diagnostic_test ,Chemistry ,High-performance liquid chromatography tandem mass spectrometries ,General Medicine ,3. Good health ,[SDV] Life Sciences [q-bio] ,surgical procedures, operative ,Blood ,Body fluids ,Liver biopsy ,Immunosuppressive Agents ,medicine.drug ,[SDV.OT]Life Sciences [q-bio]/Other [q-bio.OT] ,Liquid-Liquid Extraction ,Liquid chromatography ,chemical and pharmacologic phenomena ,Therapeutic drug monitoring ,Matrix algebra ,Tacrolimus ,03 medical and health sciences ,medicine ,Humans ,Ascomycin ,Mass spectrometry ,[SDV.OT] Life Sciences [q-bio]/Other [q-bio.OT] ,Spectrometry ,010401 analytical chemistry ,Organic Chemistry ,Drug products ,Liquids ,Concentration ranges ,0104 chemical sciences ,Protein precipitation ,High performance liquid chromatography - Abstract
International audience; Tacrolimus whole-blood concentrations imperfectly reflect concentrations at the effect site. Tacrolimus concentrations in the transplanted organ could be more relevant to predict rejection events. Because liver biopsy cannot be repeatedly performed after liver transplantation, we suggested measuring tacrolimus in the bile to have a cost-effective and clinically implementable surrogate marker of intra-hepatic tacrolimus concentration. We developed and fully validated a liquid chromatography–tandem mass spectrometry method for the determination of tacrolimus in human bile. Sample purification was achieved using protein precipitation and liquid–liquid extraction with ethyl-acetate. Gradient elution was performed using a C18 analytical column with a 5 min run-time. The method was linear from 0.5 ng/mL to 20 ng/mL. In this concentration range, within-day and between-day precisions as well as overall bias were within ±15%. Matrix effect was fully corrected by the internal standard (ascomycin). The assay was optimized to achieve good selectivity in this complex biological matrix. Tacrolimus was found to be stable in bile stored 6 months at −80 °C, after 3 freeze and thaw cycles, 20 h at room temperature and 24 h in extracts kept at 15 °C in the auto-sampler. The method was applied to quantify tacrolimus in bile from liver transplant recipients. It allowed getting preliminary data about tacrolimus excretion profile in bile and showed the lack of correlation between tacrolimus whole blood concentration and tacrolimus liver exposition. This alternative and innovative analytical approach of tacrolimus bio-analysis appears suitable for further studies evaluating relevance of biliary tacrolimus concentration as a new pharmacological marker of immunosuppressive activity. © 2016 Elsevier B.V.
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- 2016
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26. P0709 : Survival of patients infected by chronic hepatitis c and f0f1 fibrosis at baseline after a 15 years follow-up
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Romain Moirand, Yoann Désille, Yves Deugnier, C. Lelan, Anne Guillygomarc'h, Dominique Guyader, P. Houssel-Debry, I. Renard, Marianne Latournerie, Edouard Bardou-Jacquet, Caroline Jezequel, Fabrice Lainé, Milieux aquatiques, écologie et pollutions (UR MALY), Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA), Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CRLCC Eugène Marquis (CRLCC), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
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medicine.medical_specialty ,Hepatology ,business.industry ,[SDV]Life Sciences [q-bio] ,medicine.disease ,Gastroenterology ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Chronic hepatitis ,Fibrosis ,Internal medicine ,medicine ,030211 gastroenterology & hepatology ,030212 general & internal medicine ,Baseline (configuration management) ,business ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience; no abstract
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- 2015
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27. Portal cavernoma or chronic non cirrhotic extrahepatic portal vein obstruction
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Elkrief, Laure, Houssel-Debry, Pauline, Ackermann, Oanez, Franchi-Abella, Stéphanie, Branchereau, Sophie, Valla, Dominique, Hillaire, Sophie, Dutheil, Danielle, Plessier, Aurélie, Hernandez-Gea, Virginia, and Bureau, Christophe
- Abstract
Chronic non cirrhotic extrahepatic portal vein obstruction (EHPVO) refers to the cavernomatous transformation of the portal vein (the so-called “portal cavernoma”) which occurs following acute thrombosis of the portal vein in the absence of recanalization. In adults, EHPVO mainly occurs following thrombosis, while in children it may be related to congenital malformations and/or neonatal umbilical venous catheterization. However, 50% of the cases of EHPVO remain idiopathic [1]. Risk factors and associated diseases should be investigated (chapter 1). Indeed, the presence of a thrombophilic alteration, in particular myeloproliferative neoplasm impacts prognosis and determine a causal treatment.
