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Biomedical subjects

C Hiesse

Publications and source records attributed to C Hiesse.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Multivisceral Kaposi's disease and encrusted pyelitis in a renal transplantation recipient].

Immunosuppression therapy carries inherent risks involving the occurrence of infections and neoplasms. Whereas therapeutic advancement have reduced its frequency, encrusted pyelitis reappears in kidney-transplanted patients and may lead to detransplantation. It is related to chronic urological infections and not inevitably favored by endoscopic explorations. Kaposi's sarcoma is the third cause of tumor in renal-transplanted patients. It is rarely multivisceral and develops exceptionally in the transplant. We report the case of a 60 year-old woman who developed an encrusted pyelitis and a Kaposi's sarcoma in a kidney which was transplanted 14 months earlier.

Female↗
PubMed1995

[Blood transfusion before kidney transplantation, is it indicated?].

The beneficial effect of blood transfusions on the prognosis of renal transplantation has been recognized since 1972, and has led transplant centres to adopt a systematic transfusion policy in end-stage renal disease patients requiring a graft. By the end of the eighties, the dramatic improvement in the results of transplantation, the disappearance of transfusions prescribed in haemodialyzed patients after recombinant human erythropoietin became available and finally the evidence of the transfusion risk have raised questions both on transfusion policy, and even on the reality of the transfusion effect itself. The consequence has been great discrepancy in the current policies of different renal transplantation centres: some countries (USA, Great Britain, Scandinavia, Southern Europe) have nearly abandoned transfusion protocols, while others (Benelux, France) remain confident in their transfusion policy. The effect of transfusions on 1-year graft survival has not been detected since 1988 in multicentre international registry reports. However, recent studies have suggested that transfusions could still have a positive effect, especially on specific endpoints, such as the acute rejection incidence observed after transplantation. Moreover, clinical and biological data show that the transfusion effect and its mechanism could depend on the HLA compatibility between the blood donor and the recipient. This justifies current and further clinical and biological investigations on the topic, in order to evaluate the possible current persistent interest of the transfusion policy before transplantation, and to elucidate the biological mechanisms of this unique attempt at immunomanipulation.

Blood Transfusion↗
PubMed1995

Five years' experience at one centre with protein A immunoadsorption in patients with deleterious allo/autoantibodies (anti-HLA antibodies, autoimmune bleeding disorders) and post-transplant patients relapsing with focal glomerular sclerosis.

Protein A is extracted from a strain of Staphylococcus aureus and binds specifically to the constant domains of immunoglobulins and possibly to fibronectin. It has already been shown that concentrations of all IgG isotypes (except IgG3) are efficiently decreased by immunoadsorption (IA) on protein A linked to sepharose beads. This system has been developed by Cobe-Excorim Co. to either remove IgG in some instances where they wil be harmful, i.e. allo- and autoantibodies inducing pathological conditions (autoimmune diseases, haematological disorders with allo/autoantibodies, anti-HLA antibodies in sensitized patients awaiting organ transplantation) or treat several immunological diseases with unknown pathogenesis. In our unit, 20 patients with high titres of anti-HLA panel-reactive antibodies, four patients with haematological disorders (haemophilia with anti-VIII antibodies and Glanzmann diseases) and three patients with post-transplant focal glomerular sclerosis (FGS) underwent IA over the past 5 years. Infectious complications were not observed after IA and the procedure was always well tolerated. In spite of the use of adjunctive immunosuppressive therapy with prednisone and cyclophosphamide, and although the reduction in serum IgG was close to 90%, the de novo synthesis of allo- and autoantibodies was important after IA procedures. In the cases of removal of anti-HLA antibodies, patients with a pre-IA antibody titre which was > 1:128 clearly did not benefit from the technique and other immunological criteria were not predictive of efficacy. Fourteen patients were transplanted, four with a well-matched kidney with both pre- and post-IA negative cross-matching, and 10 with a positive historical cross-match with the donor.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticoagulants↗
PubMed1995

Combined liver and kidney transplantation in patients with chronic nephritis associated with end-stage liver disease.

