2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by GARG, P. P. Articles by POWE, N. R. Search for Related Content PubMed PubMed Citation Articles by GARG, P. P. Articles by POWE, N. R.

Impact of Gender on Access to the Renal Transplant Waiting List for Pediatric and Adult Patients

PUSHKAL P. GARG^*,, SUSAN L. FURTH, BARBARA A. FIVUSH and NEIL R. POWE^*,,§,||

^* Robert Wood Johnson Clinical Scholars Program, Johns Hopkins University, Baltimore, Maryland.
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
^§ Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland.
^|| Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland.

Correspondence to Dr. Pushkal P. Garg, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899. Phone: 617-432-3536; Fax: 617-432-0173; E-mail: garg{at}hcp.med.harvard.edu

Abstract. While the public and policy-makers place a priority on equity in the organ allocation process, several studies suggest that women may be less likely than men to receive a renal transplant. However, the cause of this disparity and whether it exists among children with end-stage renal disease (ESRD) are unknown. To address these issues, two nationally representative cohorts of incident patients were examined: (1) 7594 adults with ESRD onset between 1986 and 1993 for whom detailed data were available from the medical record on health status; and (2) 3217 patients <20 yr old who developed ESRD between 1988 and 1993. Patients were followed from initiation of dialysis for up to 10 yr until first activation on the United Network of Organ Sharing renal transplant waiting list. Access to the list for female and male patients with ESRD was compared using Cox proportional hazards models with adjustment for demographic, socioeconomic, and clinical factors. Crude rates of wait-listing per 100 person-years of ESRD were lower for female patients than male patients in both the pediatric (28.89 versus 34.18) and adult (3.94 versus 6.54) populations. Despite adjustment for numerous confounding factors, this gender-based disparity persisted in multivariate analysis. Among children with ESRD, female patients were 14% less likely to be listed than male patients (relative hazard [RH] 0.86; 95% confidence interval [CI], 0.78 to 0.93), and in the adult group, women were 18% less likely to be activated for transplant than men (RH 0.82; 95% CI, 0.72 to 0.93). These findings suggest that female patients of all ages with ESRD face barriers in being activated for cadaveric renal transplantation. Greater attention to this issue is necessary to improve equity in the organ allocation system and potentially improve the outcomes of female patients with ESRD.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673