title: Are there good reasons for inequalities in access to renal transplantation in children?
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.
authors.affiliation: REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Hogan
authors.affiliation: REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Audry
authors.affiliation: REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France Pellegrin University Hospital, Bordeaux, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Harambat
authors.affiliation: Felix Guyon University Hospital, La Réunion, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dunand
authors.affiliation: Children University Hospital, Toulouse, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Garnier
authors.affiliation: Necker University Hospital, Paris, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Salomon
authors.affiliation: Trousseau University Hospital, Paris, France.
authors.forename: Tim
authors.initials: T
authors.lastname: Ulinski
authors.affiliation: REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France Robert Debré University Hospital, Paris, France.
authors.forename: Marie-Alice
authors.initials: MA
authors.lastname: Macher
authors.affiliation: REIN Registry, Agence de la Biomédecine, La Plaine Saint-Denis, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005602:France; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D018579:Patient Selection; D012042:Registries; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D014850:Waiting Lists; D055815:Young Adult
keywords: HLA matching; children; inequality; paediatric kidney transplantation; renal transplantation