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ABSTRACT: Lymphocele is a common surgical complication after renal transplantation. The incidence of lymphocele ranges from 0.6% to 18%. The aim of this study was to determine incidence, risk factors and prognosis of complicated lymphocele in the era of modern immunosuppression. We retrospectively reviewed 311 renal transplants from January 2003 to September 2008, we excluding patients who received sirolimus or underwent multiorgan transplantations. A complicated lymphocele was defined by the requirement for a surgical procedure for cure. Of the 311 transplant recipients, we included 269 in the study with 49 (18.9%) presenting a complicated lymphocele after transplantation. Cold ischemia time, waiting time on dialysis, gender, donor source, induction therapy (thymoglobulin vs basiliximab), and dialysis modality were similar between the 2 groups. Mycophenolate mofetil (MMF) doses were higher among the lymphocele than the nonlymphocele group (2.7 ± 0.54 g/d vs 2.36 ± 0.68 g/d; P < .05). However, the areas under the concentration-time curves of mycophenolic acid were not significantly different between the 2 groups (43.7 ± 15.3 h·mg/L vs 48 ± 21 h·mg/L; P = .33). However, a multivariate analysis showed complicated lymphocele to be associated with greater MMF doses (odds ratio [OR] 2.75; P < .01), warm ischemia time (OR 1.035; P < .05), and recipient age (OR 1.04; P < .05). In conclusion, we identified high MMF doses as an independent risk factor for lymphocele formation after renal transplantation.
Transplantation Proceedings 12/2010; 42(10):4322-5. · 1.00 Impact Factor
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ABSTRACT: In a recent study, eculizumab, a humanized monoclonal antibody which targets complement factor C5, appeared to resolve hemolysis and thrombocytopenia leading to recovery of renal function in a transplant patient during an episode of an atypical hemolytic uremic syndrome. We report the efficacy of eculizumab in a patient who presented with a recurrence of atypical hemolytic syndrome at 3 years after renal transplantation. After 17 months of eculizumab treatment, and without concomitant plasma therapy, renal function was maintained, the need for blood transfusions reduced, and acute thrombotic microangiopathy and hemolysis controlled. These data suggested that eculizumab should be considered to be a permanent treatment for this patient.
Transplantation Proceedings 12/2010; 42(10):4353-5. · 1.00 Impact Factor
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American Journal of Transplantation 09/2009; 9(11):2644-5. · 6.39 Impact Factor
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ABSTRACT: Conventional peritoneal dialysis solutions are mostly bioincompatible in relationship with a low pH, a high glucose and glucose degradation products (GDP) concentrations inducing anatomical and functional peritoneal membrane alterations. Use of icodextrin solution instead of glucose hypertonic solution preserves peritoneal membrane minimizing glucose exposure and its peritoneal absorption. Physiological fluids with a neutral pH and less GDP seem to have a positive effect on residual renal function which declines more slowly when they are early prescribed, before highly damaged and sclerotic kidneys. Preliminary data show that patients and technique survivals are better when physiological solutions are used either for diabetic and non diabetic patients. However, these new solutions do not improve peritonitis rates except for bicarbonate solutions but this fact must still be confirmed by other studies. In spite of a higher cost, physiological solutions must be proposed mainly for patients with a low comorbidity index and a high life expectancy.
Néphrologie & Thérapeutique 06/2009; 5 Suppl 4:S286-9. · 0.47 Impact Factor
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ABSTRACT: Previous series have reported weight gain after kidney transplantation. However few studies have investigated the body composition after kidney transplantation, particularly during longitudinal follow-up. In this prospective study, we assessed the changes in body composition after kidney transplantation. We also analyzed the effect of steroid withdrawal from the immunosuppressive regimen on weight gain and body composition.
Thirty-eight cadaveric kidney transplant recipients were followed for 2 years posttransplant. Total and segmental body composition were measured by dual energy X-ray absorptiometry (DEXA) at the time of transplantation as well as 3, 6, 12, and 24 months later.
In 28 patients (group A), prednisone was stopped by month 6, whereas, in 10 patients (group B), it was continued throughout the study. In the overall patient group, there were no significant changes in body weight. However, a trend to increased weight was observed in group B. In this group, patients showed an early increase in total body fat with a central accumulation of fat mass that was maintained during the follow-up period. On the other hand, total lean mass increased significantly in group A but did not change significantly in group B.
In summary, overall the group showed no major changes in body weight during the 2 years after transplantation. Steroid withdrawal in kidney transplant recipients may have a significant positive effect on body composition.
