Patient and graft outcome in current era of immunosuppression: a single centre pilot study.

OBJECTIVES: The present single centre study aims at analyzing the impact on renal allograft outcome of the important changes which occurred in the transplant population and immunosuppressive therapy during the last two decades. METHODS: From 2000 to 2013, 779 single kidney transplantations were performed on 635 patients who all received on an intent-to-treat basis steroids, a calcineurin inhibitor, mycophenolate mofetil and an induction therapy with either antithymocyte globulin or an antagonist directed to the interleukin (IL)-2 receptor. Uni- and multivariate analyses of patient and immunologic graft survival were conducted. RESULTS: The sole factor predicting patient survival is recipient's age: 10-year survival rates are 94·7, 81·6 and 57·9% for the <45, 45-60 and >60 years age groups, respectively (P<0·001). Peak (>50% panel reactive antibodies) anti-human leucocyte antigens (HLA) sensitization, cold ischaemia time and HLA-B and -DR mismatches (MM) influence graft outcome: at 10 years, the difference in 10-year survival rates is 5·9% between grafts from sensitized and not sensitized patients (90·9 vs 96·8%, P = 0·002), 3·8% between grafts with <18 and ≧18 hours cold ischaemia (96·6 vs 92·8%, P = 0·003), 7·3% between grafts with no MM and either B or DR MM versus those with B and DR MM (96·8 vs 89·5%, P = 0·002). CONCLUSION: In our single centre experience, graft survival was most strongly determined by HLA matching, offering excellent long term graft outcome to most patients.

[Why can it be difficult for clinicians to diagnose acute lyme disease? From physiopathology to diagnosis, via abductive reasoning and Bayes theorem]. / Pourquoi le diagnostic de neuroborréliose aiguë reste-t-il difficile? De la physiopathologie au diagnostic en passant par l'abduction et le théorème de Bayes.

The diagnosis of acute neuroborreliosis may be difficult if it's regarded as a "classical" infectious disease. Through a clinical case, we illustrate the difficulties met and we suggest two ways of reflexion to assist in the diagnosis:--firstly, we explain how the comprehension of the behavior of the pathogen agent, which is similar to a parasitic behavior, can help to choose and interpret the results of additional tests;--secondly, we develop practically the clinical form of Bayes's theorem to demonstrate the interest of a rational Bayesian and abductive approach which should be preferred to the classical hypothetical and deductive reasoning.

[Pseudo-hyperkalemia and hyperleukocytosis]. / Pseudo-hyperkaliémie et hyperleucocytose.

A pseudo-hyperkalemia may occur with hyperleukocytosis. It is important to recognize it early to avoid unnecessary or even dangerous treatment inducing hypokalemia. The pseudohyperkalemia is due to cell fragility coupled to mechanical phenomena during blood collecting. We report a case of pseudo-hyperkalemia in a context of acute myeloid leukemia.