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Kidney Week

Abstract: PO2434

Sex and Equity in Pediatric Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • McGill, Rita L., University of Chicago, Chicago, Illinois, United States
  • Murthy, Nevin, University of Chicago, Chicago, Illinois, United States
  • Ross, Lainie Friedman, University of Chicago, Chicago, Illinois, United States
Background

Mortality in pediatric kidney failure (ESRD) is higher in girls than in boys, in contrast to the general population. In a recent report, correcting for access to transplantation partially ameliorated this risk, prompting an examination of equity in pediatric kidney transplantation.

Methods

USRDS files were used to examine incidence of pediatric ESRD (age≤18) and initial Rx modalities from 2000-15. UNOS data were used to evaluate pediatric kidney recipients between 2000-2019. Logistic regression was used to calculate an odds ratio (OR) for receiving a living donor kidney (LD). Hazard ratios (HR) of death, graft failure and death-censored graft failure (dcGF) were obtained in Cox models stratified for LD/deceased-donor (DD). Models were adjusted for age, sex, and year of transplant and reported with 95% CI.

Results

Among 17,366 incident pediatric ESRD patients in USRDS, 42.8% were female. Mean and median age did not differ. Initial kidney treatment was transplantation in 17.9% of girls and 23.8% of boys, with more hemodialysis in girls (46.0 vs 40.5%, P<0.001).
Among 16,811 UNOS recipients, 41.0% were female. Changes in allocation policy were associated with a shift from parental donors to deceased-donors, which was more marked in female recipients (figure). 42.8% of boys and 39.7% of girls received LD (P<0.001); adjusted OR of receiving LD was 0.91 (0.85, 0.98, P=0.007) for girls. Compared to boys, girls had inferior outcomes with DD, with HRs: death 1.51 [1.30, 1.76], graft failure 1.31 [1.21, 1.40], and dcGF 1.30 [1.20,1.40, P<0.001 for all]. LD outcomes did not differ by sex.

Conclusion

Female children have fewer early transplants and higher odds of receiving DD kidney transplants that are associated with inferior outcomes than their male counterparts. Attention to sex-specific disparities may improve ESRD outcomes in girls.

Living (LD) & Deceased-donors (DD) in male (M) and female (F) recipients