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- 2020
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28. Mortality after Transplantation for Hepatocellular Carcinoma: A Study from the European Liver Transplant Registry
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Pommergaard, Hans-Christian, Rostved, Andreas Arendtsen, Adam, René, Salizzoni, Mauro, Bravo, Miguel Angel Gómez, Cherqui, Daniel, De Simone, Paolo, Houssel-Debry, Pauline, Mazzaferro, Vincenzo, Soubrane, Olivier, García-Valdecasas, Juan Carlos, Prous, Joan Fabregat, Pinna, Antonio D., O’Grady, John, Karam, Vincent, Duvoux, Christophe, and Thygesen, Lau Caspar
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Background and Aims:Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. Methods:We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. Results:We included 22,787 patients, of whom 96.5% had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.23–1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95% CI 0.99–1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95% CI 2.21–3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95% CI 1.31–2.00). Conclusions:Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.
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- 2020
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29. Influence de 4 solutions de préservation sur la durée de réanimation, la survie du greffon et du patient après transplantation hépatique
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Savier, E., Brustia, R., Golmard, J.-L., Scatton, O., Mallet, A., Cherqui, D., Adam, R., Ciacio, O., Pittau, G., Trechot, B., Boudjema, K., Houssel-Debry, P., Merdignac, A., Rayar, M., Soubrane, O., Dokmak, S., Dondero, F., Sepulveda, A., Bachellier, P., Addeo, P.-F., Faitot, F., Navarro, F., Herrero, A., Jaber, S., Pageaux, G.-P., Vaillant, J.-C., Rousseau, G., Siksik, J.-M., Le Treut, Y.P., Gregoire, E., Hardwigsen, J., Compagnon, P., Lim, C., Salloum, C., Chirica, M., Abba, J., Letoublon, C., Pruvot, F.-R., Boleslawski, E., Salame, E., Barbier, L., Mabrut, J.Y., Mohkam, K., Suc, B., Maulat, C., Chiche, L., Laurent, C., Jeune, F., Perdigao, F., Dao, T., Mulliri, A., Gugenheim, J., Boilot, O., Buc, E., Branchereau, S., Chardot, C., and Heyd, B.
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Le but de l’étude était d’évaluer le rôle pronostique de 4 solutions de conservation en transplantation hépatique (TH).
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- 2020
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30. Performance of B-mode ratio and 2D shear wave elastography for the detection and quantification of hepatic steatosis and fibrosis after liver transplantation
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Dubois, Marine, Ronot, Maxime, Houssel-Debry, Pauline, Brun, Vanessa, Rayar, Michel, Auger, Magali, Beuzit, Luc, Turlin, Bruno, Aubé, Christophe, and Paisant, Anita
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- 2020
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31. OR01: A Low Transversal Psoas Muscle Thickness Assessed by Computed Tomography (CT) Scan is a Prognostic Factor in Cirrhotic Patients on Waiting-List for Liver Transplantation
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Audrey Huguet, Dominique Guyader, L. Legros, Marianne Latournerie, Caroline Jezequel, E. Bardou Jacquet, P. Houssel Debry, and Ronan Thibault
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Prognostic factor ,medicine.medical_specialty ,Nutrition and Dietetics ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Computed tomography ,Liver transplantation ,Critical Care and Intensive Care Medicine ,Waiting list ,Transversal (combinatorics) ,medicine ,Radiology ,business - Published
- 2016
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32. Oral pulmonary vasoactive drugs achieve hemodynamic eligibility for liver transplantation in portopulmonary hypertension.
