Baroux, Noémie <br/><br/>
Access to the kidney transplantation waiting list for peritoneal dialysis patients in New Caledonia and Wallis and Futuna 

 -  2022.<br/>							 
<br/><br/> 8 
<br/><br/> Introduction Since 2012, a deceased donor kidney transplant program has been available for dialysis patients living in New Caledonia in collaboration with the Royal Prince Alfred Hospital in Sydney, Australia. This program has reduced the time spent out-of-territory for a kidney transplant, and has reduced the economic burden of end-stage kidney disease in New Caledonia. We undertook a review of kidney transplants in patients on peritoneal dialysis in New Caledonia and Wallis and Futuna. The primary aim was to describe access to kidney transplant evaluation for dialysis patients. The secondary aim was to compare patients with a compliant kidney transplant evaluation to patients with no transplant evaluation and no obvious identified reasons. Methods All patients on peritoneal dialysis in New Caledonia and Wallis and Futuna as of July 31, 2018, were included. A standardized form was completed by two nephrologists. The shared electronic medical record was used to collect information. A kidney transplant evaluation was considered to be compliant for patients registered on the transplant waiting list, patients with identified medical contraindications, or patients whose evaluation was started within the previous 6 months. Results In total, 61 patients were included. The average age was 62 years old. The average time since diagnosis of chronic kidney disease was 6.7 years, and the average duration of dialysis was 2.0 years. Among these patients, 11 (18%) were registered on the waiting list, 26 (43%) had at least one medical contraindication for kidney transplant, 3 (5%) had started evaluation within the previous 6 months, and 21 (34%) had begun evaluation longer than 6 months ago or had not started the evaluation process, without an identified medical contraindication. Among these 21 patients, the three most common reasons were problems with scheduling the evaluation (67%; n = 14), living in a remote location (48%; n = 10), and an intercurrent health event (29%; n = 6). Among patients living in Nouméa and the surrounding area, 74% had a compliant transplant evaluation, compared to 44% of patients living outside of this area (p = 0.058). Nearly one in two patients who were not on the waiting list had not received any information about kidney transplantation, or the information was not included in their medical record. Conclusion This study reveals the two main factors of non-compliant transplant evaluation: living outside Nouméa and the surrounding area, and problems with scheduling pre-transplant evaluation. There is also a lack of information provided to patients. These risk factors for late and non-inclusion on the waiting list must be considered by health care teams. This review will provide a baseline to assess the impact of actions to improve access to kidney transplantation in New Caledonia.