#4642 DO WOMEN HAVE LESS ACCESS TO THE KIDNEY TRANSPLANTATION WAITING LIST THAN MEN IN FRANCE?

Abstract

Abstract Background and Aims Studies performed in several countries and in some French regions showed that women have less access to kidney transplantation waiting list (KTWL) than men. The aim of this study is to analyse women's access to the kidney transplantation waiting list at the national level and in all French regions. Method This is a retrospective cohort study using the French National Renal Epidemiology registry (REIN). All incident patients initiated dialysis from 2017 to 2019 and aged between 18 and 85 were included. Patients were followed three years from the dialysis start. Our outcome of interest was the registration on the KTWL 1 and 3 years following dialysis initiation. We performed Cox proportional hazard models, adjusted on age, comorbidities and neighbourhood deprivation level using European Deprivation Index (EDI), at national level and in all French regions. The sex/age and sex/EDI interactions were studied. Results 29 395 patients started dialysis in 2017-2019. 35% were women. 40% of female and 34% of male patients lived in most deprived areas. Men were more comorbid than women were at dialysis start. At the national level, women had less access to the KTWL compared to men one (adjHR: 0.91; IC95: [0.87 – 0.96]) and three years (adjHR: 0.87 [0.84 – 0.91]) after dialysis start. There was no significant sex/EDI interaction but a significant sex/age interaction. Therefore, the analyses were stratified by age (<60 and ≥ 60 years old). Only women aged more than 60 had less access to the KTWL at one year (adjHR: 0.76 [0.71 – 0.82]) and three years (adjHR: 0.75 [0.71 – 0.81]). At regional level, the same trends were found in Nouvelle Aquitaine and Pays de Loire one-year after dialysis start and two more regions (Bourgogne-Franche-Comté and Île-de-France) 3 years after dialysis start. Conclusion This study shows that women have less access to KT WL one and three years after dialysis start on the national level and in some regions. This disparity is found to be present especially among patients aged beyond 60 years. A qualitative study is planned to better understand this sex based disparity.