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Background: The optimal management of immunosuppressive therapy (IT) after kidney allograft failure (KAF) remains controversial. Although maintaining IT may reduce HLA‐sensitization and improve access to retransplantation, it may also increase the rate of immunosuppression‐related complications. The overall impact on patient mortality is unknown. The main objective of this study was to compare the evolution of HLA‐sensitization 6 months after KAF according to IT management. Methods: Individual clinical and health care data were extracted from the French national end‐stage kidney disease registry (Renal Epidemiology and Information Network [REIN]) and the French National Health Data system (SNDS), respectively. Patients aged > 18 years returning to dialysis after KAF between January 2008 and December 2019 in Lorraine were included. Patients were classified into two groups, IT continuation or IT discontinuation. HLA‐sensitization was defined as an increase in incompatible graft rate (IGR) between KAF and 6 months post‐KAF (change to a higher predefined category (0%–5%), (5%–20%), (20%–50%), (50%–85%), (85%–95%), (95%–98%), (98%–100%)). Secondary outcome was patient survival according to IT management. Results: A total of 121 patients were included, 35 (29%) of whom continued IT. HLA‐sensitization after KAF tended to be higher in the "IT discontinuation" group (57% vs. 38% in the "IT continuation" group, p =.07). In multivariate analysis, IT continuation was associated with a lower increase in IGR (OR.37, 95% CI [.14;.93]). IT management was not associated with patient mortality. Conclusions: Continuation of IT after KAF was associated with less change in IGR and was not associated with excess mortality. [ABSTRACT FROM AUTHOR]

In the Lorraine area (France), dialysis centers propose an educational program to improve patient’s ability to perform dialysis by themselves. The objective was to assess changes in health-related quality of life (HRQoL) during the first year of dialysis, comparing independent patients with patients on in-center dialysis. All patients aged between 18 and 70 and having started their first dialysis between June 1997 and June 1999 in the Lorraine area were included. Socio-demographic, medical data and HRQoL (KDQoL) were assessed for each patient at enrollment, at 6 and 12 months. At 12 months, 195 patients were in dialysis, 147 were non-autonomous, and 48 were autonomous. Independent patients were younger, were more often in occupational activity, had a lower body mass index and had fewer comorbidities. Several dimensions of the HRQoL were significantly higher in autonomous patients at baseline: physical functioning (60.4 vs. 50.7) and work status (30.9 vs. 18.4); and at 12 months: less burden of kidney disease (51.7 vs. 37.3), fewer effects of kidney disease (65.9 vs. 54.0), cognitive function (72.0 vs. 62.7) and role-emotional (53.0 vs. 34.5). These results show improved HRQoL among independent patients. Our regional care network may be a particularly useful model for undertaking actions motivating the healthcare teams and for enhancing the human resources devoted to patient education. [ABSTRACT FROM AUTHOR]

A letter is presented which discusses a study that examined chronic haemodialysis (HD) patients in Lorraine, France. Some of the variables considered include administration of heparin, iron and parenteral nutrition. Figures showing the frequency of occurrence scores for main events during HD sessions are presented. A workload score for haemodialysis care was constructed using frequency occurrence values. Regular care and complex care were the two management profiles defined in the study.

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