Olivier Guillaud

Hospices Civils de Lyon, Lyons, Rhône-Alpes, France

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Publications (84)315.72 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The efficacy and safety of tacrolimus (Tac) twice-a-day (BID) and once-a-day (QD) formulations are considered to be similar. However, the available information regarding initiation of TacQD is sparse and practical information is lacking. Based on a literature review, clinical efficacy and safety trials, French experts in the liver transplantation field were asked (1) to highlight pharmacokinetic differences between both formulations, (2) to assess efficacy and safety of the QD formulation in the context of de novo initiation or conversion, (3) to provide their recommendations for initiation and day-to-day management of TacQD. The same efficacy and safety profile is found for both immediate-release and prolonged-release tacrolimus. Pharmacokinetic differences carry on absorption due to the difference in formulations but not on metabolism or excretion. TacQD offers a better reproducibility in exposure than TacBID but is associated with an increased risk of disturbed absorption in case of change in intestinal motility. The same therapeutic drug monitoring with TacQD and BID could be applied, based on Cmin, as there is a similar strong correlation between Cmin and AUC for both formulations. Different protocols for TacQD initiation were described through numerous studies, excepted for early conversion: initiation on D0, using 0.10 to 0.20mg/kg/day as monotherapy, or lower dosages in case of concomitant immunosuppressant treatment or poor graft quality; early conversion from D5 to 6 months, preferably before hospital discharge, using a 1mg/kg/d: 1.3 mg/kg/d schedule and with first Cmin assessment 48H after the conversion; later conversion (>6 months post-transplantation) using a milligram-to-milligram dosage schedule, and with dose adjustment based on weekly Cmin measurement. Experts underline that an increase in treatment adherence was expected using TacQD in liver recipients. TacQD have the same efficacy and safety profile than TacBID. De novo introduction or later conversion are well documented but could differ from day-to-day practice. This article is protected by copyright. All rights reserved. © 2015 American Association for the Study of Liver Diseases.
    Liver Transplantation 08/2015; DOI:10.1002/lt.24228 · 3.79 Impact Factor
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    ABSTRACT: Alcoholic liver disease (ALD) is a major indication for liver transplantation (LT). Recurrent alcoholic cirrhosis (RAC) after LT can occur but has not been studied. The aims of this study were to estimate the prevalence, predictive factors, and natural history of RAC after LT. All patients transplanted for ALD between 1990 and 2007 in three French centers were included. The diagnosis of RAC was based on histological evidence or a series of features combined with severe alcoholic relapse. Among 1,894 adult LT patients, 712 were transplanted for alcoholic cirrhosis and survived >6 months. After a mean follow-up of 9 years, 128 patients (mean age at LT 47.2±7.1 years old, 78.9% men) experienced severe alcoholic relapse (18.0% of cases). Severe alcoholic relapse occurred after a median delay of 25 months (range 4-157) after LT. RAC was diagnosed in 41 patients with severe relapse (32%). The diagnosis of RAC was made after a median delay of 5.1 years (range 1.8-13.9) after LT and of 4.0 years (range 1.2-11.5) after relapse. RAC was significantly associated with younger age and a shorter period of pre-LT abstinence. One-, 5-, 10-, and 15-year survival was 100, 87.6, 49.7, and 21.0%, respectively, for RAC patients vs. 100, 89.4, 69.9, and 41.1%, respectively, for the patients without RAC (P<0.001). RAC occurs in <6% of ALD transplant patients. One-third of severe alcoholic relapse patients develop RAC <5 years after transplantation with a very poor prognosis.Am J Gastroenterol advance online publication, 14 July 2015; doi:10.1038/ajg.2015.204.
