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Abstract: TH-PO893

Care Considerations and Management of Transgender Individuals After Kidney Transplantation: A Single Institution Experience and Literature Review

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Basera, Pragati, King George's Medical University, Lucknow, Uttar Pradesh, India
  • Anand, Manish, University of Cincinnati, Cincinnati, Ohio, United States
  • Govil, Amit, University of Cincinnati, Cincinnati, Ohio, United States
  • Jaiswal, Shikha, University of Cincinnati, Cincinnati, Ohio, United States

It is estimated that there are 0.04% to 0.06% transgender people in the United States. More than 4000 of them are affected by End Stage Kidney Disease (ESKD). There are limited studies on transgender patients undergoing kidney transplantation, and there is little awareness about the challenges faced by them. We describe 2 cases at our center highlighting this and review available literature.

Case Description

Case #1: 48-year-old Trans-female, with past medical history of ESKD secondary to IgA nephropathy and major depressive disorder(MDD), underwent Deceased Donor Kidney Transplant (DDKT) in 2018. Course was notable for recurrent Herpes labialis. Patient reported onset of gender dysphoria 6 months post-transplant. Patient sought gender-affirming care and started transdermal estradiol, finasteride and cosmetic hair removal. Counseling, screening for sexually transmitted infections, and age-appropriate cancer screening were done at each visit. MDD and medication adherence improved significantly. Renal function has remained stable.

Case #2: 57-year-old Trans-male with ESKD secondary to polycystic kidney disease, underwent DDKT in 2016. Patient reported onset of gender dysphoria in early childhood and took depot medroxyprogesterone since puberty to suppress menstruation. 3 years post-transplant, patient sought gender-affirming care, started testosterone injections, and had bilateral mastectomy. Post this, patient developed polycyathemia, and most recently was diagnosed with osteoporosis. Renal function has remained stable and medication adherence has been good.


Transitioning through gender-affirming care can be stressful for a Transgender person.
In the early peri-transplant phase, estrogen may lead to venous thromboembolic events and allograft loss. When used with calcineurin inhibitors (CNI) or Bactrim, androgen-lowering agents like spironolactone can increase hyperkalemia risk. Erythropoiesis is stimulated by androgenic therapy and may increase polycythemia risk. Gender-affirming surgeries can cause urological complications. Regular screening for osteoporosis and sexually transmitted infections, as well as psychotherapeutic support, is necessary. As hormone therapy can affect muscle mass and body composition, it is recommended to use a non-sex-dependent estimation of GFR using cystatin C.