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Publications
Publications (67)
Introduction
Immunoglobulin A nephropathy (IgAN) associated with cirrhosis is frequent but often overlooked because it is largely considered silent. Until now, little has been known about their presentation and outcomes.
Methods
We conducted a retrospective multicenter study on patients with kidney biopsy-proven cirrhosis-related IgAN (cirrhosis-I...
As nephrologists who often see patients with inflammatory bowel disease [IBD] at the request of their gastroenterologist, we read with interest the ECCO Guidelines on Extra-Intestinal Manifestations [EIM] in IBD which you recently published.¹ It struck us that the kidney was not even mentioned. Renal involvement was overlooked in a similar way in t...
Circulating immune cells are critical mediators of the response to inflammation upon recruitment to the tissue but how gene expression state influences recruitment is not well known. Here we report the longitudinal single-cell transcriptome profiling of blood mononuclear cells in patients undergoing kidney transplantation rejection. We identify a g...
The choice between Basiliximab (BSX) or Anti-Thymocyte Globulin (ATG) as induction therapy in non-immunized kidney transplant recipients remains uncertain. Whilst ATG may allow steroid withdrawal and a decrease in tacrolimus, it also increases infectious complications. We investigated outcomes in non-immunized patients receiving a very low dosage o...
Kidney transplant survival is shortened by chronic rejection and side effects of standard immunosuppressive drugs. Cell-based immunotherapy with tolerogenic dendritic cells has long been recognized as a promising approach to reduce general immunosuppression. Published trials report the safety and the absence of therapy-related adverse reactions in...
Background:
Chronic hypomagnesemia is commonly due to diarrhea, alcoholism, and drugs. More rarely, it is caused by genetic defects in the effectors of renal magnesium reabsorption.
Methods:
In an adult patient with acquired severe hypomagnesemia, hypocalcemia, tubulointerstitial nephropathy, and rapidly progressing kidney injury, similarities b...
Introduction:
In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit-risk ratio, we established a strategy consisting of time-limited belatacept therapy/transient calcineurin inhibitor withdrawal, whose results are analy...
Purpose:
Parathyroidectomy to treat tertiary hyperparathyroidism (THPT) is now on a par with calcimimetic treatment. The effects of cinacalcet and parathyroidectomy on kidney transplant function remain controversial. The aim of this study was to evaluate kidney transplant function in THPT patients treated either by parathyroidectomy, cinacalcet, o...
Background:
The prevalence, prognostic role, and diagnostic value of blood pressure in immune-mediated thrombotic thrombocytopenic purpura (iTTP) and other thrombotic microangiopathies (TMAs) remain unclear.
Methods:
Using a national cohort of iTTP (n = 368), Shigatoxin-induced hemolytic uremic syndrome (n = 86), atypical hemolytic uremic syndro...
In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit-risk ratio, we established a strategy consisting of time-limited belatacept therapy / transient calcineurin inhibitor withdrawal, whose results are analyzed in that s...
Introduction
Cyst infection is a known complication of autosomal dominant polycystic kidney disease (ADPKD). Here, we describe incidence, risk factors, clinical presentation, and outcomes of cyst infection in kidney transplant recipient.
Methods
We conducted a single-centre retrospective cohort study of ADPKD patients with renal allografts between...
Background
The recognition that metabolism and immune function are regulated by an endogenous molecular clock generating circadian rhythms suggests that the magnitude of ischemia-reperfusion and subsequent inflammation on kidney transplantation, could be affected by the time of the day.
Methods
Accordingly, we evaluated 5026 first kidney transplant...
Introduction
L’hyperéosinophilie est fréquente en hémodialyse. Elle est historiquement légère et liée au défaut de biocompatibilité du circuit extracorporel. Plus rarement elle accompagne des infections ou des néoplasies.
Description
Nous rapportons une série de six patients avec une hyperéosinophilie sévère consécutive à la pose d’un cathéter vei...
Main problem
The number of kidney transplant candidates with prosthetic heart valves (PHVs) is increasing. Yet, outcomes of kidney transplantation in these patients are still unclear. This is the first report of post-transplant outcomes in patients with PHVs at time of kidney transplantation.
