ASSOCIATION OF GENDER AND ACCESS TO CADAVERIC RENAL-TRANSPLANTATION

Previous studies have revealed that females are less likely than mates to receive a renal transplant, the most successful form of treatment of end-stage renal disease (ESRD). The purpose of this study was to de termine whether the barrier is to inclusion on the transplant waiting list or to transplantation after being placed on the transplant waitin g list. An existing data set was used that included data from the Mich igan Kidney Registry, supplemented with data received from the Organ P rocurement Agency of Michigan. White and black patients less than 65 y ears of age and starting ESRD treatment between January 1, 1984, and D ecember 31, 1989, were included. Cox proportional hazards models were used to determine the effect of gender on (1) time to transplantation among all ESRD patients, (2) time from diagnosis of ESRD to inclusion on the transplant waiting list among all ESRD patients, and (3) time f rom inclusion on the waiting list to transplantation among those patie nts on the waiting list. Patients were censored at the time of living- related transplantation or death, and were monitored until December 31 , 1989. In all, 5,026 incident ESRD patients were included in the stud y (44.3% female). Of these, 1,626 patients were included on the waitin g list (40.1% female); 823 of these received a transplant (37.7% femal e). Adjusting for age, race, and diagnosis, females were 25% less like ly to receive a cadaveric transplant than males (female to male relati ve rate ratio [RR], 0.75; P < 0.001). Females with ESRD aged 46 to 55 years and 56 to 65 years were 33% (RR, 0.67; P < 0.001) and 29% (RR, 0 .71; P < 0.05) less likely to be included on the transplant waiting li st, respectively, than their male counterparts. There was no differenc e in the rate of wait list inclusion among ESRD patients younger than 46 years. Females with ESRD who were included on the transplant waitin g list were 26% (RR, 0.74; P < 0.001) less likely to receive a transpl ant than males on the waiting list. These results indicate that female s are both less likely to be on the transplant waiting list (ages over 45 years) and, once on the list, less likely to receive a transplant (all ages) than males. Further study is necessary to determine the fac tors contributing to these important barriers to transplantation among females with ESRD. (C) 1997 by the National Kidney Foundation, Inc.