Transplant Disparity Limited to Older Women

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After age 45, women are less likely than men to have access to renal transplants, large study finds.

Numerous studies have documented that women have lower rates of access to renal transplantation than men, but new findings suggest this disparity is limited to older women and those with comorbidities.

In a national cohort study of 563,197 patients with first-onset end-stage renal disease, Dorry L. Segev, MD, and collaborators at Johns Hopkins University in Baltimore, examined access to transplantation (ATT), defined as either registration for the deceased donor waiting list or receiving a live-donor transplant, and survival benefit from transplantation.

Overall, women were 11% less likely than men to have ATT, the researchers reported in the Journal of the American Society of Nephrology (2009; published online ahead of print). When the researchers stratified subjects by age, women aged 18-45 years had equivalent ATT to men.

With increasing age, however, ATT for women declined substantially. Women aged 66-75 years and those older than 75 years had 29% and 59% less likely than men to have ATT, even though the survival benefit from transplantation between men and women was similar in all age groups. In addition, ATT for women with comorbidities was lower than for men with the same comorbidities, despite similar survival benefits from transplantation.

“This study suggests that there is no disparity in ATT for women in general but rather a marked disparity in ATT for older women and women with comorbidities,” the authors concluded.

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