Seoul Virus Infection in Humans, France, 2014-2016.

We report detection of Seoul virus in 3 patients in France over a 2-year period. These patients accounted for 3 of the 4 Seoul virus infections among 434 hantavirus infections (1.7%) reported during this time. More attention should be given to this virus in Europe where surveillance has been focused mostly on Puumala and Dobrava-Belgrade hantaviruses.

The changes in NT-proBNP plasma concentrations during dialysis are highly dependent of the dialysis membrane ultrafiltration coefficient.

BACKGROUND: NT-proBNP is a powerful marker with diagnostic and pronostic value for heart failure. It is of particular interest in patients with end-stage renal disease who are at high risk for heart failure. The aim of this study was to investigate the effect of hemodialysis on plasma NT-proBNP concentrations. METHODS: NT-proBNP concentration was measured in 67 patients before and after hemodialysis. RESULTS: In the 20 patients dialyzed with a membrane whose ultrafiltration coefficient was below or equal to12, NT-proBNP concentration was comparable after and before dialysis (16611+/-21024 vs. 15216+/-19027 pg/ml, NS). At the opposite, in the 47 patients dialyzed with a membrane whose ultrafiltration coefficient was above or equal to 40, NT proBNP concentration was 35% lower after dialysis compared to before dialysis (11983+/-21819 vs. 18574+/-31862 pg/ml, p<0.0001). CONCLUSIONS: In patients dialyzed with a membrane whose ultrafiltration coefficient is high, dialysis is likely to decrease results by one third. Thus sampling blood before dialysis in hemodialyzed patients appears as the best time to stratify the cardiovascular risk in these patients.

Intravenous immunoglobulins and transplantation for patients with anti-HLA antibodies.

Transplantation for patients possessing allo-antibodies against HLA antigens can be delayed for years, and, once the graft has been transplanted, its survival is significantly reduced. We and others have shown that administration of intravenous immunoglobulins (IVIgs) can induce a profound and sustained decrease in the titres of the anti-HLA antibodies, thus greatly enhancing the chances of those patients to obtain a transplant. In a number of cases, pre-treatment sera contained anti-donor antibodies that disappeared after IVIg administration. A similar approach, combining plasmapheresis and low-dose IVIgs, has shown similar results and has been successfully applied to ABO-incompatible transplantations. Patient and graft survival are excellent, despite a rather high rate of rejections, most notably humoral ones. These protocols thus demonstrate that the presence of anti-donor antibody, once an absolute contra-indication to transplantation, can, nowadays, be considered as an immunological hurdle that can be managed through appropriate immunological manipulation.

Desensitization and subsequent kidney transplantation of patients using intravenous immunoglobulins (IVIg).

Transplantation of patients possessing antibodies against allo-HLA antigens can be delayed for years. We have shown that administration of intravenous immunoglobulins (IVIg) can induce a profound and sustained decrease in the titers of anti-HLA antibodies. We report here the first series of patients desensitized, then transplanted using IVIg therapy. Fifteen patients have been included and treated with IVIg, given as 3 monthly courses of 2g/kg body weight. Thirteen of those 15 patients (87%) were effectively desensitized and underwent immediate transplantation. Eleven were transplanted with a cadaveric donor, and two with a living donor against which the pretreatment cross-match was positive. One graft was lost from thrombosis and one from rejection. All other patients had uneventful courses, without any episodes of rejection, with a follow-up of more than 1 year. Thus, IVIg therapy allows safe and prompt kidney transplantation of immunized patients.