Hiesse Christian
Service de néphrologie et de transplantation rénale, hôpital Foch, 40, rue Worth, BP 36, 92151 Suresnes cedex, France; Université Paris-Ouest, 92000 Nanterre, France.
Nephrol Ther. 2013 Nov;9(6):441-50. doi: 10.1016/j.nephro.2013.02.002. Epub 2013 Mar 7.
Kidney transplantation activity in France is among the most important worldwide: in 2011, 2976 transplants have been performed (47.5 per million population), and the number of patients living with a functional graft is estimated around 30,000, representing 44.7% of all patients (n = 67,270) treated for end-stage renal failure. However, the rate of preemptive kidney transplants remains very low, only 3.3% of incident patients starting renal replacement therapy. The analysis of demand showed a progressive increase in recent years, as demonstrated by the registration rate on the kidney transplantation waiting list, increasing by 5% yearly between 2006 and 2010, but with huge differences according to age categories and regional registration areas, reflecting discrepant appreciations in indications for kidney transplantation. The median waiting time between registration and transplantation increased progressively in recent years, reaching 22.3 months with considerable variations according to regional areas and transplantation teams. Kidney transplantation activity, while increasing continuously, is far to cover the rising demand, and inexorably patients accumulate on the waiting list (around 9000 patients were registered by January 2012). This situation is the consequence of insufficient organ procurement activity. The deceased organ procurement rate remained high: 1572 harvested donors in 2011 (24.1 per million population), but the proportion of older donors rose in recent years, to reach the rate of 26% of donors older than 65 years in 2011. The procurement activity of donors after cardiac arrest was reintroduced in 2006, but increased slowly: 65 transplants were performed in 2011 using kidney procured in non heart-beating donors. The living donor kidney transplantation activity has markedly increased recently: 302 living donor transplantations were performed in 2011, representing 10.1% of the kidney transplantations. Facing the predictable increase in the number of candidates, all efforts should be put together, by increasing the living donor transplantation activity and by supporting and promoting the deceased donor procurement activity.
2011年共进行了2976例移植手术（每百万人口中有47.5例），功能正常移植物的存活患者数量估计约为30000人，占所有接受终末期肾衰竭治疗患者（n = 67270）的44.7%。然而，预先性肾脏移植的比例仍然很低，仅占开始肾脏替代治疗的新发病例患者的3.3%。需求分析显示近年来呈逐步上升趋势，肾脏移植等待名单上的登记率就表明了这一点，2006年至2010年间每年增长5%，但根据年龄类别和地区登记区域存在巨大差异，这反映出对肾脏移植适应症的不同认识。登记与移植之间的中位等待时间近年来逐渐增加，达到22.3个月，根据地区和移植团队的不同存在很大差异。肾脏移植活动虽然持续增加，但远远无法满足不断增长的需求，患者不可避免地在等待名单上累积（到2012年1月约有9000名患者登记）。这种情况是器官获取活动不足的结果。已故器官获取率仍然很高：2011年有1572名捐献者（每百万人口中有24.1名），但近年来老年捐献者的比例有所上升，2011年65岁以上捐献者的比例达到了26%。2006年重新引入了心脏骤停后捐献者的获取活动，但增长缓慢：2011年使用非心跳捐献者获取的肾脏进行了65例移植手术。活体捐献者肾脏移植活动最近显著增加：2011年进行了302例活体捐献者移植手术，占肾脏移植手术的10.1%。面对候选者数量可预见的增加，应通过增加活体捐献者移植活动以及支持和促进已故捐献者获取活动，共同做出所有努力。
