Modelling syllepse in medical knowledge bases with application in the domain of organ failure and transplantation

Abstract. The Etablissement français des Greffes (EfG) is a public health agency in charge of organs, tissues and cells transplantation in France. Among EfG's missions is the evaluation of the organ retrieval and transplantation activities, which relies on a national information system (IS). In order to facilitate data recording, to improve information quality and homogeneity, to allow data interchange and semantic interoperability with hospital information systems and other registries, a specific work as been initiated dealing with ontological foundations of medical terminology in the domain of organ failure and transplantation. The aim of this paper is to describe how the syllepse appeared to us as a key figure that accounts for medical knowledge acquisition.

Toward Organ Shortage Resilient Allocation Policies Using Real-Time Queueing Models For Liver Transplantation

We report in this paper on the potential interest of real-time queueing models to optimize organ allocation policies. We especially focus on building organ shortage resilient policies in terms of equity, as we experienced differential impact of the COVID epidemic organ shortage on transplant access, according to the cause of liver failure. Patient's death on the waiting list or dropout for being too sick, resulting from the absence of a timely available organ, is chosen as the main equity metric. Results obtained with the composite allocation score used in France is challenged against the so-called Early Simulated Deadline First (ESDF) real-time queueing discipline, under increasing levels of organ shortage, by extensive simulations. The ESDF policy is a variant of the well-know Earliest Deadline First (EDF) policy, which was shown as optimal in various contexts in the queueing literature. In the present case, the time to the deadline represents the remaining life duration of patients-which is of course unknown. So we propose to simulate a fictional life-duration, and give priority to the earliest simulated deadline. This leads to a simple and comprehensive representation of the system at hand by a Markov process. Our simulation results clearly show that the ESDF policy allows to maintain equity between indications, conversely to the scoring policy, which was not resilient to increasing levels of organ shortage

Toward Organ Shortage Resilient Allocation Policies Using Real-Time Queueing Models For Liver Transplantation

We report in this paper on the potential interest of real-time queueing models to optimize organ allocation policies. We especially focus on building organ shortage resilient policies in terms of equity, as we experienced differential impact of the COVID epidemic organ shortage on transplant access, according to the cause of liver failure. Patient's death on the waiting list or dropout for being too sick, resulting from the absence of a timely available organ, is chosen as the main equity metric. Results obtained with the composite allocation score used in France is challenged against the so-called Early Simulated Deadline First (ESDF) real-time queueing discipline, under increasing levels of organ shortage, by extensive simulations. The ESDF policy is a variant of the well-know Earliest Deadline First (EDF) policy, which was shown as optimal in various contexts in the queueing literature. In the present case, the time to the deadline represents the remaining life duration of patients-which is of course unknown. So we propose to simulate a fictional life-duration, and give priority to the earliest simulated deadline. This leads to a simple and comprehensive representation of the system at hand by a Markov process. Our simulation results clearly show that the ESDF policy allows to maintain equity between indications, conversely to the scoring policy, which was not resilient to increasing levels of organ shortage

The essential of 2012 results from the French Renal Epidemiology and Information Network (REIN) ESRD registry

International audienceThe French Renal Epidemiology and Information Network (REIN) registry began in 2002 to provide a tool for public health decision support, evaluation and research related to renal replacement therapies (RRT) for end-stage renal disease (ESRD). It is relying on a network of nephrologists, epidemiologists, patients and public health representatives. Continuous registration covers all dialysis and transplanted patients. In 2012, in France, 10,048 patients started a RRT (154 per million inhabitants). Elders provided majority of new patients (median age at RRT start: 70 years old). New patients had a high and age increasing rate of comorbidities, especially diabetes (42% of the new patients) and cardiovascular comorbidities (>50% of the new patients). Like previous years, incidence is stabilized. On December 31, 2012, 73,491 patients were receiving a RRT in France (1127 per million inhabitants, 56% on dialysis and 44% living with a functional renal transplant). More than 50% of patients were undergoing in-center hemodialysis with significant variations among regions. An increase in medical satellite unit hemodialysis but a decrease in self-care unit hemodialysis rates were noticed across the time, whereas peritoneal dialysis remained stable at 7%. Five years after starting RRT, the overall survival rate was 51% but only 16% among patients over 85 years. Mortality rate was highly dependent on treatment and age; transplanted patients aged 60-69 had a 27/1000 patients-year mortality rate versus 133 for a dialysis patient. Patients who started dialysis had a probability of first wait-listing of 4.8% at the start of dialysis (pre-emptive registrations) and 27% at 72 months. Whatever their diabetes status was, patients older than 60 had poor access to the waiting list. Seventeen percent of the patients received a first renal transplant within 15.4 month median time; 3% had received a pre-emptive graft. Ten years after the start of the French ESRD registry, this report provides a comprehensive and nation-wide overview of dialysis and transplantation cares in France, including overseas

Day-time declamping is associated with better outcomes in kidney transplantation: the circarein study