Methods
We conducted a matched cohort study among recip...
Objectives
To assess the impact of expanded criteria donors (ECD) on urinary complications in kidney transplantation.
Patients and Methods
The UriNary Complications Of Renal Transplant (UNyCORT) is a cohort study based on the French prospective Données Informatisées et VAlidées en Transplantation/Computerized and VAlidated Data in Transplantation...
Background
Since the beginning of our pancreas transplant program, plasma C‐peptide was routinely measured daily during the postoperative period. We aimed to evaluate the clinical interest of the C‐peptide in the follow‐up of pancreas transplantation with a particular look on early graft failure.
Methods
From 2000 to 2016, 384 pancreas transplanta...
Background
Whilst there are a number of publications comparing the relationship between body mass index (BMI) of kidney transplant recipients and graft/patient survival, no study has assessed this for a French patient cohort.
Methods
In this study, cause-specific Cox models were used to study patient and graft survival and several other time-to-ev...
Résumé
Introduction
La pénurie de transplants rénaux incite au quotidien à repousser les limites d’éligibilité au don. De nombreux donneurs en état de mort encéphalique présentent une insuffisance rénale aiguë lors de leur décès. Est-ce une réelle contre-indication au prélèvement et à une transplantation rénale ? Cette étude a pour objectif d’éval...
Introduction
Myelodysplastic syndromes (MDS) are characterized by a high prevalence of associated autoimmune manifestations. Kidney involvement has been rarely reported in MDS patients. We report on the spectrum of kidney pathological findings in MDS patients.
Mothods
We retrospectively identified MDS patients who had undergone a kidney biopsy bet...
Background and objectives
Keratinocyte cancers, which primarily comprise squamous cell carcinomas and basal cell carcinomas, represent a major concern and potential risk for kidney transplant recipients. Hydrochlorothiazide, a diuretic widely used to treat hypertension, has been implicated in skin photosensitivity reaction. Recent studies conducted...
The optimal duration of eculizumab treatment in patients with atypical haemolytic uremic syndrome (aHUS) remains poorly defined. We conducted a prospective national multicentric open-label study in order to assess eculizumab discontinuation in children and adults with aHUS. Fifty-five patients (including 19 children) discontinued eculizumab (mean d...
Kidney transplant recipients have been supposed vulnerable to severe Covid-19 infection, due to their comorbidities and immunosuppressive therapies. Mild-term complications of Covid-19 are currently unknown, especially in this population. Herein, we report two cases of BKV replication after non-severe SARS-CoV-2 infection. The first case was a 59-y...
Belatacept has increasingly been used as a replacement for calcineurin inhibitors (CNI) in kidney transplant recipients (KTRs) with poor graft function in the early post‐transplant period, allowing to improve kidney function in these most often elderly patients, transplanted from extended‐criteria donors (1,2). When, there is still limited insight...
If all immunocompromised patients can experience Post Transplantation Lymphoproliferative Disorder (PTLD) due to EBV reactivation, EBV‐seronegative recipients in which primary infection can occur, are at higher risk of developing PTLD when transplanted with an organ from an EBV seropositive donor(1,2). In our center, among 73 EBV‐seronegative adult...
Background
Numerous studies have reported a weekend effect on outcomes for diseases treated at hospitals. No study has been conducted in France for kidney transplantation. We therefore performed a cohort‐based study to evaluate whether outcomes of kidney transplant recipients display a weekend effect.
Methods
Data were extracted from the French DI...
Background
The treatment of active antibody‐mediated rejection (ABMR) is still a matter of debate, the place of rituximab remaining controversial. The French multicenter double‐blind RITUX‐ERAH study included 38 patients with ABMR in the first year of renal transplantation. All patients received plasma exchanges, intravenous immunoglobulins, cortic...
Tacrolimus, the cornerstone immunosuppression after simultaneous pancreas and kidney transplantation, may exert nephrotoxic and diabetogenic effects. We therefore prospectively compared in an open‐label, randomised, monocentric, 5‐year follow‐up study, a tacrolimus‐ and a sirolimus‐based immunosuppressive regimen. Randomisation using the block meth...
