Didier Samuel

Publications (185)1093.18 Total impact

• Article: Fungal infections after liver transplantation: outcomes and risk factors revisited in the MELD era.

  Faouzi Saliba, Valérie Delvart, Philippe Ichaï, Najiby Kassis, Françoise Botterel, Liliana Mihaila, Daniel Azoulay, René Adam, Denis Castaing, Stéphane Bretagne, Didier Samuel
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  ABSTRACT: Antifungal prophylaxis is recommended in high-risk patients, but risk criteria remain unclear and the predictive value of Model of End-Stage Liver Disease (MELD) score is unknown. In a retrospective, single-center analysis of 667 liver transplants, potential risk factors for fungal infection were assessed, including MELD score. Antifungal prophylaxis was administered in 198 patients (29.4%). During follow-up (mean 43.6 ± 29.6 months), 263 patients (39.4%) developed ≥1 episode of fungal infection, and 187 (28.0%) patients developed a probable or proven invasive fungal infection requiring systemic antifungal treatment. Patients receiving antifungal prophylaxis had a lower incidence of fungal infection (29.8% vs. 43.5% without prophylaxis, p < 0.001) and invasive fungal infection (17.7% vs. 32.4%, p < 0.001). One-yr patient survival was 91%, 85% and 69%, respectively, in patients with no fungal infection, fungal colonization and treated invasive fungal infection (p < 0.001); graft survival was 88%, 85% and 66% (p < 0.001). Multivariate analysis indicated that MELD score of 20-30 or ≥30 was associated with a 2.0-fold or 4.3-fold increase in relative risk of fungal infection, respectively, and a 2.1-fold or 3.1-fold increase in relative risk of invasive fungal infection. In conclusion, liver transplant patients with a MELD score ≥20, and particularly patients with a score ≥30, are candidates for antifungal prophylaxis.
  Clinical Transplantation 05/2013; · 1.67 Impact Factor
• Article: Postliver transplantation pulmonary complications: is modified clinical pulmonary infection score applicable?

  Eric Levesque, Didier Samuel
  Transplantation 04/2013; 95(7):e43-4. · 4.00 Impact Factor
• Article: Acute liver failure: current trends.

  Faouzi Saliba, Didier Samuel
  Journal of Hepatology 04/2013; · 9.26 Impact Factor
• Article: Cirrhotic patients in the ICU: prognostic markers and outcome.

  Faouzi Saliba, Philippe Ichaï, Eric Levesque, Didier Samuel
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  ABSTRACT: Give an update on the importance of prognostic scores at admission to the ICU for defining short-term outcome in critically ill cirrhotic patients. Highlight the correlation between the development of sepsis and/or organ failure and outcome. ICU mortality rate of cirrhotic patients admitted to the ICU ranges from 34 to 69%. Few improvements in the management of these patients occurred during the last decade. Definitive treatment relies mainly on the availability of transplant organs. ICU scores (mainly Sequential Organ Failure Assessment score) when performed at admission or within 2-4 days from admission are superior to liver specific scores (Model for End-Stage Liver Disease and Child-Pugh scores) to determine outcome. Cirrhotic patients with three or more organ failures have higher mortality then general ICU patients in the same condition. An attempt to define an entity called 'acute on chronic liver failure' that characterizes better those patients with worse outcomes according to the numbers of organ failures is currently undergoing. Early referral of cirrhotic patients to ICU before the development of multiple extrahepatic organ failure is essential to improve outcome. Current scores should be used only for clinical trials and not to determine the potential futility or costs of an ICU admission.
  Current opinion in critical care 04/2013; 19(2):154-60. · 2.67 Impact Factor
• Article: Liver transplantation in the human immunodeficiency virus-hepatitis C virus coinfected patient: Time to sum up.

  Didier Samuel, Jean-Charles Duclos-Vallee
  Hepatology 01/2013; 57(1):409-11. · 11.66 Impact Factor
• Article: Portal stenting for hepatocellular carcinoma extending into the portal vein in cirrhotic patients.

