title: Facilitating access to the renal transplant waiting list does not increase the number of transplantations: comparative study of two French regions.
abstract: BACKGROUND
  In France, there are important regional disparities of access to the renal transplant waiting list and transplantation. Our objectives were to compare the characteristics of patients with end-stage renal disease (ESRD) of two French regions (Ile-de-France and Bretagne) and to identify determinants of access to the waiting list and subsequent transplantation, with a focus on temporary inactive status (TIS) periods.
  
  
  METHODS
  All 18-80-year-old incident patients who started dialysis in Ile-de-France or Bretagne between 2006 and 2009 were included (n= 6160). Associations between patients' characteristics and placement on the waiting list or transplantation were assessed using a Fine and Gray model to take into account the competing risk of death and living donor transplantation.
  
  
  RESULTS
  At the end of the follow-up (31 December 2013), more patients had undergone transplantation in Bretagne than in Ile-de-France (30 versus 27%), although the percentage of waitlisted patients was higher in Ile-de-France than in Bretagne (47 versus 33%). More patients were on TIS and with a longer median TIS duration in Ile-de-France. Independent of age and clinical characteristics, patients in Bretagne were less likely to be waitlisted than those in Ile-de-France [subdistribution hazard ratio 0.77 (95% confidence interval 0.7-0.9)]. After waitlisting, patients in Bretagne were four times more likely to be transplanted.
  
  
  CONCLUSIONS
  Our study highlights clinical practice differences in Bretagne and Ile-de-France and shows that facilitating access to the waiting list is not sufficient to improve access to renal transplantation, which also depends on organ availability.
authors.affiliation: EHESP, Sorbonne Paris Cité, METIS, Avenue du professeur Léon Bernard, 35043 Rennes, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Lefort
authors.affiliation: CHU Pontchaillou, Service de Néphrologie, Rennes, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Vigneau
authors.affiliation: EHESP, Sorbonne Paris Cité, METIS, Avenue du professeur Léon Bernard, 35043 Rennes, France.
authors.forename: Annelen
authors.initials: A
authors.lastname: Laurent
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, INSERM UMRS 1138 team 22; CHU Necker-Enfants Malades, Biostatistics Unit, Paris, France.
authors.forename: Saïd
authors.initials: S
authors.lastname: Lebbah
authors.affiliation: EHESP, Sorbonne Paris Cité, METIS, Avenue du professeur Léon Bernard, 35043 Rennes, France.
authors.forename: Nolwenn
authors.initials: N
authors.lastname: Le Meur
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, INSERM UMRS 1138 team 22; CHU Necker-Enfants Malades, Biostatistics Unit, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Jais
authors.affiliation: Hôpital Bichat - Claude-Bernard, Service de Néphrologie, Université Paris Diderot, DHU FIRE, INSERM U1149, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Daugas
authors.affiliation: EHESP, Sorbonne Paris Cité, METIS, Avenue du professeur Léon Bernard, 35043 Rennes, France.
authors.forename: Sahar
authors.initials: S
authors.lastname: Bayat
keywords: chronic renal failure; dialysis; end-stage renal disease; epidemiology; kidney transplantation