A variety of renal diseases can be associated with end-stage liver diseases requiring orthotopic liver transplantation (OLT), including cirrhosis-associated glomerulonephritis (GN), and nephropathy unrelated to the liver disease. A retrospective survey showed that nine patients undergoing liver transplantation in our centre had histologically proven GN or interstitial nephritis with renal failure and/or nephrotic-range proteinuria, and experienced severe complications post-OLT since nephrotoxic immunosuppressive drugs (CsA and FK506) could not be adequately given. Four of the nine patients died. Therefore, combined liver-kidney transplantation has been suggested as first choice treatment in such patients. From January 1990 to February 1994, in patients with end-stage liver disease referred for OLT, and who presented with unexplained renal function impairment and/or significant proteinuria, severe nephropathy was confirmed by renal biopsy in nine: four mesangiocapillary GN with immune deposits, one membranous nephropathy, two diabetic glomerulosclerosis and two interstitial nephritis. All underwent liver transplantation immediately followed by kidney transplantation. The postoperative period was uneventful, and neither death nor renal failure were recorded. Combined transplantation resulted in all patients in the normalization of renal function, and in the disappearance of proteinuria within the first postoperative month. From 6 months to 4 years post-transplant, the renal function remained within normal ranges in all patients. Routine renal transplant biopsy was performed in two patients with pre-transplant cirrhosis-associated GN, and showed no evidence of recurrence of the original nephropathy. We conclude that combined liver-kidney transplantation is an adequate therapeutic option in patients with end-stage liver disease associated with advanced kidney disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Immunoadsorption of anti-HLA antibodies on protein A-sepharose columns in hyperimmunized recipients waiting for transplantation].

In an attempt to reduce anti-HLA immunization in 15 patients awaiting for renal grafts and who were immunized against 65% of a panel of lymphocytes (titre 1/8 to 1/128), were given 5 to 7 sessions of immunoadsorption on protein A columns, immunosuppressor drugs (corticosteroids: 1 mg/kg/day + cyclophosphamid: 2 mg/kg/day) and intravenous polyclonal immunoglobulins. The antibody titres decreased in all patients, but this protocol did not sufficiently block resynthesis of antibodies. Among the 12 patients who were transplanted, the graft functioned correctly in 8 after a follow-up of 3 months to 3 years. Three early graft failures occurred in the group of 5 patients whose had had a positive cross-match before treatment. This treatment did not appear to increase the frequency of infectious complications immediately after transplantation.

Adult↗
PubMed1994

Induction of peripheral T cell tolerance and allo/xenoimmunity.

It is theoretically impossible or at least difficult to tolerize animals in xenogeneic situation, particularly in non-concordant species. Both humoral defense and several cellular components (T and non T) are offensive weapons which can be directed at myriad of self-antigens in a normal situation, at allo-antigens in abnormal situations, at xeno-antigens in exceptional situations. In either cases, the fine epitopic definition of allo/xeno antigens seen by the TCR is far from being totally known. From recent studies showing the precise requirement of peptides assembly composition in the MHC class I and II groove it should be theoretically possible to tolerize any group of peptides if they are presented, some other, because not presented, may remain ignored, thus apparently tolerized. It is also know, that transplantation tolerance is not a law of "either nothing or all" but a multiple process depending of both the affinity of the TCR and the nature/compositions of the target. In view of the complex array of factors influencing the pathway of T cell activation, three forms of T cell non responsiveness may be suggested in the context of xenogeneic recognition: physical deletion of potentially reactive T cells occurring predominantly in the thymus, non reactivity of T cells resulting from their failure to be influenced by antigens, and anergy possibly due to inappropriate signals from non professional antigen presenting cells. Future investigations must elucidate the requirements for inducing these events in a purpose of xenogeneic organ transplantation.

Clonal Anergy↗
PubMed1993

[Role of cyclosporin in renal transplantation].

The cyclosporine era started 10 years ago in organ transplantation, especially in renal transplantation. Following the pioneering works showing the efficacy and its synergism with other immunosuppressors, a second step consisted in a better use by decreasing the induction dose and a closer definition of its side effects. A major improvement in the results (increase of 5 to 10% in patient survival and of 10 to 20% in graft survival), a decrease in the number of acute rejection episodes, in the cumulative doses of steroids, in the duration of hospitalization and in the total cost of transplantation made this drug as the worldwide used agent, now considered as the milestone in immunosuppression. Over all, organ transplantation is needing a more specific immunological agent, deprived if possible of major side effects. In these regards, each new agent should be considered only if compared to the "gold standard", namely cyclosporine.

Clinical Protocols↗