Vinson Amanda Jean, Zhang Xun, Grinspan Lauren T, Foster Bethany J
Nephrology Division, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
Research Institute of the McGill University Health Centre, Montréal, QC, Canada.
Transplant Direct. 2025 Aug 22;11(9):e1856. doi: 10.1097/TXD.0000000000001856. eCollection 2025 Sep.
Sex differences in excess mortality risk (ie, above expected in the age-, sex-, and race-matched general population) among candidates waitlisted for transplant may reflect sex bias in access to the waitlist, disparities in allocation policies, and/or sex differences in care for patients with organ failure.
We used time-dependent relative survival models to determine the relative excess risk of mortality in females compared with males recorded in the Scientific Registry of Transplant Recipients who were waitlisted for kidney, heart, or liver transplant from 1988 to 2019, accounting for the modifying effects of candidate age and listing era.
Among 644 262 kidney and 106 353 heart candidates, excess mortality was higher in female than male kidney candidates <60 y, but lower in female kidney candidates ≥60 y and heart candidates ≥12 y; patterns did not differ by era. Among 259 230 liver candidates, patterns differed by era of waitlisting. Excess mortality was lower for female than male liver candidates 0-12 and 25-44 y, and higher for females than males 13-24 y, without differences by era. Excess mortality was lower for female than male liver candidates 45-59 y waitlisted 1988-2011, but not different by sex for those waitlisted 2012-2019. Among liver candidates ≥60 y, excess mortality did not differ by sex for those waitlisted 1988-2011 but was higher for females than males waitlisted 2012-2019.
The patterns of sex differences in excess mortality observed among waitlisted transplant candidates likely reflect the selection of healthier, lower-risk females than males for waitlisting and higher mortality risks for females with organ failure.
等待移植的候选者中，超额死亡风险（即高于年龄、性别和种族匹配的普通人群预期）的性别差异可能反映了等待名单获取方面的性别偏见、分配政策差异和/或器官衰竭患者护理中的性别差异。
我们使用时间依赖的相对生存模型，来确定1988年至2019年在器官共享联合网络登记处登记等待肾、心脏或肝移植的女性与男性相比的相对超额死亡风险，同时考虑候选者年龄和登记时代的修正作用。
在644262名肾移植候选者和106353名心脏移植候选者中，年龄小于60岁的女性肾移植候选者的超额死亡率高于男性，但60岁及以上的女性肾移植候选者和12岁及以上的心脏移植候选者的超额死亡率低于男性；不同时代的模式没有差异。在259230名肝移植候选者中，模式因登记等待时代而异。0至12岁和25至44岁的女性肝移植候选者的超额死亡率低于男性，13至24岁的女性肝移植候选者的超额死亡率高于男性，不同时代无差异。1988年至2011年登记等待的45至59岁女性肝移植候选者的超额死亡率低于男性，但2012年至2019年登记等待的该年龄段患者的超额死亡率无性别差异。在60岁及以上的肝移植候选者中，1988年至2011年登记等待的患者超额死亡率无性别差异，但2012年至2019年登记等待的女性患者超额死亡率高于男性。
等待移植的候选者中观察到的超额死亡率性别差异模式，可能反映了等待名单上选择的女性比男性更健康、风险更低，以及器官衰竭女性的死亡率更高。