  Eric Vibert, Daniel Azoulay, Antonio Sa Cunha, Rene Adam, Didier Samuel, Denis Castaing
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  ABSTRACT: BACKGROUND AND AIMS: Macroscopic portal vein invasion complicating hepatocellular carcinoma in the setting of cirrhosis is associated with a very low survival. To prevent the malignant progression from a portal branch to the main portal trunk, we have placed noncovered metallic stents extending from the portal trunk to the contralateral tumor free portal pedicle. METHODS: Fifty-Four patients (age: 60 ± 11 years) were treated. Thirty-four (60%) patients were Child A and 20 (40%) were Child B-C. Tumoral thrombosis involved 1st or 2nd order branches in 41 (82%) patients and partially the main trunk in 13 (24%). Open surgical insertion (via ileal vein) as an alternative to a percutaneous approach was used in 14 (24%) patients. RESULTS: Early mortality (<30 days) was 7%. Following stent insertion, a transarterial chemoembolization was performed in 26 (48%) patients. After stenting, overall survival at 6, 12, and 24 months were 47%, 44%, and 36%, respectively. Bilirubin > 30 µmol/L and open surgical insertion were predictive of short-term mortality. In the good group, overall survival at 6, 12, and 24 months were 69%, 61%, and 46%, respectively. CONCLUSIONS: The transhepatic deployment of metallic stent seems to improve survival of patients with hepatocellular carcinoma complicated by portal vein tumoral thrombosis and could allow subsequent treatments. J. Surg. Oncol © 2012 Wiley Periodicals, Inc.
  Journal of Surgical Oncology 12/2012; · 2.10 Impact Factor
• Article: The positive financial impact of using an Intensive Care Information System in a tertiary Intensive Care Unit.

  Eric Levesque, Emir Hoti, Sofia de La Serna, Houssam Habouchi, Philippe Ichai, Faouzi Saliba, Didier Samuel, Daniel Azoulay
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  ABSTRACT: INTRODUCTION: In the French healthcare system, the intensive care budget allocated is directly dependent on the activity level of the center. To evaluate this activity level, it is necessary to code the medical diagnoses and procedures performed on Intensive Care Unit (ICU) patients. The aim of this study was to evaluate the effects of using an Intensive Care Information System (ICIS) on the incidence of coding errors and its impact on the ICU budget allocated. PATIENTS AND METHODS: Since 2005, the documentation on and monitoring of every patient admitted to our ICU has been carried out using an ICIS. However, the coding process was performed manually until 2008. This study focused on two periods: the period of manual coding (year 2007) and the period of computerized coding (year 2008) which covered a total of 1403 ICU patients. The time spent on the coding process, the rate of coding errors (defined as patients missed/not coded or wrongly identified as undergoing major procedure/s) and the financial impact were evaluated for these two periods. RESULTS: With computerized coding, the time per admission decreased significantly (from 6.8±2.8min in 2007 to 3.6±1.9min in 2008, p<0.001). Similarly, a reduction in coding errors was observed (7.9% vs. 2.2%, p<0.001). This decrease in coding errors resulted in a reduced difference between the potential and real ICU financial supplements obtained in the respective years (€194,139 loss in 2007 vs. a €1628 loss in 2008). CONCLUSION: Using specific computer programs improves the intensive process of manual coding by shortening the time required as well as reducing errors, which in turn positively impacts the ICU budget allocation.
  International Journal of Medical Informatics 12/2012; · 2.41 Impact Factor
• Article: Resection or Transplantation for Early Hepatocellular Carcinoma in a Cirrhotic Liver: Does Size Define the Best Oncological Strategy?

