Browsing by Author "Esposito, Laure"

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A Monocentric Observational Study of Darbepoetin Alfa in Anemic Hepatitis-C-Virus Transplant Patients Treated With Ribavirin
(Başkent Üniversitesi, 2008-12) Kamar, Nassim; Rostaing, Lionel; Esposito, Laure; Ribes, David; Guitard, Joëlle
Objectives: Darbepoetin alfa is used to treat renal anemia; however, little information is available concerning its use during the posttransplant period, especially in HCV-positive patients treated with ribavirin for active hepatitis C. Materials and Methods: This study investigated the efficacy and safety of using darbepoetin alfa in this population during a 6-month treatment period. All anemic patients were HCV/RNA-positive, treated with ribavirin, and had impaired renal function. Patients (n=7) who had not been treated previously with recombinant human erythropoietin (rHuEPO) were placed in “group no rHuEPO.” Patients previously with recombinant human erythropoietin (n=16; “group rHuEPO”) were switched to darbepoetin alfa according to the European summary of product characteristics. Results: Seventy-three percent of the patients were men. The mean creatinine clearance at baseline was 58.7 ± 21.5 mL/min. All patients received an immunosuppressive treatment. Although mean hemoglobin levels remained stable in group no rHuEPO and increased in group rHuEPO, the difference was not statistically significant. Also, the median darbepoetin-alfa–weighted dose in group no rHuEPO increased while it remained stable in group rHuEPO, as did the median daily dosage of ribavirin; however, these differences were not statistically significant. Creatinine levels and creatinine clearance levels remained stable throughout the study. No significant medical events related to the treatment were reported during the study. Conclusions: Darbepoetin alfa was found to be efficient and well tolerated in correcting renal anemia in transplant recipients treated with ribavirin for active hepatitis C.
Effects of Intraoperative versus Postoperative Administration of Rabbit Antithymocyte Antibodies on 1-Year Renal Function in Renal Transplant Patie
(Başkent Üniversitesi, 2006-06) Kamar, Nassim; Esposito, Laure; Ribes, David; Tkaczuk, Jean; Cointault, Olivier; Lavayssiere, Laurence; Abbal, Michel; Durand, Dominique; Rostaing, Lionel
Objectives: The aim of our study was to prospectively assess 1-year allograft outcomes and the evolution of lymphocyte subsets in a group of renal transplant patients who had received intraoperative rabbit antithymocyte antibodies (RATG). Materials and Methods: We compared 1-year allograft transplant outcomes in renal transplant recipients who had received intraoperative RATG (group 1, n = 53) with the outcomes observed in patients in a historical control group who had received postoperative RATG (group 2, n = 49). RATG were given at the same dosage (1 mg/kg) during the first 3 days, and then the dosage was adapted according to CD2 count, until calcineurin inhibitors were started. Results: The overall dosage of RATG administered was significantly lower in group 1. At day 4, CD2, CD3, and CD19 T-cell subset counts were significantly higher in patients in group 1. From 3 months after transplantation, CD4/CD8 ratios were significantly lower in patients in group 1 because of a rapid regeneration of CD8 T cells. One-year total lymphocyte counts were significantly higher in patients in group 1. There were fewer severe infectious complications in patients in group 1. One-year renal function was better in patients in group 2. Donor age was the only independent factor associated with renal function at both 1 month and 1 year after transplantation. Conclusions: When RATG are infused intraoperatively, a lower total amount of RATG is required to prevent acute rejection as compared with postoperative RATG infusion. Consequently, fewer serious lymphopenia-associated complications are observed during the first year after transplantation
Perihepatitis and Perinephric Abscess Due to Mycoplasma hominis in a Kidney Transplant Patient
(Başkent Üniversitesi, 2007-12) Camara, Boubou; Mouzin, Marc; Kamar, Nassim; Rostaing, Lionel; Durand, Dominique; Game, Xavier; Guitard, Joelle; Esposito, Laure; Ribes, David
Mycoplasma hominis has been incriminated in several genital and extragenital infections. Here, we report the first case of perihepatitis associated with a perinephric abscess in a woman who had received a kidney transplant. Four months after the transplant, the patient was admitted for perirenal allograft pain, fever, and elevated inflammatory parameters and liver enzyme levels. A renal ultrasonography found a collection of fluid. Results of blood and urine analyses were within normal limits. Fluid aspiration of the peritoneal cavity was performed, and the results of cultures for bacteria and fungi were negative. The patient was treated by surgical lavage of the peritoneal cavity. Her fever resolved 5 days later. Two months after surgical lavage of the peritoneal cavity, her liver enzyme levels returned to the normal range. Three months after surgical lavage, cultures of the perinephric fluid showed Mycoplasma hominis. We conclude that in patients who present with perinephric fluid suspected of being infected, bacteriologic analysis of the fluid (from surgical lavage of the peritoneal cavity) should be performed. Antibiotics active against intracellular bacteria should be administered.