International audienceDespite improvements in organ preservation techniques and efforts to minimize the duration of cold ischemia, ischemia–reperfusion (IR) injury remains associated with poor graft function and long-term survival in kidney transplantation. We recently demonstrated a clinically significant day-time variation in myocardial tolerance to IR, transcriptionally orchestrated by the circadian clock. Patient and graft post-transplant survival were studied in a cohort of 10,291 patients first transplanted between 2006 and 2017 to test whether kidney graft tolerance to IR depends on the time-of-the-day of clamping/declamping, and thus impacts graft and patient survival. Post-transplant 1- and 3-year survival decreased with increasing ischemia duration. Time-of-the-day of clamping did not influence outcomes. However, night-time (vs. day-time) declamping was associated with a significantly worse post-transplant survival. After adjustment for other predictors, night-time (vs. day-time) declamping remained associated with a worse 1-year (HR = 1.26 (1.08–1.47), p = 0.0028 by Cox multivariable analysis) and 3-year (HR = 1.14 (1.02–1.27), p = 0.021) outcome. Interestingly, the deleterious impact of prolonged ischemia time (>15 h) was partially compensated by day-time (vs. night-time) declamping. Compared to night-time declamping, day-time declamping was associated with a better prognosis of kidney transplantation despite a longer duration of cold ischemia

Organ procurement and transplantation during the COVID-19 pandemic

International audienc

Effects of the dialysate calcium concentrations and mineral bone disease treatments on mortality in The French Renal Epidemiology and Information Network (REIN) registry

International audienceBackground: In patients on hemodialysis (HD), the various chemical elements in the dialysate may influence survival rates. In particular, calcium modifies mineral and bone metabolism and the vascular calcification rate. We studied the influence of the dialysate calcium concentration and the treatments prescribed for mineral bone disease (MBD) on survival.Methods: All patients in REIN having initiated HD from 2010 to 2013 were classified according to their exposure to the different dialysate calcium concentrations in their dialysis unit. Data on the individual patients' treatments for MBD were extracted from the French national health database. Cox proportional hazard models were used to estimate mortality hazard ratios (HR) associated with time-dependent exposure to dialysate calcium concentrations and MBD therapies, adjusted for comorbidities, laboratory and technical data.Results: Dialysate calcium concentration of 1.5 mmol/L was used by 81% of the dialysis centers in 2010 and in 83% in 2014. Most centers were using several formulas in up to 78% for 3 formulas in 2010 to 86% in 2014. In full adjusted Cox survival analyses, the percentage of calcium >1.5 mmol/L and <1.5 mmol/l by center and the number of formula used per center were not associated with survival. Depending on the daily dose used, the MBD therapies were associated with survival improvement for calcium, native vitamin D, active vitamin D, sevelamer, lanthanum and cinacalcet in the second and third tertiles of dose.Conclusion: No influence of the dialysate calcium concentration was evidenced on survival whereas all MBD therapies were associated with a survival improvement depending on the daily dose used

Analysis, evaluation and adaptation of the ReTransQoL: a specific quality of life questionnaire for renal transplant recipients

International audienceBackgroundEnd stage renal disease (ESRD) profoundly impacts the lives of patients. Kidney transplantation provides the greatest health-related quality of life (HRQOL) improvement. Its measurement has become an important outcome parameter and a very important criterion in the evaluation of any type of medical treatment, especially in the field of renal transplantation.In 2007, a specific self-administered questionnaire for renal transplant recipients was developed in the French language: the ReTransQol (RTQ).After 5 years of use, the properties of the RTQ needed to be re-evaluated in a larger sample.This paper describes the analysis of the ReTransQol and its adaptation to achieve an improved and revised version.MethodsThe study design included three analysis phases for two samples of adult renal transplant recipients which came from two cross-sectional multicenter studies carried out in France in 2007 and 2012. Psychometrics properties like construct validity, acceptability and feasibility, reliability and convergent validity were evaluated and every analysis resulted in a new version of the questionnaire: the RTQ V2. The construct validity of the new RTQ was assessed with a Confirmatory Factor Analysis on a large sample of patients.ResultsThe study samples included 1,059 patients and 1,591 patients, respectively.After a principal component analysis, item reduction was performed and a total of 13 items were deleted. A final version of the RTQ V2 was created and comprised of 32 items describing 5 domains: Physical Health, Social Functioning, Medical Care, Treatment and Fear of Losing Graft.The explained variance between the first and second RTQ versions improved from 46.3% to 53.1%. All psychometric properties of RTQ V2 were satisfactory: IIC >0.4, IDV (%) of 100% and Cronbach’s Alpha >0.7 in every dimension. The confirmatory analysis showed that the overall scalability of the RTQ V2 was satisfactory; all items showed a good fit to the Rasch model within each dimension, and showed INFIT statistics inside the acceptable range.ConclusionsPsychometric properties allow this new version of the questionnaire to be used to assess different specific dimensions for the renal transplant population, more effectively than previously possible