Social inequalities in health are a major public concern. Some of these inequalities are currently not well documented, and are thus largely absent from debate. One important health issue is renal disease and access to the corresponding therapies (dialysis and renal transplant). These two therapeutic options have very different consequences in terms of labour market participation and physical well-being. Renal transplants offer patients an enhanced quality of daily life and a longer life expectancy, but this option is limited by organ availability. Here, drawing on two recent surveys, Christian B audelot , Yvanie C aillé , Olivier G odechot and Sylvie M ercier examine socially differentiated access to these two therapies and explore the underlying mechanisms. At each stage in the disease and its treatment, a cumulative process puts the least educated patients at a disadvantage in terms of access to a kidney transplant.