Girls less likely to make transplant list

UC DAVIS (US) — A recent study found that girls were 22 percent less likely than boys to get placed on a kidney transplant waiting list.

“If the goal is to get them transplanted as soon as possible, then they need to be wait-listed as soon as possible,” says lead author Stephanie Nguyen, assistant professor of pediatric nephrology at the University of California, Davis. “The longer they’re waiting for a transplant, the worse their outcomes will be.”

Nguyen says the findings, reported in the journal Pediatric Transplantation, are a clarion call for clinicians to pay close attention to the transplant evaluation process and to ensure that girls are given opportunities to receive transplants as quickly as possible.

For the study, researchers reviewed data from approximately 4,473 patients whose health information was included in the North American Pediatric Renal Trials and Collaborative Studies database, a large, voluntary collaborative effort of 150 renal treatment centers in the United States, Canada, Mexico and Costa Rica.

The study found that girls were less likely to have been placed on the wait list to receive a new kidney at dialysis initiation, six months after starting dialysis, and even 12 months after starting dialysis. Girls also were less likely to have a living-related donor and to have pre-emptive transplants than boys.

No readily apparent factors could account for girls not being wait-listed as frequently as boys, such as medical reasons or family preference—even after adjusting for multiple confounding factors, such as age, race or ethnicity, underlying diagnosis, and time of follow up.

The reason most often given for why girls were not placed on the wait list at every point in time was that their “work-up was in progress.”

A December 2010 study by researchers at UC Davis—published in the journal Transplantation—found the longer a child is on dialysis while awaiting a kidney transplant, the greater the likelihood that he or she will experience graft failure and organ rejection once they do receive a kidney transplant.

The lead author for that study, Lavjay Butani, professor of pediatric nephrology, says the findings suggest that, as is the case in adults, whenever possible children should not be placed on certain types of dialysis prior to transplantation and that the duration of dialysis should be minimized.

“Children who face kidney transplant fare best when they receive the organ without undergoing dialysis,” Butani says. “The longer the dialysis prior to the operation, the worse is the survival of the kidneys.”

The study also suggests that children should be wait-listed for transplant immediately.

Butani says the findings pose “important questions that need to be addressed, to better explore and understand the reasons behind this gender difference in access to organ transplants and to determine if there are biological factors that may lead to a more time consuming work-up to prepare girls for a transplant.

“In the absence of such considerations, it is the responsibility of all health-care providers treating this population to facilitate rapid transition of all children who are dialysis-dependent towards successful transplantation.”

Researchers from the EMMES Corporation and Johns Hopkins University contributed to the study.

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