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L Rostaing

Publications and source records attributed to L Rostaing.

At least 37 records · Page 2Linked to original sources
PubMed2005

A third renal transplantation: is it relevant and is it worth it?

INTRODUCTION: The aim of this retrospective study was to determine the outcome of third cadaveric renal transplantations performed between 1989 and 2004 among a cohort of 35 patients whose immunosuppression included induction therapy and calcineurin inhibitors. Most patients were highly sensitized with 1 (0-4) HLA (classes I + II) incompatibility between donor and recipient. RESULTS: The median follow-up time was 57 months (range, 1-190). Fourteen patients experienced delayed graft function that required posttransplantation hemodialysis. The current patient and graft survival rates were 91.4% and 82.8%, respectively. At last follow-up, 6 grafts had been lost: 1 due to primary nonfunction; 1 due to an urinary leak (day 45); 2 deaths with functioning grafts; and 2 chronic allograft nephropathies (CAN) at 85 and 60 months posttransplantation, respectively. Among the 10 patients who experienced acute rejection episodes, half were steroid-sensitive, whereas the others required OKT3 therapy. Overall, when excluding the 2 patients who presented with early loss of their grafts, 13 of 33 patients (39.4%) developed CAN, which led to the graft loss in only 2 cases. The mean creatinine clearance was 57 +/- 23 mL/min at year 5. Of the 35 recipients, 12 (34.3%) developed graft/perigraft complications, among whom 10 (83.3%) required treatment. The most frequent complication was lymphocele (M = 4; 11.4%) or infections that led to rehospitalization (n = 17). CONCLUSION: Results from third transplantations were encouraging. Thus, despite the organ shortage, a third graft was worth it!

Adult↗
PubMed2005

Assessment of glomerular and tubular functions in renal transplant patients receiving cyclosporine A in combination with either sirolimus or everolimus.

AIMS: The aim of this study was to examine the glomerular filtration rate (GFR) and tubular function at three months after renal transplantation in two groups of patients receiving cyclosporine A associated with either sirolimus (SRL) (n = 18) or everolimus (RAD) (n = 12), two structurally similar immunosuppressant drugs. RESULTS: Donors' and recipients' characteristics and mean cyclosporine A trough levels were similar in the two groups. The mean sirolimus trough level was 12.01 +/- 1.6 ng/ml whereas the mean everolimus trough level was 4.23 +/- 0.36 ng/ml. GFR, equated by the clearance of inulin, was higher in RAD patients (64 +/- 4 ml. min- 1.1.73 m(-2)) than in SRL patients (49 +/- 4 ml.min(-1) .1.73 m(-2)) (p < 0.05). The significant difference in GFR between the groups was not affected by differences in mean arterial blood pressures, or by differences in daily prednisone dosages, cyclosporine trough levels, or SRL and RAD trough levels. Phosphatemia, renal phosphate threshold (TmPO4/ GFR ratio) and uric acid clearance were significantly lower in the SRL than in the RAD group, despite similar levels of parathyroid hormone. Finally, urinary acid excretion was significantly lower in the RAD group. CONCLUSION: In conclusion, regarding nephrotoxicity, our preliminary data suggest that it seems to be preferable to combine cyclosporine with RAD rather than with sirolimus in renal transplant patients. However, long-term renal effects of this combination are still to be determined in a larger cohort.

Adult↗
PubMed2005

Sulfadiazine-related obstructive urinary tract lithiasis: an unusual cause of acute renal failure after kidney transplantation.

We report on the first case of acute renal failure related to obstructive urinary tract lithiasis involving sulfadiazine crystals in a kidney transplant recipient. This patient had disseminated toxoplasmosis which was treated by sulfadiazine (4 g/day) and pyrimethamine (50 mg/day). In the fourth week of anti-toxoplasmosis therapy, he presented with obstructive acute renal failure: the plasma creatinine level increased from 220 micromol/l to 547 micromol/l. Apercutaneous pyelography was conducted showing the presence of a lithiasis located at the junction between the graft ureter and the bladder. Six days later, he underwent surgery to retrieve an orange-colored, friable stone. Its spectrophotometric analysis confirmed that the stone consisted of N-acetyl sulfadiazine crystals.

