Individual and regional factors of access to the renal transplant waiting list in france in a cohort of dialyzed patients.

Several studies have investigated geographical variations in access to renal transplant waiting lists, but none has assessed the impact on these variations of factors at both the patient and geographic levels. The objective of our study was to identify medical and non-medical factors at both these levels associated with these geographical variations in waiting-list placement in France. We included all incident patients aged 18-80 years in 11 French regions who started dialysis between January 1, 2006, and December 31, 2008. Both a multilevel Cox model with shared frailty and a competing risks model were used for the analyses. At the patient level, old age, comorbidities, diabetic nephropathy, non-autonomous first dialysis, and female gender were the major determinants of a lower probability of being waitlisted. At the regional level, the only factor associated with this probability was an increase in the number of patients on the waiting list from 2005 to 2009. This finding supports a slight but significant impact of a regional organ shortage on waitlisting practices. Our findings demonstrate that patients' age has a major impact on waitlisting practices, even for patients with no comorbidity or disability, whose survival would likely be improved by transplantation compared with dialysis.

The random phase approximation applied to ice.

Standard density functionals without van der Waals interactions yield an unsatisfactory description of ice phases, specifically, high density phases occurring under pressure are too unstable compared to the common low density phase Ih observed at ambient conditions. Although the description is improved by using functionals that include van der Waals interactions, the errors in relative volumes remain sizable. Here we assess the random phase approximation (RPA) for the correlation energy and compare our results to experimental data as well as diffusion Monte Carlo data for ice. The RPA yields a very balanced description for all considered phases, approaching the accuracy of diffusion Monte Carlo in relative energies and volumes. This opens a route towards a concise description of molecular water phases on surfaces and in cavities.

Disparities in policies, practices and rates of pediatric kidney transplantation in Europe.

We aimed to provide an overview of kidney allocation policies related to children and pediatric kidney transplantation (KTx) practices and rates in Europe, and to study factors associated with KTx rates. A survey was distributed among renal registry representatives in 38 European countries. Additional data were obtained from the ESPN/ERA-EDTA and ERA-EDTA registries. Thirty-two countries (84%) responded. The median incidence rate of pediatric KTx was 5.7 (range 0-13.5) per million children (pmc). A median proportion of 17% (interquartile range 2-29) of KTx was performed preemptively, while the median proportion of living donor KTx was 43% (interquartile range 10-52). The median percentage of children on renal replacement therapy (RRT) with a functioning graft was 62%. The level of pediatric prioritization was associated with a decreased waiting time for deceased donor KTx, an increased pediatric KTx rate, and a lower proportion of living donor KTx. The rates of pediatric KTx, distribution of donor source and time on waiting list vary considerably between European countries. The lack of harmonization in kidney allocation to children raises medical and ethical issues. Harmonization of pediatric allocation policies should be prioritized.

[Evolution of the access to the kidney transplantation in France of foreign patients and French patients living in overseas territories]. / Évolution de l'accès à la greffe rénale en France des patients étrangers ou résidant outre-mer.

In France, foreign patients, whether resident or not in France, can register on the national waiting list under administrative and financial conditions. We performed a retrospective analysis to evaluate the access to kidney transplantation on a cohort 2004-2008, using the national registry. Among the 14,732 patients registered during this period, 15.3% are of non-French nationality (3.4% other European, 5.9% North African, 3.9% sub-Saharan African, 2.9% other). Among the 84.6% of French nationality, 3.3% are living in French overseas territories. Compared to the 17.6-month median waiting time of the cohort, median waiting time differs significantly between groups, from 15.7 months for mainland French patients to 36 months for sub-Saharan African patients. Despite the regular development of the allocation rules, these disparities in access to transplantation are mainly, but not completely, explained by blood group or HLA matching difficulties. After adjustment for the other factors known to be significantly linked to a difficult access to transplantation, North and sub-Saharan African patients have the worst difficulties. Future research should consider nonmedical factors, such as socio-economic or socio-cultural factors, potentially relevant to avoid disparities in access to transplantation and should aim at developing specific interventions.

Development of Poland's Central Bone Marrow Donor Registry Affects Donor Searches for Patients With Hematological Diseases.

