Olivier Guillaud

HCL, Noida, Uttar Pradesh, India

Are you Olivier Guillaud?

Claim your profile

Publications (69)154.08 Total impact

  • [Show abstract] [Hide abstract]
    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; · 1.63 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 2.57 Impact Factor
  • [Show abstract] [Hide abstract]
    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 06/2014; · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 0.80 Impact Factor
  • [Show abstract] [Hide abstract]
    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.
    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 02/2014; 12(1):55-61.
  • [Show abstract] [Hide abstract]
    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; · 3.43 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 0.80 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 9.86 Impact Factor
  • [Show abstract] [Hide abstract]
    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; · 5.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In an era of organ scarcity, the use of left liver grafts for adult recipients could increase the access to liver transplantation (LT). The aim of this study was to evaluate the results in a single-center series of adult left LT over a 14-yr period. Between March 1996 and March 2010, 30 adult patients underwent LT with a left liver obtained from 16 split cadaveric livers and 14 living donors (LD). Portal vein inflow modulation was performed in selected cases. A total of 19 (63.3%) grafts had early dysfunction leading to graft failure in six cases (20%). One third of the grafts developed small-for-size syndrome (SFSS). One-yr patient and graft survival was 80% and 76.7%, respectively. Regarding two successive periods, one-yr patient and graft survival dramatically increased from 62.5% to 100% (p = 0.01) and 56.2% to 100% (p = 0.002), respectively. Multivariate analysis disclosed that completion of a portosystemic shunt and the occurrence of post-operative ascites were significantly associated with graft failure. Our results support that improved surgical techniques and careful patient selection can lead to a safe use of left livers for transplantation in adult recipients. Inflow modulation could be performed in very selected cases.
    Clinical Transplantation 06/2013; · 1.63 Impact Factor
  • Jérôme Dumortier, Olivier Guillaud, Olivier Boillot
    [Show abstract] [Hide abstract]
    ABSTRACT: After organ transplantation, strategies to simplify the therapeutic regimen may improve adherence and prevent acute organ rejection and/or late graft loss. The aim of the present study was to evaluate the safety and efficacy of conversion from a twice-daily to once-daily tacrolimus formulation in a large cohort of adult liver transplant (LT) patients. This retrospective observational single centre study included 394 LT patients with at least 6 months post-transplant follow-up, and no rejection episodes in the last three months. Conversion from a twice-daily to a once-daily formulation was based on a 1:1 proportion. Median age at the time of conversion was 53 yr (range: 18-72 yr); 66% were men. The main indication for liver transplant was alcoholic cirrhosis in 41%. Median conversion time after LT was 74 months (range: 6-218 months). Mean serum tacrolimus trough level decreased after conversion (pre-conversion level = 6.1±5.6 ng/mL vs. post-conversion level = 4.9±2.5 ng/mL, p < 0.05). After a mean follow-up of 24 months after conversion, 6 patients were converted to ciclosporine, 14 patients had stopped all calcineurine inhibitors, 16 patients had returned to twice-daily tacrolimus and 358 patients were still on one-daily tacrolimus. Acute rejection episode was observed in 7 patients. In conclusion, the results of our experience indicate that conversion from a twice-daily to a once-daily tacrolimus formulation is a safe and effective strategy in the management of stable liver transplant patients. © 2013 American Association for the Study of Liver Diseases.
    Liver Transplantation 03/2013; · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Liver cirrhosis is a recognized risk factor for intrahepatic cholangiocarcinoma (I-CCa). Small I-CCa nodules might be undiagnosed or misdiagnosed as hepatocellular carcinoma (HCC) in the context of liver cirrhosis. The aim of this study was to determine the prevalence and clinical impact of undetected I-CCa in liver explants of adult cirrhotic patients undergoing liver transplantation (LT). From December 1985 to November 2008, a first LT was performed in 993 adult cirrhotic patients in three French academic Hospitals. All liver explants were analyzed for the presence of nodules. The diagnosis of HCC was made in 331 cases (33.3% of the patients). Similarly, an I-CCa was identified in 10 (1%) patients, with a mean size of 31 ± 17 mm. The mean age at transplantation was 58.8 yr (range 45 - 66), and all the patients were men. The mean follow-up after LT was 33 months (range 4-52). Post-transplant tumor recurrence was observed in five patients (50%), after a mean delay of 10 months. All five patients died. Malignant recurrence was associated with the presence of venous emboli on liver explants. Our results suggest that unrecognized I-CCa complicating liver cirrhosis is a rare entity, associated with high risk of recurrence and poor prognosis.