Acute Kidney Injury↗
PubMed2004

Cyclosporine-A-based immunosuppression and renal functional reserve in organ-transplant patients.

The glomerular filtration rate (GFR) may increase after oral protein overload or after an amino acid infusion. Renal functional reserve (RFR) is defined as the difference between the poststimulation and the baseline glomerular filtration rate. RFR has been studied in transplant patients. The results have been conflicting because RFR may be affected by donor age, the time from transplantation, the type of immunosuppression, the basal GFR, the body surface area, and the presence of calcium channel blocker therapy. We observed that during the first year posttransplantation renal recipients maintained on cyclosporine (CsA) therapy retain a level of RFR that represents approximately 30% of the baseline GFR. Moreover, hypertensive cyclosporine treated renal transplant patients on calcium channel blocker therapy do not exhibit permanent glomerular hyperfiltration until 8 months posttransplantation. Finally, both renal and heart transplant patients on cyclosporine therapy possess renal reserve, but the single renal graft in renal transplant patients shows a proportionally higher baseline GFR and a better ability to exhibit a RFR than the two native kidneys in heart transplant patients. Many studies, although not all, have documented a positive RFR in both children and adult cyclosporine-treated kidney graft recipients, demonstrating that hyperfiltration is not the rule following single kidney transplantation.

Adult↗
PubMed2004

Efficacy and safety of induction therapy with rabbit antithymocyte globulins in liver transplantation for hepatitis C.

BACKGROUND: Hepatitis C virus (HCV)-related end-stage liver disease (ESLD) is the leading cause for orthotopic liver transplantation (OLT). However, in recent years, the long-term results of OLT in this setting are worsening, possibly due to the powerful immunosuppressants in use. The aim of our study was to assess the safety and efficacy of induction therapy using rabbit antithymocyte globulin antibodies (RATG). METHODS: Over an 18-month period from January 2000 to June 2001, 16 patients underwent OLT for HCV-related ESLD and survived more than 1 month posttransplantation. They received induction therapy based on RATG (Thymoglobulins, Sangstat, France) at 1 mg/kg per day for 3 consecutive days, and it was then adjusted to maintain a CD2 count below 50/mm(3). Overall, RATG was given for a median of 5 days for a total dose of 406 +/- 45 mg. Steroids were started pretransplant and tacrolimus on day 1. The primary end-points were patient and graft survivals at 6 months posttransplantation, incidence of rejection, infectious complications (bacterial, viral, and fungal) and recurrence of HCV infection based on biochemical, virological, and histologic criteria. RESULTS: The survival rates were 100% for patients and 93.7% for grafts. The acute rejection rate was 37.5%. The median time to acute rejection was 15.5 days. There was only one serum sickness case. Cytomegalovirus infections occurred in 25% of patients. The rate of de novo diabetes that required insulin therapy was at 50%. The rate of HCV recurrence was 56.25%. In addition, HCV RNA serum concentrations increased significantly posttransplantation (>1 log). In conclusion, RATG induction therapy is safe and efficient in HCV-positive liver recipients.

Adult↗
PubMed2004

[Hepatitis C virus infection in renal-transplant patients].

Chronic hepatitis C virus (HCV) infection is the first cause of liver disease after renal transplantation. The prevalence of HCV infection in dialysis and in renal-transplant patients remains high. Mortality of HCV-positive renal-transplant patients is higher than that of HCV-negative ones. Liver disease and sepsis seem to be the main causes of death. Graft survival is also lower in HCV-positive renal-transplant patients. This seems to be due in part to the occurrence of de novo glomerulopathy. The effect of HCV infection upon liver fibrosis in renal-transplant patients receiving immunosuppressive treatment remains controversial. To date, there is no efficient treatment of HCV infection after renal transplantation. Consequently, it is mandatory to treat by alpha-interferon all HCV-positive/RNA-positive dialysis patients waiting for renal transplantation.