In the last 10 years, numbers of donors in the case of Polish potential unrelated hematopoietic stem cells (HSC) have increased dynamically, reaching 1,900,000 in 2020 (including donors presented in World Marrow Donor Association as PL6). On the world scale, the share of Polish donors in the global registry increased from 1% in 2010 to about 5% in 2020. The level and range of typing of potential donors has also been improving steadily toward the international "gold standard." At the end of 2020, 92% of Polish resources were at least HLA-A, B, C, DR, DQ high- or intermediate-resolution typed, mostly by way of genomic typing techniques, mostly by way of genomic typing techniques. The Central Bone Marrow Donor Registry (CBMDR) also stands out in terms of the young ages of potential donors. As of 2020, 27.2% of those registered were younger than 30 years of age, and 36.3% were aged between 30 and 40 years. Sixty percent of registered donors were female. The data in question were presented at the World Marrow Donor Association Search & Match Service, ensuring their visibility and accessibility to Polish and international search units and registries. In 2020, donors in Poland were the subject of almost 18,000 search requests from 40 countries, with 271 extended typing requests and more than 7600 confirmatory typing requests. The total number of donations from Polish donors also increased. In 2020, HSC of bone marrow, peripheral blood, or lymphocytes were collected from 1391 donors, as opposed to 94 donors in 2010. The growing number of donors available in the CBMDR means a better chance of a donor being found among Polish resources, without any need to resort to international registers. Although in 2010, just 24% of Polish recipients received HSC from Polish donors, by 2019 the figure was as high as 67%, and reached 63% in 2020. The CBMDR is an example of proper strategy on registry development being implemented in Poland.

Relative role of abdominal pelvic CT and lymphangiography in staging of testicular seminoma.

Sixty patients with testicular seminoma were reviewed regarding the evaluation of the retroperitoneal lymph nodes. Thirty-four of these patients had both abdominal pelvic computerized tomography (APCT) scan and bipedal lymphangiography (LAG). In 21 patients, the results of the two studies were in agreement. However, 11 patients had positive LAG and negative APCT, while only 2 had a positive APCT and negative LAG. We recommend that patients with testicular seminoma have an APCT. If findings are negative, LAG should be done.

Radiologic staging of chest in testicular seminoma.

We investigated the usefulness of chest x-ray (CXR), conventional planar tomography (TOM), and computerized axial tomography (CAT) in evaluating patients with Stages I and II testicular seminoma. All patients had a CXR, and 22 patients had either TOM or CAT as part of initial staging. No occult pulmonary or mediastinal nodal disease was found during initial staging, and none of the patients manifested recurrence of tumor in these sites as a first event. Review of the literature corroborates our finding of a very small thoracic failure rate in early stage seminoma. Routine use of CAT or TOM is not indicated in staging these patients.

[Vitamin A poisoning revealed by hypercalcemia in a child with kidney failure]. / Intoxication à la vitamine A révélée par une hypercalcémie chez un enfant insuffisant rénal.

BACKGROUND: Patients with chronic renal failure are at risk of vitamin A intoxication, a risk that must be evoked when unexplained hypercalcemia occurs. CASE REPORT: An 8 year-old boy with Alagille syndrome and chronic renal failure was admitted because of general deterioration, and bone pain. Severe hypercalcemia (3.9 mmol/L) was present. Serum phosphate, parathyroid hormone and 25 OH D3 levels were normal; 1-25 (OH)2 D3 levels were undetectable. Hypercalcemia was attributed to vitamin A intoxication, due to the administration of a mean daily dose of 12000 IU of vitamin A for at least 2 years. The diagnosis was confirmed by high plasma levels of retinol (1475 micrograms/L). Hypercalcemia only partially responded to treatment with bisphosphonates, calcitonin and dialysis with low calcium dialysate. Serum vitamin A levels remained elevated one month after vitamin A withdrawal. The boy died two months after admission from atrioventricular block. CONCLUSION: Vitamin A administration induces a high risk of intoxication in patients with chronic renal failure. Serum vitamin A concentrations are elevated in these patients, because of decreased renal metabolism of retinol, and vitamin A supplements must be avoided.

[ESRD in children and adolescents]. / Enfants et adolescents en IRCT.

This chapter provides indicators to describe the specificity of End Stage Renal Disease in children in France and to study these patients'outcome and the choices of treatment modalities. In 2011, the incidence and the prevalence of ESRD among patients under 20 years old remained stable at 8 and 53 pmp respectively. The first causes of ESDR remain uropathies and hypodysplasia followed by glomerulonephritis and genetic diseases. Considering the initial treatment, we found a high rate of hemodialysis and a low rate of peritoneal dialysis that is mainly used in younger children. In 2011, 31 preemptive transplantations were performed accounting for 27.7% of new patients. Finally, survival analysis confirm that younger children (under 4 years old) have the highest risk of death (88% survival rate at 2 years vs. 98% in patients over 4 years old) and that the treatment of choice remains the renal transplantation since it increases the expected remaining lifetime of 20 to 40 years depending on the considered age.

The influence of fibrin stabilization and fibrinolysis on the fibrin-adhesive system. A clinical study using radioactively marked fibrinogen as a tracer.

