Organ transplant is now a standard treatment for many diseases which have reached a terminal phase: heart, liver or kidney failure, obstructive lung disease, cystic fibrosis … In 2014, in France, 54 659 people received transplants of a functioning graft, which represents an increase of 26 % in 10 years*.
However, despite the developments over more than half a century, transplant surgery still has limitations. If acute rejection is now well mastered with a survival rate of over 90% of the grafts after one year for kidney transplants, 75% for heart, 76% for lung and 84% for the liver, chronic rejection is still frequent and mostly misunderstood. 10 years after the transplant, 50% of kidney-transplant recipients will have lost their graft.
When chronic rejection is identified, it is often too late and no treatment is effective: thus to identify the biological warning signs of graft loss, as early as possible is crucial for its survival, as it gives the opportunity to take action ; this is what is at stake with biomarkers.
With a wealth of over 10 years experience in this field, Dr. Sophie Brouard, in collaboration with Dr. Nicolas Degauque, a researcher in the team and Pr. Magali Giral, nephrologist at Nantes University Hospital, is developing a project to identify specific biomarkers, which are associated with the emergence of the chronic rejection phenomena in kidney transplantation. In parallel, working with a rare cohort of patients who accept their graft naturally, their team is seeking to identify markers which are associated with their transplanted kidney tolerance status. The implementation of these programs requires the long-term monitoring of many transplanted patients. This is made possible by the use of the DIVAT clinical database and the DIVAT biocollection that is centralizing clinical data for 20 years and biological samples since 2004, from patients who received a kidney transplant.
Building on this experience, the team of Pr. Antoine Magnan, lung specialist at Nantes University Hospital, in collaboration with Dr. Brouard, is developing a similar approach in the field of lung transplant, which has grown strongly in recent years with an increase of 34 % from 2010 to 2014. Chronic rejection is the major cause of death after several years after a lung transplantation and concerns about 30% of lung-transplant recipients within 3 years after transplantation. Pr. Magnan relies for this on the first monitoring cohort of patients who received a lung transplant (COLT), a cohort which he developed and which involved all the French lung transplant centers and also a Belgian center.
The results of these research programs, which have been initiated within the CESTI IHU since 2013, have allowed the registration of three patents in 2014.
* Biomedicine Agency 2014 Report.