Outcome-dependent geographic and individual variations in the access to renal transplantation in incident dialysed patients: a French nationwide cohort study

Adélaide Pladys (1, 2) , Camille Morival , Cécile Couchoud (3) , Christian Jacquelinet (4, 3) , Emmanuelle Laurain (5) , Sylvie Merle (6) , Cécile Vigneau (7, 8) , Sahar Bayat (1, 2)

1 EHESP - École des Hautes Études en Santé Publique [EHESP]
2 REPERES - Recherche en Pharmaco-épidémiologie et Recours aux Soins
3 Agence de la biomédecine [Saint-Denis la Plaine]
4 CESP - Centre de recherche en épidémiologie et santé des populations
5 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
6 Réseau Rein [Le Lamentin, Martinique]
7 CHU Pontchaillou [Rennes]
8 Irset - Institut de recherche en santé, environnement et travail

This study investigated geographic variations of access to renal transplantation using three outcomes (access to the transplant waiting list, access to renal transplantation after waitlisting and access to renal transplantation after dialysis start). Associations of patient-related and regional variables with the studied outcomes were assessed using a Cox shared frailty model and a Fine and Gray model. At the study endpoint (December 31, 2015), 26.3% of all 18-90-year-old patients who started dialysis in the 22 mainland and 4 overseas French regions in 2012 (n=9312) were waitlisted and 15.1% received a kidney transplant. The geographic disparities of access to renal transplantation varied according to the studied outcome. Patients from the Ile-de-France region had the highest probability of being waitlisted, but were less likely to receive a kidney transplant. Two regional factors were associated with the access to the waiting list and to renal transplantation from dialysis start the incidence of preemptive kidney transplantation and of ESRD. The use of different outcomes to evaluate access to kidney transplantation could help healthcare policy-makers to select the most appropriate interventions for each region in order to reduce treatment disparities.

Keywords: Access to renal transplantation; REIN registry; End stage renal disease; Geographic disparities

Domains: Life Sciences [q-bio]; Life Sciences [q-bio]; Human health and pathology; Hépatology and Gastroenterology

Adélaide Pladys, Camille Morival, Cécile Couchoud, Christian Jacquelinet, Emmanuelle Laurain, et al.. Outcome-dependent geographic and individual variations in the access to renal transplantation in incident dialysed patients: a French nationwide cohort study. Transplant International, 2019, 32 (4), pp.369-386. ⟨10.1111/tri.13376⟩. ⟨hal-01940385⟩