Chumdermpadetsuk Ritah R, Montalvan Adriana, Canizares Stalin, Chopra Bhavna, Pavlakis Martha, Lee David D, Eckhoff Devin E
Beth Israel Deaconess Medical Center Department of Surgery, Boston, MA.
Beth Israel Deaconess Medical Center Department of Medicine, Boston, MA.
Kidney360. 2024 Dec 1;5(12):1893-1901. doi: 10.34067/KID.0000000581. Epub 2024 Sep 16.
Female overrepresentation in living kidney donation stems from higher self-referral rates, not differences in approval or follow-through. Male volunteers are not more likely to be declined as donors due to medical contraindications, contrary to common assumptions. Engaging more male volunteers in living donation could expand access to kidney transplantation and reduce waitlist times.
Multiple studies have shown that female volunteers are living donors (LDs) for kidney transplantation at higher rates than male volunteers. However, the underlying reasons for this observation are not well understood. We examined the LD evaluation process to determine the point at which sex imbalance arises. On the basis of a previous study, we hypothesized that both sexes are equally likely to become approved as LDs, but female volunteers are more likely to follow through with donation.
This is a single-institution retrospective chart review of self-referrals for LD evaluation between January 2009 and December 2022. Self-referrals were identified using the Organ Transplant Tracking Record database and cross-referenced with billing data. Exclusion at each stage of evaluation was recorded and compared between sexes using log binomial regression; unadjusted and adjusted (for donor age, race, ethnicity, relationship to recipient, and recipient sex) risk ratios with 95% confidence interval were determined.
One thousand eight hundred sixty-one self-referrals were reviewed, including 1214 female (65.2%) and 647 male (34.8%) volunteers, resulting in 146 approvals and 125 donations (76/125, 60.8% female, 49/125, 39.2% male). Adjusted risk ratios indicated no significant differences between sexes in completing medical and/or psychosocial workup, having medical and/or psychosocial contraindications, being approved for donation, and proceeding with donation. The top medical contraindications for both sexes were obesity, hypertension, and nephrolithiasis.
Female overrepresentation among LDs is likely due to the 1.9 times higher rate of self-referral for evaluation. After this point, both sexes were equally likely to complete workup, be approved, and follow through with donation. Increased efforts to engage male volunteers at the initial self-referral stage has the potential to expand access to LD kidney transplantation.
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活体肾捐献中女性占比过高源于更高的自我推荐率，而非审批或后续流程的差异。与普遍看法相反，男性志愿者作为捐献者因医学禁忌被拒绝的可能性并不更高。让更多男性志愿者参与活体捐献可扩大肾移植的可及性并缩短等待名单时间。
多项研究表明，女性志愿者作为肾移植活体捐献者的比例高于男性志愿者。然而，这一观察结果的潜在原因尚不清楚。我们研究了活体捐献评估过程，以确定性别失衡出现的环节。基于此前一项研究，我们假设两性成为获批活体捐献者的可能性相同，但女性志愿者更有可能完成捐献。
这是一项对2009年1月至2022年12月期间自我推荐进行活体捐献评估的单机构回顾性病历审查。通过器官移植跟踪记录数据库识别自我推荐者，并与计费数据进行交叉核对。记录评估各阶段的排除情况，并使用对数二项回归比较两性之间的情况；确定未调整和调整后（针对捐献者年龄、种族、民族、与受者的关系以及受者性别）的风险比及95%置信区间。
共审查了1861例自我推荐者，包括1214名女性（65.2%）和647名男性（34.8%）志愿者，最终有146人获批，125人进行了捐献（125例中76例为女性，占60.8%；49例为男性，占39.2%）。调整后的风险比表明，两性在完成医学和/或心理社会检查、存在医学和/或心理社会禁忌、获批捐献以及进行捐献方面无显著差异。两性最主要的医学禁忌是肥胖、高血压和肾结石。
活体捐献者中女性占比过高可能是由于自我推荐评估率高出1.9倍。在此之后，两性完成检查、获批和进行捐献的可能性相同。在初始自我推荐阶段加大吸引男性志愿者的力度有可能扩大活体肾移植的可及性。
本文包含一个播客，链接为https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2024_12_26_KID0000000581.mp3