Antiviral Agents↗
PubMed2003

Screening for hepatitis B virus DNA in serum of organ donors and renal transplant recipients.

In order to determine the impact of screening potential organ donors for hepatitis B virus DNA using a standardized test, the serum of 145 donor candidates was tested. All of the candidates were negative for hepatitis B virus DNA, but the status of one donor was doubtful for hepatitis B virus surface antigen and seven donors tested positive for hepatitis B virus core antibody without hepatitis B virus surface antigen. Nine transplant recipients tested positive for hepatitis B virus surface antibody; they were given kidneys from the donor with a doubtful hepatitis B virus surface antigen result and from four of the seven donors who tested positive for hepatitis B core antibody. Follow-up revealed no case of hepatitis B transmission. In this study, screening for hepatitis B virus DNA was useful and did not lead to donor organ shortage. Patients with hepatitis B virus surface antibodies can safely be given kidneys from donors who are positive for hepatitis B core antibody but negative for hepatitis B virus DNA.

DNA, Viral↗
PubMed2003

Automated extraction and quantification of human cytomegalovirus DNA in whole blood by real-time PCR assay.

The measurement of human cytomegalovirus (HCMV) DNA in blood is becoming the standard method for monitoring HCMV infection in immune-suppressed and unsuppressed patients. As various blood compartments can be used, we have compared the HCMV DNA measured in whole blood (WB), peripheral blood leukocytes (PBL), and plasma by real-time PCR. We tested 286 samples: HCMV DNA was extracted automatically from WB and PBL with the MagNA Pure instrument (Roche Molecular Biochemicals) and manually from plasma samples. The HCMV DNA from WB, PBL, and plasma was measured by real-time Light Cycler PCR. Primers and probe were located in the UL 83 region. HCMV DNA was detected more frequently in WB (88.5%) than in the PBL (65.7%) (P < 0.0001) or the plasma (55.2%) (P < 0.0001). There was a good correlation between the positive results in WB and in PBL (r = 0.68; P < 0.0001), and 3.15 log(10) genome copies in 200000 PBL, equivalent to the threshold value of 50 pp65-positive polymorphonuclear cells per 200000 leukocytes, was equivalent to 3.4 log(10) genome copies in 200 microl of WB. WB was shown to be suitable for automated extraction and the quantitation of HCMV DNA by real-time Light Cycler PCR by analysis of serial samples from representative patients of various populations. This system may be very useful for monitoring of immune-suppressed and unsuppressed patients.

Adult↗
PubMed2003

[Is there a place for ribavirin in the treatment for renal transplant patients infected by hepatitis C virus?].

Treatment of chronic hepatitis C in renal-transplant (RT) recipients with alpha-interferon is associated with a high rate of acute rejection. We therefore evaluated the biochemical, virological, histological efficacies, as well as the safety of one year ribavirin monotherapy in 16 HCV-(+) RNA (+) RT patients (group A) matched to 32 HCV-(+) RNA (+) RT patients (group B) who did not receive ribavirin. Ribavirin was initially started at a daily dose of 1000 mg and then adapted to hemoglobin level. Ribavirin monotherapy was associated with a significant decrease in AST, ALT and gamma glutamyl transpeptidase levels. Serum creatinine decreased as well. When proteinuria was present (n = 5), this decreased or disappeared. There was no significant changes in HCV viremia. The histological analysis of liver biopsies revealed a significant progression in liver fibrosis with no improvement in inflammation scores. There was a significant decrease in hemoglobin levels, despite an important support by recombinant erythropoeitin. However, in three cases, ribavirin therapy had to be stopped. In group B, after 1 year of follow up, there was a significant increase in serum ALT and creatinine values. Proteinuria decreased in only 2 of 12 patients. In conclusion, one year ribavirin therapy in HCV-(+) RNA (+)ve RT has no impact upon liver histology, although it improves liver enzyme levels. It impact upon renal function remains unknown. Nevertheless when proteinuria is present it disappears.

