Accès à la liste d’attente de greffe rénale des patients en dialyse péritonéale de Nouvelle-Calédonie et Wallis et Futuna

Abstract

Introduction

Since 2012, a deceased donor kidney transplant program exists for dialysis patients living in New-Caledonia in collaboration with Royal Prince Alfred Hospital in Sydney, Australia. This program has reduced the time spent out-of-territory for a renal transplantation and has reduced the economic burden of end stage renal disease in New-Caledonia. We have realised a photography of kidney transplants evaluation for patients in peritoneal dialysis in New-Caledonia and Wallis and Futuna. The first aim was to describe access to kidney transplants evaluation for dialysis patients. A second aim was to compare patients with a conformed kidney transplant evaluation and patients without transplant evaluation with no obvious reasons identified.

Method

All patients in peritoneal dialysis in New-Caledonia and Wallis and Futuna at the 2018, 31^st july were included. A standardised form was filled by two nephrologists. The computerised shared medical record was used to collect information. A kidney transplant evaluation was adequate for patients registered on transplant waiting list, patients with medical contraindications identified or patients with evaluation exams begun less than 6 months.

Results

In total, 61 patients were included. The average age was 62 years old. The chronic kidney disease care average time was 6.7 years and the dialysis average time was 2.0 years. Among them, 11 (18 %) were registered on the waiting list, 26 (43 %) had at least one kidney transplant medical contraindication, 3 (5 %) had begun transplant exam since less than 6 months and 21 (34 %) had no transplant exam begun or transplant exam begun since more than 6 months without medical contraindication identified. Among those 21 patients, the three most common reasons were a faulty programming transplant exam (67 %; n = 14), a remote living place (48 %; n = 10) and an intercurrent health event (29 %; n = 6). Among patients living in Noumea and suburbs, 74 % had a conformed transplant evaluation against 44 % in patients living outside Noumea and suburbs (P = 0.058). Nearly one in two patients not on the waiting list had have no information about kidney graft or the information was not recorded in the medical record.

Conclusion

This study showed two main factors of a non-conformed transplantation evaluation: living outside Noumea and suburbs and a non-efficient planning of pre-transplant assessment exams. There is also a lack of information to the patient. These risk factors for late registration and non-registration must be considered by the healthcare teams. This study will provide a point of reference to assess the impact of actions to improve access to renal transplantation deployed in New-Caledonia.