title: A multicentre study of registration on renal transplantation waiting list of the elderly and patients with type 2 diabetes.
abstract: BACKGROUND
  Studies in the USA have shown that some patients (African-Americans, women, the elderly and diabetics) were less likely to receive renal transplants. In order to identify patient characteristics modifying the likelihood of being wait-listed, we studied registration on renal transplantation waiting list (WLR) focusing on elderly (age > or =60 years) and on patients with type 2 diabetes (D2) in three departments of nephrology in the Rhône-Alpes county in France.
  
  
  METHODS
  In a cohort of 549 patients who reached end-stage renal disease (ESRD) between 1995 and 1998 in these units, we analysed the rates of pre-transplant evaluation (PTE), the duration of PTE, the rates of exclusion from transplantation by PTE and the rates of WLR. With Cox regression model, we identified the characteristics that have independent and significant effects on the likelihood of being registered after the first renal replacement therapy (RRT).
  
  
  RESULTS
  In this cohort, 185 patients (33.7%) were wait-listed by 31.03.00 and no patient > or =70 years was evaluated or registered. In univariate analysis, PTE and WLR rates were lower in the elderly (21.5 and 20.0%, respectively) than those <60 years (79.1 and 70.2%, P < 0.001) and in D2 (33.0 and 24.2%) than in non-D2 (65.8 and 60.6%, P < 0.001). The duration of PTE was longer in D2 than in non-D2 (12.7 +/- 11.0 vs 7.5 +/- 7.1 months, P < 0.01). Among patients excluded from PTE, more patients without relevant co-morbidities [e.g. rapidly progressive ESRD, cardiovascular disease (CVD), malignancy] were present in the elderly (> or =70 years: 14.8%; 60-69 years: 17.0%; <60 years: 6.4%) and in D2 (18.0%) than in non-D2 (10.9%). The adjusted relative risks (aRR) of being wait-listed after first RRT were significantly lowered by age and D2 (aRR, 95% CI): 60-64 year olds (0.44%: 0.26-0.75), 65-69 year olds (0.07%: 0.03-0.20) and D2 (0.41%: 0.24-0.69). Other conditions associated with a lower aRR were rapidly progressive ESRD (0.21%: 0.08-0.55), CVD (0.59%: 0.36-0.94), malignancy (0.13%: 0.04-0.46) and psychosis (0.05%: 0.01-0.35).
  
  
  CONCLUSIONS
  Advanced age and D2 were associated with low PTE and WLR rates even after adjustment for other patient characteristics.
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Lyon Sud Hospital, Claude Bernard University, 165 chemin du Grand Revoyet, 69495 Pierre Bénite Cedex, France. emmanuel.villar@chu-lyon.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Villar
authors.forename: Muriel
authors.initials: M
authors.lastname: Rabilloud
authors.forename: François
authors.initials: F
authors.lastname: Berthoux
authors.forename: Paul
authors.initials: P
authors.lastname: Vialtel
authors.forename: Michel
authors.initials: M
authors.lastname: Labeeuw
authors.forename: Claire
authors.initials: C
authors.lastname: Pouteil-Noble
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D014850:Waiting Lists