Sex inequality in kidney transplantation rates

Background: Men in the United States undergoing renal replacement therapy a re more likely than women to receive a kidney transplant. However, the abil ity to pay may, in part, he responsible for this finding. Objective; To compare adult male and female transplantation rates in a sett ing in which equal access to medical treatment is assumed. Methods: Using data from the Canadian Organ Replacement Register, the rate of first transplantations was computed for the 20131 men and the 13458 wome n aged 20 years or older who initiated renal replacement therapy between Ja nuary 1, 1981, and December 31, 1996. Poisson regression analysis was used to estimate the male-female transplantation rate ratio, adjusting for age, race, province, calendar period, underlying disease leading to renal failur e, and dialytic modality. Actuarial survival methods were used to compare t ransplantation probability for covariable-matched cohorts of men and women. Results: Men experienced 20% greater covariable-adjusted kidney transplanta tion rates relative to women (rate ratio, 1.20; 95% confidence interval, 1. 13-1.27). The sex disparity was stronger for cadaveric transplants (rate ra tio, 1.23) compared with those from living donors (rate ratio, 1-10). The 5 -year probability of receiving a transplant was 47% for men and 39% for wom en within covariable-matched cohorts (P<.001). The sex disparity in transpl antation rates increased with increasing age. The sex effect was weaker amo ng whites and Oriental persons (Chinese, Japanese, Vietnamese, Cambodian, L aotian, Filipino, Malaysian, Indonesian, and Korean) and stronger among bla cks, Asian Indians (Indian, Pakistani, and Sri Lankan), and North American Indians (aboriginal). Conclusion: Since survival probability and quality of life are superior for patients who undergo transplantation relative to those who undergo dialysi s, an increased effort should be made to distribute kidneys available for t ransplantation more equitably by sex among patients undergoing renal replac ement therapy.