Prevalence of Cryoglobulinemia and Autoimmune Markers in Liver Transplant Patients
(Başkent Üniversitesi, 2008-09) Garrouste, Cyril; Rostaing, Lionel; Blancher, Antoine; Durand, Dominique; Lavayssière, Laurence; Esposito, Laure; Boulestin, Anne; Kamar, Nassim
Objectives: To examine the prevalence of cryoglobulinemia and autoimmune markers in stable liver transplant recipients and to determine risk factors and clinical impact. Materials and Methods: Ninety-two liver transplant recipients were tested for cryoglobulinemia, hepatitis B and C, complement C3, complement C4, CH50, antinuclear antibodies, anticytoplasmic neutrophil antibodies, anticardiolipid antibodies, rheumatoid factors, and lymphocyte subpopulations. Liver, renal, and hematology tests were done. Immunosuppressive regimens were based on calcineurin inhibitors in 94.6% of the patients. Results: Cryoglobulinemia was present in 18 patients (19.5%) with characteristics of type II in 27.7%, type III in 61.3%, and indeterminate in 11%. Cryoglobulinemia was present in 55.5% of patients with positive hepatitis C virus serology compared with 35.86% of patients with negative hepatitis C virus serology (P = .06). Among those with hepatitis C virus markers, cryoglobulinemia was present in 30%. Anticytoplasmic neutrophil antibodies were positive in 23% of the patients with cryoglobulinemia, but in only 5.4% of the patients without cryoglobulinemia (P = .006). Albuminemia was significantly lower in patients with cryoglobulinemia (38 ± 4.2 g/L) than it was in patients without cryoglobulinemia (40.2 ± 3.4; P = .05). Cryoglobulinemia was symptomatic in 4 patients (22.2% of all patients). Independent factors associated with cryoglobulinemia were presence of anticytoplasmic neutrophil antibodies, more than 4 HLA incompatibilities, alanine aminotransferase level of 0.68 µkat/L or more, and an albuminemia level greater than 38 g/L. Conclusions: Cryoglobulinemia is frequent after liver transplant and is symptomatic in approximately 20% of all patients.
Unusual Presentation of Cytomegalovirus Infection in Patients After Organ Transplant
(Başkent Üniversitesi, 2009-03) Guilbeau-Frugier, Céline; Rostaing, Lionel; Tiple, Aurélien; Kamar, Nassim; Esposito, Laure; Mengelle, Catherine; Combelles, Sophie; Otal, Philippe
Objectives: Cytomegalovirus (CMV) infection has an enormous impact in solid-organ transplant patients. In immunocompromised patients, CMV is associated with well-known direct effects. We herein describe 3 unusual patterns occurring in the setting of tissue-invasive CMV associated with high viral load. Materials and Methods: Of our 3 cases, the first patient after kidney transplant presented with cholestasis related to radiological cholangitis; the second patient after heart transplant presented with erythema nodosum with CMV infection as the sole cause; and the third patient after kidney transplant presented with acute renal failure related to mild interstitial nephritis with acute tubular necrosis and tubulitis. Results: The first patient’s cholestasis resolved with antiviral therapy, as did the erythema nodosum and CMV infection of the heart transplant patient. The third patient’s acute renal failure resolved by increased steroid dosage, plasma exchanges, and ganciclovir therapy. Conclusions: These 3 unusual presentations of tissue-invasive CMV had favorable outcomes with antiviral therapy.