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Biomedical subjects

M Hourmant

Publications and source records attributed to M Hourmant.

85 records · Page 5Linked to original sources
PubMed1987

Prevention of rejection of kidney transplants by monoclonal antibody directed against interleukin 2.

The effect of 33B3.1, a rat IgG2a monoclonal antibody (MAb) directed against interleukin 2 receptors on activated T lymphocytes, was studied during the first two weeks after transplantation in an attempt to prevent rejection in primary, cadaveric, kidney transplant recipients. 9 patients received 5 mg 33B3.1 daily by intravenous infusion for 14 days (group A) and 18 received 10 mg daily (group B). Both groups also received prednisone and azathioprine. In threatened rejection, rescue treatment consisted of anti-thymocyte globulin (ATG). 33B3.1 was well tolerated, with mild fever during the first 2 days being the most common side-effect. 3 patients in group A had a reversible acute rejection episode before day 14, whereas only 1 patient in group B had reversible rejection. 20 of 30 historical control patients (prednisone/azathioprine) and 2 of 55 patients previously treated with ATG had a rejection episode in a similar period after transplantation. Trough levels of 33B3.1 in the blood ranged from undetectable to 1.6 micrograms/ml in group A and from 0.3 to 9 micrograms/ml in group B. Most patients had antibodies against 33B3.1 by the end of treatment.

Acute Disease↗
PubMed1987

[Use of delayed cyclosporin A in after administration of anti-lymphocyte serum in kidney transplantation].

In this randomized one-center study in kidney transplantation delayed administration of CyA following conventional treatment with anti-thymocyte globulin (ATG) (group CyA, 48 patients) is compared with conventional treatment (including ATG) as sole immuno-suppressive treatment (group STD, 27 patients). Graft survival was significantly better with CyA (84% vs. 63% at 3 years). CyA efficacy seemed related with the decrease of rejection severity rather than of its frequency. Delayed introduction of the drug reduced its nephrotoxicity and short and longterm transplant function of patients under CyA were similar to controls. Finally from the 1st year post-grafting corticosteroids were withdrawn in more than 80% of recipients receiving CyA.

Adrenal Cortex Hormones↗
PubMed1985

[Use of cyclosporin A after antilymphocyte serum in renal transplantation].

For the past 18 months, cyclosporin A has been used in our renal transplantation center, according to a randomized protocole in which the drug is introduced late (3rd month), following a standard treatment with prednisone, azathioprine and antilymphocyte serum, in a low dosage (4-6 mg/mg/day) and alone. This protocol has been designed to preserve the full benefits of the antilymphocyte serum given immediately after transplantation, to reduce the risk of cyclosporine nephrotoxicity and to allow the withdrawal of corticosteroids. When compared with 27 patients under standard treatment, the 31 patients who received cyclosporin A have an actuarial graft survival rate of 94% at 12 and 18 months, against 68% in the other group. At least one rejection episode was observed in 43% and 51% of patients under respectively cyclosporin A and standard treatment. Renal function remained stable after cyclosporin A was introduced and 1 year post-grafting mean serum creatinine values were similar in both groups. Acute and chronic nephrotoxicity has been the major complication of cyclosporin A. Excellent results (94% graft survival rate at 18 months) can be obtained using the sequential association of antilymphocyte serum and cyclosporin A, without the impairement in renal function that has been observed in other studies where cyclosporin A is given on the day of transplantation.

Antilymphocyte Serum↗
PubMed1985

[Kidney failure patients undergoing hemodialysis with aluminum poisoning after renal transplantation: electro-clinical aspects].

A renal transplantation was performed on 6 dialysis patients using high concentration aluminum water. The post-graft course in 3 patients led to the appearance of worsening or neurological symptoms, with associated deterioration on the EEG. In 3 other patients there was progressive improvement in clinical signs, though with long-term persistance of electrical abnormalities in 1 case. These 6 cases are compared with 10 dialysis patients without aluminum intoxication who underwent renal transplantation in the same conditions. These results are then analyzed with reference to those already published in the literature. Three factors (length of exposure, water aluminum concentration and seizure disorder) seem significant to the prognosis of renal transplantation in patients with aluminum intoxication.

Adult↗
PubMed1985

Transmission of Mycobacterium tuberculosis with renal allografts.

Disseminated tuberculosis occurred in 2 allograft recipients of kidneys procured on the same donor. Both recipients were treated by low dose prednisolone and azathioprine, and one of them was on a special protocol including antilymphocyte globulins as rejection prophylaxis. None of them experienced acute rejection. The early posttransplant period was uneventful except for the occurrence of mild viral infections in both cases (herpes simplex virus in case 1 and cytomegalovirus in case 2). 2 and 6 months after transplantation, respectively, patient 1 developed acute fever, asthenia, and disorientation while patient 2 presented with spiking fever and miliary pneumonitis. Mycobacterium tuberculosis grew in the urine of both recipients in the absence of clinical genitourinary symptoms. The two mycobacterial species had the same bacteriologic characteristics and the same antibiotic sensitivity. As the recipients had no evidence of a previous history of active tuberculosis, it is suggested, as for some other infectious agents, that mycobacterium was transmitted along with the transplanted kidneys.

Azathioprine↗
PubMed1985

Comparison of three immunosuppressive regimens in kidney transplantation: a single-centre randomised study.