  Rene Adam, Prashant Bhangui, Eric Vibert, Daniel Azoulay, Gilles Pelletier, Jean-Charles Duclos-Vallée, Didier Samuel, Catherine Guettier, Denis Castaing
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  ABSTRACT: BACKGROUND:: Resection and liver transplantation (LT) are the only curative options for hepatocellular carcinoma in cirrhotic patients (HCC-cirr). OBJECTIVE:: We tried to define the best primary intention-to-treat strategy in patients undergoing either resection or LT for early single HCC-cirr (≤5 cm). METHODS:: From 1990 to 2010, 198 patients with early HCC-cirr underwent either resection (group R, n = 97) or LT (group T, n = 101) as the primary procedure. Our policy was to prioritize Childs A patients with peripheral lesions for resection rather than LT. Patient and tumor characteristics, and outcomes (recurrence-free survival [RFS] and overall survival [OS]), were studied. RESULTS:: A longer diagnosis-to-surgery interval, more Child Pugh B/C patients, and more tumor nodules (on histopathological examination) were found in group T patients. The postoperative mortality (4.1% vs 3.0%, P = 0.72) and rate of major complications (19.1% vs 24.7%, P = 0.35) were similar in groups R and T, respectively, whereas tumor recurrence was higher in group R (62% vs 10% in group T, P < 0.0001). The 5-year OS (75% vs 52%, P = 0.0008) and RFS (72% vs 20%, P < 0.0001) were better in group T; similarly, more patients were disease free at last follow-up (27% vs 62%, P < 0.0001). Resection as the surgical procedure, tumor diameter 3 cm or more on histology, and microvascular tumor invasion were poor prognostic factors for OS and RFS. Including dropout patients from LT list in the analysis, the outcomes in group T were still better (70% and 61% vs 51% and 36% at 5 and 10 years, P = 0.01). CONCLUSIONS:: On an intention-to-treat basis, LT is associated with the best survival outcomes in patients with early HCC-cirr. Resection may achieve comparable OS in patients with single HCC-cirr of size smaller than 3 cm; however, the RFS still remains lower than that in patients of group T. This study could serve as a guide for HCC-cirr patients who are candidates for either resection or LT.
  Annals of surgery 10/2012; · 7.90 Impact Factor
• Source

  Available from: Emmanuelle Corruble

  Article: The Transplanted Organ Questionnaire: A validation study.

  Emmanuelle Corruble, Caroline Barry, Isabelle Varescon, Denis Castaing, Didier Samuel, Bruno Falissard
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  ABSTRACT: The transplanted organ is a key element of the recipient's daily life. But its representations are neither spontaneously expressed by patients, nor taken into account by transplantation professionals. Our objective was to assess specifically the transplanted organ representations in liver transplant recipients. In a prospective cohort study, 134 liver transplanted (LT) patients were assessed using the Transplanted Organ Questionnaire (TOQ), a new specifically designed questionnaire, fulfilled 3, 6, 12, 24, and 36months post-LT. The TOQ comprised three dimensions, explaining 44% of the total variance: Donor (21.3%) measuring the recipients' concerns about the donor, Positive attitude towards the transplant (13.4%), and Psychological Rejection (9.3%), measuring a lack of incorporation of the transplant. These three dimensions have a high internal consistency (Cronbach alpha: 0.91, 0.76 and 0.56) and are stable over time. Older recipients had more concern about the Donor than younger ones. As compared to other medical primary diagnoses, viral hepatitis was associated with higher scores on the subscales Positive attitude towards the transplant and Psychological Rejection. Interestingly, Psychological rejection predicted increased long term risk of death (HR, 1.20; 95% CI, 1.01-1.44, P=.046) under multivariate Cox analyses, independently from other variables. The transplanted organ representations as specifically assessed by the Transplanted Organ Questionnaire (TOQ) are relevant in liver transplant recipients. Interventions based on the transplant representations after LT should be assessed in further studies. Indeed, preventing psychological rejection of the transplanted organ and facilitating its psychological incorporation may decrease long term mortality after LT.
  Journal of psychosomatic research 10/2012; 73(4):319-24. · 2.91 Impact Factor
• Article: Efficacy of retreatment of HCV infection after liver transplantation (LT): Role of aggressive approach (LT-12-335).

