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Original ArticlesTransplantation
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Sex Disparity in Deceased-Donor Kidney Transplant Access by Cause of Kidney Disease

Patrick Ahearn, Kirsten L. Johansen, Jane C. Tan, Charles E. McCulloch, Barbara A. Grimes and Elaine Ku
CJASN February 2021, 16 (2) 241-250; DOI: https://doi.org/10.2215/CJN.09140620
Patrick Ahearn
1Division of Nephrology, Stanford University, Palo Alto, California
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Kirsten L. Johansen
2Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota
3Division of Nephrology, University of Minnesota, Minneapolis, Minnesota
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Jane C. Tan
1Division of Nephrology, Stanford University, Palo Alto, California
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Charles E. McCulloch
4Department of Epidemiology and Biostatistics, University of California, San Francisco, California
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Barbara A. Grimes
4Department of Epidemiology and Biostatistics, University of California, San Francisco, California
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Elaine Ku
4Department of Epidemiology and Biostatistics, University of California, San Francisco, California
5Division of Nephrology, University of California, San Francisco, California
6Division of Pediatric Nephrology, University of California, San Francisco, California
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Abstract

Background and objectives Women with kidney failure have lower access to kidney transplantation compared with men, but the magnitude of this disparity may not be uniform across all kidney diseases. We hypothesized that the attributed cause of kidney failure may modify the magnitude of the disparities in transplant access by sex.

Design, setting, participants, & measurements We performed a retrospective cohort study of adults who developed kidney failure between 2005 and 2017 according to the United States Renal Data System. We used adjusted Cox models to examine the association between sex and either access to waitlist registration or deceased-donor kidney transplantation, and tested for interaction between sex and the attributed cause of kidney failure using adjusted models.

Results Among a total of 1,478,037 patients, 271,111 were registered on the waitlist and 89,574 underwent deceased-donor transplantation. The rate of waitlisting was 6.5 per 100 person-years in women and 8.3 per 100 person-years for men. In adjusted analysis, women had lower access to the waitlist (hazard ratio, 0.89; 95% confidence interval, 0.89 to 0.90) and to deceased-donor transplantation after waitlisting (hazard ratio, 0.96; 95% confidence interval, 0.94 to 0.98). However, there was an interaction between sex and attributed cause of kidney disease in adjusted models (P<0.001). Women with kidney failure due to type 2 diabetes had 27% lower access to the kidney transplant waitlist (hazard ratio, 0.73; 95% confidence interval, 0.72 to 0.74) and 11% lower access to deceased-donor transplantation after waitlisting compared with men (hazard ratio, 0.89; 95% confidence interval, 0.86 to 0.92). In contrast, sex disparities in access to either the waitlist or transplantation were not observed in kidney failure secondary to cystic disease.

Conclusions The disparity in transplant access by sex is not consistent across all causes of kidney failure. Lower deceased-donor transplantation rates in women compared with men are especially notable among patients with kidney failure attributed to diabetes.

  • diabetes
  • chronic dialysis
  • disparity
  • kidney transplantation
  • kidney failure
  • Received June 8, 2020.
  • Accepted December 14, 2020.
  • Copyright © 2021 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 16 (2)
Clinical Journal of the American Society of Nephrology
Vol. 16, Issue 2
February 08, 2021
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Sex Disparity in Deceased-Donor Kidney Transplant Access by Cause of Kidney Disease
Patrick Ahearn, Kirsten L. Johansen, Jane C. Tan, Charles E. McCulloch, Barbara A. Grimes, Elaine Ku
CJASN Feb 2021, 16 (2) 241-250; DOI: 10.2215/CJN.09140620

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Sex Disparity in Deceased-Donor Kidney Transplant Access by Cause of Kidney Disease
Patrick Ahearn, Kirsten L. Johansen, Jane C. Tan, Charles E. McCulloch, Barbara A. Grimes, Elaine Ku
CJASN Feb 2021, 16 (2) 241-250; DOI: 10.2215/CJN.09140620
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Keywords

  • diabetes
  • chronic dialysis
  • disparity
  • kidney transplantation
  • kidney failure

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