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Facilitating access to the renal transplant waiting list does not increase the number of transplantations: comparative study of two French regions
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Facilitating access to the renal transplant waiting list does not increase the number of transplantations: comparative study of two French regions
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Journal Article
Facilitating access to the renal transplant waiting list does not increase the number of transplantations: comparative study of two French regions
2016
Overview
In France, there are important regional disparities of access to the renal transplant waiting list and transplantation. Our objectives were to compare the characteristics of patients with end-stage renal disease (ESRD) of two French regions (Ile-de-France and Bretagne) and to identify determinants of access to the waiting list and subsequent transplantation, with a focus on temporary inactive status (TIS) periods.MethodsAll 18–80-year-old incident patients who started dialysis in Ile-de-France or Bretagne between 2006 and 2009 were included (n = 6160). Associations between patients' characteristics and placement on the waiting list or transplantation were assessed using a Fine and Gray model to take into account the competing risk of death and living donor transplantation.ResultsAt the end of the follow-up (31 December 2013), more patients had undergone transplantation in Bretagne than in Ile-de-France (30 versus 27%), although the percentage of waitlisted patients was higher in Ile-de-France than in Bretagne (47 versus 33%). More patients were on TIS and with a longer median TIS duration in Ile-de-France. Independent of age and clinical characteristics, patients in Bretagne were less likely to be waitlisted than those in Ile-de-France [subdistribution hazard ratio 0.77 (95% confidence interval 0.7–0.9)]. After waitlisting, patients in Bretagne were four times more likely to be transplanted.ConclusionsOur study highlights clinical practice differences in Bretagne and Ile-de-France and shows that facilitating access to the waiting list is not sufficient to improve access to renal transplantation, which also depends on organ availability.
Publisher
European Renal Association - European Dialysis and Transplant Association,Oxford University Press