In many fields of surgery the use of highly concentrated human fibrinogen, which forms a fibrin clot when thrombin is added, is gaining increasing importance for tissue adhesion. A number of experimental and clinical reports on fibrin sealing have been published during recent years. The question underlying our present investigations is as follows: What happens to the tissue adhesive after its application to a wound in clinical use, i.e., how much time is required for complete resorption of the seal due to fibrinolytic processes? Skin graftings of the face (required to close defects caused by the excision of basal or spinal cell carcinomas) were performed by glueing rhomboid flaps or full thickness skin grafts to the wounds with the tissue adhesive to which 125I-marked fibrinogen has been added. Activity counts were recorded daily and CPM were plotted versus time to obtain summation curves. The physiological processes of fibrin stabilization and fibrinolysis are extensively discussed as both factors influence the tissue adhesive and thus have to be accounted for in clinical practice.

[Prognosis of prune belly syndrome]. / Pronostic du syndrome d'aplasie des muscles de la paroi abdominale.

The Prune Belly syndrome (PBS) is unfrequent. Fourteen cases have been followed in our unit during the last 20 years. Four infants (29%) died during the first months of life, because of neonatal sepsis (2 cases) or end-stage renal failure (2 cases). Among the other 10 cases, 6 (43%) had normal glomerular filtration rate at a mean age of 10 years 6 months (6 months to 15 years), 4 had chronic renal failure, including 3 cases who developed end-stage renal failure at 8, 8 years 8 months and 17 years respectively. Resection of an urethral obstruction was performed in 2 cases. This surgical indication remains widely accepted, while the current tendency is to limit ureteral surgery in PBS. Orchidopexy was performed in 4 children, 3 of them less than 6 years 6 months of age. Fertility of these early operated children remains to be established, as all adults reported in the literature remain sterile when orchidopexy was not performed or was performed after age 6.

[Complication of a vegetarian diet in a breast-fed girl (author's transl)]. / Complications d'une diéte végétarienne chez une enfant nourrie au sein.

A case is presented of megaloblastic anemia with metabolic acidosis. The baby was eleven months old. She was strictly fed with human milk from a vegetarian mother. Baby's and mother's B 12 serum levels were low. Baby's weight and neurological development were retarded. Complications included acido-cetosis, coagulation disorder and liver disorder. All these problems were corrected by cobalamine supplementation. X-rays also disclosed bone demineralization.

[Chronic renal insufficiency in the child. Etiology, development and prognosis]. / Insuffisance rénale chronique chez l'enfant. Etiologie, évolution et pronostic.

Our study concerned 147 children with chronic renal failure (CRF) (creatinine clearance less than 50 ml/min/1.73 m2). Its goal was to analyse the distribution of primary renal diseases, natural history of renal failure (RF) according to etiology, and long term survival. Renal diseases responsible for RF were: malformations of the urinary tract (38%), glomerular pathology (26%), hereditary renal diseases (20%), isolated renal hypoplasias (11%), and miscellaneous (5%). Corticoresistant nephrosis accounted for 34% of glomerular diseases and nephronophtisis 63% of hereditary renal diseases. On the whole, RF was related with an uropathy or renal hypoplasia in half of cases and with congenital renal disease in almost 3/4 of cases. The natural history varied according to primary renal disease: slow deterioration after a period of relative stability for uropathy or renal hypoplasias, slow and regular deterioration for nephronophtisis, rapid deterioration for glomerular diseases.

[Acute kidney failure caused by hyperphosphoremia in tumor lysis]. / Insuffisance rénale aiguë par hyperphosphorémie au cours des lyses tumorales.

We report the cases of two children presenting with tumor lysis syndrome responsible for major hyperphosphatemia, hypocalcemia and acute renal failure and treated by hemodialysis. Twenty similar cases have been reported in the literature. Hyperphosphatemia responsible for hypocalcemia and renal failure occurs within 24 to 48 hours after the onset of chemotherapy, is maximal on the 2nd or 3rd day and is, on the average, of 7 days duration. Short-term functional renal prognosis is good but long-term studies are lacking. The usual preventive measures are not always sufficient to prevent these accidents. A dialysis is appropriate when phosphatemia rises rapidly and exceeds 5 mmol/l, when the creatinine plasma level exceeds 200 mumol/l and kaliemia 6 mmol/l and when hyperphosphatemia is associated with severe clinical signs.

Pharmacokinetics of ganciclovir in renal transplant children.

Three cytomegalovirus (CMV)-seronegative children received renal transplants from CMV-seropositive donors and developed clinical symptoms of CMV infection between days 20 and 34 post transplantation. Ganciclovir (DHPG) was administered in a 1-h infusion, and the doses and dose intervals were adapted to the degree of renal insufficiency, according to the manufacturer's recommendations for adults. Individual pharmacokinetic parameters of DHPG were determined and were markedly altered. Plasma clearances were 0.4, 1.1 and 2.2 ml/min per kg and were related to individual creatinine clearances (20, 45 and 60 ml/min per 1.73 m2); the corresponding elimination half-lives were 23.7, 9.9 and 3.9 h. In two patients, the doses had to be further reduced in order to maintain plasma levels within the recommended values for peak and trough plasma concentrations. Therefore, monitoring of DHPG appears essential in adjusting dosage for optimal efficacy and minimal toxicity.