    The American Journal of Gastroenterology 07/2015; DOI:10.1038/ajg.2015.204 · 9.21 Impact Factor
  • Gastroentérologie Clinique et Biologique 06/2015; DOI:10.1016/j.clinre.2015.04.003 · 1.98 Impact Factor
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    04/2015; DOI:10.1055/s-0034-1391902
  • C Morin · O Guillaud · M Pioche · C Bergoin · T Ponchon · JC Saurin
    Endoscopy 02/2015; 47(03). DOI:10.1055/s-0035-1545401 · 5.20 Impact Factor
  • Endoscopy 02/2015; 47(03). DOI:10.1055/s-0035-1545396 · 5.20 Impact Factor
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    ABSTRACT: ESD is the reference method to achieve en bloc resections for large digestive lesions. Nevertheless, it is a difficult and risky technique. Animal models exist to teach the initial skills, particularly in Japan, where pigs' stomachs are dedicated models to gastric ESD. In Europe, we have to develop different strategies of teaching with dedicated colon models. A pig colon is a good model but thinner and narrower than a human's. In this present work, we evaluated a bovine colon model to perform rectal ESD in retroflexion. First, we prepared six bowels to precise the preparation protocol. Then, two endoscopists unexperienced in ESD performed 64 procedures on eight models. Learning curves and factors of variation were studied. A precise protocol to prepare the colon was defined. The two students achieved en bloc resection in 89.1 % of cases with a rate of 6.2 % of perforations. A large heterogeneity appeared between the speed and the success rate depending mainly on the age of the animal bowel. Using calf colons, the failure rates were higher (p = 0.002) and the speed was lower (p < 0.001) than for adult bovine ones. A learning curve appeared with, respectively, 0.49 and 0.59 cm(2)/min throughout the study. No significant difference appeared between measured and calculated specimen areas. Bovine colon is a new model to teach ESD in colorectal conditions. The bovine age is important to homogenize the model. A learning curve existed with a time procedure decreasing throughout the study. Further studies are needed to evaluate the precise learning curve with more students. A bovine colon model is a suitable model to teach colorectal ESD. Nevertheless, an adult bovine colon model is more homogeneous than a calf one.
    Surgical Endoscopy 01/2015; 81(5). DOI:10.1007/s00464-014-4062-0 · 3.31 Impact Factor
  • Transplant International 01/2015; 28:19-19. · 3.16 Impact Factor
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    ABSTRACT: Non alcoholic fatty liver disease (NAFLD) is a potential long-term complication after liver transplantation (LT) and can occur as recurrent disease in patients transplanted for NAFLD, or de novo NAFLD in the others. The aim of this study was to compare these 2 different entities. From a cohort of adult patients transplanted between 2000 and 2010, we selected all patients with a diagnosis of NAFLD made at liver biopsy examination during post-LT follow-up; clinical, biological and histological features of patients with recurrent NAFLD or de novo NAFLD were compared. The diagnosis of post-LT NAFLD was made in 91 patients during the study period, from which 11 were classified as recurrent NAFLD and 80 as de novo NAFLD. Sex ratio, age, prevalence of hypercholesterolemia, obesity and hypertension were not statistically different between groups. Prevalence of diabetes mellitus was higher in patients with recurrent NAFLD (100% vs. 37.5%, p<0.001). At 5-year, severe fibrosis (F3 or F4) and steato-hepatitis were more frequent in patients with recurrent NAFLD than in the group of de novo NAFLD: 71.5% vs. 12.5% (p<0.01) and 71.5% vs. 17.2% (p<0.01), respectively. NAFLD was already present in 67% of the patients after 1 year in the group of patients with de novo NAFLD, and in 100% of the patients in the group of patients with recurrent NAFLD. According to successive liver biopsies, steatosis disappeared in 18 patients (22.5%) with de novo NAFLD and in none with recurrent NAFLD. In conclusion, our results strongly suggest that recurrent and de novo NAFLD after LT are different entities; recurrent NAFLD appeared to be an earlier-onset, more severe and not reversible disease. Liver Transpl , 2014. © 2014 AASLD.
    Liver Transplantation 09/2014; 20(9). DOI:10.1002/lt.23936 · 3.79 Impact Factor
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    ABSTRACT: Background: The aim of this retrospective study was to evaluate the prognostic value of different scores (including Child-Pugh and Model for End Stage Liver Diseases) in cirrhotic patients treated with transjugular intrahepatic porto-systemic shunt for refractory ascites. Methods: Overall, 111 patients with transjugular intrahepatic porto-systemic shunt insertion between January 1998 and July 2012 were included. Results: Survival rates (without transplantation) were 82.0% at 3 months, and 59.4% at 1 year. In addition to standard parameters, a new simple classification based on platelet count and glomerular filtration rate showed strong prognostic ability and could distinguish 3 groups of patients (Log-rank test, p < 0.001): a "good-prognosis" group with platelet counts above 125 x 10(9) L-1 and a glomerular filtration rate above 90 mL/min (1-year survival rate 92%), a "poor-prognosis" group with platelet counts below 125 x 10(9) L-1 and a glomerular filtration rate below 90 mL/min (1-year survival rate 34.8%), and an "intermediateprognosis" group (1-year survival rate 58.2%). Multivariate analysis showed a hazard ratio of 6.34 for the intermediate class and of 12.623 for the high class. Conclusions: A new and simple classification including platelet count and glomerular filtration rate is highly predictive of survival in patients with refractory ascites treated with transjugular intrahepatic porto-systemic shunt and could be used to select patients for this procedure.
