Kidney transplantation in the hospital of Tours: 2000 transplantation in 30 years!

2015 is an important year for the nephrologists and all the medical community of the University Hospital of Tours, and the FHU SUPORT: on the 25th September, the 30 years of kidney transplantation in Tours have been celebrated in presence of personalities recognized in the specialty.

In mid-March 2015, the 2000th kidney transplantation has been performed at Tours University Hospital. This is an opportunity to review the fantastic progress of medicine during this period and to honor one of the pioneers of kidney transplantation in Tours, Professor Yvon Lebranchu.

 

A little history

Since the 50s, medical teams put much hope in kidney transplantation, but immune problems (risk of rejection) made all results deceiving. Until the early 1970s, the access to treatment for patients with very advanced stage of kidney failure was very difficult. Then dialysis techniques have been gradually developed, allowing some patients to survive, whereas before they were condemned.

Then, thanks to the discovery of new pharmacological molecules and a better understanding of the immune system, the grafts remained in average longer in place in recipients, from the 1980s.

 

At the University Hospital of Tours

After a first attempt in kidney transplantation in 1978 at University Hospital of Tours (which ended in failure almost immediat), the program stopped until 1985. Under the leadership of Prof. Bagros and Prof. Nivet and the responsibility of Prof. Lanson and Prof. Lebranchu, the first kidney transplantation took place on 20 October 1985. The kidney recipient has been living with a functioning graft until 1996. The transplantation activity then increased in steps. While the number of transplants in 1995 was stabilized at 50 per year and around 80 in 2005, the number of annual kidney transplantation is still increasing to over 100 transplantations per year in 2007.

For 5 years, the activity is between 110 and 130 kidney transplantations which correlate with an enlargement of the indications of transplantation. A child of tender age (22 months) has received a kidney graft and 80 years old patients have been transplanted. The procurement of the kidney in living donors (it is possible to donate a kidney if the donor is in very excellent health) is more and more frequently proposed and performed at the HU of Tours (14 transplants from living donors in 2014).

This increasing of the transplantation activity is now possible because of the well structured network around the kidney transplantation within the Nephrology-Clinic Immunology service, and also thanks to the dynamism of the services of urology and histology, the biological laboratories, the imaging services and the staff providing a particularly suitable support (ditticienne, coordinators of transplantation, psychologists).

photo Y LEBRANCHU 25 09 15Prof. Yvon Lebranchu (photo) initiated the kidney transplantation program at the University Hospital of Tours in 1985. Under his leadership, this activity raised with a high requirement on care quality and monitoring of transplanted patients. This has achieved more than 2,000 kidney transplantations in Tours with active cohort near 1500 transplanted patients.

Transplantation represents a priority for the HU; this is largely du to the competency, the dynamic and federative action of Yvon Lebranchu. Unusual pedagogue, Yvon Lebranchu knows how to make understand complex mechanisms. He often uses metaphors which sometimes gives the impression that immunology is available all of us. He participated in the creation of the transplantation IUD (unique in France) and Master 2 “Relationship graft Host” that remain today among the teachings of reference in organ and tissue transplantation. Unquestionably Yvon Lebranchu years ago understood the importance of research in the University Hospital. He has always supported the transversality in clinical research and research teams (from bench to bedside) (256 publications). Yvon Lebranchu is still active as a Member of the Academy of Medicine, consultant at the ARS and as part of the research team EA 4245 where he leads several projects (http://cdg.univ-tours.fr/accueil/).

To donate a kidney, if the donor is in very excellent health, is more and more frequently proposed and performed at the HU of Tours (14 transplants from living donors in 2014). “We are currently in a situation of shortage of organs. […] We are entering a new paradigm shift in France: to overcome this shortage, now is the ideal transplantation with a living donor without going through dialysis. This is called a preemptive transplantation.” Prof. Yvon Lebranchu (The New Republic, the 06/26/15).

 

The kidney transplant center in region

Thus, the recruitment of very healthy patients includes the 6 departments of the Region Centre (approximately 60% of the Tours CHRU kidney transplanted patients do not live in Loire Valley but in other departments center of the region). In addition, despite the increasing activity, the results of University Hospital are excellent. In fact, these results are regularly published by the biomedicine agency (supervising all transplant activities in France). A recent showed that the HU of Tours is among the best among all transplant centers in France in patient survival with a functioning kidney graft after 5 years. As for the other organs, the kidney transplantation requires a regular monitoring in an adapted structure with a polyvalent technical platform. Thus, all patients with a functioning graft are monitored regularly to the HU of Tours (at least two visits per year). Even if a number of patients lost their graft after a few years, or are deceased with a functional kidney graft, this cohort currently represents about 1,500 patients.

Le 12 octobre 2015