Un score pronostic de décès après 3 ans de dialyse a été développé chez les patients incidents de plus de 70 ans pour proposer un bilan pregreffe chez les patients avec le meilleur pronostic (Dusseux et al KI 2015). L’objectif de l’étude est de réaliser une étude d’impact sur l’utilisation systématique de ce score pour réaliser une évaluation pregreffe et augmenter l’accès à l’inscription sur liste. Dans le cadre d’un PHRC régional (2015), nous avons proposé à tous les centres d’une région d’inclure les patients incidents ≥ 70 ans dans le premier mois de dialyse avec un score ≤ 9 points en 2017–19 pour réaliser systématiquement un bilan prégreffe. Le critère d’évaluation était la fréquence d’inscription à 2 ans. Nous avons donc comparé le pourcentage d’inscription de cette population inclus dans le PHRC(GPHRC) aux patients enregistrés dans REIN(GREIN) avec le même score et sur la même période mais non inclus dans le PHRC. Secondairement nous avons étudié le GREIN en distinguant les patients des centres n’ayant inclus aucun patient dans le PHRC(GREIN0) et les centres ayant inclus au moins un patient(GREIN1). 1166 pts de plus de 70 ans ont initié la dialyse dans 24 centres dont 46(4 %) inscrits sur liste d’attente avant mise en dialyse et 286 patients non-inscrits à l’initiation de la dialyse avec un score ≤ 9 points. 42 patients de 11 centres ont été inclus dans GPHRC et 244 patients n’ont pas été inclus dans le PHRC(GREIN). Le nombre d’inscrit à 24 mois dans GPHRC est de 16/42(38 %) et dans le GREIN de 43/244(17,6 %) ( p = 0,002) dont 21/105(20 %)(GREIN1) et 22/139(16 %)(GREIN0) (p globale = 0,007). Le refus du patient pour un bilan prégreffe est élevé dans GPHRC(20 %). L’utilisation du score systématique dans le 1er mois de dialyse est associée à une augmentation significative du nombre d’inscrits sur liste à 2 ans.

Objectif Évaluation du cas d’une patiente dialysée avec diurèse conservée, traitée par Lu177-DOTATATE. Étude de la tolérance avec analyse de l’impact sur l’activité circulante du débit de dose corps entier et l’exposition des personnels.

Background: Living-kidney transplantation is increasing because of the scarcity of kidneys from deceased donors and the increasing numbers of patients on waiting lists for a kidney transplant. Living-kidney transplantation is now associated with increased long-term patient- and allograft-survival rates. Objectives: The purpose of this retrospective study was to identify, in a cohort of 44 ABO-incompatible (ABOi) live-kidney transplant patients, the main complications that occurred within 6 months post-transplantation, and to compare these findings with those from 44 matched ABO-compatible (ABOc) live-kidney transplant patients who were also from our center. Patients and Methods: This single-center retrospective study assessed post-transplantation complications in 44 ABO-i versus 44 matched ABO-c patients. All patients were comparable at baseline except that ABO-i patients had greater immunological risks. Results: During the 6-month post-transplant period, more ABO-i patients presented with postoperative bleeds, thus requiring significantly more blood transfusions. Bleeds were associated with significantly lower values of fibrinogen, platelets, prothrombin time, and hemoglobin levels. Surgical complications, patient- and graft-survival rates, and kidney-function statuses were similar between both groups at 6 months post-transplantation. Conclusions: We conclude that impairment of hemostatic factors at pre-transplant explained the increased risk of a post-transplant bleed in ABO-i patients.

We undertook a prospective collaborative study to determine the efficacy and tolerance of immunoadsorption (Immunosorba, Fresenius) coupled with tacrolimus, MMF, and steroids during the 2 weeks before transplantation. Rituximab was administred 1 month before the transplantation, and high doses IVIg were given at the end of IA sessions. Anti-HLA antibodies (Luminex) were monitored twice a week. Kidney transplantations were performed with living or cadaveric donors if the CDC crossmatch was negative. Between 2009 and 2013, 14 highly sensitized patients were included in the study, and 10 of them could be successfully transplanted with their living donor despite the presence of high titers DSA (> 3000 MFI) before IA. Three of these patients had acute humoral rejection which was reverted by high doses steroids, IA and IvIg. To date, graft and patient survival are 100%. Among the 4 patients who remained with high titers DSA after IA, 3 could be transplanted within 1 to 3 months with a cadaveric donor and are doing well. During the same period, 14 other sensitized patients who did not have living donor and who were on the waiting list since 6 to 8 years underwent 5 to 20 sessions of IA coupled to immunosuppressive treatment, which induced a profound decrease in total Ig and in anti-HLA antibodies. Ten of them could be transplanted with a cadaveric donor, the CDC crossmatch on the day of transplantation being negative. Acute humoral rejection occurred in 5 of these patients, 4 of whom had an historical positive CDC crossmatch. To date, graft survival is 80% and patient survival is 80% (one death due to aspergillosis, one unrelated to immunosuppression). In conclusion, non specific IA coupled to immunosuppressive treatments are effective and relatively safe in sensitized patients, and can be used before transplantation with both living and cadaveric kidney donors. An historical positive CDC crossmatch remains a strong predictor of acute humoral rejection after transplantation.

