Bromberger Bianca, Spragan Danielle, Hashmi Sohaib, Morrison Alexander, Thomasson Arwin, Nazarian Susanna, Sawinski Deirdre, Porrett Paige
Departments of Surgery and.
Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Soc Nephrol. 2017 Oct;28(10):3025-3033. doi: 10.1681/ASN.2016101059. Epub 2017 May 8.
The presence of sex disparity in living donor kidney transplantation (LDKT) remains controversial. To determine if women fall behind men in LDKT evaluation, we performed an intention to treat study of 2587 candidates listed for kidney transplant at a single transplant center over 7 years. We found that women and men kidney transplant candidates engaged an equivalent type and number of prospective living donors. However, sex-specific differences in sensitization history and histocompatibility reduced the rate of LDKT for women by 30%. Pregnancy-induced incompatibility with spouse donors was limiting given that spouses were among the individuals most likely to complete donation. Notably, participation in a kidney paired exchange program eliminated sex-based differences in LDKT. Collectively, these data suggest that pregnancy is a formidable biologic barrier for women and contributes uniquely to sex disparity in LDKT. Targeted efforts to improve transplant center participation in paired kidney exchanges may increase sex equity in LDKT.
活体供肾移植（LDKT）中存在的性别差异仍存在争议。为了确定女性在LDKT评估中是否落后于男性，我们对一家移植中心7年间列入肾脏移植名单的2587名候选者进行了一项意向性治疗研究。我们发现，女性和男性肾脏移植候选者接触的潜在活体供者类型和数量相当。然而，致敏史和组织相容性方面的性别特异性差异使女性的LDKT率降低了30%。鉴于配偶是最有可能完成捐赠的人群之一，妊娠导致的与配偶供者不相容是一个限制因素。值得注意的是，参与肾脏配对交换计划消除了LDKT中的性别差异。总体而言，这些数据表明，妊娠是女性面临的一个巨大生物学障碍，并且对LDKT中的性别差异有独特影响。有针对性地努力提高移植中心参与配对肾脏交换的程度，可能会增加LDKT中的性别公平性。
