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. 2024 Sep 27;39(10):1613-1623.
doi: 10.1093/ndt/gfae047.

Lower access to kidney transplantation for women in France is not explained by comorbidities and social deprivation

Latame Komla Adoli  1 , Cécile Couchoud  2 , Valérie Chatelet  3 , Thierry Lobbedez  3 , Florian Bayer  2 , Elsa Vabret  1 , Jean-Philippe Jais  4 , Eric Daugas  5 , Cécile Vigneau  6 , Sahar Bayat-Makoei  1
Affiliations

Lower access to kidney transplantation for women in France is not explained by comorbidities and social deprivation

Latame Komla Adoli et al. Nephrol Dial Transplant. .

Abstract

Background: Access to kidney transplantation (KT) remains challenging for patients with end-stage kidney disease. This study assessed women's access to KT in France by considering comorbidities and neighbourhood social deprivation.

Methods: All incident patients 18-85 years old starting dialysis in France between 1 January 2017 and 31 December 2019 were included. Three outcomes were assessed: access to the KT waiting list after dialysis start, KT access after waitlisting and KT access after dialysis start. Cox and Fine-Gray models were used. Gender-European Deprivation Index and gender-age interactions were tested and analyses were performed among strata if required.

Results: A total of 29 395 patients were included (35% of women). After adjusting for social deprivation and comorbidities, women were less likely to be waitlisted at 1 year {adjusted hazard ratio [adjHR] 0.91 [95% confidence interval (CI) 0.87-0.96]} and 3 years [adjHR 0.87 (95% CI 0.84-0.91)] after dialysis initiation. This disparity concerned mainly women ≥60 years of age [adjHR 0.76 (95% CI 0.71-0.82) at 1 year and 0.75 (0.71-0.81) at 3 years]. Access to KT after 2 years of waitlisting was similar between genders. Access to KT was similar between genders at 3 years after dialysis start but decreased for women after 4 years [adjHR 0.93 (95% CI 0.88-0.99)] and longer [adjHR 0.90 (95% CI 0.85-0.96)] follow-up.

Conclusions: In France, women are less likely to be waitlisted and undergo KT. This is driven by the ≥60-year-old group and is not explained by comorbidities or social deprivation level.

Keywords: chronic kidney disease; deprivation; gender; inequalities; kidney transplantation.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Study flow diagram presenting patients selection.
Figure 2:
Figure 2:
Percentage of patients living in the most deprived areas (EDI 5) and difference between genders per region in France (e.g. in Brittany, 2–14% of patients lived in the most deprived areas; the percentage of women living in the most deprived areas was 3.3% higher than in men).
Figure 3:
Figure 3:
Association between gender and access to KTWL or KT (multivariable Cox model with death censored). All models were adjusted for baseline comorbidities and EDI level. The figure shows the HRs and 95% CIs of women versus men for the whole cohort and for the age-stratified analyses.
Figure 4:
Figure 4:
Map showing access to the KTWL in regions at (A) 1 year and (B) 3 years after dialysis start. Overseas regions are not represented.
See this image and copyright information in PMC

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