Equally Interchangeable? How Sex and Gender Affect Transplantation

Abstract

Organ transplantation as an option to overcome end-stage diseases is common in countries with advanced healthcare systems and is increasingly provided in emerging and developing countries. A review of the literature points to sex- and gender-based inequity in the field with differences reported at each step of the transplant process, including access to a transplantation waiting list, access to transplantation once waitlisted, as well as outcome after transplantation. In this review, we summarize the data regarding sex- and gender-based disparity in adult and pediatric kidney, liver, lung, heart, and hematopoietic stem cell transplantation and argue that there are not only biological but also psychological and socioeconomic issues that contribute to disparity in the outcome, as well as an inequitable access to transplantation for women and girls. Because the demand for organs has always exceeded the supply, the transplant community has long recognized the need to ensure equity and efficiency of the organ allocation system. In the spirit of equity and equality, the authors call for recognition of these inequities and the development of policies that have the potential to ensure that girls and women have equitable access to transplantation.

FGF15 improves outcomes after brain dead donor liver transplantation with steatotic and non-steatotic grafts in rats

“…36 However, data on the potential sex differences in clinical LT outcomes are also controversial. 37 Clinical LT is far more common in men (approximately 60%-70%), 37 which could make interpretation of clinical results difficult when evaluating the impact of sex on outcomes. Further LT studies should address whether sex influences BD-induced intestinal inflammation and LT outcomes.…”

Disadvantage of Small (<60 kg) Adult Candidates on the Liver Transplantation Waitlist

“…Although no transplant center will allocate liver grafts based on recipient sex, female sex may be associated with multiple factors, including size that poses a disadvantage on the waitlist. [14][15][16][17] In the current study, cases were chosen based on weight rather than height, since in our center size matching is based on recipient weight. Nevertheless, similar effects may be present if matching is based on height instead of weight, as height is associated with anteroposterior dimensions of the abdominal cavity.…”

Is It Time for Operation Warp Speed in Transplant Research?

“…Although initially focused on mentorship across the continents, the strategic “reboot” supported by President Nancy Ascher in 2017 led to the creation of Pillar 1, focused on networking and career advancement, and Pillar 2, supporting studies in sex and gender in transplantation. Recent “crowd-sourced” publications 9 , 10 highlight the imperatives to study sex and gender in immunology and clinical care and outcomes. Also during this period of awareness, there have been calls to action by the Transplantation Society of Australia and New Zealand 4 and nephrology community 11 for opportunities for women leaders.…”