    Clinical Transplantation 02/2013; · 1.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Chronic hepatitis C virus (HCV) infection is the most common chronic liver disease in patients with end stage renal disease (ESRD) and is well known as a frequent cause of mortality and graft loss among haemodialysed and kidney transplant patients. Up to now, there are no data on antiviral efficacy and tolerability of available protease inhibitors (telaprevir and boceprevir) in HCV infected haemodialysed patients. METHODS: We report 4 cases of HCV infected haemodialysed patients, who have not responded to a prior course of pegylated interferon (Peg-IFN) and ribavirin (RBV) and who were listed for kidney transplantation (KTx). These 4 patients received a second-line antiviral treatment with Peg-IFN, RBV and telaprevir. RESULTS: After 12 weeks of triple therapy, tolerability was acceptable and HCV-RNA became undetectable in 3/4 patients. Mild side-effects included anaemia leading to increasing the doses of erythropoietin (EPO). Dose of RBV ranged from 200mg three times a week to 200mg/day. CONCLUSION: Triple therapy with a first generation protease inhibitor could be the new standard for the treatment of HCV patients with ESRD. This needs to be confirmed by larger series.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 11/2012; · 3.12 Impact Factor
  • Journal of Hepatology 07/2012; · 9.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The combination of ursodeoxycholic acid (UDCA) and vitamin E is a therapeutic option for nonalcoholic steatohepatitis (NASH) but randomized controlled studies have produced inconsistent results. The objective of this study was to report the long-term tolerability and efficacy of this combination in our ten-year single center experience. The study group included 101 adult patients with persistent elevation of serum aminotransferases (AST and ALT) and/or γ glutamyl-transferase (GGT), in whom a histological diagnosis of NASH was made from January 1998 to January 2009, and who were treated with a combination of UDCA with vitamin E. Median body mass index (30 kg/m(2)) remained unchanged during the study. UDCA and vitamin E were well tolerated (5% withdrawal for side effects). Mean serum AST, ALT and GGT levels (expressed as times of Upper Normal Limit) diminished significantly (1.39 ± 0.74 to 0.78 ± 0.34 for AST, 1.72 ± 0.92 to 0.91 ± 0.69 for AST and 3.25 ± 2.85 to 1.30 ± 1.30 for GGT). AST, ALT and GGT reached normal range in 80%, 70% and 65% of the patients, respectively. From the ten patients who had a second liver biopsy during follow-up, NAS score improved in seven, and worsened in one. The combination of UDCA with vitamin E significantly improves liver function tests in long-term and is very well tolerated.
    Gastroentérologie Clinique et Biologique 12/2011; 36(2):146-55. · 0.80 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Allocation of graft in liver transplantation (LT) depends mainly on Model for End Stage Liver Disease (MELD) score. We studied the prognostic ability of three metabolic liver function tests in 560 cirrhotic patients listed for transplantation, in comparison with MELD and Child-Turcotte-Pugh (CTP) scores. Indocyanine green retention rate (ICG), aminopyrine breath test (ABT), and galactose elimination capacity were performed at the time of listing in addition to standard biological parameters. Seventy-three patients died on waiting list, 438 were transplanted, and 73 died after LT. Cox regression analysis and receiver operating characteristic curves with c-statistics were calculated after stratification according to CTP and MELD score. For the mortality before transplantation, c-statistics showed that ICG and ABT had a slightly better prognostic ability (0.73 and 0.68, respectively) than MELD score (0.66), and similar to CTP score (0.70). ABT's prognostic ability remained significant once the MELD score (below and above 20) had already been taken into account. Only ICG had a prognostic ability to predict the survival after LT, even after stratification according to MELD and CTP score. Our results strongly support that ABT and ICG may be useful in the ranking of the patients in LT list, adding prognosis information in association with MELD score.
