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Biomedical subjects

M Pastural

Publications and source records attributed to M Pastural.

7 recordsLinked to original sources
PubMed2001

Renal transplantation in a patient with hypocomplementemic urticarial vasculitis syndrome.

We describe a 36-year-old man who presented with hypocomplementemic urticarial vasculitis syndrome (HUVS) with severe renal involvement. Despite steroid therapy, the patient developed end-stage renal disease (ESRD) leading to chronic hemodialysis therapy. Renal transplantation was performed after hemodialysis therapy (secondary), and the patient developed a typical HUVS relapse 9 months after transplantation despite conventional immunosuppressive therapy that was successfully treated with plasma exchange. This case shows for the first time that HUVS can induce severe renal involvement responsible for ESRD and that HUVS can relapse after renal transplantation. It also suggests that plasma exchange therapy may be of value for rapidly controlling the clinical symptoms.

Adult↗
PubMed2000

[Recent immunologic aspects].

Three main aspects of rejection are described in kidney transplantation: hyperacute graft rejection mediated by cytotoxic antibodies, acute rejection initiated by lymphocytes T CD4+ activated after direct or indirect pathways of allopeptides recognition, and chronic rejection (graft chronic dysfunction). Immunologic and non-immunologic factors have been implicated in the development of chronic rejection but there is no evidence for a unique physiopathological pathway. The various steps of immune response in acute rejection have been better defined in the past years. The development of new immunosuppressive drugs and their combination have led to drastic decrease of acute graft rejection occurrence. On the other hand, highly HLA sensitized recipients, chronic graft rejection and toxicity of immunosuppressive drugs should support active research but the final goal is the induction of a specific tolerance.

Graft Rejection↗
PubMed2000

[Results of 25 years of kidney transplantation].

Between 1975 and 2000, 1008 renal transplantations were performed in 935 recipients at Henri Mondor hospital. The mean objective of this study is to analyse patient and graft survivals at long term. For kidney transplantations performed respectively before and after 1985, ten years patient survival was 74.3% +/- 0.03 and 85.7% +/- 0.01, p = 0.03 and ten years graft survival was 39.5% +/- 0.04 and 71.9% +/- 0.02 after 1985, p = 0.001. Since 1985, an enhancement in graft actuarial survival still improved (one year survival 86.1% +/- 0.01 versus 90.8% +/- 0.02, three years survival 78.5% +/- 0.02 versus 85.5% +/- 0.02, five years survival 71.7% +/- 0.02 versus 78.8% +/- 0.04, for the years 1985-1994 versus 1995-2000, p < or = 0.05). Immunosuppressive drugs may contribute to results enhancement in kidney transplantation while other non immunologic factors are becoming more predominant.

Adolescent↗
PubMed1999

[Use of mycophenolate mofetil (MMF) in kidney transplantation: results of a single center trial].

Mycophenolate Mofetil (MMF) is a new immunosuppressant demonstrated to be effective at the dose of 2 to 3 g/day. The objective of this study was to determine whether MMF could be used at a lower dose with the same efficacy. Two patient groups were studied: 334 patients treated with azathioprine (AZA) and 60 patients treated MMF (at the dose of 750 mg/day, for patients receiving triple combination therapy or 1.5 g/day for those receiving two-agent combination therapy). The rest of the treatment was identical for the 2 groups. The main endpoint was the incidence of acute rejection at 3 months, which was 16% in the MMF group and 35% in the AZA group (p = 0.003). Multivariate analysis confirmed the impact of the type of purine synthesis inhibitor used (AZA or MMF, p = 0.007) on the acute rejection rate at 3 months. This study confirms the value of MMF, even at doses lower than those recommended in the international literature, with improved safety. MMF has now replaced azathioprine in our immunosuppressant protocols.

Adult↗