Bloembergen W E, Port F K, Mauger E A, Briggs J P, Leichtman A B
Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, USA.
J Am Soc Nephrol. 1996 Aug;7(8):1139-44. doi: 10.1681/ASN.V781139.
Renal transplantation is the most successful treatment strategy for patients with ESRD to improve survival and quality of life. The study presented here examines the relationship of gender and living related (LR) transplantation donor and recipient rates in the United States. National data from the United States Renal Data System (USRDS) were used for this study. All LR transplants occurring between 1991 and 1993 among blacks and whites were included (N = 6193). Transplantation and donation rates for men and women were calculated. Poisson regression was used to calculate female/male transplantation and donation rate ratios. Overall, women were 10% less likely to receive a LR transplant than men (rate ratio [RR] = 0.90, P < 0.001). This gender difference increased over time from 1991 (Female/Male RR = 0.95, P = not significant [NS]) to 1993 (RR = 0.85, P < 0.001). In contrast, women were significantly more likely to donate a kidney than men (RR = 1.28, P < 0.001 and RR = 1.29, P < 0.001 among whites and blacks, respectively). Analyses by age subgroups revealed that only among ESRD patients aged 20 to 44 yr was the likelihood of receiving a LR kidney transplant equal for men and women. Higher donation rates among women compared with men were observed in all donor age and race subgroups except young blacks (aged 0 to 19 yr). Recipient gender appeared to influence donation rates. The female-to-male relative donation rates were higher when donations were to female, compared with male, recipients. This study of national data suggests an imbalance in LR donation and transplantation between men and women. Women are more likely to donate a kidney but are less likely to receive a LR transplant than men. Several potential explanatory factors are explored. These findings suggest a need for the development of gender-appropriate interventions to encourage donation among men and LR transplantation among women, to ultimately facilitate greater use of this ESRD treatment modality.
肾移植是终末期肾病（ESRD）患者提高生存率和生活质量最成功的治疗策略。本文所呈现的研究探讨了美国性别与活体亲属（LR）移植供体及受体比例之间的关系。本研究使用了来自美国肾脏数据系统（USRDS）的全国数据。纳入了1991年至1993年间黑人和白人中所有的LR移植病例（N = 6193）。计算了男性和女性的移植及捐赠比例。采用泊松回归计算女性/男性移植及捐赠比例。总体而言，女性接受LR移植的可能性比男性低10%（比例比[RR] = 0.90，P < 0.001）。这种性别差异随时间推移而增大，从1991年（女性/男性RR = 0.95，P = 无显著差异[NS]）到1993年（RR = 0.85，P < 0.001）。相比之下，女性捐赠肾脏的可能性显著高于男性（白人中RR = 1.28，P < 0.001；黑人中RR = 1.29，P < 0.001）。按年龄亚组分析显示，仅在20至44岁的ESRD患者中，男性和女性接受LR肾移植的可能性相等。除年轻黑人（0至19岁）外，在所有供体年龄和种族亚组中均观察到女性的捐赠比例高于男性。受体性别似乎会影响捐赠比例。与男性受体相比，当捐赠给女性受体时，女性与男性的相对捐赠比例更高。这项基于全国数据的研究表明，男性和女性在LR捐赠和移植方面存在不平衡。女性更有可能捐赠肾脏，但接受LR移植的可能性低于男性。探讨了几个潜在的解释因素。这些发现表明需要制定适合性别的干预措施，以鼓励男性捐赠和女性接受LR移植，最终促进这种ESRD治疗方式的更广泛应用。