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Legros, Ludivine, Chabanne, Céline, Camus, Christophe, Fournet, Maxime, Houssel-Debry, Pauline, Latournerie, Marianne, Jezequel, Caroline, Rayar, Michel, Boudjema, Karim, Guyader, Dominique, and Bardou-Jacquet, Edouard
- Abstract
Background and aims Portopulmonary hypertension (POPH) hampers survival of patients with cirrhosis and portal hypertension and may preclude liver transplantation (LT). Management of such patients with oral pulmonary vasoactive drugs (PVD) has not been standardized. Our aim was to assess the efficacy and safety of oral PVD for management of POPH. Methods All patients treated by oral PVD (bosentan, ambrisentan, sildenafil, tadalafil) for POPH were retrospectively studied. Significant response was defined for the patients who reached the following LT eligibility criteria: mean pulmonary artery pressure (MPAP) <35 mmHg or MPAP between 35 and 50 mmHg with pulmonary vascular resistance (PVR) <250 dyn s cm −5 . Results 20 patients were followed for 38 (19–57) months. Oral PVD improved MPAP (−8 [−19, +2] mmHg), PVR (−201 [–344, –68] dyn s cm −5 ) and 6-min walk distance (+52 [−51, +112] m). Fifty-three percent of evaluable patients reached eligibility to LT criteria, of whom 5 were transplanted. Baseline MPAP > 51 mmHg and/or PVR > 536 dyn s cm −5 predicted non response to treatment. Five-years survival was 53%. No worsening of cirrhosis or serious adverse effect was recorded. Conclusion Oral pulmonary vasoactive drugs are safe in cirrhotic patients with POPH. These treatments improved hemodynamic conditions allowing patients access to liver transplantation eligibility. [ABSTRACT FROM AUTHOR]
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- 2017
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33. Hepatic encephalopathy post liver transplantation
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Morandeau, Emilie, Rayer, Cassandra, Jezequel, Caroline, Guyader, Dominique, Houssel-Debry, Pauline, Bardou-Jacquet, Edouard, and Legros, Ludivine
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- 2020
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34. High Intrapatient Variability of Tacrolimus Exposure in the Early Period After Liver Transplantation Is Associated With Poorer Outcomes
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Rayar, Michel, Tron, Camille, Jézéquel, Caroline, Beaurepaire, Jean Marie, Petitcollin, Antoine, Houssel-Debry, Pauline, Camus, Christophe, Verdier, Marie Clémence, Dehlawi, Ammar, Lakéhal, Mohamed, Desfourneaux, Véronique, Meunier, Bernard, Sulpice, Laurent, Bellissant, Eric, Boudjema, Karim, and Lemaitre, Florian
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The authors of this retrospective study assessed the association between high intrapatient tacrolimus variability during the first postoperative month and liver transplant outcome measures, including graft survival and tacrolimus-related toxicities.
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- 2018
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35. Sofosbuvir-Based Regimens in HIV/HCV Coinfected Patients After Liver Transplantation: Results From the ANRS CO23 CUPILT Study
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Antonini, Teresa Maria, Coilly, Audrey, Rossignol, Emilie, Fougerou-Leurent, Claire, Dumortier, Jérôme, Leroy, Vincent, Veislinger, Aurélie, Radenne, Sylvie, Botta-Fridlund, Danielle, Durand, François, Houssel-Debry, Pauline, Kamar, Nassim, Canva, Valérie, Perré, Philippe, De Ledinghen, Victor, Rohel, Alexandra, Diallo, Alpha, Taburet, Anne-Marie, Samuel, Didier, Pageaux, Georges-Philippe, and Duclos-Vallée, Jean-Charles
- Abstract
This multicenter study reports excellent results achieved with interferon-free sofosbuvir-based therapy in hepatitis C-HIV coinfected patients with recurrent hepatitis C, not different from those obtained by monoinfected recipients.
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- 2018
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36. Bariatric surgery and liver transplantation, here we are now: A French nationwide retrospective study
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Dumortier, Jérôme, Erard, Domitille, Villeret, François, Faitot, François, Duvoux, Christophe, Faure, Stéphanie, Francoz, Claire, Gugenheim, Jean, Hardwigsen, Jean, Hiriart, Jean-Baptiste, Houssel-Debry, Pauline, Bello, Arnaud Del, Lassailly, Guillaume, Vanlemmens, Claire, Saliba, Faouzi, Altman, Clara, Latournerie, Marianne, Dharancy, Sébastien, and Debs, Tarek
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At the time of the growing obesity epidemic worldwide, liver transplantation (LT) and metabolic syndrome are closely linked: non-alcohol-related fatty liver disease (NAFLD) is one of the leading indications for liver transplantation, and metabolic syndrome can also appear after liver transplantation, in relation to immunosuppressive medications and weight gain, whatever was the initial liver disease leading to the indication of LT. Therefore, the role of bariatric surgery (BS) is important due to its longer-lasting effect and efficacy. We performed a retrospective review of all 50 adult French liver transplant recipients who had a history of bariatric surgery, including 37 procedures before transplantation, and 14 after. There were three significantly different characteristics when comparing pre-and post-LT BS: patients were older (at the time of BS), presented more frequently arterial hypertension (at the time of LT), and the proportion of NAFLD as initial liver disease leading to LT was lower, in the post-LT group. Regarding pre-LT BS, in one case BS was complicated by liver failure leading to the rapid indication of LT; it was the single patient for whom the delay between BS and LT was less than 1 year; there was no patient who specifically underwent BS for the purpose of LT listing.
