Specificities of Meningitis and Meningo-Encephalitis After Kidney Transplantation: A French Retrospective Cohort Study.

Kidney transplant recipients develop atypical infections in their epidemiology, presentation and outcome. Among these, meningitis and meningoencephalitis require urgent and adapted anti-infectious therapy, but published data is scarce in KTRs. The aim of this study was to describe their epidemiology, presentation and outcome, in order to improve their diagnostic and management. We performed a retrospective, multicentric cohort study in 15 French hospitals that included all 199 cases of M/ME in KTRs between 2007 and 2018 (0.9 case per 1,000 KTRs annually). Epidemiology was different from that in the general population: 20% were due to Cryptococcus neoformans, 13.5% to varicella-zoster virus, 5.5% to Mycobacterium tuberculosis, and 4.5% to Enterobacteria (half of which produced extended spectrum beta-lactamases), and 5% were Post Transplant Lymphoproliferative Disorders. Microorganisms causing M/ME in the general population were infrequent (2%, for Streptococcus pneumoniae) or absent (Neisseria meningitidis). M/ME caused by Enterobacteria, Staphylococci or filamentous fungi were associated with high and early mortality (50%-70% at 1 year). Graft survival was not associated with the etiology of M/ME, nor was impacted by immunosuppression reduction. Based on these results, we suggest international studies to adapt guidelines in order to improve the diagnosis and the probabilistic treatment of M/ME in SOTRs.

Impact of COVID-19 on 2020 transplant activity and waiting lists in France✰,✰✰.

The COVID-19 pandemic strongly affected organ procurement and transplantation in France, despite the intense efforts of all participants in this domain. In 2020, the identification and procurement of deceased donors fell by 12% and 21% respectively, compared with the mean of the preceding 2 years. Similarly, the number of new registrations on the national waiting list declined by 12% and the number of transplants by 24%. The 3-month cumulative incidence of death or drop out for worsening condition of patients awaiting a liver transplant was significantly greater in 2020 compared to the previous 2 years. Continuous monitoring at the national level of early post-transplant outcomes showed no deterioration for any organ in 2020. At the end of 2020, less than 1% of transplant candidates and less than 1% of graft recipients - of any organ - had died of COVID-19.

Donor-estimated GFR as an appropriate criterion for allocation of ECD kidneys into single or dual kidney transplantation.

It has been suggested that dual kidney transplantation (DKT) improves outcomes for expanded criteria donor (ECD) kidneys. However, no criteria for allocation to single or dual transplantation have been assessed prospectively. The strategy of DKT remains underused and potentially eligible kidneys are frequently discarded. We prospectively compared 81 DKT and 70 single kidney transplant (SKT) receiving grafts from ECD donors aged >65 years, allocated according to donor estimated glomerular filtration rate (eGFR): DKT if eGFR between 30 and 60 mL/min, SKT if eGFR greater than 60 mL/min. Patient and graft survival were similar in the two groups. In the DKT group, 13/81 patients lost one of their two kidneys due to hemorrhage, arterial or venous thrombosis. Mean eGFR at month 12 was similar in the DKT and SKT groups (47.8 mL/min and 46.4 mL/min, respectively). Simulated allocation of kidneys according to criteria based on day 0 donor parameters such as those described by Remuzzi et al., Andres et al. and UNOS, did not indicate an improvement in 12-month eGFR compared to our allocation based on donor eGFR.

Factors associated with regional disparities for registration on the French national liver transplantation waiting list.

AIM: This study compared the gap between supply and need for liver transplantation among the geographic regions of France. METHODS: Supply was estimated by registration rates on the national waiting list and need by cirrhosis-related death rates. Hierarchical ascendant classification and principal component analysis were applied to identify regional patterns in the gap between supply and need. Associations between socio-ecodemographics and regional healthcare factors were investigated. RESULTS: We have found regional disparities between supply and need, mainly in regions with high rates of cirrhosis-related death. Among the 22 regions studied, six regional patterns were identified. The biggest gap between supply and need was found in regions characterized by the lack of a regional transplantation center or a low density of general and specialized practitioners. These regions were mainly rural or without a city with more than 200,000 inhabitants, and had high proportions of young people and lower social classes. The smallest gap between supply and need was found in regions presenting the opposite patterns. CONCLUSION: These results might be considered by health authorities when planning resource allocation for liver transplantation. Transplantation teams and their networks should strive for better geographical access before registration on the waiting list.

[Labour epidural analgesia for a woman with hereditary macrothrombocytopenia]. / Analgésie péridurale obstétricale chez une patiente présentant une macrothrombocytopénie familiale.

Epidural analgesia is often considered as risk of epidural haematoma in a patient with thrombocytopenia. In this observation, uncomplicated epidural analgesia was performed in a pregnant woman with hereditary macrothrombocytopenia. She received continuous epidural labour analgesia for a vaginal delivery with a platelet count at 63x10(9)/l but platelets with high mean platelet volume (20fL) and normal function. No neurological sequelae or excessive bleeding occurred.

[Outcome of the use of albumin and colloid plasma substitutes from 1989 to 1993 in a French University Hospital Center]. / Evolution de la consommation d'albumine et des substituts colloïdaux du plasma de 1989 à 1993 dans un Centre Hospitalier Universitaire français.

OBJECTIVES: To evaluate the use of plasma substitutes (albumin, gelatins, dextrans, starches) from 1989 to 1993 in a 3000-bed University hospital and to assess the impact of the 1989 consensus conference of the French speaking Society of Intensive Care Medicine on the choice of plasma substitutes for treatment of hypovolaemia. STUDY DESIGN: Retrospective study of a case series. METHODS: Data on the use of albumin and artificial plasma substitutes were obtained from Blood Bank and Pharmacy. RESULTS: Between 1989 and 1993, the total amount of administered plasma substitutes decreased by 20%, allowing a saving of 1.7 million FF. There was a 60% decrease in the use of gelatins and dextrans. The starches, introduced in 1991, became in 1993 the most used plasma substitute, with 37% of the total. The use of albumin showed only a 32% decrease and was still in 1993 the main source of expenditure for plasma substitutes, with 3.8 million FF and 80% of the total cost. The number of plasmapheresis increased by 15%, whereas the use of albumin for plasmapheresis, almost constant in absolute value, increased from 31% in 1989 to 45% in 1993 of the total expenses. There were large differences between the services regarding the use of albumin. Intensive care and surgical units represented 70% of the total (plasmapheresis excluded). In this group, the overall fall of use was 22%, some units obtaining a 93% decrease whereas other did not change in spite of constant admission numbers. Medical units decreased their albumin use by 53%. CONCLUSION: The decrease in the albumin use between 1989 and 1993 was not significant. The impact of the consensus conference, if any, was weak. A careful evaluation of the prescriptions would be necessary to improve the compliance of clinical practice with recommendations by the consensus conference.