Emmanuel Morelon

An alternative approach to estimate age‐related mortality of kidney transplant recipients compared to the general population: results in favor of old‐to‐old transplantations

Compared to dialysis, kidney transplantation appears to be the best treatment for chronic kidney failure, even for older aged patients. Nevertheless, the individual benefit of transplanting elderly patients has to be balanced against the corresponding increase in the number of patients awaiting grafts. We analyzed the excess mortality related to kidney transplant recipients by taking into account the expected mortality of the general population (additive regression model for relative survival). We applied this method to a cohort of patients who received a first deceased‐donor kidney transplant between 1998 and 2009 in France (DIVAT, n = 3641). Overall 10‐year mortality was 13%. As expected, recipient age was the main risk factor associated with overall mortality. In contrast, recipient age was no longer significantly associated with the excess of mortality related to kidney transplant status by subtracting the expected mortality of the general population. Delayed graft function (DGF), pretransplantation immunization, and past history of diabetes appeared as the main risk factors of this higher mortality rate. Our results constitute a strong argument in favor of kidney transplantation, regardless of the patients age. Preventing DGF may be more effective for decreasing the risk of death specifically attributable to the disease.

New Clinicopathological Findings in a Patient with Face Allotransplantation

During the follow-up the recipient developed primary asymptomatic EBV infection, followed by EBVC B-cell lymphoma and hepatic leiomyosarcoma, for which the immunosuppressive treatment was greatly reduced. During the first post-transplant year, acute rejection (AR) episodes were completely reversed with steroids. Subsequently, several episodes of AR occurred that were difficult to reverse with steroids and Campath-1; they manifested clinically with graft erythema and histologically with lichenoid changes of the epidermis and appendages. Since the second post-transplant year the allografted facial skin became progressively sclerotic and presented pigmented macules on a background of hypopigmentation and telangiectases, realizing a poikilodermatous aspect. Skin biopsies showed epidermal atrophy, basal cell vacuolization and diffuse dermal sclerosis. In the superficial dermis there were rare CD3C and CD4C lymphocytes and in the deep dermis few TIAC1 cytotoxic lymphocytes. The large vessels seemed unaffected while dermal capillaries showed thickened walls and narrowed lumina. Donor specific anti-HLA class II antibodies were detected transiently in January 2010.