[Who are these patients on dialysis and not on the kidney transplant waiting list?]

Access to kidney transplants for patients with end-stage chronic renal disease is a major challenge in France. Registration on the transplant waiting list is a mandatory step to be able to access this technique. The Haute Autorité de santé (HAS) updated, in 2015, the contraindications to access this list. In this context, we wanted to make an inventory of the reasons for non-registration on the renal transplant waiting list in patients on dialysis for at least a year, aged less than 80 years, in France. All patients included in the Epidemiology and Nephrology Information Register (REIN), who were supposed to have their annual monitoring point from August 1 to November 30, 2016 meeting the criteria, were included and a dedicated questionnaire was completed by their dialysis center. Thus, 3172 patients were analyzed: 2302 (73%) had a medical contraindication to transplant, most often (33%) vascular, 458 (14%) refused to be registered, with proportionately more women in this category, and finally in 412 patients (13%), there was no reason given in our questionnaire. However, for 65% of patients in the latter category, an assessment for registration had started. There were therefore, in our cohort, only 144 patients (4.5%) without explanation for the non-registration. This national study is the first to give a view of the reasons for non-registration on the renal transplant list in France. Unsurprisingly, medical contraindication is the primary reason in this population of chronic patients. The high refusal rate should be emphasized and analyzed more precisely, in particular with the patient's point of view. And finally, very few patients have no informed reason or current assessment.