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Multicenter Study
. 2015 Dec;30(12):2080-7.
doi: 10.1093/ndt/gfu356. Epub 2014 Nov 23.

Are there good reasons for inequalities in access to renal transplantation in children?

Julien Hogan  1 , Benoit Audry  1 , Jérôme Harambat  2 , Olivier Dunand  3 , Arnaud Garnier  4 , Rémi Salomon  5 , Tim Ulinski  6 , Marie-Alice Macher  7 , Cécile Couchoud  1
Affiliations
Multicenter Study

Are there good reasons for inequalities in access to renal transplantation in children?

Julien Hogan et al. Nephrol Dial Transplant. 2015 Dec.

Abstract

Background: Studies in the USA and Europe have demonstrated inequalities in adult access to renal transplants. We previously demonstrate that the centre of treatment was impacting the time to be registered on the renal waiting list. In this study, we sought to ascertain the influence of patient and centre characteristics on the probability of transplantation within 1 year after registration on the waiting list for children.

Methods: We included patients <18 years awaiting transplantation from the French ESRD National Registry. The effects of patient and centre characteristics were studied by hierarchical logistic regression. Centre effects were assessed by centre-level residual variance. A descriptive survey was performed to investigate differences in the centres' practices, and linear regression was used to confirm findings of different HLA compatibility requirements between centres.

Results: The study included 556 patients treated at 54 centres; 450 (80.9%) received transplants in the year after their listing. HLA group scarcity, time of inactive status during the year, pre-emptive listing and listing after age 18 were associated with lower probabilities of transplantation. Patient characteristics explained most of the variability among centres, but patients treated in paediatric centres had a lower probability of transplantation within 1 year because of higher HLA compatibility requirements for transplants.

Conclusions: Although patient characteristics explained most of the inter-centre variability, harmonization of some practices might enable us to reduce some inequalities in access to renal transplantation while maintaining optimal transplant survival and chances to get a second transplant when needed.

Keywords: HLA matching; children; inequality; paediatric kidney transplantation; renal transplantation.

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Figures

FIGURE 1:
FIGURE 1:
Funnel plot of crude centres' rate of non-transplantation at 12 months after registration on the waiting list.
FIGURE 2:
FIGURE 2:
Funnel plot of adjusted centres' rate of non-transplantation at 12 months after registration on the waiting list.
See this image and copyright information in PMC

References

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