  Marina Berenguer, Bruno Roche, Victoria Aguilera, Jean-Charles Duclos-Vallée, Laia Navarro, Angel Rubín, Jose-Antonio Pons, Manuel de la Mata, Martín Prieto, Didier Samuel
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  ABSTRACT: Treatment with pegylated interferon (pIFN) + ribavirin (RBV) results in about 30% sustained viral response (SVR) in naïve HCV-infected liver transplant (LT) recipients. There are almost no data regarding retreatment (RETx) outcome. We aimed to assess the efficacy, tolerability and SVR predictors of anti-HCV RETx in recurrent HCV. Methods: Data on RETx at four centers were retrieved from prospectively collected databases. Patients were non-responders (NR) or relapsers (RR) to a prior course of standard or pIFN ± RBV. Results: Of 301 post-transplant treatment experienced-patients, only 79 (26%) patients, {age: 59 (35-77) years, 72% male} mostly infected with genotype 1 (87%) were retreated with pIFN-RBV at a median of 6.9 years (175 days-21.6 years) since LT. In the first course of therapy, 35.5% had been treated with standard IFN, 49.5% had been on Tac, 52% on steroids and 49.5% were RR. RETx was started at a median of 1.9 (45 days-8.2) yrs since the end of first course. The proportion of cirrhotics had increased from 10% to 37% (p<0.0001). In addition, full starting RBV doses (p=0.031), growth factors (erythropoietin, p<0.0001, GCSF, p=0.048) and transfusions (p=0.027) occurred more frequently in RETx patients, and treatment duration was longer (p=0.031). An end-of-treatment response was achieved in 61% with SVR in 28 (35%). SVR was associated with improved survival. Variables predicting SVR were age (p=0.037), disease severity {fibrosis: F0-2: 50% vs F3-4: 25%; p=0.031; bilirubin, p=0.006; platelet count, p=0.035), adherence and viral kinetics. None of those without early viral response achieved an SVR while 61% of those with rapid response did. Importantly, Type of IFN in the first course had no effect on SVR; there was a trend for prior RR to achieve higher SVR than prior NR. Conclusions: RETx patients, a difficult-to-treat population, can achieve an SVR in one third of cases. SVR is associated with enhanced survival. Variables predicting SVR are similar to those described in naïve treated LT recipients and include age, disease severity, adherence and viral kinetics. © 2012 American Association for the Study of Liver Diseases.
  Liver Transplantation 09/2012; · 3.39 Impact Factor
• Source

  Available from: Emmanuelle Corruble

  Dataset: JPR TOQ 2012

  Emmanuelle Corruble, Caroline Barry, Isabelle Varescon, Denis Castaing, Didier Samuel, Bruno Falissard
• Article: Iodide Transporter NIS Regulates Cancer Cell Motility and Invasiveness by Interacting with the Rho Guanine Nucleotide Exchange Factor LARG.

  Claire Lacoste, Julie Hervé, Myriam Bou Nader, Alexandre Dos Santos, Nicolas Moniaux, Yannick Valogne, Rodrick Montjean, Olivier Dorseuil, Didier Samuel, Doris Cassio, Carla Portulano, Nancy Carrasco, Christian Bréchot, Jamila Faivre
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  ABSTRACT: A number of solute carrier (SLC) proteins are subject to changes in expression and activity during carcinogenesis. Whether these changes play a role in carcinogenesis is unclear, except for some nutrients and ion carriers whose deregulation ensures the necessary reprogramming of energy metabolism in cancer cells. In this study, we investigated the functional role in tumor progression of the sodium/iodide symporter (NIS; aka SLC5A5), which is upregulated and mislocalized in many human carcinomas. Notably, we found that NIS enhanced cell migration and invasion without ion transport being involved. These functions were mediated by NIS binding to leukemia-associated RhoA guanine exchange factor, a Rho guanine exchange factor that activates the small GTPase RhoA. Sequestering NIS in intracellular organelles or impairing its targeting to the cell surface (as observed in many cancers) led to a further increase in cell motility and invasiveness. In sum, our results established NIS as a carrier protein that interacts with a major cell signaling hub to facilitate tumor cell locomotion and invasion. Cancer Res; 72(21); 1-11. ©2012 AACR.
  Cancer Research 09/2012; · 7.86 Impact Factor
• Article: Liver-kidney recipients with chronic viral hepatitis C treated with interferon-alpha.

