Access to Kidney Transplantation in France of Non-French Patients and French Patients Living in Overseas Territories

Abstract

Median waiting time differed significantly between groups, from 13.8 months for mainland French patients to 39.5 months for sub-Saharan African patients. After adjustment for other factors significantly linked to waiting time, French residents of FOT (RR=0.83; P<0.001) and patients from sub-Saharan Africa (RR=0.75; P<0.0001) were found to wait significantly longer than other patients. HLA matching level, particularly HLA-A and HLA-B, was worse for African patients. After adjustment for the transplant team, cold ischemia time was found to be longer for Greeks (30.4 hr, P<0.0001) and French patients living in FOT (33.3 hr, P<0.0001) than for mainland French patients (21.2 hr). CONCLUSIONS.: Programs promoting organ donation aimed at minorities of African origin should improve their access to transplantation in France. We also need to strengthen international cooperation programs in certain countries to assist access to transplantation and to increase graft quality.

Are There Inequities in Treatment of End-Stage Renal Disease in Sweden? A Longitudinal Register-Based Study on Socioeconomic Status-Related Access to Kidney Transplantation

“…We also found that patients with Swedish citizenship had higher chance of access to kidney transplantation compared to non-Swedish patients, which was consistent with a French study [25]. The suggested reason may be that patients of non-Swedish were less likely to have an adequate Human Leukocyte Antigen (HLA)—and blood group-matched kidney than patients of European origin [25]. Socioeconomic and culture factors may also limit access to kidney transplantation [39], however Sweden provides healthcare coverage for other citizenship similar to Swedish citizenship so financial obstacles to kidney transplantation should be much smaller than in other countries.…”

“…The potential mechanism may be spousal kidney donation, more developed social networking, and more qualified for kidney transplantation duo to less depression [36] and positive health behaviors in terms of alcohol and drug abuse [37,38]. We also found that patients with Swedish citizenship had higher chance of access to kidney transplantation compared to non-Swedish patients, which was consistent with a French study [25]. The suggested reason may be that patients of non-Swedish were less likely to have an adequate Human Leukocyte Antigen (HLA)—and blood group-matched kidney than patients of European origin [25].…”

“…These factors included age at start of RRT [8,9], gender [8,9], year of first RRT [16], marital status [11], residence area (county) [9], citizenship [25], primary renal disease [8,9], and comorbidities [8,9]. Based on the distribution of transplantation events [26], age was divided into four age groups: 18–39, 40–49, 50–59, ≥60 years old.…”

Should we perform kidney transplants on foreign nationals?

“…An Israeli study showed similar results 26. There are no Canadian data on this issue, and the situation might be different from that in the USA, of Canada's universal health insurance; for example, in France, where there is also universal health insurance, the proportion of FN patients waitlisted for an organ transplant increased between 1996 and 2008 13 16…”

Provision of long-term renal replacement therapy to non-national patients in South Africa

“…In general, nations with greater transplantation resources may permit limited access to LTRRT for non-nationals, while those with fewer resources tend to exclude such patients from their programmes (Table 2). [14,17,25,26,28,[29][30][31][32][33][34][35]…”