Three immunosuppressive regimens have been compared: conventional treatment including anti-thymocyte globulin (ATG) (32 patients) with cyclosporine (Cys) alone (21 patients), sequential combination of ATG with Cys (35 patients). Actuarial graft survivals were: ATG 73 per cent, Cys alone 88 per cent at nine months and ATG/Cys 92 per cent at one to two years. Transplant function was significantly worse with Cys as initial treatment compared with that in controls, while it was similar with ATG/Cys. The Cys dose used was low and no severe infection nor immunoglobulin abnormalities were noticed. Corticosteroids were withdrawn with both Cys protocols, except for rejection treatment.

Antilymphocyte Serum↗
PubMed1983

Plasma exchange in early kidney graft rejection associated with anti-donor antibodies.

Patients with early rejection of kidney allografts associated with anti-donor antibodies have been randomized in two groups which received, respectively, either the conventional corticosteroid/azathioprine treatment or extensive plasma exchanges (PE) plus the conventional treatment. Data on the monitoring of anti-T or anti-B donor lymphocytes, as well as anti-panel or autoreactive cytotoxicity are described. Although the titer of anti-donor antibodies is decreased in the PE-treated group there is no sustained improvement of graft function compared to the control group. Thus, in these stereotyped rejection episodes, which are likely to be antibody mediated, there is no significant effect of extensive and early plasma exchange.

Antibodies↗
PubMed1981

[Kinetics of plasma and urine aluminium after renal grafting (author's transl)].

Kinetics of plasma and urine aluminium (Al) were studied prospectively in 40 kidney recipients during 6 months following grafting, including 2 patients with dialysis encephalopathy. Two groups of patients were defined according to graft function outcome. Group I: successful grafting, either immediate (Ia), or delayed (Ib); group II: immediate and definitive graft failure. A control group was added including hemodialysis patients undergoing non-transplantation surgery (without steroid therapy). Recipients of group I excreted high amounts of A1 and progressively normalized their plasma A1 within 6 months (13 Micron g/1 +/- 7 versus less than 10 Micron g/1 in normal subjects). The average A1 excretion during the first month was 9539 Micron g +/- 12.233 Micron in group Ia and 9048 Micron g +/- 4445 Micron g in group Ib. In one encephalopathic patient (group Ia), it even reached 2166 Micron g per day and amounted to 44.727 Micron g during the first month. In all groups taken as a whole, an early period of increase in plasma A1 occurred which was moderate and observed mostly in patients with low initial plasma A1 values (less than 50 Micron g/1) in group Ia, but high and significant (p less than 0.01) in group Ib. This increase was present as well in group II (p less than 0.01) but to a somewhat lesser extent than in group Ib. The mechanism of this sharp increase of plasma A1 in the early period following grafting is not clear. Two major factors are discussed : steroid therapy or A1 (OH)3 ingestion, but there was no correlation between given doses and plasma A1 levels after grafting; persistent hyperparathyroidism which could enhance A1 intestinal absorption.

Adolescent↗
PubMed1979

Beneficial effect of blood transfusion. Role of the time interval between the last transfusion and transplantation.

We analyzed the effect of blood transfusion (BT) on kidney allograft survival in 163 recipients. Transfused recipients (121) had better graft outcome than those never transfused (42), the difference being statistically significant at 3, 6, 12, and 24 months; however, the transfused group had a longer period of hemodialysis (P = 0.01). HLA antigen distribution does not bias the data. The group who had received the last BT within 3 months before grafting had a significantly better graft outcome than the nontransfused group (P less than 0.05 at 3, 6, and 24 months). They also did better (but not significantly) than the group who had been transfused more than 6 months before grafting. The group receiving two to five BTs had the highest rate of graft survival (P less than 0.05, 0.001, and 0.05 at 6, 12, and 24 months) as compared to the nontransfused. Practical suggestions for systematic BTs during hemodialysis are made.

Adolescent↗
PubMedDate not supplied

[Test of differential anti-T and anti-B lymphocyte compatibility in renal transplantation. A partial solution to the problem of hyperimmune patients].

In view of their beneficial effect on the functional survival of transplanted kidneys, pretransplantation blood transfusions of haemodialysed patients have become routine procedure. At the same time, the number of hyperimmune patients awaiting transplantation has been increasing, as these are often excluded on account of positive cross-match. Cross-matching is usually done by testing recipients' sera against total donor's lymphocytes, so that positive cross-match due to specific anti-T cell cytotoxic antibodies cannot be differentiated from that due to anti-B cell antibodies. Differential anti-T cell and anti-B cell cross-matching showed no significant difference between the survival of 34 transplants with B cell-positive cross-match and that of 126 transplants with B cell-negative cross-match (67% and 60% respectively at 12 months). It also showed that anti-B cell antibodies had no adverse effect on the survival of transplants. The presence of antibodies or auto-antibodies with optimal cytotoxicity at 4 degrees C did not appear to correlate with a significantly longer transplant survival as compared to other transplanted patients. Finally, a high degree of a anti-T cell immunization or a strongly positive B cell cross-match on transplantation day did not seem to jeopardize transplant survival in a B-cell-positive cross-match population of transplanted patients. The differential cross-matching method has made it possible to successfully transplant a substantial number of hyperimmune patients: at least 62% of patients with B cell-positive cross-match also had positive total lymphocyte cross-match which would have precluded renal transplantation.

Antilymphocyte Serum↗