Gender Disparities in Access to Pediatric Renal Transplantation in Europe: Data From the ESPN/ERA-EDTA Registry

J. Hogan, C. Couchoud, M. Bonthuis, J. W. Groothoff, K. J. Jager, F. Schaefer, K. J. Van Stralen, D. Shitza, R. Kramar, R. Oberbauer, S. Baiko, A. Sukalo, K. van Hoeck, F. Collart, J. M. des Grottes, D. Pokrajac, H. Resić, B. Prnjavorac, D. Roussinov, D. BatinićM. Lemac, J. Slavicek, T. Seeman, K. Vondrak, J. G. Heaf, U. Toots, P. Finne, C. Grönhagen-Riska, M. Lasalle, E. Sahpazova, G. Gersdorf, C. Barth, C. Scholz, B. Tönshoff, G. Ioannidis, A. Kapogiannis, F. Papachristou, G. Reusz, S. Túri, L. Szabó, T. Szabó, Z. S. Györke, E. Kis, R. Palsson, V. Edvardsson, B. Gianoglio, T. de Palo, C. Pecoraro, S. Picca, S. Testa, the ESPN/ERA-EDTA Registry

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Inequalities between genders in access to transplantation have been demonstrated. We aimed to validate this gender inequality in a large pediatric population and to investigate its causes. This cohort study included 6454 patients starting renal replacement therapy before 18 years old, in 35 countries participating in the European Society for Paediatric Nephrology/European Renal Association–European Dialysis and Transplant Association Registry. We used cumulative incidence competing risk and proportional hazards frailty models to study the time to receive a transplant and hierarchical logistic regression to investigate access to preemptive transplantation. Girls had a slower access to renal transplantation because of a 23% lower probability of receiving preemptive transplantation. We found a longer follow-up time before renal replacement therapy in boys compared with girls despite a similar estimated glomerular filtration rate at first appointment. Girls tend to progress faster toward end-stage renal disease than boys, which may contribute to a shorter time available for pretransplantation workup. Overall, medical factors explained only 70% of the gender difference. In Europe, girls have less access to preemptive transplantation for reasons that are only partially related to medical factors. Nonmedical factors such as patient motivation and parent and physician attitudes toward transplantation and organ donation may contribute to this inequality. Our study should raise awareness for the management of girls with renal diseases.

Original languageEnglish
Pages (from-to)2097-2105
Number of pages9
JournalAmerican Journal of Transplantation
Volume16
Issue number7
DOIs
Publication statusPublished - Jul 1 2016

Fingerprint

Edetic Acid
Kidney Transplantation
Registries
Transplantation
Pediatrics
Renal Replacement Therapy
Transplants
Tissue and Organ Procurement
Nephrology
Glomerular Filtration Rate
Proportional Hazards Models
Chronic Kidney Failure
Renal Dialysis
Motivation
Appointments and Schedules
Cohort Studies
Logistic Models
Physicians
Kidney
Incidence

Keywords

  • clinical research/practice
  • ethics and public policy
  • kidney transplantation/nephrology
  • organ allocation
  • organ procurement and allocation
  • pediatrics
  • recipient selection
  • registry/registry analysis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Hogan, J., Couchoud, C., Bonthuis, M., Groothoff, J. W., Jager, K. J., Schaefer, F., ... the ESPN/ERA-EDTA Registry (2016). Gender Disparities in Access to Pediatric Renal Transplantation in Europe: Data From the ESPN/ERA-EDTA Registry. American Journal of Transplantation, 16(7), 2097-2105. https://doi.org/10.1111/ajt.13723

Gender Disparities in Access to Pediatric Renal Transplantation in Europe : Data From the ESPN/ERA-EDTA Registry. / Hogan, J.; Couchoud, C.; Bonthuis, M.; Groothoff, J. W.; Jager, K. J.; Schaefer, F.; Van Stralen, K. J.; Shitza, D.; Kramar, R.; Oberbauer, R.; Baiko, S.; Sukalo, A.; van Hoeck, K.; Collart, F.; des Grottes, J. M.; Pokrajac, D.; Resić, H.; Prnjavorac, B.; Roussinov, D.; Batinić, D.; Lemac, M.; Slavicek, J.; Seeman, T.; Vondrak, K.; Heaf, J. G.; Toots, U.; Finne, P.; Grönhagen-Riska, C.; Lasalle, M.; Sahpazova, E.; Gersdorf, G.; Barth, C.; Scholz, C.; Tönshoff, B.; Ioannidis, G.; Kapogiannis, A.; Papachristou, F.; Reusz, G.; Túri, S.; Szabó, L.; Szabó, T.; Györke, Z. S.; Kis, E.; Palsson, R.; Edvardsson, V.; Gianoglio, B.; de Palo, T.; Pecoraro, C.; Picca, S.; Testa, S.; the ESPN/ERA-EDTA Registry.

