The European Renal Association (ERA) Registry collects data on patients with kidney failure receiving kidney replacement therapy (KRT). This paper presents a summary of the ERA Registry Annual Report 2023, and focuses specifically on comparisons by age. The complete ERA Registry Annual Report 2023 is available in the Supplementary information. For 2023, data were collected from 34 countries in Europe and countries bordering the Mediterranean Sea. Using these data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities, and expected remaining lifetimes were calculated. In 2023, the ERA Registry covered 519 million people in the participating countries. The incidence of KRT was 151 per million population (pmp). Among incident patients, 29% were aged ≥75 years, 64% were male, and the most common primary renal disease (PRD) was diabetes mellitus (22%). Most patients (83%) started KRT with haemodialysis (HD), 11% started with peritoneal dialysis (PD), and 6% underwent pre-emptive kidney transplantation. On 31 December 2023, the prevalence of KRT was 1101 pmp. Among prevalent patients, 24% were aged ≥75 years, 62% were male, and the most common PRD was of miscellaneous origin (18%). Moreover, 56% of prevalent patients received HD, 5% received PD, and 39% were living with a functioning graft. In 2023, the kidney transplantation rate was 43 pmp, with 69% of kidneys coming from deceased donors. For patients starting KRT between 2014 and 2018, 5-year survival probability was 51%. The proportions of incident and prevalent patients aged ≥75 varied considerably across European countries. In addition, incident patients aged ≥75 were more often male, and had more often hypertension as PRD compared with younger patients. Only 1% of incident patients aged ≥75 received a pre-emptive kidney transplant, while among prevalent patients of the same age, 22% was living with a functioning graft.
The French composite cardiac allocation score is based on an algorithm that includes interacting components. This multi-step system may hinder understanding of the decision-making process leading to candidate ranking. This study aimed to provide insights into the variables contributing to the ranking of the French transplant candidates. This national cohort study included all candidates ranked between January 2018 and December 2023. The primary endpoint was the normalized ranking of candidates. After determining the most effective machine learning model for predicting ranking, we applied SHapley Additive exPlanations analysis to highlight the relationship between contributing factors and predicted ranking. During the study period, 365,310 rankings were generated, of which 197,684 rankings from 2,430 donors and 3,221 candidates, were other than zero. The post-transplant survival filter was activated in 7% of cases. The top five factors contributing to the predicted ranking were the combined veno-arterial extracorporeal membrane oxygenation/natriuretic peptide variable, total bilirubin level, transport time from procurement to transplant center, candidate age and estimated glomerular filtration rate. The candidate’s sex, blood type, and indication for transplantation had minimal impact on ranking. These results show that our allocation system combines urgency and efficiency, while limiting influence of variables associated with reduced access to transplant.
Background:Our study aims to describe the French heart-lung graft allocation system, to compare it with allocation systems used in other countries, and to explore potential solutions to improve access to this rare transplantation procedure. Methods:Our study integrates published literature and multidisciplinary expert opinions to examine heart-lung graft allocation in France. Results:The heart-lung transplantation (HLTx) programme was initiated in France in 1987. The number of procedures then increased steadily until the 2010s. Improved knowledge on right ventricular function recovery after double lung transplantation (LTx) for pulmonary hypertension combined with the organ shortage then led to a sharp drop in the number of HLTx recipients worldwide. In France, the number of HLTx procedures is only about ten per year and the main indication is Eisenmenger syndrome. Most HLTx candidates in France receive grafts only if they are in the high-urgency category highlighting the difficulty of access to heart-lung transplants. A re-appraisal of graft allocation rules thus seems mandatory to allow graft access to patients who do not meet high-urgency criteria and whose better general health predicts better post-HLTx outcomes. Conclusions:As HLTx candidates in France are placed on the heart-transplant list in competition with heart-only transplant candidate, one option would be to reconsider the heart score assigned to HLTx candidates upon listing.
The creation of the National Health Data System aims to collect, structure, and make analyzable the various documents resulting in particular from hospitalization, outpatient care, death certificates, and disability-related measures, in order to provide a population-based, longitudinal, and consistent view of care pathways.
