Johns Hopkins Gazette | January 20, 2009
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The newspaper of The Johns Hopkins University January 20, 2009 | Vol. 38 No. 18
Older Women Less Likely Than Men to be Listed for Kidney Transplants

By Eric Vohr
Johns Hopkins Medicine

A Johns Hopkins transplant surgeon has found strong evidence that women over 45 are significantly less likely to be placed on a kidney transplant list than their male counterparts, even though women who receive a transplant stand an equal chance of survival.

"As women age, that discrepancy widens to the point where women over 75 are less than half as likely as men to be placed on a kidney transplant list," said lead researcher Dorry Segev, a transplant surgeon at Johns Hopkins. "If the women have multiple illnesses, the discrepancy is even worse."

In a new study, appearing online Jan. 7 in the Journal of the American Society of Nephrology, Segev and his team looked at data from the United States Renal Data System kidney transplant list of 563,197 patients who developed first-onset end-stage renal disease between 2000 and 2005. USRDS tracks all patients who start dialysis, get placed on the transplant waiting list or receive a transplanted organ. The likelihood of getting on a transplant list was calculated after adjusting for factors that determine the patient's relative rate of survival after transplantation compared to dialysis.

When the results were stratified for age, the likelihood that women ages 18 to 45 made it onto the transplant list was equivalent to that of men. However, as women's age increased, their likelihood of being placed on the transplant list fell incrementally. Women ages 46 to 55 were 3 percent less likely to be put on the list, women 56 to 65 were 15 percent less likely, women 66 to 75 were 29 percent less likely, and women 75 or older were 59 percent less likely. These disparities existed whether the recipient was seeking a deceased- or live-donor kidney. The chance of a woman getting listed was worse if she had additional diseases such as diabetes or heart disease.

Segev said he believes the gap is the result of what he calls an unsubstantiated "perceived frailty" of women that factors subconsciously into the listing process. Two main steps determine who is placed on the United Network for Organ Sharing kidney transplant list: referral by a nephrologist and the patient's acting on that referral.

"It appears as though either the nephrologist believes women have a worse chance of survival or some women don't think they will have a good outcome," Segev said. "Once they are listed, however, women and men have an equal chance of getting a kidney, regardless of age."

Segev said that this "perceived frailty" has no basis in fact. For every age group analyzed in this study, women had similar or slightly higher survival rates after transplantation than men.

"This is different from most factors that create access to transplant disparities, such as obesity and race," Segev said. "Those disparities continue even once you've been listed — for example, blacks are less likely to get listed and, once they're listed, are also less likely to receive a transplant."

Other researchers from the Johns Hopkins University School of Medicine who contributed to this study are Robert Montgomery and Lauren M. Kucirka, both of the Department of Surgery; and Pooja C. Oberai, Rulan S. Parekh, L. Ebony Boulware and Neil R. Powe, all of the Department of Medicine.


Related Web sites

Johns Hopkins Comprehensive Transplant Center


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