Evaluation of a New Regional Organization to Promote Access to Renal Transplantation

Hospices Civils de Lyon4,000 enrolled

Overview

Patients with terminal chronic kidney disease (CRD) need renal function supplementation, namely dialysis or renal transplantation. Transplantation is the most efficient and cost-effective treatment. Early and equitable access to transplantation is a public health issue. Access to transplantation is facilitated by early and systematic information and assessment of patients for inclusion in the national waiting list for transplantation prior to the onset of dialysis, and by the development of transplantation from living donors. In France, there are wide disparities in access to national waiting list registration and transplantation. One of the causes of these inequalities in access would be the disparity in referral practices to a transplant medical and surgical team authorized to register the individual on the national waiting list. The aim of the TRACE study is to evaluate the impact of a new regional organization promoting renal transplantation on access to renal transplantation.

Study Type

OBSERVATIONAL

Enrollment

4,000

Conditions

Renal Failure

Interventions

Regional organization for promotion of renal transplantationOTHER

Early identification of candidates for renal transplantation * with the help of a care coordinator Inform all patients appropriately about the techniques of renal function supplementation * delivered by expert patients and a care coordinator Assist the nephrologists in patient graft pathway * Multidisciplinary assessment of patients in dedicated web-conferencing meetings bringing together nephrologists and transplant team (" WebRCP of kidney transplant orientation") * Helping to carry out the pre-graft assessments of patients by a care coordinator

Eligibility

Sex: ALLMin age: 18 YearsMax age: 84 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patient older than 18 years and younger than 85 years. * Entered in the French Network Epidemiology and Information in Nephrology register * Renal function supplementation begun in 2013 -- 2014 (period before regional organization implementation) or in 2018 -- 2019 (period after regional organization implementation). Exclusion Criteria: \- Patient followed in a Center of nephrology-dialysis or of Renal transplantation located outside French Auvergne Rhône Alpes or Center Regions.

Outcomes

Primary Outcomes

Cumulative incidence rate of access to renal transplantation for patients with end-stage renal failure

Access to renal transplantation is defined by: * Pre-emptive renal transplantation with living donor or deceased donor * Registration on the national waiting list for renal transplantation

Time frame: At 24 months after initiation of renal function supplementation