Adult↗
PubMed2003

[Hepatitis C infection among patients receiving hemodialysis].

In France, the prevalence of hepatitis C virus (HCV) infection in chronic hemodialysis patients is high, about 15 to 42%. Although the incidence and the prevalence of HCV infection decreased during the last decade, de novo cases of HCV infection still occur in hemodialysis units. To date the nosocomial transmission is the principal cause of contamination. The strict application of universal precautions and the separation of chronic hemodialysis patients according to their virological status may decrease the incidence of HCV infection in hemodialysis units. The transaminase level and HCV viremia are lower in chronic hemodialysis patients than that in the general population. Liver disease seems also to be less aggressive. Chronic hemodialysis patients presenting acute hepatitis C infection and those waiting for renal transplantation have to be treated by interferon-alpha (IFN-alpha), since the virological response is elevated and sustained. In case of cirrhosis or severe liver disease, a combined liver-kidney transplantation can be proposed after IFN-alpha therapy. Finally, in chronic hemodialysis who are not candidate for renal transplantation IFN-alpha therapy can be discussed according the patients' age and general health status.

Antiviral Agents↗
PubMed2001

Transient renal effects of sildenafil in male kidney transplant recipients.

BACKGROUND: Sildenafil (Viagra) improves erection by sustaining Guanosine 3', 5'-cyclic monophosphate (cGMP)-mediated smooth muscle relaxation in the corpus cavernosum. It also induces systemic vasodilation, resulting in a minor decrease in blood pressure. We evaluated the effect of one dose of sildenafil on graft function and hemodynamics in impotent male transplant recipients. METHODS: Two sets of combined lithium, inulin, and p-amino hippurate clearance studies were conducted, with and without sildenafil (100 mg orally) in 11 male kidney transplant recipients (KTRs). RESULTS: Sildenafil increased glomerular filtration rate by 14+/-4 from the baseline value of 55+/-7 ml x min(-1) x 1.73 m2(-1) (P<0.01), whereas calculated renal vascular resistances decreased by 40+/-18 from the baseline value of 247+/-29 mmHg/L x min(-1) x 1.73 m2-1 (P<0.05). CONCLUSIONS: The oral administration of sildenafil in KTRs did not impair the function of the graft. In terms of renal physiology, the observed modifications did not warrant any specific precautions when offering sildenafil to KTRs suffering from erectile dysfunction.

Erectile Dysfunction↗
PubMed2001

Induction versus noninduction in renal transplant recipients with tacrolimus-based immunosuppression.

BACKGROUND: The aim of this study was to compare the efficacy and safety of induction treatment with antithymocyte globulins (ATG) followed by tacrolimus therapy with immediate tacrolimus therapy in renal transplant recipients. METHODS: This 12-month, open, prospective study was conducted in 15 centers in France and 1 center in Belgium; 309 patients were randomized to receive either induction therapy with ATG (n=151) followed by initiation of tacrolimus on day 9 or immediate tacrolimus-based triple therapy (n=158). In both study arms, the initial daily tacrolimus dose was 0.2 mg/kg. Steroid boluses were given in the first 2 days and tapered thereafter from 20 mg/day to 5 mg/day. Azathioprine was administered at 1-2 mg/kg per day. RESULTS: At month 12, biopsy-confirmed acute rejections were reported for 15.2% (induction) and 30.4% (noninduction) of patients (P=0.001). The incidence of steroid-sensitive acute rejections was 7.9% (induction) and 22.2% (noninduction)(P=0.001). Steroid-resistant acute rejections were reported for 8.6% (induction) and 8.9% (noninduction) of patients. A total of nine patients died. Patient survival and graft survival at month 12 was similar in both treatment groups (97.4% vs. 96.8% and 92.1% vs. 91.1%, respectively). Statistically significant differences in the incidence of adverse events were found for cytomegalovirus (CMV) infection (induction, 32.5% vs. noninduction, 19.0%, P=0.009), leukopenia (37.3% vs. 9.5%, P<0.001), fever (25.2% vs. 10.1%, P=0.001), herpes simplex (17.9% vs. 5.7%, P=0.001), and thrombocytopenia (11.3% vs. 3.2%, P=0.007). In the induction group, serum sickness was observed in 10.6% of patients. The incidence of new onset diabetes mellitus was 3.4% (induction) and 4.5% (noninduction). CONCLUSION: Low incidences of acute rejection were found in both treatment arms. Induction treatment with ATG has the advantage of a lower incidence of acute rejection, but it significantly increases adverse events, particularly CMV infection.