Transplantation Proceedings 01/2007; 38(10):3517-9. · 1.00 Impact Factor
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ABSTRACT: The Registre de Dialyse Péritonéale de Langue Française (RDPLF Registry) is a non-profit association that has been set up to assist physicians and nurses in evaluating their practical experience and results regarding peritoneal dialysis (PD). Five French-speaking and two Spanish-speaking countries have participated in this initiative (which includes 21 000 patients). In France, 82% of all PD patients are included in the registry and the main results for the period from 1995 to January 2006 form the basis of this report: of 11 744 incident patients with a median age of 71 years, 21.5% were over 80 years of age and 56% were not able to perform PD treatment at home without assistance. Eighty-six percent of the latter group received external assistance from a private nurse and 14% were aided by their family. The overall average rate of peritonitis was one episode every 29 months. The probability of being peritonitis-free appeared to be better for patients on automated PD (59.4% at 2 year) than for those on continuous ambulatory PD (55.3%), but this finding requires further validation. The average waiting time before transplantation was about 2 years. In patients who had undergone transplantation, the peritonitis rate was one episode per 42 months before transplantation compared to one episode per 29 months for patients who had not received a transplant. Eighty-three percent of patients had a hemoglobin level greater than 11 g%. Catheter survival was 92% at 2 years post-insertion and 85% at 5 years, with 94% being implanted by experienced surgeons. In conclusion, the RDPLF results demonstrate that PD may be successfully prescribed for older patients who receive assistance either from their family or from a nurse. Further, a larger number of younger patients should also be prescribed this technique in France. Patients eligible for transplantation and on short-term PD have the lowest risk of developing peritonitis; PD before transplantation may help prolong residual renal function, and initial treatment by PD may also help to preserve vascular access for the future.
Kidney international. Supplement 12/2006;
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ABSTRACT: Mycophenolic acid (MPA) pharmacokinetics exhibit large variability in transplant recipients and may be altered due to concurrent immunosuppressants. Little is known about the influence of sirolimus (SRL) on MPA pharmacokinetics in kidney transplant patients.
We studied the areas under concentration-time curves (AUC) for MPA in 15 patients receiving immunosuppression combining SRL with mycophenolate mofetil (MMF). The pharmacokinetic measurements were performed in all patients using three MMF dosing regimens (0.5 g twice a day, 0.75 g twice a day, 1 g twice a day). Similar blood AUC profiles were also sampled from 12 patients treated with a fixed dose of MMF 1 g twice a day and cyclosporine (CsA). MPA was measured using HPLC; the AUC0-12 of MPA was determined by the trapezoidal method using four sampling time points: C0, C1, C3, C5.
While patients on SRL were receiving 0.75 g MMF twice a day, mean AUC0-12 and C0 values of MPA were comparable to those of patients receiving CsA and 1 g MMF twice a day (54.1 +/- 17.6 and 3 +/- 1.87 vs 51.7 +/- 16.7 mg.h/L and 2.76 +/- 1.57 mg/L, respectively). On the other hand, 0.5 g MMF twice a day with SRL therapy resulted in AUC0-12 and C0 values of MPA of 32.3 +/- 12.6 mg.h/L and 2.32 +/- 1.72 mg/L, respectively, whereas, 1 g MMF twice a day with SRL resulted in AUC0-12 and C0 values of MPA of 70.9 +/- 19.3 mg.h/L and 4.7 +/- 2.44 mg/L, respectively.
These findings demonstrate that MPA exposure in the presence of SRL is higher than that with CsA. It appears that the MMF dose should be reduced to 0.75 g twice a day in patients receiving SRL to obtain AUC0-12 of MPA levels comparable to that in patients treated with CsA and MMF 1 g twice a day.
Transplantation Proceedings 04/2005; 37(2):864-6. · 1.00 Impact Factor
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La Revue de Médecine Interne 09/2001; 22(8):763-4. · 0.61 Impact Factor
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B Hurault de Ligny,
I Etienne,
A Francois,
O Toupance,
M Buchler,
G Touchard,
P Lepogamp,
F Comoz, T Lobbedez,
M Godin,
J P Ryckelynck,
Y Lebranchu
Transplantation Proceedings 01/2001; 32(8):2760-1. · 1.00 Impact Factor
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Transplantation Proceedings 01/2001; 32(8):2771-2. · 1.00 Impact Factor
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ABSTRACT: Even though computerized workstations bring undisputed benefits in nursing units, introducing them is still hard when most of the staff members have to share the workstation. We took advantage of the implementation of the drug prescription software SAUPHIX in a nephrology department to better define the encountered difficulties. The workstation described in this paper is shared by physicians who enter their prescriptions (proprietary names, doses, routes of administration), nurses who use dosage schedules for drug administration, and the chemist who has authority to control prescription orders.
Six months after the implementation of the workstation, physicians and nurses had to fill out an anonymous questionnaire aimed at assessing each function of the software.
Prescriptions proved to be more accurate and legible, while management of drugs was more precise. However, interns complained that entering data was time consuming. Furthermore, they raised objections to control of prescription orders. Nurses criticized dosage schedules, the primary reason being that they had to change their practice. The convenience of notebooks was questioned by both physicians and nurses who would have preferred a greater number of desktop computers at their disposition.