    Digestive and Liver Disease 08/2014; 46(11). DOI:10.1016/j.dld.2014.06.013 · 2.89 Impact Factor
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    ABSTRACT: De novo malignancies are a main cause for late death after liver transplantation (LT). Everolimus (ERL) is an immunosuppressive agent with anti-tumoral properties. The aim of the present retrospective study was to identify prognostic factors, including conversion to ERL, for patients presenting non cutaneous de novo solid organ malignancy after LT for alcoholic cirrhosis. The study population consisted in 83 patients (presenting 100 tumours, including 75% of upper aero-digestive tract cancers), among the 398 patients who underwent LT for alcoholic cirrhosis in our centre. After diagnosis, ERL was introduced in 38 patients and calcineurin-inhibitor was discontinued in 64.1% of them. Tumour stage was a significant prognostic factor with a 1-year survival at 82.6% for early stages, 63.4% for intermediate stages (N+) and 27.4% for disseminated diseases (p<0.001). Associated relative risk factor was 2.202 (95%CI 1.044-4.644) for intermediate stages and 5.743 (95%CI 2.436-13.541) for metastatic stages. One and 5-year survival was 77.4% and 35.2% in ERL group vs. 47.2% and 19.4% in the non-ERL group, respectively (p=0.003). The relative risk factor for ERL was 0.447 (95%CI 0.257-0.778). Our results strongly suggest that conversion to ERL improves the prognosis of de novo malignancies after LT for alcoholic cirrhosis. Prospective studies are needed to confirm this benefit. This article is protected by copyright. All rights reserved.
    Clinical Transplantation 07/2014; 28(12). DOI:10.1111/ctr.12430 · 1.49 Impact Factor
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    ABSTRACT: Background Optimization of multi b-values MR protocol for fast intra-voxel incoherent motion imaging of the liver at 3.0 Tesla.MethodsA comparison of four different acquisition protocols were carried out based on estimated IVIM (DSlow, DFast, and f) and ADC-parameters in 25 healthy volunteers. The effects of respiratory gating compared with free breathing acquisition then diffusion gradient scheme (simultaneous or sequential) and finally use of weighted averaging for different b-values were assessed. An optimization study based on Cramer-Rao lower bound theory was then performed to minimize the number of b-values required for a suitable quantification. The duration-optimized protocol was evaluated on 12 patients with chronic liver diseasesResultsNo significant differences of IVIM parameters were observed between the assessed protocols. Only four b-values (0, 12, 82, and 1310 s.mm−2) were found mandatory to perform a suitable quantification of IVIM parameters. DSlow and DFast significantly decreased between nonadvanced and advanced fibrosis (P < 0.05 and P < 0.01) whereas perfusion fraction and ADC variations were not found to be significant.Conclusion Results showed that IVIM could be performed in free breathing, with a weighted-averaging procedure, a simultaneous diffusion gradient scheme and only four optimized b-values (0, 10, 80, and 800) reducing scan duration by a factor of nine compared with a nonoptimized protocol. Preliminary results have shown that parameters such as DSlow and DFast based on optimized IVIM protocol can be relevant biomarkers to distinguish between nonadvanced and advanced fibrosis. J. Magn. Reson. Imaging 2014. © 2014 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 07/2014; 41(5). DOI:10.1002/jmri.24693 · 2.79 Impact Factor
  • Gastroenterology 05/2014; 146(5):S-864. DOI:10.1016/S0016-5085(14)63143-7 · 13.93 Impact Factor
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    ABSTRACT: Recurrent hepatitis C after liver transplantation (LT) is associated with rapid fibrosis progression. The aim of this study was to evaluate the cumulative risk for severe fibrosis and the factors influencing it. Two hundred and fifty LT patients were included 1 to 15years after LT. Recurrence of chronic hepatitis C on liver graft was classified according to Metavir score. Kaplan-Meyer estimates for actuarial progression to severe fibrosis (Metavir>F3) showed a probability of 15.2% and 44.5% at 5 and 10years, respectively. Predictive factors for progression to severe fibrosis were: use of tacrolimus as main CNI, recipient age at time of biopsy<55, donor age ≥45, graft HCV re-infection<3months, biologically suspected graft re-infection and lack of response to antiviral treatment after LT. Multivariate analysis disclosed that only donor age ≥45 (hazard ratio 2.243, 95%CI 1.264-3.983, P=0.0058) and lack of response to antiviral treatment (hazard ratio 2.816, 95%CI 1.227-6.464, P=0.0146) were associated to severe fibrosis. Our study confirms that donor age ≥45 and lack of response to antiviral treatment after LT are major predictive factors of progression of HCV recurrence on liver graft.