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- 2023
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37. Direct-acting antiviral agent–based regimen for HCV recurrence after combined liver-kidney transplantation: Results from the ANRS CO23 CUPILT study
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Dharancy, Sébastien, Coilly, Audrey, Fougerou-Leurent, Claire, Duvoux, Christophe, Kamar, Nassim, Leroy, Vincent, Tran, Albert, Houssel-Debry, Pauline, Canva, Valérie, Moreno, Christophe, Conti, Filoména, Dumortier, Jérome, Di Martino, Vincent, Radenne, Sylvie, De Ledinghen, Victor, D’Alteroche, Louis, Silvain, Christine, Besch, Camille, Perré, Philippe, Botta-Fridlund, Danielle, Francoz, Claire, Habersetzer, François, Montialoux, Hélène, Abergel, Armand, Debette-Gratien, Maryline, Rohel, Alexandra, Rossignol, Emilie, Samuel, Didier, Duclos-Vallée, Jean-Charles, and Pageaux, Georges-Philippe
- Abstract
Hepatitis C virus (HCV) infection is associated with reduced patient survival following combined liver-kidney transplantation (LKT). The aim of this study was to assess the efficacy and safety of second-generation direct-acting antivirals (DAAs) in this difficult-to-treat population. The ANRS CO23 “Compassionate use of Protease Inhibitors in Viral C Liver Transplantation” (CUPILT) study is a prospective cohort including transplant recipients with recurrent HCV infection treated with DAAs. The present work focused on recipients with recurrent infection following LKT. The study population included 23 patients. All patients received at least one NS5B inhibitor (sofosbuvir) in their antiviral regimen an average of 90 months after LKT. Ninety-six percent of recipients achieved a sustained virological response (SVR) at week 12 (SVR12). In terms of tolerance, 39% of recipients presented with at least one serious adverse event. None of the patients experienced acute rejection during therapy and there were no deaths during follow-up. The glomerular filtration rate (GFR) decreased significantly from baseline to the end of therapy. However, this study did not show that the decline in GFR persisted over time or that it was directly related to DAAs. The DAA-based regimen is well tolerated with excellent results in terms of efficacy. It will become the gold standard for the treatment of recurrent HCV following LKT.
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- 2017
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38. Efficacy and Safety of Everolimus and Mycophenolic Acid With Early Tacrolimus Withdrawal After Liver Transplantation: A Multicenter Randomized Trial
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Saliba, F., Duvoux, C., Gugenheim, J., Kamar, N., Dharancy, S., Salamé, E., Neau‐Cransac, M., Durand, F., Houssel‐Debry, P., Vanlemmens, C., Pageaux, G., Hardwigsen, J., Eyraud, D., Calmus, Y., Di Giambattista, F., Dumortier, J., and Conti, F.