In: American Journal of Transplantation, Vol. 16, No. 7, 01.07.2016, p. 2097-2105.

Research output: Contribution to journalArticle

Hogan, J, Couchoud, C, Bonthuis, M, Groothoff, JW, Jager, KJ, Schaefer, F, Van Stralen, KJ, Shitza, D, Kramar, R, Oberbauer, R, Baiko, S, Sukalo, A, van Hoeck, K, Collart, F, des Grottes, JM, Pokrajac, D, Resić, H, Prnjavorac, B, Roussinov, D, Batinić, D, Lemac, M, Slavicek, J, Seeman, T, Vondrak, K, Heaf, JG, Toots, U, Finne, P, Grönhagen-Riska, C, Lasalle, M, Sahpazova, E, Gersdorf, G, Barth, C, Scholz, C, Tönshoff, B, Ioannidis, G, Kapogiannis, A, Papachristou, F, Reusz, G, Túri, S, Szabó, L, Szabó, T, Györke, ZS, Kis, E, Palsson, R, Edvardsson, V, Gianoglio, B, de Palo, T, Pecoraro, C, Picca, S, Testa, S & the ESPN/ERA-EDTA Registry 2016, 'Gender Disparities in Access to Pediatric Renal Transplantation in Europe: Data From the ESPN/ERA-EDTA Registry', American Journal of Transplantation, vol. 16, no. 7, pp. 2097-2105. https://doi.org/10.1111/ajt.13723
Hogan, J. ; Couchoud, C. ; Bonthuis, M. ; Groothoff, J. W. ; Jager, K. J. ; Schaefer, F. ; Van Stralen, K. J. ; Shitza, D. ; Kramar, R. ; Oberbauer, R. ; Baiko, S. ; Sukalo, A. ; van Hoeck, K. ; Collart, F. ; des Grottes, J. M. ; Pokrajac, D. ; Resić, H. ; Prnjavorac, B. ; Roussinov, D. ; Batinić, D. ; Lemac, M. ; Slavicek, J. ; Seeman, T. ; Vondrak, K. ; Heaf, J. G. ; Toots, U. ; Finne, P. ; Grönhagen-Riska, C. ; Lasalle, M. ; Sahpazova, E. ; Gersdorf, G. ; Barth, C. ; Scholz, C. ; Tönshoff, B. ; Ioannidis, G. ; Kapogiannis, A. ; Papachristou, F. ; Reusz, G. ; Túri, S. ; Szabó, L. ; Szabó, T. ; Györke, Z. S. ; Kis, E. ; Palsson, R. ; Edvardsson, V. ; Gianoglio, B. ; de Palo, T. ; Pecoraro, C. ; Picca, S. ; Testa, S. ; the ESPN/ERA-EDTA Registry. / Gender Disparities in Access to Pediatric Renal Transplantation in Europe : Data From the ESPN/ERA-EDTA Registry. In: American Journal of Transplantation. 2016 ; Vol. 16, No. 7. pp. 2097-2105.
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abstract = "Inequalities between genders in access to transplantation have been demonstrated. We aimed to validate this gender inequality in a large pediatric population and to investigate its causes. This cohort study included 6454 patients starting renal replacement therapy before 18 years old, in 35 countries participating in the European Society for Paediatric Nephrology/European Renal Association–European Dialysis and Transplant Association Registry. We used cumulative incidence competing risk and proportional hazards frailty models to study the time to receive a transplant and hierarchical logistic regression to investigate access to preemptive transplantation. Girls had a slower access to renal transplantation because of a 23{\%} lower probability of receiving preemptive transplantation. We found a longer follow-up time before renal replacement therapy in boys compared with girls despite a similar estimated glomerular filtration rate at first appointment. Girls tend to progress faster toward end-stage renal disease than boys, which may contribute to a shorter time available for pretransplantation workup. Overall, medical factors explained only 70{\%} of the gender difference. In Europe, girls have less access to preemptive transplantation for reasons that are only partially related to medical factors. Nonmedical factors such as patient motivation and parent and physician attitudes toward transplantation and organ donation may contribute to this inequality. Our study should raise awareness for the management of girls with renal diseases.",
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AU - Groothoff, J. W.

AU - Jager, K. J.

AU - Schaefer, F.

AU - Van Stralen, K. J.

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AU - Roussinov, D.

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AU - Lasalle, M.

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AU - Ioannidis, G.

AU - Kapogiannis, A.

AU - Papachristou, F.

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KW - recipient selection

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