Although it is possible that the time between inclusion on the waiting around list and transplantation varies according to whether or not the patient had pre-emptive transplantation, the relationship remains significant after excluding those with pre-emptive transplantation

Although it is possible that the time between inclusion on the waiting around list and transplantation varies according to whether or not the patient had pre-emptive transplantation, the relationship remains significant after excluding those with pre-emptive transplantation. of transplantation. Patient characteristics explained most of the variability among centres, but patients treated in paediatric centres had a reduce 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 ideal transplant survival and chances to get a second transplant when needed. Keywords: children, HLA matching, inequality, paediatric kidney transplantation, renal transplantation == INTRO == Renal transplantation is recognized today as the first-choice treatment for both adults and children with end-stage renal disease (ESRD). It is associated with improved survival and has been shown to increase life Irosustat expectancy Irosustat by 2040 years for children receiving kidney grafts, compared with those who continue to be treated by dialysis [1]. It is also associated with a better quality of life [24] and with the best long-term cost-effectiveness ratio [5, 6]. Important inequalities in access to transplantation after acceptance around the waiting list exist for adults in both the USA and Europe. Although medical conditions clarify some of these inequalities, non-medical factors also affect the probability of receiving a transplant. Some of these are patient characteristics, including gender [710], race [7, 8, 1012], educational level [13] and place of residence (municipality) [9]. Others are characteristics from the centre, such as ownership Irosustat of dialysis facilities (e. g. profit or non-profit status) [14] and the presence of a transplantation unit [9]. No study has simultaneously investigated the impact of patient and centre characteristics on children’s access to renal transplantation. Accordingly, we TFRC conducted a nationwide study in France to evaluate the effect of these characteristics on wait-listed children’s access to renal transplantation, as well as to distinguish valid medical reasons, from unfounded medical or organizational reasons that aimed to be addressed. == METHODS == == Populace study == We regarded as for inclusion of all incident paediatric patients [ <18 years at commencement of renal replacement therapy (RRT)], recorded in the French REIN ESRD National Registry and registered on the renal transplantation waiting around list between 1 January 2002 and 30 June 2011. Important French specificities are Irosustat that all patients are registered around the waiting list even though a living donor transplantation is planned and that all patients starting RRT before 18 years old are eligible intended for paediatric priority for graft allocation, even if the registration occurs after 18 years. Organization, data collection and quality control of the REIN registry have been explained elsewhere [15]. Patients were followed until 30 June 2012 or until death so that all patients have at least 12 months of follow-up. == Information collected == == Patient characteristics == Relevant patient characteristics recorded in the REIN registry were the year and age at start of RRT, gender, primary renal disease, emergency RRT start (defined because an immediate RRT start), place of residence (municipality and geographic location), treatment centre, country of delivery, date of registration around the waiting list, time on inactive status on the waiting around list during the first 12 months following record and immunological data (ABO and HLA groups, anti-HLA antibodies). Height and weight, comorbidities and disabilities at baseline were also recorded [16]. From comorbidities and disabilities, we created two dichotomous variables: at least one comorbidity (yes/no) and at least one disability (yes/no). We decided growth retardation (for height and weight) according Irosustat to international standards for chronological age (cut-off 2SD) [17]. We used theNetwork Analystmodule from ARCGIS to calculate the distance between the home address and the centre of treatment and between the home and the closest paediatric transplantation centre. Because the registry does not include relevant socio-economic data for children, we used the municipality of residence as a proxy and crossed our database with unemployment and median income data from the French National Institute of Statistics and Economic Studies (INSEE) to investigate possible associations with social factors [18, 19]. Given the great variety of primary renal diseases relative to the number of patients in our study, we grouped.