Men Favored Over Women for Kidney Transplantation
In a new study, appearing online Jan. 7 in the Journal of the American Society of Nephrology, a Johns Hopkins transplant surgeon has found strong evidence that women over 45 are significantly less likely to be placed on a kidney transplant list than their male counterparts. He found this to be true even though women who receive a transplant stand an equal chance of survival.
Transplant surgeon Dr Dorrey Segev and his team looked at data from the United States Renal Data System kidney transplant list of 563,197 patients who developed first-onset end-stage renal disease (ESRD) between 2000 and 2005.
USRDS tracks all patients who start dialysis, get placed on the transplant waiting list or receive a transplanted organ. They calculated the likelihood of getting on a transplant list, adjusting for factors that determine the patient's relative rate of survival after transplantation compared to dialysis. They compared relative risks (RRs) between women and men, stratified by age categories and the presence of common comorbidities.
There findings show that overall women have less access to kidney transplantation than men.
When adjusted for age, the access to transplantation was equal among 18-45 year old women and men. As the age increased, the access to transplantation became unequal with the discrepancy truly widening for women over 75. In those over 75 years, woman are less than half as likely as men to be placed on a kidney transplant list. If the women had multiple illness such as diabetes or heart disease, the discrepancy is even more marked.
These disparities existed whether the recipient was seeking a deceased- or live-donor kidney.
Segev says he believes the gap is the result of what he calls an unsubstantiated "perceived frailty" of women. He feels this factors subconsciously into the listing process. There are two main steps that determine who is placed on the United Network for Organ Sharing kidney transplant list: 1) referral by a nephrologist and 2) the patient's acting on that referral.
Fewer women are placed on the list as their age increases or their co-diseases (diabetes, heart disease) increase. Once on the list, women and men have an equal chance of getting a kidney, regardless of age.
Women had similar or slightly higher survival rates after transplantation than men, so the “perceived frailty” of woman has no basis in fact.
Age and Comorbidities Are Effect Modifiers of Gender Disparities in Renal Transplantation; J. Am. Soc. Nephrol., first published on January 7, 2009; Dorry L. Segev, Lauren M. Kucirka, Pooja C. Oberai, Rulan S. Parekh, L. Ebony Boulware, Neil R. Powe, and Robert A. Montgomery