  Qussai Hassan, Bruno Roche, Camille Buffet, Thomas Bessede, Didier Samuel, Bernard Charpentier, Antoine Durrbach
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  ABSTRACT: Antiviral therapy with interferon-alpha (IFN-alpha) and pegylated IFN-alpha (PEG-IFN-alpha) for chronic hepatitis C (HCV)-infected kidney recipients remains controversial. IFN-alpha is not recommended in most cases because it induces severe acute graft rejection. However, IFN-alpha, as PEG-IFN-alpha, is associated with a more pronounced immune response, and is well tolerated in HCV-infected liver recipients without causing graft rejection. In combined liver-kidney transplant (LKT) recipients, IFN-alpha has been occasionally used and appears to be well tolerated. All LKT recipients with a functioning kidney and liver having a HCV replication and who needed IFN-alpha therapy have been included in the study. The occurrence of liver and/or renal acute rejection as well as the HCV replication has been collected. A total of 12 LKT patients treated with PEG-IFN-alpha plus ribavirin have been studied. No acute rejection was observed. Renal function remained stable during and after discontinuing treatment, without any graft dysfunction. Two patients had a partial viral response and four had a sustained viral response. All patients, whatever their viral response, had decreased liver-enzyme levels. Response to PEG-IFN-alpha therapy was correlated with steroid dose and transaminase level when PEG-IFN-alpha was started. These data suggest that the combination therapy of PEG-IFN-alpha plus ribavirin did not have a higher risk of acute kidney-graft rejection after liver-kidney transplantation.
  Transplant International 09/2012; 25(9):941-7. · 2.92 Impact Factor
• Article: Immunoproteomic analysis of potentially severe non graft versus host disease hepatitis following allogenic bone marrow transplantation.

  Elvire Beleoken, Rodolphe Sobesky, Jean-Pierre Le Caer, François Le Naour, Mylène Sebagh, Nicolas Moniaux, Bruno Roche, Mohammad Zahid Mustafa, Catherine Guettier, Catherine Johanet, Didier Samuel, Jean-Henri Bouhris, Jean-Charles Duclos-Vallee, Eric Ballot
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  ABSTRACT: The development of potentially severe non graft-versus-host disease (GVHD) hepatitis resembling autoimmune hepatitis (AIH) has been reported exceptionally following bone marrow transplantation (BMT). The purpose of this study was to better characterize this form of hepatitis, particularly through the identification of auto-antigens recognized by patient sera. PATIENTS AND METHODS.: Five patients who received an allogeneic BMT for the treatment of haematological diseases developed liver dysfunctions with histological features suggestive of AIH. Before and during the onset of hepatic dysfunction, sera were tested on immunoblots performed with cytosolic, microsomal, mitochondrial and nuclear proteins from rat liver homogenate and resolved by two-dimensional electrophoresis. Antigenic targets were identified by mass spectrometry. RESULTS.: During the year that followed BMT, all patients presented with GVHD. Acute hepatitis then occurred after the withdrawal, or during the tapering, of immunosuppressive therapy. At that time, no patients had a history of liver toxic drug absorption, patent viral infection or any histopathological findings consistent with GVHD. Immunoreactive spots stained by sera collected at the time of hepatic dysfunction were more numerous and more intensely expressed than those stained by sera collected before. Considerable patient-dependent pattern heterogeneity was observed. Among the 259 spots stained exclusively by sera collected at the time of hepatitis, a total of 240 spots were identified, corresponding to 103 different proteins. Twelve of them were recognized by sera from three patients. CONCLUSION.: This is the first immunological description of potentially severe non GVHD hepatitis occurring after BMT, determined using a proteomic approach and enabling a discussion of the mechanisms that transform an alloimmune reaction into an autoimmune response. Any decision to withdraw immunosuppression after allogeneic BMT should be made with caution. (HEPATOLOGY 2012.).
  Hepatology 08/2012; · 11.66 Impact Factor
• Article: Practical management of boceprevir and immunosuppressive therapy in liver transplant recipients with hepatitis C virus recurrence.

