POS-777 SEX DIFFERENCES IN ACCESS TO AND OUTCOMES AFTER PAEDIATRIC KIDNEY TRANSPLANTATION

Abstract

Introduction: Sex disparities in access to live donor transplantation and graft outcomes for women have been reported globally, however data regarding whether these disparities begin in childhood are relatively sparse. This study examines the association between sex differences and access to living donor kidney transplantation, and post-transplant outcomes in children with kidney failure. Methods: An ANZDATA Registry study of all children and adolescents (< 20 years) who underwent a first kidney transplant between 1stJanuary 2002 and 31 December 2017. Logistic regression modelling was used to assess access to pre-emptive transplantation by sex. Descriptive statistics were used to assess both the proportions of live donors by sex and mortality rates. Least absolute shrinkage and selection operator (LASSO) and Cox regression modelling were used to assess the risk factors for graft loss and acute rejection (accounting for competing risk of death or death and graft loss respectively). Results: Over a median follow up of 6.9 years (IQR 3.5-11.5), 757 children and adolescents received a first kidney transplant, of whom 497 (65.7%) received a live donor kidney and 163 (21.5%) received a pre-emptive live donor kidney transplant. There was a totalof 168 patients (22.2%) who experienced graft loss and 213 patients (28.1%) who experienced a first episode of acute rejection during study follow-up. There was no difference in the rate of graft loss or acute rejection by sex (Figures 1 and 2). Compared with boys, the adjusted hazard ratios (aHR) for graft loss and acute rejection in girls were 0.97 (95% CI 0.71-1.33, p = 0.86) and 1.09 (95% CI 0.82-1.44, p = 0.57), respectively. On multivariable logistic regression modelling, the pre-emptive live kidney donation rate (as a proportion of all patients who received a live donor kidney) in girls did not differ from that in boys (odds ratio [OR] 0.90, [95% CI 0.95-2.69, p = 0.66]). Figure 1: Risk factors for graft loss [Formula presented] Figure 2: Risk factors for acute rejection [Formula presented] Conclusions: There were no sex-based differences in access to live donor kidney transplantation (including pre-emptive live donor kidney transplantation) or graft outcomes (loss or rejection) for children in Australia or New Zealand. It remains unclear why sex disparities develop moving into adult life. Future research should focus on how to reduce (and ultimately prevent) these inequities in both access and outcomes. Conflict of interest Potential conflict of interest: RL receives PhD funding support through a Jacquot Fellowship from the Royal Australasian College of Physicians (RACP) for 2021. DJ has received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care, consultancy fees from Astra Zeneca, Bayer, and AWAK, speaker’s honoraria from ONO and BI & Lilly, and travel sponsorships from Ono and Amgen. He is a current recipient of an Australian National Health and Medical Research Council Leadership Investigator Grant.L20169054802022-02-21 <br />