    Gastroentérologie Clinique et Biologique 03/2014; 38(3). DOI:10.1016/j.clinre.2014.02.007 · 1.98 Impact Factor
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    ABSTRACT: We sought to evaluate the frequency of cardiovascular risk factors in a cohort of patients 10 years after a liver transplant, and to assess their 10-year risk of fatal cardiovascular disease using Systematic COronary Risk Evaluation (SCORE) charts. Between January 1990 and June 1996, one hundred eighty-nine adults underwent a first liver transplant in our center. Fifty-nine patients (31%) died before reaching their tenth year, and 115 patients were available with complete clinical data at 10 years. The main indications for liver transplant were alcoholic (38%) and viral cirrhosis (40%). The median age of patients was 56 (range, 29-73 y), 80% were men, 23% were obese, 16% were active smokers, 18% were diabetic, 40% had hypercholesterolemia, and 77% had hypertension. Before the tenth year after transplant, 6 deaths were because of cardiovascular diseases, which represents the third cause of late death (> 1 year after liver transplant). After liver transplant, 5% of the surviving patients underwent ischemic cardiovascular events during the first decade. At a 10-year assessment, the median estimated 10-year risk of fatal cardiovascular disease was 1% (range, 0%-9%) and 10% of the patients had a high risk (ie, SCORE ≥ 5%). Our results suggest that the frequency of cardiovascular events is relatively low after a liver transplant, even if most of the patients had 1 or more cardiovascular risk factors. Nevertheless, clinicians should perform a similar evaluation 15 or 20 years after the liver transplant because cardiovascular risk exponentially increases with age.
    02/2014; 12(1):55-61. DOI:10.6002/ect.2013.0208
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    ABSTRACT: Long-lasting lifting is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water-jet injection of saline solution or by injection of viscous macromolecular solutions. Combination of the jet injection and the macromolecular viscous solutions has never been used yet. We assessed the ability of a new water-jet system to inject viscous solutions in direct viewing and in retroflexion. We compared jet injection of saline solution and hyaluronate 0.5 % to perform ESD on ex vivo pig stomachs in order to evaluate the benefits of macromolecular solutions when injected by a jet-injector system. This is a prospective comparative study in pig stomachs. Using the jet injector, four viscous solutions were tested: hydroxyethyl starch, glycerol mix, hyaluronate sodic (0.5 %), and poloxamer mix. Ten ESDs larger than 25 mm (five in direct viewing and five in retroflexion) and one larger than 10 cm were performed with each solution. ESD with hyaluronate jet injection was then compared with ESD with saline jet injection by performing 50 ESDs in each group. A single, minimally-experienced operator conducted all the procedures. All 145 resections were complete, including all marking points with two perforations. Eleven jet ESDs per solution were conducted without any injection issue. In the second part of the study, when compared with saline, significant benefit of hyaluronate was observed on dissection speed (0.80 vs. 1.08 cm(2)/min, p < 0.001). This is the first report on a jet-injector system allowing injection of macromolecular viscous solutions even with retroflexed endoscope. Jet injection of macromolecular solutions can speed up dissection in comparison with saline, and should now be tested on humans.
