La situation sanitaire de la Nouvelle-Calédonie présente les données de l'année 2015 ainsi que les évolutions des années précédentes. L'année 2015 a été marquée notamment par la circulation des trois arboviroses : dengue, chikungunya et zika. Le renforcement des mesures de contrôle sanitaire aux frontières et les actions de lutte anti-vectorielle menées par l'ensemble des partenaires ont permis d'éviter la survenue d'une épidémie. Ce bilan 2015 restitue par ailleurs l'ensemble des données recueillies par le service de santé publique de la direction des affaires sanitaires et sociales de la Nouvelle-Calédonie. Il a pu être élaboré grâce à la collaboration de tous les partenaires, médecins, institutions qui oeuvrent directement ou indirectement pour améliorer la santé de la population calédonienne. Qu'ils en soient remerciés pour leur contribution à cette mission et leur participation à l'élaboration de ce document, tout comme des remerciements particuliers sont également adressés à ceux qui ont fourni des synthèses ou qui ont rédigé des chapitres. Le soutien constant des directions des actions sanitaires et sociales des trois Provinces mérite d'être souligné. Enfin, il faut remercier l'équipe du service de santé publique pour la quantité et la qualité du travail fourni depuis la collecte, l'analyse et la rédaction de ce rapport, qui a pu être mené à bien en dépit d'une équipe réduite pendant l'année 2016. Certains recueils sont exhaustifs. D'autres données proviennent d'études spécifiques, des réseaux sentinelles, des bilans d'activité des établissements et structures de santé, et sont représentatifs de la situation réelle. Cependant, pour d'autres recueils, tributaires des déclarations des professionnels de santé et d'autres partenaires, les données sont incomplètes du fait de sous-déclarations. De ce fait, les chiffres ne représentent pas l'incidence exacte de certaines pathologies. Elles restent cependant des indicateurs essentiels pour le suivi des tendances. Cette situation nous impose d'améliorer encore la qualité du recueil ainsi que la participation des professionnels de santé, notamment le secteur libéral de Nouméa, pour parfaire cet outil indispensable à l'élaboration de la politique de santé. La lecture de ce document doit tenir compte des commentaires et, dans certains cas, ne pas être interprétés de manière hâtive. Plus encore, lorsque des réserves méthodologiques sont énoncées. Ce document représente un constat à un moment donné. C'est un outil, remis à jour chaque année, indispensable pour guider la réflexion, le choix et les interventions de tous les acteurs de la santé publique. Il est encore incomplet, les résultats et leur présentation demeurent perfectibles. Toutes vos remarques et vos suggestions seront les bienvenues et permettront l'enrichissement de nos connaissances mutuelles. Le site Internet de la DASS-NC (www.dass.gouv.nc) vous permet de télécharger la situation sanitaire de la Nouvelle-Calédonie sur l'année en cours et les années précédentes. Nous ne pouvons que vous recommander de con...
Background: Kidney transplantation performed in the presence of high-titre donor-specific antibodies (DSA) may result in hyper-acute or accelerated antibody-mediated rejection and rapid allograft loss. Previous studies have shown that this risk may be mitigated with simultaneous liver-kidney transplantation (SLKT); however, the mechanisms are not well defined. Here we report the evolution of pre-formed, high-level DSAs in two highly sensitised SLKT recipients peri-operatively and describe a profound sustained depletion of all DSAs from the time of liver anastomosis with no extra desensitisation therapy required. Case presentation: Two patients underwent SLKT and received our centre's standard renal transplant immunosuppression with basiliximab and methylprednisolone for induction therapy and prednisolone, mycophenolate and tacrolimus for maintenance therapy. HLA antibody samples were collected pre-operatively, and immediately post-liver and post-kidney revascularisation, and then regularly in the post-transplant period. Complement Dependant Cytotoxicity (CDC) crossmatches were also performed. Both patients were highly sensitised with a PRA over 97%. One patient had a positive Band T-cell crossmatch pre-transplant. These positive CDC crossmatches became negative and the level of pre-formed DSAs reduced profoundly and rapidly, within 3 h post-liver revascularisation. The reduction in pre-formed DSAs, regardless of subclass, was seen immediately postliver revascularisation, before implantation of the renal allografts. No significant reduction in non-donor specific HLA-antibodies was observed. Both patients maintained good graft function with no rejection on kidney allograft protocol biopsies performed at 10-weeks post-transplant. Conclusions: These cases support the protective immunoregulatory role of the liver in the setting of SLKT, with no extra desensitisation treatment given pre-operatively for these highly sensitised patients.
Introduction: Demand for donor kidneys far exceeds the availability of organs from deceased donors. Living donor kidneys are an important part of addressing this shortfall, and laparoscopic nephrectomy is an important strategy to reduce donor morbidity and increase the acceptability of living donation. Aim: To retrospectively review the intraoperative and postoperative safety, technique, and outcomes of patients undergoing donor nephrectomy at a single tertiary hospital in Sydney, Australia. Method: Retrospective capture and analysis of clinical, demographic, and operative data for all living donor nephrectomies performed between 2007 and 2022 at a single University Hospital in Sydney, Australia. Results: Four hundred and seventy-two donor nephrectomies were performed: 471 were laparoscopic, two of which were converted from laparoscopic to open and hand-assisted nephrectomy, respectively, and one (.2%) underwent primary open nephrectomy. The mean warm ischemia time was 2.8 min (±1.3 SD, median 3 min, range 2-8 min) and the mean length of stay (LOS) was 4.1 days (±1.0 SD). The mean renal function on discharge was 103 μmol/L (±23.0 SD). Seventy-seven (16%) patients had a complication with no Clavien Dindo IV or V complications seen. Outcomes demonstrated no impact of donor age, gender, kidney side, relationship to the recipient, vascular complexity; or surgeon experience, on complication rate or LOS. Conclusion:Laparoscopic donor nephrectomy is a safe and effective procedure with minimal morbidity and no mortality in this series.
Introduction: Static deceased donor rates are helping increase the demand for live donor renal transplantation. With new initiatives in live donor renal transplantation such as ABO incompatible and paired exchange it is important to understand the reasons for potential live donor pairs not proceeding to transplantation. Methods: Retrospective review of records held from 2003-2007 of results of assessment of blood group compatible prospective live kidney donor and recipient pairings. The number declined for ABO incompatibility cannot be reliable determined. Results: 151/306(49%) of potential pairs did not proceed to transplantation. Reasons for non progression to transplantation were donor issues in 65/151(43%), a positive X-match in 47/151(31%), recipient issues in 39/151(26%). In potential donors issues precluding donation were medical in 24/65(40%)[abnormal GFR 10; diabetes 8; cardiac 6], followed by psychosocial in 21/65(32%) and problems with renal anatomy on imaging 9/65(14%). In recipients medical issues in 34/39(87%) most frequently precluded transplantation followed by psychosocial issues in 5/39(13%). Recipient medical issues predominantly included cardiac in 8/34(23%), malignancy in 5/34(15%), ongoing treatment of hepatitis C in 4/34(12%), complications of diverticular disease in 3/34(9%). Renal function stabilised in 4/34(12%) of these recipients precluding transplantation in the short term. Two recipients (6%) were deemed to not be suitable for ABOI renal transplantation (programme commenced mid 2007), due to high Antibody titres and 2/34(6%) recipients deceased during the workup period. Conclusions: In the last 5 years close to 50% of potential live donor renal transplant pairs did not proceed to transplantation. This has implications both for resourcing of the programme and future strategies that may allow transplantation between pairs previously turned down during workup.
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