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Review
. 2022 Mar;42(2):219-229.
doi: 10.1016/j.semnephrol.2022.04.011.

Sex and Gender Differences in Kidney Transplantation

Goni Katz-Greenberg  1 , Silvi Shah  2
Affiliations
Review

Sex and Gender Differences in Kidney Transplantation

Goni Katz-Greenberg et al. Semin Nephrol. 2022 Mar.

Abstract

Sex and gender often are used interchangeably, but are two distinct entities, with sex being the biological attribute and gender including the social, psychological, and cultural aspects of one's identity. Kidney transplantation has been proven to be the best treatment for end-stage kidney disease, improving both quality of life and life-expectancy for most patients. However, gender disparities in access to and outcomes of kidney transplantation remain despite the plethora of evidence showing the advantages of kidney transplantation to our patients. Data have shown that women are less likely to be waitlisted for a kidney transplant and to receive a deceased donor or a living donor kidney. On the other hand, women are more likely than men to become living kidney donors. Although some state the latter is the result of the female gender to nurture and care for loved ones, others believe this observation is because women often are incompatible with their spouse or child because pregnancy is a strong sensitizing event, which stems from the biological rather than the social differences between the sexes. Influence of sex and gender is not limited to access to kidney transplantation, but rather exist in other areas of transplant medicine, such as the difference observed in transplant outcomes between the sexes, variability in immunosuppression metabolism, and even in more contemporary areas such as recent data showing sex-based differences in outcomes of kidney transplant recipients with coronavirus disease-2019, with males having an increased incidence of acute kidney injury and death.

Keywords: Sex; gender; kidney; men; transplantation; women.

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Conflict of interest statement

Conflict of interest statement: none.

Figures

Figure 1.
Figure 1.
Sex and gender differences in kidney transplantation. Abbreviations: CKD, chronic kidney disease; ESKD, end-stage kidney disease.
Figure 2.
Figure 2.
Adjusted end-stage kidney disease (ESKD) incidence in the United States, stratified by sex. Adapted from the US Renal Data System 2020 Annual Data Report.
Figure 3.
Figure 3.
Time on the kidney transplant waitlist in the United States, stratified by sex. Adapted from the US Renal Data System 2020 Annual Data Report.
See this image and copyright information in PMC

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