    Clinical Transplantation 12/2010; 25(5):755-65. · 1.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to evaluate the tolerability of the conversion from calcineurin inhibitor (CNI) to everolimus (ERL) in maintenance liver transplant (LT) recipients. From January 2005 to March 2008, ERL was introduced after LT as maintenance immunosuppressive therapy because of (i) de novo or recurrent cancer after LT, (ii) pre-existing liver carcinoma on the liver explant or (iii) CNI toxicity. CNI dosage was progressively reduced until discontinuation. The study population included 94 patients, of mean age 57 ± 10. The mean delay between LT and ERL introduction was 5 ± 5 yr. After a mean follow-up of 12 ± 7 months, 70% of the patients did present at least one side effect. The mean trough level of ERL was 6 μg/L at the end of follow-up. Main side effects included hyperlipidemia (37%), dermatitis (19%), mucositis (15%), and proteinuria (18%). Biopsy-proven acute rejection occurred in 9% of patients. Global ERL discontinuation rate was 21% (16% because of side effects). The results of our experience indicate that conversion to ERL is associated with adverse effects in 70% of patients leading to drug discontinuation in 16% (and amenable to dose reduction in the remainders). Longer follow-up periods are necessary to capture the impact of ERL fully on renal function and survival in cancer patients.
    Clinical Transplantation 12/2010; 25(4):660-9. · 1.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Transcatheter local thrombolytic therapy in patients with portosplanchnic venous thrombosis has been used in few cases. Here, we present our single-center experience with transcatheter thrombolytic therapy in three patients with extensive refractory portal and transjugular intrahepatic portosystemic shunt (TIPS) thrombosis. Thrombolytic therapy was successful for all three patients. Two patients developed minor procedure-related bleeding. Local thrombolysis could be proposed in case of TIPS thrombosis for patients in whom the venous flow cannot be restored by using conventional anticoagulant therapy and stent mechanical revision.
    Gastroentérologie Clinique et Biologique 10/2010; 34(12):721-5. · 1.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Mycophenolate mofetil (MMF) is a cornerstone immunosuppressive drug after liver transplantation (OLT). The aim of this study was to evaluate the long term results of the addition of MMF in maintenance OLT recipients. From 1996 to 2006, MMF was introduced because of (1) histologic features of rejection or (2) calcineurin inhibitor (CNI) toxicity in order to reduce CNI dosage. The study population included 208 patients (median, age 54 ± 9 years), with a median delay between OLT and MMF introduction of 54 ± 43 months. The median dosage of MMF was 1180 mg/d at the end of follow-up. After a median follow-up of 50 ± 26 months, 26.4% of the patients taking MMF did present ≥1 side effect and MMF discontinuation rate was 13.8% (transient in 3.8%). The main side effects were digestive disorders (45%), pruritus ± rash ± mucitis (12.7%), and myelosuppression (16.4%). MMF was withdrawn because of digestive disorders (17.2%), pruritus ± rash ± mucitis (17.2%), and myelosuppression (24.1%). The mean glomerular filtration rate as calculated by the Cockcroft-Gault formula value significantly increased after the introduction of MMF (58.1 vs 71.4 mL/min; paired t-test; P < .01). Improvement of renal function was significantly associated with initial association with tacrolimus (vs cyclosporine), initial trough level of cyclosporine (not tacrolimus), delay between OLT and MMF introduction, and age of renal impairment. Our results suggest that the introduction of MMF in OLT maintenance recipients is efficient and well-tolerated (one quarter of the patients presented significant side effects, leading to treatment discontinuation in 10% of the patients).
    Transplantation Proceedings 09/2010; 42(7):2602-6. · 0.95 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Tuberous sclerosis complex is a genetic multisystem disorder characterised by widespread hamartomas in several organs, including the brain, heart, skin, eyes, kidney, lung, and liver. Hepatic multiple, bilateral angiomyolipomas are a rare and usually asymptomatic complication in patients with tuberous sclerosis. We report here the case of a patient who needed liver transplantation because of debilitating manifestations and mechanical complications of massive liver involvement by multiple angiomyolipomas (severe malnutrition, anorexia and abdominal pain). Seventeen tumors, from 2 to 16 cm in diameter, were identified at examination of the liver explant. No feature suggestive of malignant behaviour was identified at histological examination. In conclusion, this unusual indication of liver transplantation underlines the interest of this therapeutic approach for benign tumors for which the multiplicity of the lesions and their huge volume prevent any attempt at surgical resection.
    Gastroentérologie Clinique et Biologique 09/2010; 34(8-9):494-8. · 1.14 Impact Factor

Publication Stats

360 Citations
154.08 Total Impact Points

Institutions

  • 2014
    • HCL
      Noida, Uttar Pradesh, India
  • 2007–2014
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
    • University of Geneva
      • Division of Gastroenterology and Hepatology
      Genève, GE, Switzerland
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2006–2013
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France