  Audrey Coilly, Valérie Furlan, Bruno Roche, Caroline Barau, Coralie Noël, Laurence Bonhomme-Faivre, Teresa Maria Antonini, Anne-Marie Roque-Afonso, Didier Samuel, Anne-Marie Taburet, Jean-Charles Duclos-Vallée
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  ABSTRACT: Hepatitis C virus (HCV) recurrence is the most important complication in HCV liver transplant patients. Boceprevir with pegylated interferon and ribavirin (PegIFN/RBV) enabled improvement in sustained virological response rates of patients with genotype 1 HCV. Boceprevir interacts with immunosuppressive therapy (IT) by inhibiting the cytochrome P450 3A enzyme. Our aim was to study interactions and assess the safety of boceprevir in the context of HCV recurrence. Boceprevir (800 mg three times a day) initiated after a 4-week lead-in phase was associated with cyclosporine (three patients), tacrolimus (two patients), and everolimus (one patient) in five liver transplant patients with genotype 1 HCV infection who experienced HCV recurrence. The mean follow-up period after HCV therapy was 14.8 ± 3.1 weeks. Estimated oral clearances of IT decreased on average by 50%, requiring reduced dosing regimens. Anemia occurred in all patients, with a mean fall in hemoglobin levels between baseline and week 12 of 3.12 ± 2.27 g/dl. All patients required administration of β-erythropoietin (n = 5), three needed ribavirin dose reduction, and one needed a blood transfusion. A virological response was observed in all patients (mean HCV viral load [HVL] decrease at week 12, 6.64 ± 0.35 log(10) IU/ml). These preliminary results in liver transplant patients with HCV recurrence demonstrate the feasibility and safety of coadministration of boceprevir and IT.
  Antimicrobial Agents and Chemotherapy 08/2012; 56(11):5728-34. · 4.84 Impact Factor
• Article: Pulmonary Complications After Elective Liver Transplantation-Incidence, Risk Factors, and Outcome.

  Eric Levesque, Emir Hoti, Daniel Azoulay, Isabelle Honore, Bruno Guignard, Eric Vibert, Philippe Ichai, Fadi Antoun, Faouzi Saliba, Didier Samuel
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  ABSTRACT: : After liver transplantation (LT), postoperative pulmonary complications (PPC) occur in approximately 35% to 50% of the recipients. Among these PPC, pneumonia is the most frequently encountered. Pulmonary dysfunction has also been widely reported among patients awaiting LT. The links between this dysfunction and PPC have not been clearly established. In this present cohort study, we evaluated the incidence and profile of post-LT pneumonia and identified potential preoperative risk factors. METHODS: The postoperative clinical course of 212 liver transplant recipients between January 2008 and April 2010 was analyzed. These patients were treated in a single intensive care unit and received standardized postoperative care. RESULTS: During the postoperative period, 47 (22%) patients developed pneumonia, of whom 20 (43%) developed respiratory failure requiring mechanical ventilation. Univariate analysis showed that several preoperative factors (age of recipient, model for end-stage liver disease score, indication for LT, platelet count, and restrictive lung pattern revealed by preoperative pulmonary function tests) and the transfusion (blood units and fresh frozen plasma units) during the operative period were associated with pneumonia. Using multivariate analysis by logistic regression, only a restrictive lung pattern (odds ratio=3.14; 95% confidence interval, 1.51-6.51; P=0.002) and the international normalized ratio measured prior LT (OR=4.95; 95% confidence interval, 1.86-8.59; P=0.0004) were independent predictors of pneumonia after LT. CONCLUSION: Pneumonia is common among patients undergoing LT and is a major cause of morbidity. A restrictive pattern on preoperative pulmonary testing and a higher international normalized ratio measured prior LT were associated with more risk of postoperative pneumonia.
  Transplantation 08/2012; 94(5):532-538. · 4.00 Impact Factor
• Article: Liver transplantation in delta virus infection.

