Outcome and outlook of living donor kidney transplantation activity in France

Agence de la biomédecine, direction médicale et scientifique-1, avenue du Stade-de-France-Saint-Denis, 93212 La-Plaine cedex, France.
Néphrologie & Thérapeutique (Impact Factor: 0.4). 02/2011; 7(7):535-43. DOI: 10.1016/j.nephro.2011.01.001
Source: PubMed


In France, the bioethic law of 2004 authorized the extension of the living donor (LD) pool to members of the extended family and any person justifying of a 2 year-long relationship. The number of living donor kidney transplantation (LDKT) increased until reaching a maximum of 246 grafts in 2006 (9% of total activity). Two years later, in 2008, LKG activity slowed down to 7.6% of the total activity (222 grafts).
We analyzed all LDKT carried out in France since 2000 according to various indicators. In addition, a questionnaire was sent to renal transplant teams in order to identify potential causes for the decrease in LKG observed in France.
From 2000 to 2006, over 1400 LDKT were performed in France. However, donor to recipient relations show that the large increase observed in 2006 was not linked to the extension of the LD pool. LDKT activity then started decreasing as soon as 2007. The questionnaire was sent back by 40/44 (91%) renal transplant teams. Their answers led to the identification of potential constrain impacting LDKT activity in France. Among these obstacles: workload and time-consuming to prepare the transplantation and the donor, ethical constrains and lack of appropriate communication and information delivered to the professionals.
The important increase in LKG activity in 2006 is not clearly understood. However, several approaches to develop the activity in the next years have been identified.

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    ABSTRACT: The renal transplantation is nowadays the reference treatment of ESRD. Living donor kidney transplantation is less often performed in France than in other countries. Nevertheless, numerous French and international surveys have evidenced that it provides the recipients a longer life expectancy and a better quality of life. Donors themselves, what do they become? How are they? For the first time in France, a survey has been implemented to investigate the quality of life of living kidney donor to one of their close relations. This study has been undertaken by the Agency of the biomedecine and the service Clinical Epidemiology and Evaluation (EEC), of the University teaching hospital of Nancy. The main objective was to describe the quality of life of the living donors having given a kidney for more than a year and less than 5 years. The secondary objective was to contribute to the knowledge of the main factors associated to the living kidney donor quality of life, one year after the donation.Participants had to be living in France at the time of the donation which had taken place between June 30th, 2005 and March 1st, 2009. A folder gathering various self-administrated questionnaires was sent to the place of residence of the donor between March and April, 2010. These data were completed by medical data collected near the transplantation centres by the Agency of biomedecine within the framework of the register CRISTAL. They included the characteristics of the donation and of the donor at the very time of the donation, 3 months after the donation and at the last annual assessment.Three living donors in four, that is 501 persons, agreed to fully participate. They constituted a representative national sample of all the living donors of this period. The non participants were younger (4.5 years on average) and had a less adequate annual follow-up. The women were more represented (61 %) than men. The median age was 53 years. More of 2/3 were employed at the time of the survey. The three main categories of donors were ascendants (36 %), collateral (33 %) and spouses (26%).The donation decision was taken without hesitation (94 %) and at an early stage of the evolution of the recipient renal disease (64 %). The delivered information was considered globally satisfactory except for the painful consequences and for the scar. The living donors were, long after their donation, in an excellent physical health state according to the SF36 summarized physical score and this especially when they were old as compared to the same age and sex general population. This phenomenon highlights the drastic selection of the potential donors. The only factor influencing the level of long term physical health was the surgical technique: the 261 subjects having undergone a cœlioscopy had less often presented post operative pain (OR=0.5; 0.3–0.8; P
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    ABSTRACT: France has reached a pretty good level of activity, comparable to southern European countries: in 2011, 4945 transplantations (TX) have been performed among them, 2976 (60%) kidney TX, 1164 (24%) liver TX, 398 (8%) heart TX and 312 (6.3%) lung TX. However, the progression has slowed down since 2008 like in many countries. The potential of donors is mainly represented by the donor after brain-death (DBD) (90%), living donor (LD) for kidneys transplantation participates for only 10% of the overall kidney TX, and donor after cardiac death (DCD) activity, just started in 2006, for 2.2%. Current challenges to maximize the existing activity of DBD rely upon the implementation of program aimed to monitor deceased organ donation potential, a comprehensive approach of the regional disparities covering the steps of the detection of the potential donor, the rate of organ procurement and the refusal rate to organ donation. The profile of the donors has changed due to substantial epidemiologic shifts and a growing shortage of organs. The resource of expanded criteria donor (ECD) is widely used, mainly defined by a criteria of age. This policy is acceptable and successful under specific allocation scheme based on a donor-recipient matching. Before the TX needs of the population have been adequately met, the opportunities for improvement should be the development of DCD and LD activities, in addition to DBD activity. The extension to the DCD of the 3rd category of Maastricht is currently devised as a possible option for the future. The development of perfusion machine, available for kidney preservation and soon for the other organs is a new technical challenge that might increase the donor pool to previously discarded grafts. This superior and cost-effective method evaluated for ECD kidney preservation has also a potential of resuscitation and prediction of post-transplant outcome. To give a new launch to the TX activity as it was done in 2000, the Agency together with the professionals, has elaborated a "new action plan" for the next few years, which has been acted on April 2012 by the Minister of health.
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    ABSTRACT: Aim of the study To overview the demographics data leading to organ shortage and to determine the possible solutions. Materials and methods A review of the literature on kidney transplant shortage was performed using PubMed (articles in English and French). The annual reports of the Agence de la Biomédecine on renal transplantation and the rapport on “Chronic kidney disease” of the “Haute Autorité de santé” were included. Results The fight against kidney grafts shortage of is multifactorial. Improving the identification of potential donors with a national and hospital policy promulgation of organ donation and a better understanding of the reasons for refusal are one of the solutions. The number of organs can also be increased through expanded criteria donors (selection of adapted recipients), the donors deceased from cardiac arrest (with adequate use of machine perfusion), the living donor transplant (including cross donation) and derogatory transplantation (hepatitis B, hepatitis C, HIV). Conclusion There are several ways to fight the shortage of graft. It is a set of measures that should be implemented and the reflection must be comprehensive to allow the fight against organ shortage. In France, among the different strategies, the development of graft living donor should be a national priority.
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François-Xavier Lamy