Younger women have equivalent access to kidney transplants compared with their male counterparts, but older women receive transplants much less frequently than older men, according to a new study. The results suggest that steps are needed to ensure that women are provided with equal opportunities to receive kidney transplants as they age.
Researchers have reported that women have less access to kidney transplants than men, but this recent study indicates that this disparity does not affect all women. Dorry Segev, MD, of the Johns Hopkins Medical Institutions in Baltimore, MD, and his colleagues discovered this by studying the United States Renal Data System, which collects, analyzes, and distributes information about end-stage kidney disease in this country. Their analysis included 563,197 patients with end-stage kidney disease diagnosed between 2000 and 2005.
The investigators found that while young women in this group had equivalent access to transplantation when compared with their male counterparts, access for older women decreased significantly. Specifically, women aged 18 to 45 years had access to transplantation that was equivalent to men, women aged 46 to 55 years had 3% less access, women aged 56 to 65 years had 15% less access, women aged 66 to 75 had 29% less access, and women over 75 years had 59% less access.
Segev says this "perceived frailty" has no basis in fact. For every age group analyzed in this study, women had similar or slightly higher survival rates after transplantation than men.
These disparities existed for both access to the deceased donor waiting list as well as access to live donations. However, the gender disparities were limited to referral to the waiting list—once a woman was on the transplant list, her chances of receiving a transplant were equivalent to a man's. This is very different from other disparities in transplantation such as race disparities, in which African Americans are less likely to be referred to the waiting list and are also less likely to receive a transplant once on the list.
Dr. Segev and his team also found that for every age group analyzed in this study, women had a similar or slightly higher survival benefit from transplantation compared with men, indicating that there is no reason to deny women transplants as they age.
These findings could help researchers develop ways to reduce disparities in kidney allocation. "Knowing that the gender disparity is limited to older women indicates that efforts should be made to identify specific differences between older men and older women—rather than general differences between all men and women—in an effort to minimize the gender disparity in access to transplantation," said Dr. Segev.
- Older Age and Comorbidities as Effect Modifiers of Transplant Gender Disparities. Journal of the American Society Nephrology, March 2009
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