[Efficacy of highly active antiretroviral therapy alone in the treatment of diffuse lymphocytic infiltration syndrome in an ivorian patient living with HIV: a case report]. / Efficacité du traitement antirétroviral hautement actif seul dans le traitement du syndrome d'infiltration lymphocytaire diffus chez une patiente ivoirienne vivant avec le VIH : à propos d'un cas.

Objective: We report in this work the efficacy of highly active antiretrovirals (ARVs) alone in the treatment of diffuse infiltrative lymphocytosis syndrome (DILS) without the use of corticosteroids, which appears risky in patients living with HIV. Observation: This is a 60-year-old HIV-positive patient, discovered during the etiological workup of renal failure, which revealed a non-nephrotic glomerular profile. The renal biopsy found an interstitial infiltrate of CD8 suggestive of DILS. Management consisted in starting ARV treatment alone (lamuvidine, abacavir and raltegravir) without associated corticosteroid therapy. The clinical evolution under treatment was marked by a recovery of the renal function with a creatininemia at 99 µmol/l, a regression of the proteinuria, a CD4 rate at 293/mm3 and an HIV viral load at 533.3 copies or 1.6 log in the space of 3 months. Conclusion: DILS is a diffuse systemic disease in HIV patients who are usually under poor virological control. In view of the strong immunosuppression and the absence of other infiltrative diseases, it appeared to us to be risky and unjustified to add a corticosteroid therapy.

Living Kidney Donor Transplantation in a Resource-limited Country: The Ivory Coast Experience.

Renal transplantation that offers a good quality of life still is not performed by the majority of countries of black Africa. We started a pilot project of renal transplantation in Ivory Coast 2 years ago. The present paper reports the preliminary results, difficulties related to the program, and perspectives regarding its expansion. Ten living related kidney transplantations have been performed over a 2-year period. Recipients and their respective donors were male. The mean age of the recipients was 42.8 years (22-57), and the mean age of the donors was 29.4 years (22-43). The mean number of mismatches was 3.2 (0-6). None was immunized. Recipients and donors were all EBV IgG positive and CMV IgG positive. All but 1 case were induced with basiliximab. The mean graft and patient survival time was 16.6 months (6-26). The mean cold ischemic time was 2.27 hours (1-3.32). The mean serum creatinine at discharge was 241.87 µmol/L (115.18-1063.2), at 6 months was 117.20 µmol/l (95.6-139.9), at 12 months was 104.55 µmol/L (62.02-132.9), and at 24 months was 104.55 µmol/L (62.02-132.9). The mean cyclosporine through level (C0) at 6 months was 137.57 ng/mL (70-366), at 12 months was 117.33 ng/mL (62-197), and at 24 months was 78 ng/mL. The mean cyclosporine 2-hour post-administration concentration levels (C2) at 6 months was 764.9 ng/mL (430-1421), at 12 months was 937.17 ng/mL (483-1292), and at 24 months was 690.66 ng/mL (488-853). Main complications were sepsis, adenovirus hemorrhagic cystitis, new-onset diabetes after transplantation, delayed graft function, polycythemia, and cytomegalovirus infection. No clinical rejection was diagnosed over the 2-year period. Patient and graft survival was 100% at a mean post-transplantation time of approximately 16.6 months.

Outcomes of renal patients from the Ivory Coast transplanted abroad: time for a local kidney transplantation program.

BACKGROUND: The outcomes of transplanted kidney recipients from "transplant tourism" have been reported to be alarming. The present study was an attempt to examine the results of renal patients from the Ivory Coast transplanted abroad returning home for follow-up. PATIENTS AND METHODS: This retrospective analysis includes renal patients from the Ivory Coast transplanted abroad between 1995 and 2009 and followed up by our nephrology clinic. We collected pre- and posttransplant parameters for statistical analyses. RESULTS: The 16 patients had a median age of 48 years (range = 32.5-53.75). The median age of kidney donors was 44 years (range = 30.75-51.25). Initial kidney disease was hypertension in 10 patients (62.5%) and diabetes in three patients (18.8%). They received organs from living donors (37.5% related [LRD] and 37.5% unrelated [LURD]). Initial immunosuppression consisted of induction (72.7%), tacrolimus (75%), and mycophenolate mofetil (100%). Two patients (12.5%) experienced late acute rejections, resulting in graft loss. The overall graft survival was 93% at 1 year and 80% at 5 years. Five patients died over the study period, corresponding to an overall mortality rate of 9.25/100 patient-years. The overall median patient survival was 6.25 years (range = 4.19-7.58). Patient survivals at 1 and 5 years were 93% and 53%, respectively. No factors seemed to influence survival (either graft or patient) upon multivariate analysis. Comparison between LRD and LURD recipients revealed no statistical difference among posttransplant characteristics and survivals. CONCLUSION: Mortality of renal patients from the Ivory Coast transplanted abroad is high. Financial exhaustion after transplantation renders follow-up precarious. A local kidney transplantation program in the Ivory Coast appears more urgent than ever.