Artificial intelligence as the pacemaker of the future of kidney transplantation in French Guiana

Abstract

Abstract Background Chronic kidney disease (CKD) is a growing global health challenge, with particularly high incidence rates in French Guiana. Geographic isolation, a shortage of specialists, and logistical barriers constrain access to kidney transplantation, the treatment of choice for end-stage renal disease (ESRD). Objectives This commentary aims to address the knowledge gap regarding the potential of AI and teleexpertise in reducing health inequities in remote French Guiana and to provide practical guidance for implementation. Content French Guiana faces particular difficulties: vast Amazonian geography, dispersed multicultural and multilingual communities, and structural limitations of the health system. We explore AI applications in nephrology, including Banff Automation and the iBox model, as well as teleexpertise platforms such as NephroWise. Comparisons with similar deployments in other isolated regions highlight the practical obstacles and adaptations necessary for successful implementation. Ethical and regulatory concerns are detailed, including algorithmic bias, GDPR compliance, and culturally adapted strategies for informed consent in multilingual and vulnerable populations. Examples from other remote regions illustrate the real-life consequences of the digital divide, implementation failures, and algorithmic misclassification, emphasizing that these are concrete barriers and not merely theoretical points. Existing structures, such as CIC-EC for data hosting and ARS Guyane’s digital health strategies, provide a foundation for implementation. A roadmap is proposed to scale pilot programs. Conclusions French Guiana could serve as a model for AI-enabled transplantation follow-up in ultra-peripheral regions. Urgent investment by policymakers and health authorities is needed to reduce inequities and position the territory as a global pilot site, with a clear call to action for structured pilot programs, investment in training, infrastructure readiness, and integration strategies to maximize impact. We should emphasize ethical considerations and culturally adapted strategies for informed consent, data security, and equitable access as core strengths.