  Bruno Roche, Didier Samuel
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  ABSTRACT: Liver transplantation is the only therapy for patients with end-stage liver disease, hepatocellular carcinoma, or fulminant hepatitis due to hepatitis D virus (HDV) and hepatitis B virus (HBV) coinfection or superinfection. Patients chronically coinfected with HDV are less at risk of HBV recurrence and have a better survival rate than patients infected with HBV alone. Patients coinfected with HDV generally do not require pretransplant antiviral therapy. Rates of recurrent HBV-HDV infection are lower than 5% using low-dose intramuscular (IM) HBIg and antiviral prophylaxis in combination. Few studies have evaluated the possibility of using shorter-term HBIg (12-24 months) then switching to antiviral therapy. Although HBV replication can be controlled by potent HBV-polymerase inhibitors, reappearance of HBsAg and/or the persistence of HBV DNA in serum, liver, or peripheral blood mononuclear cells might have deleterious consequences in the setting of HBV-HDV coinfection as they may provide the biologic substrate to the reactivation of HDV. No effective antiviral drug is available for the treatment of graft infection with HDV.
  Seminars in Liver Disease 08/2012; 32(3):245-55. · 7.05 Impact Factor
• Article: Outcomes associated with amphotericin B lipid complex (ABLC) prophylaxis in high-risk liver transplant patients.

  Faouzi Saliba, Valérie Delvart, Philippe Ichaï, Najiby Kassis, Françoise Botterel, Liliana Mihaila, Daniel Azoulay, René Adam, Denis Castaing, Stéphane Bretagne, Didier Samuel
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  ABSTRACT: Antifungal prophylaxis with liposomal amphotericin B in high-risk liver transplant recipients is recommended, but experience with amphotericin B lipid complex (ABLC, Abelcet(®)) in this setting is limited. Data from 615 liver transplants performed during 1999-2005 were analyzed retrospectively. High-risk patients (n = 146) received a mean cumulative ABLC dose of 955 ± 609 mg (mean duration of 23.3 ± 11.9 days). Low-risk patients (n = 469) received no prophylaxis. During a mean follow-up of 43.8 ± 29.2 months, fungal infections occurred in 32.2% of ABLC patients versus 43.5% of non-prophylaxis patients (P = 0.015). The overall rate of invasive fungal infection was 12.3% in the ABLC group versus 15.6% in the non-prophylaxis patients (P = 0.34). Any Candida infection (ABLC 29.5%, non-prophylaxis 41.2%, P = 0.011), probable or proven invasive Candida infection requiring systemic antifungal treatment (ABLC 18.5%, non-prophylaxis 32.4%, P = 0.001) and invasive abdominal candidiasis during the first 3 months (ABLC 4.1%, non-prophylaxis 9.2%, P = 0.049) were significantly less frequent in the ABLC group. There was no significant difference between groups in the incidence of Aspergillus infections. The ABLC group showed no evidence of nephrotoxicity. In conclusion, the marked and significant differences in infection rates and requirement for systemic treatment in this large population suggest that targeted use of low-dose ABLC therapy to high-risk patients is a valid prophylactic strategy following liver transplantation.
  Medical mycology: official publication of the International Society for Human and Animal Mycology 07/2012; · 2.13 Impact Factor
• Article: Operative risks of domino liver transplantation for the FAP liver donor and the FAP liver recipient.

