Julien Hogan1, Benoit Audry1, Jérôme Harambat2, Olivier Dunand3, Arnaud Garnier4, Rémi Salomon5, Tim Ulinski6, Marie-Alice Macher7, Cécile Couchoud1. 1. REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France. 2. REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France Pellegrin University Hospital, Bordeaux, France. 3. Felix Guyon University Hospital, La Réunion, France. 4. Children University Hospital, Toulouse, France. 5. Necker University Hospital, Paris, France. 6. Trousseau University Hospital, Paris, France. 7. REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France Robert Debré University Hospital, Paris, France.
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.
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.
Authors: R A Wolfe; V B Ashby; E L Milford; A O Ojo; R E Ettenger; L Y Agodoa; P J Held; F K Port Journal: N Engl J Med Date: 1999-12-02 Impact factor: 91.245
Authors: Michael Boehm; Marjolein Bonthuis; Marlies Noordzij; Jérôme Harambat; Jaap W Groothoff; Ángel Alonso Melgar; Jadranka Buturovic; Ruhan Dusunsel; Marc Fila; Anna Jander; Linda Koster-Kamphuis; Gregor Novljan; Pedro J Ortega; Fabio Paglialonga; Maria T Saravo; Constantinos J Stefanidis; Christoph Aufricht; Kitty J Jager; Franz Schaefer Journal: Pediatr Nephrol Date: 2018-12-26 Impact factor: 3.714