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1.
Am J Transplant ; 10(10): 2263-9, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20840478

ABSTRACT

Kidney transplantation is now considered as a reasonable option for HIV-infected patients with end-stage renal disease. We describe here a retrospective study conducted in five transplantation centers in Paris. Twenty-seven patients were included. Immunosuppressive protocol associated an induction therapy and a long-term treatment combining mycophenolate mofetil, steroids and either tacrolimus or cyclosporine. All the patients had protocol biopsies at 3 months and 1 year. Patient's survival was 100% at 1 year and 98% at 2 years. Graft survival at 1 and 2 years is 98% and 96% at 1 and 2 years, respectively. The mean glomerular filteration rate values at 12 and 24 months were 60.6 mL/min/1.73 m² (range 23-98) and 65.4 mL/min/1.73 m² (range 24-110), respectively. Acute cellular rejection was diagnosed in four cases (15%). Because of high trough levels of calcineurin inhibitor, protease-inhibitor therapies were withdrawn in 11 cases. HIV disease progression was not observed. One patient developed B-cell lymphoma. In conclusion, our study confirms the safety of renal transplantation in HIV-infected patients with few adverse events and a low incidence of acute rejection.


Subject(s)
HIV Infections/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Adult , Cyclosporine/administration & dosage , Female , Graft Rejection/epidemiology , Graft Survival , HIV Infections/surgery , Humans , Immunosuppressive Agents/administration & dosage , Kidney Failure, Chronic/etiology , Kidney Transplantation/adverse effects , Male , Middle Aged , Paris/epidemiology , Retrospective Studies , Tacrolimus/administration & dosage
2.
Arthritis Care Res (Hoboken) ; 62(12): 1787-95, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20740617

ABSTRACT

OBJECTIVE: Management of nonviral cryoglobulinemia vasculitis has yet to be defined. Rituximab has emerged as a novel and promising therapeutic alternative, but data are scarce. Our objective was to evaluate the safety and efficacy of rituximab in nonviral cryoglobulinemia vasculitis in off-trial real-life patients. METHODS: Prospective data from the French AutoImmunity and Rituximab (AIR) registry, which includes data on patients with autoimmune disorders treated with rituximab in off-label conditions, were analyzed. RESULTS: Twenty-three patients received treatment with rituximab for cryoglobulinemia vasculitis. Tolerance was marked by the occurrence of side effects in almost half of the patients, including severe infections in 6 (26%) of 23, with a rate of 14.1 per 100 patient-years. These infections occurred in a particular subset of patients ages>70 years, with essential type II mixed cryoglobulinemia and renal failure with a glomerular filtration rate of <60 ml/minute, and receiving high-dose corticosteroids. Three of these patients died. In contrast, clinical and immunologic efficacy was noted in all evaluable patients. Clinical relapses occurred in half of the patients after a median time of 13.5 months following rituximab administration, and were more frequent in patients refractory to previous immunosuppressive therapy than in previously untreated patients. CONCLUSION: Data from the AIR registry show a dramatic efficacy and a steroid-sparing effect of rituximab, but also show the occurrence of severe infections in elderly patients with renal failure and high-dose steroids. The role of rituximab in nonviral cryoglobulinemia vasculitis remains to be defined in well-designed randomized controlled trials.


Subject(s)
Antibodies, Monoclonal, Murine-Derived/therapeutic use , Autoimmunity , Cryoglobulinemia/drug therapy , Immunologic Factors/therapeutic use , Registries , Vasculitis/drug therapy , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal, Murine-Derived/administration & dosage , Antigens, CD20 , Cryoglobulinemia/complications , Cryoglobulinemia/immunology , Dose-Response Relationship, Drug , Female , Follow-Up Studies , France , Humans , Immunologic Factors/administration & dosage , Male , Middle Aged , Prospective Studies , Rituximab , Treatment Outcome , Vasculitis/etiology , Vasculitis/pathology
3.
Am J Transplant ; 9(11): 2542-51, 2009 Nov.
Article in English | MEDLINE | ID: mdl-19843032

ABSTRACT

It has been suggested that dual kidney transplantation (DKT) improves outcomes for expanded criteria donor (ECD) kidneys. However, no criteria for allocation to single or dual transplantation have been assessed prospectively. The strategy of DKT remains underused and potentially eligible kidneys are frequently discarded. We prospectively compared 81 DKT and 70 single kidney transplant (SKT) receiving grafts from ECD donors aged >65 years, allocated according to donor estimated glomerular filtration rate (eGFR): DKT if eGFR between 30 and 60 mL/min, SKT if eGFR greater than 60 mL/min. Patient and graft survival were similar in the two groups. In the DKT group, 13/81 patients lost one of their two kidneys due to hemorrhage, arterial or venous thrombosis. Mean eGFR at month 12 was similar in the DKT and SKT groups (47.8 mL/min and 46.4 mL/min, respectively). Simulated allocation of kidneys according to criteria based on day 0 donor parameters such as those described by Remuzzi et al., Andres et al. and UNOS, did not indicate an improvement in 12-month eGFR compared to our allocation based on donor eGFR.


