Soluble human leukocyte antigen-G [sHLA-G] in Tunisia kidney transplantation

To investigate the relationship between the soluble HLA-G [sHLA-G] and the appearance of acute renal rejection [AR] episodes we have quantify in this study the level of sHLA-G by enzyme-linked immunosorbent assay in 42 kidney transplant patients classified in two groups: G1: 17 patients with acute rejection [AR+] and G2: 25 patients without AR [AR-]. To establish our normal sHLA-G ranges, serum samples from 18 healthy controls were tested. Pre-transplantation sHLA-G levels were significantly increased in patients [mean +/- standard error of the mean, 60.48 +/- 12.18 Units/ml] than healthy subjects [19.11 +/- 4.9 Units/ml] [p=0.001]. Although the difference was not statistically significant, G1 patients [AR+] revealed lower levels of sHLA-G [mean +/- standard error of the mean, 31.25 +/- 6.71 Units/ml] compared to G2 patients [AR-] [53.43 +/- 17.21 Units/ml]. Nevertheless, the course of total sHLA-G levels was nearly identical in patients with and without rejection. Nonparametric analysis revealed that pre-transplantation levels of sHLA-G < 18.00 Units/ ml [sensitivity: 87.8% and specificity of 72.2%] were not related to rejection. Also, multivariate analysis regarding anti-HLA antibody status, recipient age and gender showed that sHLA-G could not be an independent risk factor for renal graft rejection. However, a higher sera levels of sHLA-G seemed to contribute to better kidney allograft survival rate after 10 years of follow-up [significance tendency: p=0.091] as shown by the survival analysis. Because of the small number of subjects studied, these results must be treated with caution. A much larger cohort of kidney transplant patients according to acute rejection would seem necessary to confirm these findings

[Peritoneal dialysis in elderly]

Peritoneal dialysis is used more and more as treatment of substitution of the end stage renal disease at the old subjects of more than 65 years and its effectiveness and its good tolerance were shown. To study the epidemiological and clinical profile of these patients, the indication and the advantages of PD, the various complications, the elements of prognostic and the survival of the patients and the technique. We made a retrospective study including a series of 13 old patients of more than 65 years and treaties by PD during the period extending from the 1983/2/11 to the 2005/12/31. They are 10 men and 3 women on average of 70 +/- 3, 1 year and representing 3, 62%of the totality of the patients. The diabetic and vascular nephropathies represent the first cause of ESRD. The PD was used of first intention at 53,84%of the patients whose majority suffers from a malnutrition due to advanced age, anorexia, psychological disorders, bad dental state and uraemia. The cardiovascular complications are frequent in this age bracket explaining heavy morbidity. The pulmonary and urinary infectious complications are also frequent. The more frequent peritonitis compared to the literature, are comparable between the 2 age brackets

[Lupus nephritis and pregnancies about 43 cases]

In lupus nephritis, pregancies can be associated with worsening of nephropathy and several other maternal and foetal complications. We analyzed in this retrospective study on a period of 30 years, maternal and fetal outcome of 43 pregancies occuring in 21 women treated for lupus nephritis. Pregnancies were sudivided in 2 groups: G1 including 17 pgnancies that underwent with proteinuria>1g/24 hours and/or high blood pressure and/or creatinemia>140 micro mol. G2 including 26 pregnancies underwent in absence of all these factors during at least 3 months. Renal flares occured in 17 pregnancies [G1: 34, 6%NS] with renal function impairement in II cases [G1: 41, 7%, G2:15, 3%, p: 0, 01] and preeclampsia in 14 pregnancies [G1 :57, 3%, G2: 42, 7%NS]. Fetal loss occured in 8 cases [G1 29, 4%G2: 11%, p=0, 01]. Among live births there were 17 preterm deliveries [G1 62%, G2 63%NS]. We found that pregnant women with Iupus nephritis remain at high risk of relapses and prematurity. Renal function impairement and fetal loss are more freqnent when lupus nephritis is active at conception. Close monitoring of these patients and planification of pregnancies reduces these complications

[Indications, complications and cost of internal jugular catheters in hemodialysed patients: study of 533 cases]

Central venous catheters for hemodialysis are very useful as blood accesses when arteriovenous fistulas [AVF] are not available. The aim of this study is to analyse the clinical impact of internal jugular catheters [IJC] in hemodialysed patients and to assess their economic consequences. It is a prospective study realised from July 1998 to March 2002 including 533 hemodialysed patients without functional AVF: 280 males and 253 females aged between 17 and 87 years [mean age: 54.1 +/- 15 years]. Single lumen polyurethane Vygon were used. All catheters were placed using Seldinger procedure and the posterior route of Jernigan which is more comfortable for patient. Indications of IJC placement were new hemodialysed patients without AVF in 73.5% cases and no functional AVF in 26.5% cases. During the period of the study, IJC was placed in 533 patients. We failed to place the IJC at the first attempt in 42 patients but we succeded in placing it on the controlateral side. During IJC placement, we observed 50 [9.4%] cases of accidental puncture of carotid artery. The median duration use of IJC was 41 days [extreme: to 413 days]. IJC were removed mainly because of the use of AVF in 469 [88%] cases and the catheter infection in 41[77%] cases. Bacteriological analysts were made only for 25 patients: staphylococci were identified in 16 cases and catheter cultures were negative in the 9 other cases. All patients were treated with antibiotics. Outcome was favourable for 39 of them and we had 2 deaths by septicemia. The IJC cost was 44,287 Tunisian Dinars [DT] coresponding to 31.633 ' including 10125 DT [7,232'] for infectious treatment. The use of IJC is frequent in our center with a high rate of infectious complications which increased the hemodialysis cost. The realisation of AVF. in patients with chronic renal failure before the beginning of hemodialysis, is the best way to limit the use of catheters