Introduction
Les alternarioses sont des phaeohyphomycoses dont la localisation est préférentiellement cutanée ; elles touchent principalement des sujets immunodéprimés.
Observation
Nous rapportons une série de 13 cas de patients atteints d’alternariose cutanée, vus au CHU de Nantes entre 2008 et 2019. Soixante-neuf pour cent des patients étaient d...
Donor-specific anti-HLA antibodies (DSAs) are a major risk factor associated with renal allograft outcomes. As a trigger of B cell antibody production, T follicular helper cells (Tfhs) promote DSA appearance. Herein, we evaluated whether circulating Tfhs (cTfhs) are associated with the genesis of antibody-mediated rejection. We measured cTfh levels...
Introduction
L’insuffisance rénale chronique est responsable de troubles phosphocalciques et osseux, secondaires en particulier à l’hyperparathyroïdie dont souffrent les patients dialysés. Les KDIGO définissent les objectifs phosphocalciques chez les patients dialysés mais peu d’études indiquent les apports calciques recommandés. Des apports calciq...
Infection due to species other than Candida albicans is increasing among solid organ transplant recipients. Candida utilis, commonly used in the food industry, is considered as a low‐virulence yeast. We report the first case of C. utilis fungemia involving a solid organ transplant recipient. The infection was triggered by the withdrawal of a ureter...
Post-transplantation lympho-proliferative disorder (PTLD) pathogenesis is related to EBV infection. Mismatch with the donor (EBV D+/R-) is the main risk factor for both early PTLD (< 1 year post transplantation) and late (> 1 year). In these at-risk patients, the role of antiviral prophylaxis for preventing PTLD remains controversial. We analysed t...
Renal operationally tolerant patients (TOL) display a defect in B cell differentiation, with a deficiency in plasma cells. Recently described, T follicular helper cells (Tfh) play a critical role in B cell differentiation. We analyzed blood Tfh subsets in TOL and transplanted patients with stable graft function under immunosuppression (STA). We obs...
Belatacept (Bristol-Myers Squibb, Princeton, NJ) is a biologic that targets CD80/86 and prevents its interaction with CD28 and its alternative ligand, cytotoxic T lymphocyte antigen 4 (CTLA-4). Clinical experience in kidney transplantation has revealed a high incidence of rejection with Belatacept, especially with intensive regimens, suggesting tha...
Novel therapies that specifically target activation and expansion of pathogenic immune cell subsets responsible for autoimmune attacks are needed to confer long-term remission. Pathogenic cells in autoimmunity include memory T lymphocytes that are long-lived and present rapid recall effector functions with reduced activation requirements. Whereas t...
CD28 and CTLA-4 are prototypal co-stimulatory and co-inhibitory cell surface signaling molecules interacting with CD80/86, known to be critical for immune response initiation and regulation, respectively. Initial “bench-to-beside” translation, two decades ago, resulted in the development of CTLA4-Ig, a biologic that targets CD80/86 and prevents T-c...
Selective targeting of CD28 might represent an effective immunomodulation strategy by preventing T cell costimulation, while favoring coinhibition since inhibitory signals transmitted through CTLA-4; PD-L1 and B7 would not be affected. We previously showed in vitro and in vivo that anti-CD28 antagonists suppress effector T cells while enhancing reg...
Three months after a kidney transplant, a man experienced an internuclear ophthalmoplegia. Magnetic resonance imaging found a punctuate hyperintensity of the brainstem. Afterwards, the patient presented with peripheral facial paralysis. A complete morphologic assessment showed an increase of the brainstem lesion, together with an excavated pulmonar...
Antagonist anti-CD28 antibodies prevent T-cell costimulation and are functionally different from CTLA4Ig since they cannot block CTLA-4 and PDL-1 co-inhibitory signals. They demonstrated preclinical efficacy in suppressing effector T cells while enhancing immunoregulatory mechanisms. Because a severe cytokine release syndrome was observed during th...
CD28, CTLA-4 and PD-L1, the three identified ligands for CD80/86, are pivotal positive and negative costimulatory molecules that, among other functions, control T cell motility and formation of immune synapse between T cells and antigen-presenting cells (APCs). What remains incompletely understood is how CD28 leads to the activation of effector T c...