Adult↗
PubMed2001

Nosocomial outbreak of influenza virus A (H3N2) infection in a solid organ transplant department.

BACKGROUND: There is a strong body of evidence in favor of influenza virus immunization in solid organ recipients. However, little attention has been devoted to other reservoirs, such as the patients' relatives and, at the time of hospital admission, to the healthcare workers. METHODS: Analysis of the epidemiology of an outbreak of nosocomial influenza A in a solid organ transplant unit. RESULTS: Four cases of influenza A virus infection were reported during a short 4-day outbreak in a 12 single-room transplant unit. None of the patients had been immunized against influenza. Three patients had not been visited by their relatives between admission and influenza infection. Three nurses, among the 27 healthcare workers, presented with clinical flu symptoms at times consistent with nosocomial transmission. CONCLUSIONS: Because the prevention of influenza infection by vaccination warrants a global strategy to target the different reservoirs, we suggest that the modern policy of vaccinating solid organ patients should be extended both to their relatives and to the healthcare workers of transplant units.

Adult↗
PubMed2001

[Kidney transplantation. Results and indications].

Results of renal transplantation are better than those of dialysis. The indications of transplantation are constantly increasing and comprise more and more populations at risk, notably older patients and diabetics. Specific evaluation of such potential recipients can lead to indication for transplantation and registry on the waiting list. The insufficient number of available cadaver kidneys leads to harvesting borderline organs particularly from the elderly or patients with vascular disease. Before definite decision for transplantation is made, case-by-case evaluation has to be made of the potential risks of donor-recipient matching regarding the risk/benefit for the recipient. Only a significant increase in the number of available organs will relieve the constraints of the problem.

Adult↗
PubMed2001

Reversible posterior leukoencephalopathy syndrome in hepatitis C virus-positive long-term hemodialysis patients.

Chronic hepatitis C virus (HCV) infection is quite prevalent in long-term hemodialysis (HD) patients. Patients who are candidates for renal transplantation might be treated, before grafting, with interferon-alpha (IFN-alpha). Among 39 HCV-positive long-term HD patients treated with IFN-alpha, we observed three cases of reversible posterior leukoencephalopathy syndrome (PLES). PLES included headaches in three patients, confusion in three patients, cortical blindness in two patients, visual hallucinations in one patient, seizures in three patients, and respiratory distress in one patient in a context of fluid overload and severe hypertension in all cases. The three patients were receiving IFN-alpha and recombinant erythropoietin therapies simultaneously for de novo anemia. Contrast-enhanced computed tomography scan or magnetic resonance imaging showed low-density areas in the occipital lobes (in three patients), frontal lobes (in one patient), and temporal lobes (in one patient). After withdrawal of IFN-alpha and recombinant erythropoietin therapies, hemodiafiltration, and symptomatic treatment of seizures and hypertension, PLES was reversible within 1 week in one patient, 10 days in one patient, and 2 months in the third patient. Our case reports show the occurrence of reversible PLES in HCV-positive long-term HD patients treated with IFN-alpha. Physicians caring for HCV-positive long-term HD patients treated with IFN-alpha need to be particularly cautious when these patients receive simultaneously recombinant erythropoietin and when IFN-alpha therapy induces a weight loss, which indicates a reduction in dry weight.

Adult↗