- Abstract
SIMCERwas a 6‐mo, multicenter, open‐label trial. Selected de novoliver transplant recipients were randomized (week 4) to everolimus with low‐exposure tacrolimus discontinued by month 4 (n = 93) or to tacrolimus‐based therapy (n = 95), both with basiliximab induction and enteric‐coated mycophenolate sodium with or without steroids. The primary end point, change in estimated GFR(eGFR; MDRD formula) from randomization to week 24 after transplant, was superior with everolimus (mean eGFRchange +1.1 vs. −13.3 mL/min per 1.73 m2for everolimus vs. tacrolimus, respectively; difference 14.3 [95% confidence interval 7.3–21.3]; p < 0.001). Mean eGFRat week 24 was 95.8 versus 76.0 mL/min per 1.73 m2for everolimus versus tacrolimus (p < 0.001). Treatment failure (treated biopsy‐proven acute rejection [BPAR; rejection activity index score >3], graft loss, or death) from randomization to week 24 was similar (everolimus 10.0%, tacrolimus 4.3%; p = 0.134). BPARwas more frequent between randomization and month 6 with everolimus (10.0% vs. 2.2%; p = 0.026); the rate of treated BPARwas 8.9% versus 2.2% (p = 0.055). Sixteen everolimus‐treated patients (17.8%) and three tacrolimus‐treated patients (3.2%) discontinued the study drug because of adverse events. In conclusion, early introduction of everolimus at an adequate exposure level with gradual calcineurin inhibitor (CNI)withdrawal after liver transplantation, supported by induction therapy and mycophenolic acid, is associated with a significant renal benefit versus CNI‐based immunosuppression but more frequent BPAR. This multicenter, open‐label trial of de novoliver transplant recipients randomized at week 4 to everolimus with low‐exposure tacrolimus discontinued by month 4, or to standard tacrolimus‐based therapy with both basiliximab induction and enteric‐coated mycophenolate sodium ± steroids, shows a significant renal benefit for the everolimus‐treated group versus the control arm but more frequent mild or moderate biopsy‐proven acute rejection.
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- 2017
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39. Rivaroxaban Prophylaxis in Noncirrhotic Portal Vein Thrombosis.
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Plessier, Aurélie, Goria, Odile, Cervoni, Jean Paul, Ollivier, Isabelle, Bureau, Christophe, Poujol-Robert, Armelle, Minello, Anne, Houssel-Debry, Pauline, Rautou, Pierre Emmanuel, Payancé, Audrey, Scoazec, Giovanna, Bruno, Onorina, Corbic, Michele, Durand, Francois, Vilgrain, Valérie, Paradis, Valérie, Boudaoud, Larbi, de Raucourt, Emmanuelle, Roy, Carine, and Gault, Nathalie
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THROMBOEMBOLISM risk factors ,HEMORRHAGE risk factors ,RESEARCH ,PATIENT aftercare ,VEINS ,CONFIDENCE intervals ,RIVAROXABAN ,VENOUS thrombosis ,RISK assessment ,TREATMENT effectiveness ,RANDOMIZED controlled trials ,PORTAL vein ,THROMBOEMBOLISM ,DESCRIPTIVE statistics ,PORTAL hypertension ,STATISTICAL sampling ,DISEASE complications ,EVALUATION - Abstract
Background: In patients with noncirrhotic chronic portal vein thrombosis (PVT), the benefit of long-term anticoagulation is unknown. We assessed the effects of rivaroxaban on the risk of venous thromboembolism and portal hypertension-related bleeding in such patients. Methods: In this multicenter, controlled trial, we randomly assigned patients with noncirrhotic chronic PVT without major risk factors for thrombosis to receive either rivaroxaban 15 mg/day or no anticoagulation. The primary end point was 2-year thrombosis-free survival. Secondary end points included the occurrence of site-specific thromboses and major bleeding events. Results: A total of 111 participants were enrolled in the trial, with a mean age of 50.4±13.2 years; 58% of participants were men. An unplanned interim analysis was requested by the independent data safety monitoring board (DSMB) after 10 thrombotic events occurred. The thrombosis incidence rate was 0 per 100 person-years in the rivaroxaban group and 19.71 per 100 person-years (95% confidence interval, 7.49 to 31.92) in the no anticoagulation group (log-rank P=0.0008) after a median follow-up of 11.8 months. Based on the interim analysis, the DSMB recommended switching patients from the no anticoagulation group to anticoagulation. After a median follow-up of 30.3 months (intraquartile range, 24.3 to 47.8), major bleeding occurred in two patients receiving rivaroxaban and in one patient not receiving anticoagulation. No deaths occurred. Conclusions: After a median follow-up of 11.8 months, among patients with noncirrhotic chronic PVT without major risk factors for thrombosis, daily rivaroxaban reduced the incidence of venous thromboembolism and did not increase major bleeding events. (Funded by grants from the French Ministry of Health and the Association de Malades des Vaisseaux du foie; ClinicalTrials.gov number, NCT02555111.) [ABSTRACT FROM AUTHOR]
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- 2022
