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Introduction: Pre-emptive access to the kidney transplant (KT) waiting list remains limited in France, with only 3.9% of patients on pre-emptive KT and 5.6% of patients registered at the time of initiation of dialysis. A similar trend was observed in Aquitaine. The aim of this study was to assess the impact of a regional program in terms of access to the waiting list for patients initiating a kidney replacement therapy (KRT). Methods: We included all patients assessed for registration on the list between 2017 and 2020, 2017 being the reference year and 2018 the beginning of the program. Using the CRISTAL and REIN registries, we assessed changes in the number of patients on the list at the time of initiation of dialysis or transplantation. Results: The number of new assessed candidates increased gradually each year from 255 in 2017 to 352 in 2020 (+38%). The number of patients on the list sharply increased in 2018 from 229 in 2017 to 319 in 2018 (+39.3%) and then remained stable. At the initiation of KRT, the proportion of patients registered on the waiting list increased gradually from 7.1% in 2017 to 18.2% in 2020. The proportion of pre-emptive KT remained stable between 2017 and 2021 (around 7%) with a decrease in 2020 (4.6%). Approximately 60% of patients had a contraindication to transplantation throughout the study. Conclusion: This study showed that a regional program aimed at providing better information to healthcare professionals and patients and encouraging rapid assessment of transplant candidates could increase the rate of pre-emptive registration on the KT waiting list for eligible patients over 4 years.
Introduction: L'accès préemptif à la liste d'attente de transplantation rénale (TR) reste limité en France, avec seulement 3,9 % de TR préemptives et 5,6 % de patients inscrits lors de l'initiation de la dialyse. Une tendance similaire était observée en Aquitaine. L'objectif de cette étude était d'évaluer l'impact d'un programme régional en termes d'accès à la liste d'attente chez les patients débutant un traitement de suppléance. Méthodes: Nous avons inclus l'ensemble des patients évalués pour une inscription sur liste entre 2017 et 2020, 2017 étant l'année de référence et 2018 l'année de début du programme régional. Nous avons évalué de façon annuelle, grâce aux registres CRISTAL et REIN, l'évolution du nombre de patients inscrits sur liste lors de l'initiation du traitement de suppléance par dialyse ou transplantation. Résultats: Le nombre de nouveaux candidats évalués a augmenté graduellement chaque année, passant de 255 en 2017 à 352 en 2020 (+ 38 %). Le nombre de patients inscrits sur la liste a fortement augmenté en 2018 passant de 229 en 2017 à 319 en 2018 (+39,3 %), puis est resté stable. À l'initiation du traitement de suppléance, la proportion de patients inscrits a augmenté graduellement passant de 7,1 % en 2017 à 18,2 % en 2020. La proportion de TR préemptive est restée stable entre 2017 et 2021 (environ 7 %) avec une baisse en 2020 (4,6 %). Environ 60 % des patients présentaient une contre-indication à la transplantation tout au long de cette étude. Conclusion: Cette étude a montré qu'un programme régional visant à mieux informer les professionnels de santé et les patients et favorisant l'évaluation rapide des candidats à la greffe permet d'augmenter en 4 ans le taux d'inscription préemptive sur liste d'attente de TR chez les patients éligibles.
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BACKGROUND: Legionnaires disease (LD) is a rare, life-threatening opportunistic bacterial infection that poses a significant risk to patients with impaired cell-mediated immunity such as solid organ transplant recipients. However, the epidemiologic features, clinical presentation, and outcomes of LD in this population are poorly described. RESEARCH QUESTION: What are the clinical manifestations, radiologic presentation, risk factors for severity, treatment, and outcome of LD in solid organ transplant recipients? STUDY DESIGN AND METHODS: In this 10-year multicenter retrospective cohort study in France, where LD notification is mandatory, patients were identified by hospital discharge databases. Diagnosis of LD relied on positive culture findings from any respiratory sample, positive urinary antigen test (UAT) results, positive specific serologic findings, or a combination thereof. Severe LD was defined as admission to the ICU. RESULTS: One hundred one patients from 51 transplantation centers were eligible; 64 patients (63.4%) were kidney transplant recipients. Median time between transplantation and LD was 5.6 years (interquartile range, 1.5-12 years). UAT results were positive in 92% of patients (89/97). Among 31 patients with positive culture findings in respiratory samples, Legionella pneumophila serogroup 1 was identified in 90%. Chest CT imaging showed alveolar consolidation in 98% of patients (54 of 57), ground-glass opacity in 63% of patients (36 of 57), macronodules in 21% of patients (12 of 57), and cavitation in 8.8% of patients (5 of 57). Fifty-seven patients (56%) were hospitalized in the ICU. In multivariate analysis, severe LD was associated with negative UAT findings at presentation (P = .047), lymphopenia (P = .014), respiratory symptoms (P = .010), and pleural effusion (P = .039). The 30-day and 12-month mortality rates were 8% (8 of 101) and 20% (19 of 97), respectively. In multivariate analysis, diabetes mellitus was the only factor associated with 12-month mortality (hazard ratio, 3.2; 95% OR, 1.19-8.64; P = .022). INTERPRETATION: LD is a late and severe complication occurring in solid organ transplant recipients that may present as pulmonary nodules on which diabetes impacts its long-term prognosis.