  Daniel Azoulay, Chady Salloum, Didier Samuel, Violaine Planté-Bordeneuve
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  ABSTRACT: This study aimed at evaluating the operative risks of domino liver transplantation (LT). Two retrospective analyses were conducted (comparison of familial amyloid polyneuropathy (FAP) liver donors [61 patients] versus FAP nondonors [39 patients] and FAP liver recipients [61 patients] versus cadaveric liver recipients [61 patients]). First analysis showed a 60-day mortality of 6.6% for FAP donors and 7.7% for FAP nondonors (p = 1.0). Both groups had similar vascular and biliary complication rates. Both groups had similar 1- and 5-year patient and graft survival rates (83.4 % versus 87.2%, and 79.8 % versus 71.8%, p = 0.7) and (83.3% versus 87.2%, and 79.1% versus 71.8%, p = 0.7). The second analysis showed a 1.6% mortality for FAP liver recipients versus 3.2% of the control group (p = 1). Both groups had similar morbidity and technical complication rates (18.0% versus 13.1%, p = 0.45) and (0.18 versus 0.15, p = 0.65). Domino procedure doesn't add any risk to FAP donor or recipient. It increases the organ pool allowing transplantation of marginal recipients who otherwise are denied cadaveric LT.
  Amyloid: the international journal of experimental and clinical investigation: the official journal of the International Society of Amyloidosis 06/2012; 19 Suppl 1:73-4. · 2.12 Impact Factor
• Article: Treatment of recurrent HCV infection following liver transplantation: results of a multicenter, randomized, versus placebo, trial of ribavirin alone as maintenance therapy after one year of PegIFNα-2a plus ribavirin.

  Yvon Calmus, Christophe Duvoux, Georges Pageaux, Philippe Wolf, Lionel Rostaing, Claire Vanlemmens, Danielle Botta-Fridlund, Sébastien Dharancy, Jean Gugenheim, François Durand, Martine Néau-Cransac, Olivier Boillot, Olivier Chazouillères, Laurence Samelson, Karim Boudjema, Didier Samuel
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  ABSTRACT: We aimed at determining the effect of maintenance therapy with ribavirin alone, after a year of combined peginterferon-alfa 2a (PegIFNα-2a) and ribavirin therapy, on viral response and liver histology after liver transplantation (LT). Hundred and one patients with recurrent HCV and a minimum of stage 1 fibrosis (METAVIR scoring), 1-5years after LT, were enrolled. PegIFNα-2a and ribavirin were initiated at 90 μg/wk and 600 mg/d, respectively, then increased or adjusted as a function of tolerance. At 12 months, combination therapy was discontinued and patients were randomized to ribavirin or placebo for a further 12 months. Growth factor use was permitted. At 18 months, a sustained virological response (SVR) was obtained in 47.9% of patients in Per Protocol (PP) analysis, and was higher in patients with genotype 2 or 3 than in patients with genotype 1 or 4, in patients with genotypes 1+4 receiving ciclosporine than in those receiving tacrolimus, in patients with worse renal function, in those having received EPO, in patients with lower weight, and in those with lower viral load at 3 months. Using logistic regression, only the early viral response, recipient weight and renal function were independently associated with better SVR. SVR, viral load, activity, and fibrosis scores were similar, at M18 and M30, in patients randomized to ribavirin, or to placebo. A PP SVR was achieved in 47.9% of patients with established recurrent hepatitis C after LT. Maintenance therapy with ribavirin alone does not improve the virological response or the histological parameters.
  Journal of Hepatology 05/2012; 57(3):564-71. · 9.26 Impact Factor