Impact of gender on access to the renal transplant waiting list for pediatric and adult patients

• Published in: Journal of the American Society of Nephrology Vol. 11; no. 5; pp. 958 - 964
• Main Authors: GARG, P. P, FURTH, S. L, FIVUSH, B. A, POWE, N. R
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.05.2000
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Chi-Square Distribution; Child; Child, Preschool; Cohort Studies; Confounding Factors, Epidemiologic; Female; Health Services Accessibility - statistics & numerical data; Humans; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - surgery; Kidney Transplantation - statistics & numerical data; Longitudinal Studies; Male; Medical sciences; Middle Aged; Proportional Hazards Models; Sex Factors; Socioeconomic Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; United States; Waiting Lists; United States; North America; America; Kidney disease; Human; Graft(material); Urinary system disease; Sex; Transplantation; Homotransplantation; Attribution; Kidney; Chronic; Treatment; Surgery; Renal failure; Age; Public health
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/asn.v115958

While the public and policy-makers place a priority on equity in the organ allocation process, several studies suggest that women may be less likely than men to receive a renal transplant. However, the cause of this disparity and whether it exists among children with end-stage renal disease (ESRD) are unknown. To address these issues, two nationally representative cohorts of incident patients were examined: (1) 7594 adults with ESRD onset between 1986 and 1993 for whom detailed data were available from the medical record on health status; and (2) 3217 patients <20 yr old who developed ESRD between 1988 and 1993. Patients were followed from initiation of dialysis for up to 10 yr until first activation on the United Network of Organ Sharing renal transplant waiting list. Access to the list for female and male patients with ESRD was compared using Cox proportional hazards models with adjustment for demographic, socioeconomic, and clinical factors. Crude rates of wait-listing per 100 person-years of ESRD were lower for female patients than male patients in both the pediatric (28.89 versus 34.18) and adult (3.94 versus 6.54) populations. Despite adjustment for numerous confounding factors, this gender-based disparity persisted in multivariate analysis. Among children with ESRD, female patients were 14% less likely to be listed than male patients (relative hazard [RH] 0.86; 95% confidence interval [CI], 0.78 to 0.93), and in the adult group, women were 18% less likely to be activated for transplant than men (RH 0.82; 95% CI, 0.72 to 0.93). These findings suggest that female patients of all ages with ESRD face barriers in being activated for cadaveric renal transplantation. Greater attention to this issue is necessary to improve equity in the organ allocation system and potentially improve the outcomes of female patients with ESRD.