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Sicard A.,Hospices Civils de Lyon | Sicard A.,French Institute of Health and Medical Research | Sicard A.,University of Lyon | Ducreux S.,Laboratoire dhistocompatibilite | And 22 more authors.
Journal of the American Society of Nephrology | Year: 2015

Antibody-mediated rejection (AMR) is a major cause of kidney graft loss, yet assessment of individual risk at diagnosis is impeded by the lack of a reliable prognosis assay. Here, we tested whether the capacity of anti-HLA antibodies to bind complement components allows accurate risk stratification at the time of AMR diagnosis. Among 938 kidney transplant recipients for whom a graft biopsy was performed between 2004 and 2012 at the Lyon University Hospitals, 69 fulfilled the diagnosis criteria for AMR and were enrolled. Sera banked at the time of the biopsy were screened for the presence of donor-specific anti-HLAantibodies (DSAs) and their ability to bind C1q and C3d using flow bead assays. In contrast with C4d graft deposition, the presence of C3d-binding DSA was associated with a higher risk of graft loss (P<0.001). Despite similar trend, the difference did not reach significance with a C1q-binding assay (P=0.06). The prognostic value of a C3d-binding assay was further confirmed in an independent cohort of 39 patients with AMR (P=0.04). Patients with C3d-binding antibodies had worse eGFR and higher DSA mean fluorescence intensity. In a multivariate analysis, only eGFR<30 ml/min per 1.73 m2 (hazard ratio [HR], 3.56; 95% confidence interval [CI], 1.46 to 8.70; P=0.005) and the presence of circulating C3d-binding DSA (HR, 2.80; 95% CI, 1.12 to 6.95; P=0.03) were independent predictors for allograft loss at AMR diagnosis. We conclude that assessment of the C3d-binding capacity of DSA at the time of AMR diagnosis allows for identification of patients at risk for allograft loss. © 2015 by the American Society of Nephrology. Source


Labbe F.,Laboratoire Of Microbiologie | Babchia S.,Laboratoire Of Microbiologie | Evreux F.,Laboratoire Of Microbiologie | Chenal P.,Laboratoire danatomopathologie
Journal de Mycologie Medicale | Year: 2013

We report the case of an 11-year-old child with cystic fibrosis where Geosmithia argillacea has been isolated from sputum. This is a filamentous fungus (mold) recently described as emergent infectious agent in cystic fibrosis patients. In our case, the presence of G. argillacea was not associated with clinical disorder. However, recent evidence shows that it can be responsible for very serious invasive infection, especially in chronic granulomatous disease and may be, after lung transplantation. © 2013 Elsevier Masson SAS. Source


Thervet E.,University of Paris Descartes | Aouizerate J.,Service de Transplantation | Noel L.H.,Laboratoire danatomopathologie | Brocheriou I.,Service danatomopathologie | And 3 more authors.
Transplantation | Year: 2011

Background. Henoch-Schonlein Purpura nephropathy (HSPN) recurrence in renal transplant recipients (RTRs) has been reported in 35% of patients, leading in 11% of these patients to graft loss at 5 years. However, its true incidence is unknown. The aim of this study was to investigate this recurrence incidence using routine allograft biopsies (RBs). Methods. All RTRs with biopsy-proven HSP initial nephropathy were included (13 RTRs and 18 renal transplantations). At transplantation, the median age was 34 years, and 85% of RTRs were men. Overall, we analyzed 66 RBs that were routinely performed at 3 and 12 months after RT and when clinically indicated. Histologic recurrence was defined as the presence of IgA deposits within the mesangium and along the glomerular capillary walls. Results. After a median follow-up of 83 months (range, 13-232 months; interquartile range, 26-235 months), histologic recurrence was detected in 69% of patients and in 61% of grafts after a mean period of 24 months (range, 1-156 months). Clinical or biological signs were absent in all but one. Patient survival was 92.8%. Graft loss occurred in five cases, never were related to recurrence. At the last follow-up, the mean glomerular filtration rate was 48±14.2 mL/min/1.73 m; in patients with and without recurrence, the mean rates were 52.1±17.5 and 42.4±5.3 mL/min/1.73 m, respectively (P=0.27). Conclusion. Histologic recurrence of HSPN after RT is frequently observed on routine RBs but is not associated with clinical consequences. The short-term prognosis of recurrence is good, but its long-term prognosis remains to be determined. © 2011 by Lippincott Williams & Wilkins. Source


Clave A.,University of Western Brittany | Yahi H.,Service de Gynecologie Pr Cosson | Hammou J.-C.,Laboratoire danatomopathologie | Montanari S.,Covidien | And 2 more authors.
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2010

Introduction and hypothesis: Currently, most implants used for reinforcement in surgical treatment of pelvic floor disorders are knitted monofilament polypropylene (PP). While previously recognized as inert, PP is associated with high complication rates. Some recent literature suggests polyester prosthetics based on poly(ethylene terephthalate) (PET), which may be more inert in vivo. Methods: A sample of 100 implants explanted from patients due to complications was examined to evaluate the relative degradation characteristics of PP and PET prosthetics. Histological, microscopic (scanning electron microscopy, SEM) and chemical analysis (Fourier transform infrared (FTIR) spectroscopy and differential scanning calorimetry (DSC)) were conducted on these explants. Results: Poly(ethylene terephtahlate) explants appeared to sustain less degradation in vivo than the PP explants observed in this cohort. Conclusions: This is the first study to evaluate synthetic implants used in a vaginal approach for pelvic floor reinforcement. The study provides evidence contrary to published literature characterizing PP as inert in such applications. Additionally, the study suggests the need for clinical trials comparatively investigating the performance of new types of monofilament prosthetics, such as those comprising PET. © 2009 The International Urogynecological Association. Source


Thomas P.A.,Service de chirurgie thoracique | Payan-Defais M.J.,Laboratoire danatomopathologie
Revue de Pneumologie Clinique | Year: 2010

Epithelial tumours of the thymus include thymomas, thymic carcinomas and neuro-endocrine tumours. Rare, they nevertheless represent 20% of all mediastinal tumours and 50% of those located in the anterior mediastinum. Thymomas, in particular, can be associated to auto-immune disorders, among which predominates myasthenia gravis. Their clinical behaviour varies widely, from a relative indolence to the potential of lymph node and/or systematic metastases. However, even patients with an invasive disease may have a long clinical history, explaining that a 10-year or 20-year survival from diagnosis does not imply a definitive cure. In daily practice, both the clinical Masaoka's staging system and the WHO histological classification condition the treatment strategies and allow to anticipate the prognosis. The initial treatment, as well as that of the recurrence, is based mainly on a complete resection. Postoperative radiotherapy is systematically added to the treatment of invasive tumours and/or to those with an aggressive histological subtype. Inoperable or metastatic tumours require a cisplatine and anthracyclin-based chemotherapy, followed by radical surgery and/or radiotherapy. © 2009 Elsevier Masson SAS. All rights reserved. Source

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