Hôpital Rangueil

A significant proportion of patients presenting a primary sclerosing cholangitis (PSC) will require liver transplantation (LT). The present study aimed to investigate graft loss and patient death in a large cohort of patients. We conducted a nationwide multicenter retrospective study including all adult patients transplanted for PSC in France From 1985 to 2019. Were included 571 patients; median follow-up after LT was 89.0 months (IQR, 43.0-151.0). Patient survival at 5, 10 and 20 years after LT was 88.2%, 81.2% and 62.6%. After exclusion of patients who died during the first month after LT, 37 patients (6.6%) died during the first 2 years and the main cause was malignancies (n = 15, 40.5%, including 12 cases of recurrent cholangiocellular carcinoma). After 2 years, 90 patients (17.2%) died; the two main causes were malignancies (n = 36, 40.0%, including 13 cases of colorectal cancer) and sepsis (n = 23, 25.6%, of which 7 were related to recurrent PSC). Graft survival at 5, 10 and 20 years was 89.5%,78.7% and 62.7%. Independent factors associated with late patient death (after 2 years) were an older age at LT, a bilio-digestive anastomosis and the use of preventive UDCA; independent factors associated with late graft loss were recurrent PSC, cellular rejection, a younger age at LT, and the use of tacrolimus (protective). Our results emphasise that the prognosis after LT for PSC could be improved by better detection of cholangiocellular carcinoma before LT, and colorectal cancer after LT.

Chronic kidney disease and its most severe complication, end-stage renal disease (ESRD), represents an estimated financial burden of €4.4billion in 2021 in France. Therapeutic patient education (TPE) improves ESRD management and health outcomes. This study explored whether providing access to an interactive web-based TPE platform with community features was cost-effective. A within-trial cost-utility analysis was carried out over an 18 months horizon, using data from the PIC-R (Plateforme Interactive Communautaire-dialyse et transplantation Rénale) trial. ESRD or post-transplant patients were randomized 1:1:1 to a control group with no specific TPE program (Control), an intervention group with online TPE (e-TPE) and an intervention group with online TPE coupled with community features such as a patient forum and a chatroom with both patients and health care professionals (e-TPE + chat). The outcome measure was the cost per quality-adjusted life-year (QALY) and per year of full capability (YFC). Both intention-to-treat (ITT) and per protocol (PP) analyses were conducted, and missing data were handled using multiple imputation and selection models. Sensitivity analyses were performed. Among the 815 patients assessed for eligibility across 12 French centres, a total of 549 patients were included in the economic analysis: 186 in the Control group, 189 in the e-TPE group and 174 in the e-TPE + chat group. The e-TPE group demonstrated cost savings and slightly higher QALYs compared to the control group, making e-TPE dominant. Conversely, the e-TPE + chat intervention resulted in higher costs without substantial effectiveness gains, making it not cost-effective. e-TPE was deemed cost-effective for ESRD patients, while e-TPE + chat was not. Web-based platforms improve ESRD management when targeted to likely users.

Vedolizumab has become the preferred first-line advanced therapy in ulcerative colitis (UC). However, the optimal second-line treatment following vedolizumab failure remains unclear. We aimed to evaluate the effectiveness and safety of second-line therapies after first-line vedolizumab. We conducted a multicenter retrospective study including UC patients from 31 centers who received infliximab (IFX), subcutaneous (SC) anti-TNFs, or ustekinumab after vedolizumab failure. The primary endpoint was steroid-free clinical remission (SFCR) at week 14. Predictors of remission were identified using multivariate logistic regression. Among 196 patients, 99 received IFX, 27 anti-TNF SC, and 70 ustekinumab. At week 14, SFCR was achieved in 78 patients (39.8%): 38 (38.4%) with IFX, 8 (29.6%) with anti-TNF SC, and 32 (45.7%) with ustekinumab, with no significant difference between groups (p=0.32). Median treatment persistence ranged from 8 to 9.2months. Baseline corticosteroid use was associated with lower odds of SFCR (OR=0.37, 95% CI [0.18-0.73]). Adverse events occurred in 15.8% of patients, including 12.2% serious events. Overall adverse events were less frequent with ustekinumab than with IFX (10.0% vs. 24.2%, p=0.02), while serious events were comparable (5.7% vs. 16.1%, p=0.08). Discontinuation due to adverse events was more frequent with IFX (12.1%) and anti-TNF SC (14.8%) than with ustekinumab (2.9%, p=0.045 and 0.049). In UC patients failing vedolizumab, second-line IFX, anti-TNF SC, and ustekinumab showed similar effectiveness and persistence. Infliximab remains a robust option for rapid control in high inflammatory burden, whereas ustekinumab may be preferred for its superior safety profile in high-risk patients.

