Girls less likely than boys to be placed on kidney transplant wait list

[Clark]

http://universityofcalifornia.edu/sites/uchealth/2011/04/20/girls-less-likely-than-boys-to-be-placed-on-kidney-transplant-wait-list/

Girls less likely than boys to be placed on kidney transplant wait list
UC Davis study is a clarion call for clinicians to pay close attention to transplant evaluation process.

A large study of children awaiting transplantation conducted by researchers at the UC Davis School of Medicine has found that girls are significantly less likely than boys to be placed on the waiting list to receive a new kidney.The study, published online in the journal Pediatric Transplantation, found that among children and young adults under 21 years of age starting dialysis, girls were 22 percent less likely than boys to be placed on the waiting list for a new organ.
Earlier research by UC Davis found that the sooner a child with advanced chronic kidney disease receives a new kidney, the better their long-term health and the longer the life of the organ.
“If the goal is to get them transplanted as soon as possible, then they need to be wait-listed as soon as possible,” said Stephanie Nguyen, assistant professor of pediatric nephrology at the UC Davis School of Medicine and the study’s lead author. “The longer they’re waiting for a transplant, the worse their outcomes will be,” she said.
Nguyen said the study is 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, UC Davis 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.
The study found that there were no other readily apparent factors that would account for girls not being wait-listed as frequently as boys, such as medical reasons or family preference. The study also notes that girls were less likely to have a living-related donor and also were less likely to have pre-emptive transplants than boys.
Girls are less likely than boys to be on the transplant wait list, 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.”

http://www.universityofcalifornia.edu/news/article/25397



http://journals.lww.com/transplantjournal/Abstract/2011/02270/Effect_of_Pretransplant_Dialysis_Modality_and.11.aspx

Effect of Pretransplant Dialysis Modality and Duration on Long-Term Outcomes of Children Receiving Renal Transplants
Butani, Lavjay1,3; Perez, Richard V.2
Transplantation:
27 February 2011 - Volume 91 - Issue 4 - pp 447-451
doi: 10.1097/TP.0b013e318204860b
Clinical and Translational Research

Abstract
Background. Adults receiving preemptive renal transplants have better allograft survival. Our study investigated differences in graft and patient survival based on need for, and duration of, pretransplant dialysis in pediatric renal transplant recipients.

Methods. Data on pediatric kidney transplants from January 1995 to December 2000 from the Organ Procurement and Transplantation Network were included. Multivariable Cox proportional hazards analysis was performed to determine the effect of pretransplant dialysis on graft and patient survival.

Results. Of 3606 transplants, 28% were preemptive, 38% followed pretransplant hemodialysis (HD), and 34% peritoneal dialysis (PD). The 1-year acute rejection rate was lowest for the preemptive group (36%) compared with the HD (45.5%; P=0.0002) and PD (44.2%; P=0.0008) groups. On multivariable analysis, an increased relative risk of graft failure was seen with, among other variables, deceased donor transplantation and acute rejection within the first year, but not with pretransplant dialysis. When analyzed separately by donor source, pretransplant dialysis had no effect on graft survival for deceased donor graft recipients, whereas for living donor recipients, the use and duration of pretransplant HD adversely affected pediatric renal graft survival in a linear manner. No such effect was seen with pretransplant PD.

Conclusions. There is a linear increase in the risk of graft failure with the use of and increasing duration of pretransplant HD for living donor grafts. This indicates another reason to minimize the need for and duration of pretransplant HD in children with chronic kidney disease.