SP867
WHY DO GIRLS WITH END-STAGE RENAL DISEASE WAIT LONGER FOR TRANSPLANTATION THAN BOYS? Free

Introduction and Aims: Renal transplantation is recognized as the treatment of choice for end-stage renal disease (ESRD). However, important inequalities between genders in access to transplantation have been demonstrated. We aimed to validate this gender inequality in a large European population and to investigate its underlying causes.

Methods: Children starting renal replacement therapy (RRT) before 18 years old in countries participating in the ESPN/ERA-EDTA registry between 1 January 2000 and 31 December 2012 were included. Kaplan-meier analysis and Cox models were used to study the effect of gender on the time to get a transplant while hierarchical logistic regression was used to investigate the effect of gender on the access to pre-emptive transplantation.

Results: 6454 patients from 35 countries were included. Girls had a slower access to renal transplantation (HR 0·88, 95%CI 0·83-0·94) than boys because of a 23% lower probability of receiving a pre-emptive transplantation. This was partially explained by a different repartition of age groups and primary renal diseases among genders. A longer follow-up time prior to RRT was found in boys (23·0 months [IQR: 2·4-68·6]) compared to girls (14·4 months [IQR: 0·6-53·6]), p=0·009 despite a similar eGFR at first appointment with a nephrologist. A trend of faster progression towards ESRD was found in girls and may participate in the shorter time available for pre-transplantation work-up. Medical factors explained 70% of the differences in pre-emptive transplantation rates.

Conclusions: In Europe, girls present a lower access to pre-emptive transplantation that is only partially explained by medical factors. Non-medical factors such as patient motivation and parental and physician attitude towards transplantation and organ donation may contribute to this inequality between genders and need to be studied in detail. Our study should raise awareness for the management of girls with renal diseases and prompt all caregivers to avoid any undue delays in pretransplant workup.