    Surgical Endoscopy 01/2014; 28(5). DOI:10.1007/s00464-013-3378-5 · 3.31 Impact Factor
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    ABSTRACT: With small diameter endoscopes, transnasal esophagogastroduodenoscopy (t-EGD) is routinely performed. The aim of this prospective observational study was to evaluate the role of t-EGD for upper gastrointestinal bleeding (UGIB). One hundred and forty-five consecutive patients (mean age, 66±18.4 years) with suspicion of UGIB were classified a priori into 3 groups according to initial clinical presentation: (1) intensive care unit with EGD under sedation, (2) endoscopy unit with EGD under transient sedation and (3) unsedated t-EGD as "first look". Demographic, clinical and biological parameters, Rockall and Blatchford scores, endoscopic diagnosis and treatment, and outcome were analysed. Unsedated t-EGD was attempted in 89 patients, performed in 52 (5 failures, 28 contraindications) and the procedure was converted under sedation for 2 patients. Based on ASA classification, clinical (blood pressure, hemodynamical failure) and biological variables (hemoglobin, platelets, creatinine), these patients were less severe than in the other groups. Pre-endoscopic Rockall and Blatchford scores were significantly lower in this group. More patients in this group presented significant cardiovascular co-morbidity (47.2%), taking aspirin, clopidogrel and/or anticoagulant. Our results strongly support that "first look" unsedated t-EGD can avoid unnecessary sedation in selected patients with UGIB, presenting a low probability for endoscopic haemostatic treatment and high sedation risks.
    Gastroentérologie Clinique et Biologique 11/2013; 38(2). DOI:10.1016/j.clinre.2013.10.010 · 1.98 Impact Factor
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    ABSTRACT: Liver transplantation (LT) is the therapeutic option for severe complications of Wilson's disease (WD). To report on the long-term outcome of WD patients following LT. The medical records of 121 French patients transplanted for WD between 1985 and 2009 were reviewed retrospectively. Seventy-five patients were adults (median age: 29 yrs, (18-66)) and 46 were children (median age: 14 yrs, (7-17)). The indication for LT was (1) fulminant/subfulminant hepatitis (n=64, 53%), median age = 16 yrs (7-53), (2) decompensated cirrhosis (n=50, 41%), median age = 31.5 yrs (12-66) or (3) severe neurological disease (n= 7, 6%), median age = 21.5 yrs (14.5-42). Median post-transplant follow-up was 72 months (0-23.5). Actuarial patient survival rates were 87% at 5, 10 and 15 years. Male gender, pre-transplant renal insufficiency, non elective procedure and neurological indication were significantly associated with poorer survival rate. None of these factors remained statistically significant under multivariate analysis, In patients transplanted for hepatic indications, the prognosis was poorer in case of fulminant or subfulminant course, non elective procedure, pre-transplant renal insufficiency and in patients transplanted before 2000. Multivariate analysis disclosed that only recent period of LT was associated with better prognosis. At last visit, the median calculated glomerular filtration rate was 93 mL/min (33-180); 11/93 patients (12%) had stage II renal insufficiency and none had stage III. Liver failure associated with WD is a rare indication for LT (<1%) which achieves an excellent long-term outcome, including renal function.
    Journal of Hepatology 11/2013; 60(3). DOI:10.1016/j.jhep.2013.10.025 · 10.40 Impact Factor
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    ABSTRACT: Background and study aim: Endoscopic submucosal dissection (ESD) is recommended for en bloc R0 resection of superficial esophageal neoplasms larger than 20 mm, but is high risk and time-consuming. In the tunnel technique, incisions at the lower and upper lesion edges are joined by a submucosal tunnel and then lateral incisions are made. The mucosa is thereby easily separated from the muscular layer. We report our experience of esophageal tunnel ESD.Patients and methods: We retrospectively reviewed all consecutive esophageal tunnel ESDs performed at our unit between January 1 2010 and January 11 2013. Lesions were superficial esophageal neoplasms, UT1N0 at EUS. Results: 11 patients underwent tunnel ESD (nine squamous cell carcinomas, two adenocarcinomas). Mean dissected surface area was 13.25 cm². Mean procedure duration was 76.7 minutes. All 11 resections were en bloc and 9 /11 were R0. Complications were one subcutaneous emphysema with spontaneous resolution, and stenosis in 4 /11 patients (36.4 %) with resolution after 1 - 5 dilations.Conclusion: Tunnel ESD of superficial esophageal neoplasms is an interesting option, seeming to be faster and more effective than standard ESD, without higher morbidity.
    Endoscopy 10/2013; 45(12). DOI:10.1055/s-0033-1344855 · 5.20 Impact Factor

Publication Stats

557 Citations
315.72 Total Impact Points

Institutions

  • 2007–2015
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2009–2014
    • HCL
      Noida, Uttar Pradesh, India
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2007–2014
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France
  • 2013
    • University of Toronto
      Toronto, Ontario, Canada
  • 2012
    • University of Lyon
      Lyons, Rhône-Alpes, France
  • 2006
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France