Many advances have been made in the field of transplantation over the decades, but monitoring of patients after transplantation still faces challenges. This is why the KTD-innov project aims to develop a graft rejection prediction system that provides a probability of individual risks. Since the first transplant experiments at the beginning of the 20th century, what are the challenges of kidney transplantation today? Answer in figures
Kidney transplantation, A French story since the 19th century
In the history of medicine, the chapter dedicated to organ transplantation began at the end of the 19th century. Kidney transplantation plays an important role because it is the most performed organ transplantation in the world.
It was in Lyon that the pioneers of transplantation performed the first transplantations: Dr. Alexis Carrel, first of all, who in 1908 succeeded in the first kidney transplant in animals and demonstrated the effectiveness of cold to preserve organs; Dr. Mathieu Jaloubay, then, who experimented with the first kidney transplants in humans.
France will continue to play a major role in the field of kidney transplantation with the discovery of the compatibility of organs, thanks to the work of Doctors Dausset and Hamburger, of the Saint-Louis and Necker hospitals in 1962, and the establishment of bioethics laws in 1994 which place the well-being of the patient at the centre of medical research.
Since 1959, France has carried out nearly 90,000 kidney transplant operations, making kidney transplantation a treatment of choice for chronic kidney failure (CKD).
82,000 people with End Stage Renal Disease (ESRD) in France
There are two options when the disease reaches a terminal stage (End Stage Renal Disease - ESRD). The most common is hemodialysis. Today, this blood filtering technique remains constraining, as the patient must be dialysed over a period of 4 hours, 3 times a week.
The alternative for people with ESRD is a kidney transplant. The French High Authority for Health (HAS) considers transplantation to offer a better quality of life compared to dialysis. In fact, transplantation makes it possible to restore almost normal kidney activity while maintaining a lifestyle close to "normality".
More than €6,400: the monthly cost of End Stage Renal Disease (ESRD)
While dialysis can cost up to €7,200 per month, the cost of a kidney transplant is between €6,400 and €6,800. Kidney transplantation therefore represents a much more economical alternative to dialysis, with nearly €25 million saved on healthcare costs for all patients in France in 2018.
More than 3,500 kidney transplants performed each year in France
There were 3,567 new transplant patients in 2018, according to the French Biomedicine Agency, which is 215 fewer than in 2017, showing a decrease of the renal transplant activity of 11% in 2018. However, the growth rate of the number of people on the waiting list increases from year to year, with 19,625 patients waiting for a transplant in 2018, including 5,269 new patients on the waiting list, compared to 4,557 new patients in 2013. But the situation is improving as the number of transplants carried out in 2019 has risen to 3,641 operations.
1 graft available for 5 people on the waiting list
In 2018, for each available kidney, more than 5 people were on the waiting list. The HAS also estimates that only 31% of patients will receive a transplant in the first year after being placed on the list of potential recipients. Up to 15% will have to wait more than 5 years.
How can the shortage of organs for transplantation be tackled to ensure patients' comfort and chances of getting better?
85% of kidney transplants come from deceased donorS
The main source of organs comes from donations from deceased patients. In 2018, there were 1,881 brain-dead organ donors. The vast majority (93%) of these people donated at least one kidney. In 2006, organ donation became available for people who died from cardiac arrest. Today, thanks to this measure, 8% of grafts come from people who have died from heart failure.
Living donors make up 15% of donations. The French Biomedicine Agency considers this number to be low and due to the reluctance of patients to put their family and friends at risk as well as a lack of knowledge about how donors are medically monitored. Yet these donors are in better health than the general population, due to the clinicians' demands on donor monitoring.
Half the number of unallocated grafts in France than in the US
60% of transplants are kidney transplants
A 2018 study by the French Biomedicine Agency recorded 3,567 kidney transplants, 1,325 liver transplants and 450 heart transplants in one year. Despite the state of organ shortage, kidney remains the most widely transplanted organ.
On average, a kidney transplant survives 12.4 years
Today, the HAS measures graft survival time at 12.4 years, on average, after which the graft stops functioning properly. The patient must then undergo a new transplant or return to dialysis. The graft survival rate has been stable since 2010. In 2015, 1,032 transplant patients had to return to the waiting list of transplant candidates.
Graft failure is due, among other reasons, to immunological mechanisms leading to graft loss, and the field of transplantation still lacks robust assessments of immunological monitoring. It is a major issue for adapting treatment and increasing graft survival.
The KTD-innov project focuses on this issue, with the goal of developing a system for predicting rejection and providing a probability of individual risk of rejection. It will use a precision diagnostic system providing information regarding the activity and stage of the disease.
To elucidate the mechanisms of success or failure of a kidney transplant, KTD-innov collects, centralizes and analyses clinical, biological and immunological data from thousands of kidney transplant patients in France.