L'étude de l'influence d'anti A et d'anti B sur la mobilité électrophorétique des hématies a permis de constater que :-la charge superficielle diminuait en présence d'anticorps,-la diminution est fonction de l'antisérum et par suite de sa concentration,-la diminution maximum est fonction de l'hématie considérée. Ceci laisse supposer une différence entre le nombre de sites antigéniques des hématies correspondantes. Un calcul du nombre de sites pourrait être envisagé à partir des théories physico-chimiques des phénomènes de surface.Après traitement par des concentrations croissantes de broméline, la mobilité électrophorétique des globules rouges est considérablement diminuée. L'enzyme provoque ainsi une diminution de la mobilité électrophorétique des hématies pouvant dépasser 70 % de la valeur en eau physiologique.Une étude analytique montre les modifications éventuellement supportées par les antigènes érythrocytaires sous l'action de la broméline.L'enzyme attaque la membrane, ce qui aurait pour conséquence la perte d'acide sialique, d'où une diminution des forces de répulsion interglobulaires. Dans ces conditions, l'action des enzymes protéolytiques utilisés dans les laboratoires d'immunologie pour la détection et le titrage des anticorps de type non agglutinants se trouve en partie expliquée.An investigation about the influence of anti-A and anti-B antibodies upon the electrophoretic mobility of red blood cells showed that :-the superfical charge decreases in the presence of antibodies,-the maximal decrease is function of the titration of the antiserum, consequently, function of its concentration,-the maximal decrease is function of the red blood cell.This suggests a difference between the number of antigenic sites of the corresponding erythrocytes. The number of sites might be calculated by means of the physico-chemical theories of surface phenomena.After addition of increasing concentrations of bromeline, the electrophoretic mobility of red blood cells is markedly decreased. The enzyme induces a decrease of the electrophoretic mobility of red blood cells ; such decrease can be greater than 70 % of the value in saline solution.An analytical study shows the eventual alterations on erythrocyte antigens under the action of bromeline.The enzyme reacts on the membrane, which would result in the loss of sialic acid, hence a decrease of intercorpuscular repulsive forces.Then, the action of proteolytic enzymes used in immunologic laboratories for the detection and titration of antibodies of the non-agglutinating type is partly accounted for.

Objective: To determine the recommended dose (RD) of gefitinib when combined with concomitant radiotherapy (RT) in a preoperative setting in patients with locally advanced rectal cancer. Secondary objectives were to evaluate acute toxicities, pathological response rate, progression-free and overall survival (OS). Materials and Methods: 20 patients with cT3-4 or cN+ cM0 tumors were enrolled. The planned RT consisted in 50 Gy given in 2 daily fractions of 1.25 Gy in 4 weeks. During RT, gefitinib was planned to be given orally once daily with 2 successive dose levels: 250 mg and 500 mg. Rectal surgery was scheduled 5 - 6 weeks after completion of RT. The median follow-up for all patients was 57 months. Results: Among the first cohort of 6 patients, 1 patient presented a dose limiting toxicity (DLT) (Grade 3 diarrhea/dehydration). In the second cohort, 2/6 patients presented with the same DLT so that 250 mg was considered as the RD. Main acute toxicities consisted in diarrhea (grade 2 - 3, 63%), and skin reaction (in RT fields grade 2 - 3 in 42%). The 5-year actuarial OS and loco-regional control rates were of 80% and 84% respectively. Conclusion: The concomitant daily administration of 250 mg of gefitinib with 50 Gy preoperative RT is feasible with manageable toxicity. The major pathologic response rate is encouraging, though it needs further confirmation. Distant metastasis still represents a concern and new strategies to overcome this issue are warranted.

In France, kidney transplantation is part of — and is reimbursed as — treatment for chronic kidney disease.Long-term survival and quality of life are better for transplant recipients than for dialysis patients.Stagnation in the survival rate of transplants over the past 10 years has led to the development of new immunosuppressive drugs to minimize the use of corticosteroids and anticalcineurins and to induce tolerance of the transplanted kidney.The scarcity and lower quality of kidneys for transplantation is also leading to the development of new transplantation sources: donors with cardiac arrest and elderly, living and ABO-incompatible donors.En France, la transplantation rénale fait partie intégrante de la prise en charge de l'insuffisance rénale chronique.La transplantation rénale améliore la survie et la qualité de vie du patient insuffisant rénal chronique.Devant la stagnation de la survie du greffon depuis une dizaine d'années, de nouveaux immunosuppresseurs sont développés avec pour but une épargne en anticalcineurines et en corticoïdes et une induction de tolérance de l'hôte vis-à-vis du greffon.Devant la pénurie de greffons qui sont de plus de qualité moindre, de nouvelles sources de greffons, comme les donneurs âgés, les donneurs à cœur arrêté, les donneurs vivants et les donneurs ABO incompatibles, se sont développées.

A proliferation inducing ligand (APRIL) from the tumour necrosis family (TNF) promotes the natural development of solid tumours in pre-clinical models. Here, we studied the role of APRIL in patients with urothelial bladder, epithelial surface ovarian, and head and neck squamous carcinomas. By using immunohistochemistry, we revealed an upregulation of APRIL expression in lesions from a significant subset of patients compared to corresponding healthy tissues. APRIL upregulation was not due to autocrine production by tumour cells, but rather originated from infiltration of APRIL-producing neutrophils. Heparan sulphate proteoglycan (HSPG) efficiently concentrated secreted APRIL in lesions. Despite this retention, in situ APRIL upregulation did not significantly alter disease-free and overall survivals of carcinoma patients in retrospective studies. This indicates that APRIL is not potent enough to promote the development of solid tumour cells under the pressure of chemotherapy.