Subject(s)
Glomerular Filtration Rate , Kidney Transplantation/mortality , Kidney Transplantation/methods , Primary Graft Dysfunction/mortality , Primary Graft Dysfunction/prevention & control , Tissue Donors , Age Factors , Aged , Biopsy , Delayed Graft Function/mortality , Delayed Graft Function/pathology , Delayed Graft Function/prevention & control , Female , Graft Rejection/mortality , Graft Rejection/pathology , Graft Rejection/prevention & control , Graft Survival , Humans , Kaplan-Meier Estimate , Kidney/pathology , Kidney/physiology , Logistic Models , Male , Middle Aged , Postoperative Complications/mortality , Primary Graft Dysfunction/pathology , Prognosis , Tissue and Organ Procurement
4.
Am J Transplant ; 9(8): 1946-52, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19519819

ABSTRACT

Solid organ transplantations (SOT) are performed successfully in selected HIV-infected patients. However, multiple and reciprocal drug-drug interactions are observed between antiretroviral (ARV) drugs and calcineurin inhibitors (CNIs) through CYP450 metabolization. Raltegravir (RAL), a novel HIV-1 integrase inhibitor, is not a substrate of CYP450 enzymes. We retrospectively reviewed the outcomes of 13 HIV-infected transplant patients treated by an RAL + two nucleosidic reverse transcriptase inhibitor (NRTI) regimen, in terms of tolerability, ARV efficacy (plasma viral load, CD4 cell count), drug interactions, RAL pharmacokinetics and transplant outcome. Thirteen patients with liver (n = 8) or kidney (n = 5) transplantation were included. RAL was initiated (400 mg BID) either at time of transplantation (n = 6), or after transplantation (n = 7). Median RAL trough concentration was 507 ng/mL (176-890), which is above the in vitro IC95 for wild type HIV-1 strains (15 ng/mL). Target trough levels of CNIs were promptly obtained with standard dosages of tacrolimus or cyclosporine. RAL tolerability was excellent. There was no episode of acute rejection. HIV infection remained controlled. After a median follow-up of 9 months (range: 6-14), all patients were alive with satisfactory graft function. The use of an RAL + two NRTI-based regimen is a good alternative in HIV-infected patients undergoing SOT.


Subject(s)
Graft Rejection/prevention & control , HIV Infections/drug therapy , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/immunology , Liver Transplantation/immunology , Pyrrolidinones/adverse effects , Pyrrolidinones/therapeutic use , Adult , Anti-Retroviral Agents/therapeutic use , Calcineurin Inhibitors , Cyclosporine/therapeutic use , Dose-Response Relationship, Drug , Drug Interactions , Female , Graft Rejection/immunology , HIV Integrase/drug effects , HIV Integrase/metabolism , Humans , Male , Middle Aged , Pyrrolidinones/pharmacology , Raltegravir Potassium , Retrospective Studies , Tacrolimus/therapeutic use , Treatment Outcome
5.
Am J Transplant ; 8(6): 1345-8, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18522550

ABSTRACT

Fabry disease (FD) is an X-linked genetic disease, resulting from the deficiency of alpha-galactosidase A, a lysosomal enzyme responsible for the cleavage of glycosphingolipids. In absence of enzyme replacement therapy (ERT), globotriaosylceramide (Gb3) accumulates in tissue, leading to progressive organ damage with severe renal, cardiac and central nervous system complications. We herein describe the first case of successful combined and simultaneous heart and kidney transplantation in a young male patient with FD complicated by end-stage renal disease and severe heart failure not responding to late-onset ERT. Combined heart and kidney transplantation can be recommended for Fabry patients with end-stage renal disease and overt hypertrophic cardiomyopathy, severe ischemic or valvular heart disease.


Subject(s)
Fabry Disease/complications , Heart Failure/surgery , Kidney Failure, Chronic/surgery , Adult , Enzyme Therapy , Heart Failure/drug therapy , Heart Failure/etiology , Heart Transplantation , Humans , Kidney Failure, Chronic/drug therapy , Kidney Failure, Chronic/etiology , Kidney Transplantation , Male , alpha-Galactosidase/therapeutic use
6.
Article in French | MEDLINE | ID: mdl-2479094

ABSTRACT

This is a preliminary study focusing on a 2 years follow-up of 78 patients addressed to psychiatric hospitalization and psychodynamically oriented crisis intervention. Relationship between psychopathological, clinical and interactional profile at first medical interview and clinical/social assessment at 1 and 2 years follow-up were studied, indicating different predictors for long-term treatment (DSM III R diagnosis and psychotic symptoms scores) and global improvement (age and sex) as well as poorer outcome for social functioning than for symptomatic measures. Comment is also provided on the observed high concordance between clinical predictions at crisis treatment completion and research staff assessments at 1 and 2 years follow-up. The evaluated crisis intervention model was found to provide a valuable setting to structure acute psychiatric episode treatment and long-term care, even though transition from clinical recovery to effective social-interpersonal reinvestments was observed to raise problems in the addressed psychiatric population.


Subject(s)
Commitment of Mentally Ill , Crisis Intervention , Mental Disorders/therapy , Bipolar Disorder/therapy , Combined Modality Therapy , Follow-Up Studies , Humans , Mental Disorders/psychology , Personality Disorders/therapy , Physician-Patient Relations , Psychoanalytic Therapy , Schizophrenia/therapy , Switzerland
7.
Acta Psychiatr Belg ; 86(4): 381-7, 1986.
Article in French | MEDLINE | ID: mdl-3788634

ABSTRACT

This work presents an analysis instrument and the first results obtained while applying it to 280 depressive patients compared to 496 non-depressive patients who were followed during a 4 year period. The treatment follow-up permits us to present the chronological "history" of the patient's contacts with different services and to establish a classification. One of the interests, for the clinician, consists in specifying the best therapeutical approach possible. A more detailed study should allow us to relate certain patterns with diagnostic subcategories and to determine if the high proportion of short patterns corresponds to the "successful" treatments or to the dropouts.


Subject(s)
Depressive Disorder/therapy , Adult , Aged , Depressive Disorder/mortality , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Middle Aged , Switzerland
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