Open AccessOutcome‐dependent geographic and individual variations in the access to renal transplantation in incident dialysed patients: a French nationwide cohort study
Author(s) -
Pladys Adélaïde,
Morival Camille,
Couchoud Cécile,
Jacquelinet Christian,
Laurain Emmanuelle,
Merle Sylvie,
Vigneau Cécile,
Bayat Sahar
Publication year - 2019
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13376
Subject(s) - medicine , transplantation , dialysis , kidney transplantation , incidence (geometry) , cohort , psychological intervention , proportional hazards model , cohort study , intensive care medicine , physics , psychiatry , optics
Summary This study investigated geographical 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 four overseas French regions in 2012 ( n = 9312) were waitlisted and 15.1% received a kidney transplant. The geographical 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.