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

Association of chemokine and chemokine receptor polymorphisms with activity degree of IBD in Tunisian patients

Crohn's disease [CD] and ulcerative colitis [UC] have complex genetic background that is characterised by more than one susceptibility locus. To detect a possible association between the functional polymorphisms of the chemokine receptors CCR5, CCR2 and MCP-1 genes and susceptibility to CD and UC in Tunisian population, polymorphisms of CCR5-delta 32, CCR5-59029-A/G, CCR2-V64I and MCP-1-2518- G/A were analysed in 194 Inflammatory bowel disease [IBD] patients and 169 healthy blood donors using PCR-RFLP and PCR-SSP methods. The patients were classified in 126 patients with CD and 68 patients with UC. The genotypic and allelic frequencies of all polymorphisms studied, did not reveal significant differences between patients and controls, and among CD and UC patients. However, analysis of CD patients revealed that those without homozygosous G/G genotype are more frequently in remission compared to those with this genotype [OR: 0.4; 95%CI: [0.174-0.928]; p=0.03]. Also, the frequency of the CCR2-64I muted allele was statistically higher in CD patients in remission disease than those in active form [OR: 0.267; 95%CI: [0.09-0.78]; p=0.01]. Adjustment for known covariates factors [age, gender and immunosuppressive regimen] confirmed these univariate findings and revealed that the CCR5-59029-A/G and CCR2-V64I genotype were associated to remission form of CD [OR: 2.63; 95%CI: [1.01-6.80]; p=0.047 and OR: 4.64; 95%CI: [1.01-21.31]; p=0.049 respectively]. In conclusion, the present study supports the involvement of chemokine receptor [CCR2 and CCR5] polymorphisms in activity degree of the IBD disease in Tunisian patients

[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