Access to kidney transplantation in France of non-French patients and French patients living in overseas territories

BACKGROUND: In France, foreign patients, whether resident or not in France, can register on the national waiting list under certain conditions. We compared waiting time to kidney transplantation, the level of HLA matching and graft cold ischemia time between foreign patients and French patients living in mainland France or in French overseas territories (FOT). METHODS: We performed a retrospective cohort survey using the nationwide registry. Between 1996 and 2003, 18,595 patients were registered on the French waiting list. Of these, 9.9% were of non-French nationality (0.7% Greek, 1.4% Italian, 1.5% other European, 3.7% North African, 1.8% sub-Saharan African and 0.9% other), and 3.8% were French nationals living in FOT. RESULTS: 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.