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

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 t han men to receive a renal transplant. However, the cause of this disparity and whether it exists among children with end-stage renal disease (ESRD) a re 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 recor d on health status; and (2) 3217 patients <20 yr old who developed ESRD bet ween 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 r enal transplant waiting list. Access to the list for female and male patien ts with ESRD was compared using Cox proportional hazards models with adjust ment for demographic, socioeconomic, and clinical factors. Crude rates of w ait-listing per 100 person-years of ESRD were lower for female patients tha n male patients in both the pediatric (28.89 versus 34.18) and adult (3.94 versus 6.54) populations. Despite adjustment for numerous confounding facto rs, this gender-based disparity persisted in multivariate analysis. Among c hildren with ESRD, female patients were 14% less likely to be listed than m ale 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 activat ed 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 a ctivated for cadaveric renal transplantation. Greater attention to this iss ue is necessary to improve equity in the organ allocation system and potent ially improve the outcomes of female patients with ESRD.