The implementation of a computerized workstation requires information, diplomacy and negotiations to obtain real implication of the staff. Tasks and schedules must be specified for everybody. The system has to be carefully customized, according to the requirement of the unit. Computers must be properly chosen and allocated in sufficient number. Finally, appropriate preparation, staff training and follow-up of the computerized system are essential.
La Revue de Médecine Interne 09/1999; 20(8):664-9. · 0.61 Impact Factor
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European Journal of Clinical Pharmacology 06/1999; 55(3):227-8. · 2.85 Impact Factor
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E Lécluse,
J P Ryckelink, T Lobbedez,
E Saloux,
C Duarte,
F Devaluez,
B H Hurault de Ligny,
B Valette,
M Hamon,
G Grollier,
J C Potier
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ABSTRACT: The management of heart failure that has become refractory to conventional drug treatment is an increasingly frequent problem for clinicians. Peritoneal dialysis, by ultrafiltration, is an effective method to treat refractory oedema, thereby improving the functional symptoms of these patients. The objective of this article is to review the data, of the literature and to define the results and indications of this treatment, which still remains and exceptional modality.
Annales de Cardiologie et d Angéiologie 02/1999; 48(1):32-6. · 0.28 Impact Factor
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La Presse Médicale 11/1998; 27(30):1527. · 0.67 Impact Factor
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Transplantation Proceedings 10/1998; 30(6):2863-4. · 1.00 Impact Factor
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ABSTRACT: Continuous or intermittent use of unfractioned heparin is the anticoagulant of choice to prevent the extracorporeal circulation clotting during the hemodialysis session. However, low molecular weight heparin (LMVH) could be an alternative treatment especially in case of high risk bleeding or during some clinical conditions such as diabetes mellitus, cerebrovascular bleeding, malignant hypertension. LMVH may be given as a single initial bolus injection generally adequate. Heparinization must be lowered or stopped when an effective anticoagulation is previously used.
Néphrologie 02/1998; 19(4):223-5.
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ABSTRACT: To evaluate the results of vascular accesses for chronic haemodialysis in elderly patients.
56 consecutive vascular accesses for haemodialysis were performed from November 1993 to December 1995 in patients over the age of 65 years. The policy adopted was to prefer distal accesses: only forearm accesses, primary arteriovenous fistula (AVF) or radio-M venous bioprosthesis shunt (AVS) were performed. Surgical or interventional radiological reoperation rates and abandonment rates were evaluated.
13 AVF (mean age: 74.5 years) and 43 AVS (mean age: 73.8 years) were analysed. The mean number of reoperations was significantly higher in the shunt group. 1 out of 13 AVF was abandoned versus 9 out of 43 AVS (no significant difference).
AVS gave poor results in terms of reoperation rate, inducing a high cost and impairment of the quality of life of these patients. Their survival in this population was comparable to that of AVF. Several teams prefer to perform first-line humero-cephalic or humero-basilic arteriovenous fistulas whenever a simple fistula in the forearm cannot be performed. They appear to give better results, but their use in the elderly is poorly evaluated. Peritoneal dialysis may be preferable to haemodialysis in the elderly. As vascular accesses are increasingly performed in elderly subjects with a reduced life expectancy, protection of the proximal venous capital does not appear to be a sufficient argument to justify the use of AVS in this population.
This study encouraged us to abandon the use of prostheses in the forearm in favour of direct accesses in the arms.
Progrès en Urologie 02/1998; 8(1):83-8. · 0.58 Impact Factor
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Nephrology Dialysis Transplantation 02/1998; 13 Suppl 4:56-9. · 3.40 Impact Factor
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ABSTRACT: Treatment of bilateral and synchronous renal cell cancer may require bilateral nephrectomy and chronic dialysis. After an arbitrarily determined waiting period (2 years) on dialysis, kidney transplantation may be proposed.
Two patients underwent kidney transplantation after bilateral nephrectomy for early-stage low-grade renal cell cancer. Eight years after nephrectomy and 6 years after transplantation, there is no evidence of cancer recurrence and renal function is satisfactory.
Certain patients treated for cancer may be candidates for kidney transplantation, even if the risk for cancer is higher in transplant recipients. Moreover, kidney transplantation without a required period on chronic dialysis could be proposed in early-stage lowgrade renal cell cancer.
La Presse Médicale 03/1997; 26(2):66-9. · 0.67 Impact Factor
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ABSTRACT: We report the case of a 26 year old woman who presented a Henoch Schönlein purpura at 13 weeks' gestation. IgA glomerulonephritis without pejoratif feature was confirmed by renal biopsy. Corticosteroid therapy was unsuccessful on nephrotic syndrome. At 25 weeks' gestation foetal death occurred followed by a rapid development of end stage renal failure.
Néphrologie 02/1997; 18(1):27-9.
