Garg Pushkal P, Furth Susan L, Fivush Barbara A, Powe Neil R
Robert Wood Johnson Clinical Scholars Program, Johns Hopkins University, Baltimore, Maryland.
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
J Am Soc Nephrol. 2000 May;11(5):958-964. doi: 10.1681/ASN.V115958.
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.
虽然公众和政策制定者将器官分配过程中的公平性作为优先事项，但多项研究表明，女性接受肾移植的可能性可能低于男性。然而，这种差异的原因以及它是否存在于终末期肾病（ESRD）儿童中尚不清楚。为了解决这些问题，研究人员对两个具有全国代表性的新发患者队列进行了检查：（1）7594名1986年至1993年间发病的ESRD成年人，可从病历中获得有关健康状况的详细数据；（2）3217名1988年至1993年间患ESRD的20岁以下患者。患者从开始透析起随访长达10年，直至首次被列入器官共享联合网络肾移植等待名单。使用Cox比例风险模型比较了ESRD女性和男性患者进入名单的情况，并对人口统计学、社会经济和临床因素进行了调整。在儿科（28.89对34.18）和成人（3.94对6.54）人群中，女性患者每100人年ESRD的等待名单粗率均低于男性患者。尽管对众多混杂因素进行了调整，但这种基于性别的差异在多变量分析中仍然存在。在ESRD儿童中，女性患者被列入名单的可能性比男性患者低14%（相对风险[RH]0.86；95%置信区间[CI]，0.78至0.93），在成人组中，女性被激活进行移植的可能性比男性低18%（RH 0.82；95%CI，0.72至0.93）。这些发现表明，所有年龄段的ESRD女性患者在被激活进行尸体肾移植方面都面临障碍。有必要更加关注这个问题，以改善器官分配系统的公平性，并有可能改善ESRD女性患者的治疗结果。