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40. Drug transporters are implicated in the diffusion of tacrolimus into the T lymphocyte in kidney and liver transplant recipients: Genetic, mRNA, protein expression, and functionality
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Coste, Gwendal, Robin, Fabien, Chemouny, Jonathan, Tron, Camille, Le Priol, Jérôme, Bouvet, Régis, Le Vée, Marc, Houssel-Debry, Pauline, Rayar, Michel, Verdier, Marie-Clémence, Roussel, Mikael, Galibert, Marie-Dominique, Bardou-Jacquet, Edouard, Fardel, Olivier, Vigneau, Cécile, Boudjema, Karim, Laviolle, Bruno, and Lemaitre, Florian
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Because of a narrow therapeutic index and a wide inter- and intra-patient variability, therapeutic drug monitoring of the immunosuppressant drug tacrolimus (TAC) based on whole-blood concentrations (Cblood) is mandatory in solid organ transplant recipients. Using peripheral blood mononuclear cells concentrations (CPBMC) could improve patient outcomes. The poor correlation between Cbloodand CPBMCmakes hypothesize that drug transporters are implicated in the intracellular accumulation of TAC. The aim of this work was therefore to clinically study: i) the role of genetic variants and ii) the effect of mRNA and protein expression of 4 drug transporters on the TAC CPBMC/bloodratio. In addition, functional in vitroexperiments were performed to mechanistically validate the clinical observations. Genetic variants of ABCB1/P-gp and SLC28A3/CNT3 did not influence TAC CPBMCin liver transplant recipients (LTR). ABCC2/MRP2 at the mRNA level; ABCB1/P-gp, SLC28A3/CNT3 and SLC29A1/ENT1 at the protein level; correlated with the CPBMC/bloodin kidney and LTR. In vitroresults suing transporter-expressing cells confirmed that TAC is substrate of P-gp but not MRP2, whereas experiments remained inconclusive for CNT3 and ENT1. In conclusion, the genetic-transcription-protein-functional approach presented in this work provides new insights in the understanding of TAC transport at the T lymphocyte plasma membrane.
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- 2022
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41. HCV eradication does not protect from fibrosis progression in patients with fibrosing cholestatic hepatitis after liver transplantation
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Coilly, Audrey, Sebagh, Mylène, Fougerou-Leurent, Claire, Pageaux, Georges-Philippe, Leroy, Vincent, Radenne, Sylvie, Silvain, Christine, Lebray, Pascal, Houssel-Debry, Pauline, Cagnot, Carole, Rossignol, Emilie, Danjou, Hélène, Veislinger, Aurélie, Samuel, Didier, Duclos-Vallée, Jean-Charles, and Dumortier, Jérôme
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•Fibrosing cholestatic hepatitis is a rare and very severe form of HCV recurrence after liver transplantation.•Prognosis of HCV recurrence after liver transplantation has been dramatically modified because of direct antivirals.•Histological outcome of 17 patients has been studied.•Fibrosis stage worsened in the majority of patients with fibrosing cholestatic hepatitis despite HCV cure.
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- 2022
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42. COVID‐19: Thoughts and comments from a tertiary liver transplant center in France
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Tzedakis, Stylianos, Jeddou, Heithem, Houssel‐Debry, Pauline, Sulpice, Laurent, and Boudjema, Karim
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- 2020
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43. Risk factors of de novomalignancies after liver transplantation: a French national study on 11004 adult patients
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Altieri, Mario, Sérée, Olivier, Lobbedez, Thierry, Segol, Philippe, Abergel, Armand, Blaizot, Xavier, Boillot, Olivier, Boudjema, Karim, Coilly, Audrey, Conti, Filomena, Chazouillères, Olivier, Debette-Gratien, Maryline, Dharancy, Sébastien, Durand, François, Duvoux, Christophe, Francoz, Claire, Gugenheim, Jean, Hardwigsen, Jean, Houssel-Debry, Pauline, Kamar, Nassim, Latournerie, Marianne, Lebray, Pascal, Leroy, Vincent, Neau-Cransac, Martine, Pageaux, Georges-Philippe, Radenne, Sylvie, Salamé, Ephrem, Saliba, Faouzi, Samuel, Didier, Vanlemmens, Claire, Besch, Camille, Launoy, Guy, and Dumortier, Jérôme
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•After liver transplantation (LT), de novomalignancies are one of the leading causes of late mortality.•Risk factors of de novomalignancies in a large cohort of LT recipients (n=11004) are described using Fine and Gray competing risks regression analysis.•The overall incidence of de novo malignancies was 13.45%.•Were significant risk factors for de novomalignancy: recipient age, male gender, non-living donor, a first LT and the type of initial liver disease.•Initial immunosuppressive regimen had no significant impact.
