Women have less access to the kidney transplant waitlist, investigators revealed at the virtual National Kidney Foundation 2021 Spring Clinical Meetings.

According to the United States Renal Data System, 19.4% of the 1,337,386 patients receiving dialysis during 2005 to 2016 were placed on the waitlist for a deceased donor kidney transplant. Across 16 of the 18 end-stage renal disease (ESRD) networks, women had less access to the waitlist compared with White men, Reem Hamoda, MPH, MD candidate, of the University of Chicago in Chicago, Illinois, reported. Further, Black women were more disadvantaged in waitlist access than White women in ESRD Networks 3, 6, 7, 12, 14, and 18.

After the kidney allocation system (KAS) was implemented in 2015, Black women and White women had a significant 26% and 18% lower likelihood of waitlisting, respectively, compared with White men, according to a multivariable analysis. Hispanic women likewise experienced reduced access, but Asian women had increased access. The investigators estimated that 2.6% of the variation in disparities was explained by ESRD network-level variation. The model adjusted for age, clinical factors such as comorbidities, and sociodemographic factors such as neighborhood poverty.

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“More work is needed to explain geographic variation to improve racial/ethnic and gender equity in renal transplant access,” Hamoda’s team noted.

Future work should focus on identifying best practices in equitable ESRD networks, evaluating racial and sex-specific barriers and facilitators to transplant access, and implementing interventions to increase access, they stated.


Hamoda R, Patzer R, Saunders M, et al. ESRD network-level variation in racial/ethnic and sex disparities in renal transplant waitlisting. Presented at the virtual National Kidney Foundation 2021 Spring Clinical Meetings, April 6-10, 2021. Poster 366.