The COVID-19 pandemic has left many survivors with persistent respiratory symptoms such as dyspnea, chronic cough, and reduced exercise capacity. Fibrosis-like abnormalities on high-resolution CT are frequently reported in theses patient. This study aimed to describe the morphological pulmonary abnormalities identified on V/Q SPECT/CT after COVID-19 infection and to evaluate their functional consequences on regional ventilation and perfusion. We also sought to identify clinical predictors of abnormal V/Q SPECT/CT findings. This retrospective multicenter study was based on a national registry of patients referred for V/Q SPECT/CT because of persistent respiratory symptoms after COVID-19 infection. CT abnormalities were characterized using standard radiological criteria. Ventilation and perfusion were visually graded using a five-point scale. Clinical, demographic, and acute COVID-19 characteristics were analyzed to identify predictors of abnormal imaging. Among the 217 included patients (mean age 58 ± 15 years), 122 (56%) presented pulmonary abnormalities on V/Q SPECT or CT. The most frequent parenchymal abnormalities were reticulations, consolidations, atelectasis, emphysema, and ground-glass opacities. Emphysema, consolidations, and fibrosis were associated with the most severe impairments of both ventilation and perfusion. Age and pre-existing chronic lung disease were the strongest predictors of abnormal imaging, while a mild acute COVID-19 course without oxygen therapy was protective. V/Q SPECT/CT provides a comprehensive structural and functional assessment of long COVID pulmonary sequelae. It allows the differentiation between reversible inflammatory lesions and persistent structural abnormalities with lasting functional consequences.

Advanced MRI is recommended for the clinical evaluation of patients with coma. However, the implementation of these guidelines has been hindered by an inadequate identification of relevant markers among the vast amount of reported MRI-derived metrics. We developed and validated an innovative and explainable machine learning (ML) analytical pipeline to fill this critical knowledge gap. Prospective cross-sectional study. Three Intensive Critical Care Units affiliated to the University in Toulouse (France). Patients with coma (Glasgow Coma Scale score at the hospital admission ≤ 9) from either traumatic or anoxic origin. Patient's neurologic outcome was assessed at 3 months by using the Coma Recovery Scale-Revised. Whole-brain advanced structural MRI data and functional connectivity analysis of resting-state networks known to contribute to conscious processing. A specifically designed ensemble of explainable ML methods was applied and cross-validated. None. Overall, 64 patients with coma due to either traumatic (n = 26) or anoxic (n = 38) brain injuries were studied and compared with 55 controls. The median delay between ICU admission and MRI scan was 9 days (interquartile range, 6-16 d). At 3 months, 50% patients (32/64) had an unfavorable outcome. All the models showed valuable generalization capacities: coma diagnosis (mean accuracy, 0.934%), primary brain injury discrimination (mean accuracy, 0.762 %), and neurologic outcome prediction (mean accuracy, 0.824 %). A new ensemble of brain MRI-derived metrics was specifically related to coma state, its etiology, and the patient's potential for recovery at 3 months. The structural and functional integrity of mesocircuit and frontoparietal networks appeared to carry the most relevant information.