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- 2021
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44. Covid-19 in liver transplant recipients: the French SOT COVID registry
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Dumortier, Jérôme, Duvoux, Christophe, Roux, Olivier, Altieri, Mario, Barraud, Hélène, Besch, Camille, Caillard, Sophie, Coilly, Audrey, Conti, Filomena, Dharancy, Sébastien, Durand, François, Francoz, Claire, Garaix, Florentine, Houssel-Debry, Pauline, Kounis, Ilias, Lassailly, Guillaume, Laverdure, Noémie, Leroy, Vincent, Mallet, Maxime, Mazzola, Alessandra, Meunier, Lucy, Radenne, Sylvie, Richardet, Jean-Philippe, Vanlemmens, Claire, Hazzan, Marc, and Saliba, Faouzi
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•Coronavirus disease-2019 (Covid-19) is an ongoing global pandemic of major concern.•Available data on clinical presentation and prognosis in liver transplant (LT) recipients remains limited.•Disease presentation, immunosuppression management, outcomes, prognostic factors in 104 French LT recipients with Covid-19 are reported.•The composite endpoint of severe Covid-19 within 30 days after diagnosis was reached by 33.0% of the adult patients.•The 30-day mortality rate of adult patients was 20.0%, and 28.1% for hospitalized patients.
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- 2021
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45. Safety and Efficacy of 6-thioguanine as a Second-line Treatment for Autoimmune Hepatitis.
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Legué, Clémence, Legros, Ludivine, Kammerer-Jacquet, Solène, Jézequel, Caroline, Houssel-Debry, Pauline, Uguen, Thomas, Le Lan, Caroline, Guillygomarc’h, Anne, Moirand, Romain, Turlin, Bruno, Guyader, Dominique, and Bardou-Jacquet, Edouard
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- 2018
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46. A Preliminary Clinical Experience Using Hypothermic Oxygenated Machine Perfusion for Rapid Recovery of Octogenarian Liver Grafts
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Rayar, Michel, Maillot, Betty, Bergeat, Damien, Camus, Christophe, Houssel-Debry, Pauline, Sulpice, Laurent, Meunier, Bernard, and Boudjema, Karim
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- 2019
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47. NON-INVASIVE DIAGNOSIS AND FOLLOW-UP IN LIVER TRANSPLANTATION
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Dumortier, Jérôme, Besch, Camille, Moga, Lucile, Coilly, Audrey, Conti, Filomena, Corpechot, Christophe, Bello, Arnaud Del, Faitot, François, Francoz, Claire, Hilleret, Marie-Noëlle, Houssel-Debry, Pauline, Jezequel, Caroline, Lavayssière, Laurence, Neau-Cransac, Martine, Erard-Poinsot, Domitille, de Lédinghen, Victor, Bourlière, Marc, Bureau, Christophe, and Ganne-Carrié, Nathalie
- Abstract
•The possible diseases of the liver graft after transplantation are multiple and often intertwined.•Radiological methods are the standard for the diagnosis of vascular and biliary complications of transplantation.•Non-invasive evaluation of the liver graft lesions has been poorly evaluated, apart from the recurrence of hepatitis C.•Liver biopsy remains the gold standard for evaluating graft lesions in the majority of cases.
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- 2021
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48. OR01: A Low Transversal Psoas Muscle Thickness Assessed by Computed Tomography (CT) Scan is a Prognostic Factor in Cirrhotic Patients on Waiting-List for Liver Transplantation.
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Huguet, A., Bardou Jacquet, E., Houssel Debry, P., Latournerie, M., Jezequel, C., Legros, L., Guyader, D., and Thibault, R.
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- 2016
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49. Efficacy of Sofosbuvir and Daclatasvir in Patients With Fibrosing Cholestatic Hepatitis C After Liver Transplantation.
