Factors That Influence Access to the National Renal Transplant Waiting List

Abstract

Differences in listing practice exist between centers that cannot be explained by the patient case mix or center characteristics examined.

Individual and Regional Factors of Access to the Renal Transplant Waiting List in France in a Cohort of Dialyzed Patients

“…Our study also confirms previous results about the association between old age and poor access to the waiting list, reported in Lorraine (23) and in other countries (19,25,26,29,30). Compared to patients aged l8-39 years, those older than 70 years were 97.5% less likely to be placed on the waiting list, after adjustment for other patient-level and region-level factors.…”

“…Compared to polycystic kidney disease, diabetic nephropathy was associated with a lower probability of waiting-list placement, as other reports have shown (19,25,26,30). As the consistency of these findings with the studies cited above indicates, the associations for these patient-level factors are likely to be generally applicable, in France and elsewhere.…”

“…As shown in the UK (25) and in contrast to reports from Lorraine (23) and Scotland (30), treatment and follow-up at public university hospital centers, all of them performing transplantation, were not associated with waiting-list placement. Unlike findings from the US (32,43), patients at private for-profit centers did not have a lower chance of being waitlisted.…”

“…Moreover, in contrast to previous reports from the US, the United Kingdom (UK), and Scotland (25)(26)(27)(28)(29)(30)32,33), our study took a substantial number of cardiovascular and noncardiovascular comorbidities and physical or psychiatric disabilities into account. Furthermore, compared to our previous single-region study in Lorraine (23), we included additional patient-level factors: primary renal disease, arrhythmia, aneurysm, and autonomy of the first dialysis.…”

“…Similarly, a wide variety of patient-level factors have been associated with access to renal transplant waiting lists, including not only medical factors (diabetes, cardiovascular disease and other comorbidities, and causes of ESRD), but also nonmedical factors such as gender and race/ethnicity (23)(24)(25)(26)(27)(28)(29)(30)(31). Studies have also shown center-level factors (private ownership of dialysis facilities, size of renal unit, and listing practice for living donor transplantation) to be related to access to waiting lists (25,32).…”