Efficacy and Safety of Intra-gastric Balloon Placement in Dialyzed Patients Awaiting Kidney Transplantation.

BACKGROUND: The number of obese patients who are candidates for renal transplantation has considerably increased, but obesity can be a barrier to kidney transplantation. Weight loss is often difficult through diet alone. We studied the efficacy and tolerance of the intra-gastric balloon (IGB) procedure in obese patients who were undergoing dialysis and were candidates for a renal transplantation. PATIENTS AND METHODS: Obese patients (BMI > 30 kg/m2) who were candidates for renal transplantation were prospectively included in the study between 2010 and 2012. The balloon was inserted and removed during a gastric endoscopy under general anesthesia. The treatment lasted 6 months. The end point was a decrease in BMI after 6 months. Body impedance spectrometry (BIS) and nutritional statute were evaluated initially and then after IGB removal. RESULTS: Seventeen patients (nine females and eight males) with a mean age of 53.4 years [19.4-69.4] were included. The decrease in body mass index (BMI) during the 6-month placement was 3 kg/m2 (from 37.7 to 34.4 kg/m2). The mean weight loss was 7 kg. The mean percentage of excess weight loss after 6 months was 20.2 (± 11.4). The tolerance was good without any complications. Eleven patients underwent kidney transplantation. CONCLUSION: IGB in obese dialyzed patients who are candidates for renal transplantation is safe and effective. However, the amount of weight loss can vary.

Complement modulation in solid-organ transplantation.

The complement system is a major constituent of the innate immune system. It has a critical role in defense against pathogens but dysregulation of complement activation may lead to tissue injury and modulate the adaptive immune response. In organ transplantation, local complement activation is involved in hyper-acute rejection and antibody-mediated rejection. This last decade, interest in complement activation has increased due to new insights into the pathophysiology of antibody-mediated rejection, but also since the availability of news drugs that target terminal complement activation. In this review, we discuss our current understanding of how local complement activation induces acute and chronic graft injury, and review recent advances in clinical trials that block complement activation using the anti-C5 monoclonal antibody, eculizumab. Finally, we discuss how complement-targeted therapy may be integrated into our current immunosuppressive regimen and what type of patient will benefit most from this therapy.

Effect of a proteasome inhibitor plus steroids on HLA antibodies in sensitized patients awaiting a renal transplant.

BACKGROUND: This prospective monocentric study investigated the effect of corticosteroids plus bortezomib to reduce anti-HLA antibodies before renal transplantation. METHODS: Included were 23 patients with stable immunization against HLA and awaiting a kidney transplant (KT). Treatment consisted of bortezomib (1.3 mg/m) plus 40 mg of dexamethasone intravenously on days 1, 3, 8, and 10 (B+S). Class I and II anti-HLAs were determined using the single-antigen beads assay at day 0 (D0), month 1 (M1), M3, and M6. RESULTS: Antibodies against 96 class I and 76 class II antigens were investigated and patients had a mean number of 49 (± 21) antibodies against HLA on D0: 31 were against HLA class I and 17 were against HLA class II. At D0, the median was 10,734 (range, 1096-18,513) for the highest mean fluorescent intensity (hAb) anti-class I antibodies and 11,189 (range, 1276-19,176) for class II. By M3, 41% of patients had a greater than 25% decrease in class 1 hAbs and 60% by M6. By M3, 33% of patients had a greater than 25% decrease in class II hAbs and 42% by M6. At M6, 54% of anti-HLA antibodies had a sustained decrease by more than 25% and 36% were decreased by more than 50%. No predictive factors for decreased antibodies after bortezomib plus steroid therapy were identified. No serious adverse event was observed. Thereafter, 11 of 23 patients received successful transplants without having experienced acute rejection (follow-up, 18 months). CONCLUSIONS: B+S is an effective alternative therapy for reducing class I and II anti-HLA, regardless of other previous treatments.

[Acute renal failure following a treatment with acyclovir]. / Insuffisance rénale aiguë lors d'un traitement par aciclovir.

UNLABELLED: The antiviral molecule acyclovir can be responsible of severe renal dysfunction. Intratubular crystal precipitation of the drug may represent a major pathogenetic mechanism. OBSERVATION: A 30-year old, immunocompetent woman was admitted in the neurology unit for a viral meningo-encephalitic syndrome. Intravenous acyclovir was delivered at the dose of 45 mg/kg per day. Despite a neurological improvement, she developed an acute renal insufficiency with the serum creatinine increasing from 63 to 385 micromol/L within 12 days. The urine study revealed great amounts of birefringent crystals which were typical of acyclovir derived crystals according to the spectrophotometric examination. Withdrawal of acyclovir treatment in combination with oral and parenteral hydration resulted in a complete recovery of the renal function. The conditions favouring acyclovir-induced nephrotoxicity are discussed.