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Leroy, Vincent, Dumortier, Jérôme, Coilly, Audrey, Sebagh, Mylène, Fougerou-Leurent, Claire, Radenne, Sylvie, Botta, Danielle, Durand, François, Silvain, Christine, Lebray, Pascal, Houssel-Debry, Pauline, Kamar, Nassim, D’Alteroche, Louis, Petrov-Sanchez, Ventzislava, Diallo, Alpha, Pageaux, Georges-Philippe, and Duclos-Vallee, Jean-Charles
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Background & Aims Fibrosing cholestatic hepatitis (FCH) is a life-threating disorder that develops in patients with recurrent hepatitis C virus (HCV) infection after liver transplantation. Until recently, therapeutic options have been limited. We evaluated the efficacy and safety of sofosbuvir- and daclatasvir-based regimens. Methods We analyzed data from 23 patients with FCH who participated in a prospective cohort study in France and Belgium of the effects of antiviral agents in patients with recurrence of HCV infection after liver transplantation, from October 2013 through April 2014. Most of the patients had genotype 1 infections that had not responded to previous treatment; 4 patients also were infected with human immunodeficiency virus. Eight patients (37%) had ascites and 15 patients (65%) had bilirubin levels greater than 100 mmol/L; their median serum level of HCV RNA was 7 log IU/mL. The median time between transplantation and treatment initiation was 5 months. Subjects were given either sofosbuvir and daclatasvir (n = 15) or sofosbuvir and ribavirin (n = 8) for 24 weeks. The primary outcome was complete clinical response (survival without re-transplantation, bilirubin level <34 μmol/L, and no ascites or hepatic encephalopathy 36 weeks after treatment began). Results All patients survived, without re-transplantation, until week 36. Rapid and dramatic improvements in clinical status were observed. The patients’ median bilirubin concentration decreased from 122 μmol/L at baseline to a normal value at week 12 of treatment. Twenty-two patients (96%) had a complete clinical response at week 36. Despite the low rate of rapid virologic response, 22 patients (96%) achieved a sustained virologic response at week 12. The only relapse of HCV infection occurred in a patient with human immunodeficiency virus infection who received sofosbuvir and ribavirin. Tolerance was satisfactory, with no grade 3 or 4 adverse events related to sofosbuvir or daclatasvir and no significant interactions among drugs. Conclusions Sofosbuvir therapy with daclatasvir or ribavirin leads to major clinical improvement and high rates of sustained virologic response at week 12 in most patients with recurrence of HCV infection and FCH after liver transplantation. ClinicalTrial.gov no: NCT01944527 . [ABSTRACT FROM AUTHOR]
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- 2015
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50. Dexamethasone improves clinical and biological tolerance of transcatheter arterial chemoembolization for hepatocellular carcinoma.
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Masrour O, Rayer C, Giguet B, Uguen T, Morcet J, Jezequel C, Houssel-Debry P, Jegonday MA, Moirand R, and Bardou-Jacquet E
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Background: Transarterial chemoembolization (TACE) is widely used for hepatocellular carcinoma treatment but side effects hamper tolerance. Dexamethasone reduces TACE side effects in patients with viral hepatitis, but data regarding alcohol and metabolic liver diseases are lacking. We aimed to evaluate the efficacy of dexamethasone in preventing TACE-associated adverse events in European populations with predominantly alcoholic and metabolic cirrhosis., Methods: All cirrhotic patients undergoing TACE in our center between 2017 and 2021 were included. Dexamethasone was added to our protocol from 2019. Using a quasi-experimental study design, patients before and after introduction of dexamethasone in our procedure were compared. Factors associated with TACE adverse events were assessed by univariate and multivariate analysis. A sensitivity analysis was performed using propensity scores for covariate adjustment., Results: 234 patients undergoing 398 TACE procedure were included. Cirrhosis was predominantly of alcohol or metabolic etiology (86.7 %). Dexamethasone was administered in 99 procedures (24.9 %). Incidence of fever and encephalopathy at day 2 after TACE was lower in the Dexamethasone group (p < 0.001; p = 0.02 respectively). In multivariate analysis, dexamethasone was associated with lower occurrence of fever (OR=0.03; p < 0.001), lower analgesics use (OR=0.11; p = 0.002), milder liver and kidney function impairment (OR=0.98; p = 0.001 and OR=0.94; p < 0.001 for bilirubin and creatinine variation respectively). Propensity score-adjusted analyses yielded similar results., Conclusion: Dexamethasone improves TACE tolerance in a population of predominantly metabolic and alcohol cirrhosis., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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