Women, particularly those who are obese, are less likely than men to be placed on a deceased-donor kidney transplant waitlist, investigators reported during the virtual 2021 American Transplant Congress.

Once on a waitlist, however, the likelihood of receiving a transplant did not differ significantly by gender.

A team led by Jayme E. Locke, MD, MPH, director of the Comprehensive Transplant Institute at the University of Alabama at Birmingham, conducted a retrospective cohort study that included 217,320 waitlist-eligible patients with end-stage kidney disease (ESKD): 126,744 men and 90,576 women.

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Relative to men, the likelihood of women being waitlisted diminished significantly with increasing body mass index (BMI) beginning at a BMI of 18.5 kg/m2. Women with a BMI of 18.5-34.9, 35.0-39.9, 40.0-.44.9, and 45 kg/m2 or more were 14%, 29%, 32%, and 45% less likely to be placed on a waitlist, respectively, compared with men in the corresponding BMI groups, Dr Locke and her colleagues reported. Once on the transplant waitlist, the likelihood of receiving a transplant did not differ significantly between men and women after adjusting for age and race.

In a joint statement to Renal & Urology News, Dr Locke and the study’s first author, Saulat S. Sheikh, MBBS, observed, “Implicit or unconscious bias may be one significant, unidentified barrier obese women with ESKD experience in the complex multi-step transplant evaluation process. Furthermore, they may have additional social or cultural differences compared to their obese male counterparts that prevent their progress from transplant evaluation to waitlisting. The resulting disparity in access to this lifesaving therapy option is a cause for great concern with need for urgent attention.”

Drs Locke and Sheikh noted that the gender disparity in access to transplantation has persisted for more than 2 decades, “and while this is recognized by the transplant community, no intervention has yet effectively addressed this concern.”

Their study, which examined 2 components of the complex process of acquiring a transplant, “identified equity in access to waitlisting as the step along the continuum of transplant care that requires the greatest attention.”


Sheikh SS, Orandi B, Maclennan P, et al. Obesity is associated with greater gender disparity in access to kidney transplantation. Presented at: ATC 2021 virtual conference held June 4-9, 2021. Abstract 284.