Reasons for the decline in LKD remain uncertain. We hypothesized that there would be a more rapid decline in male vs female LKD and that this would vary by income and race.

We determined the annual change in LKD in males and females between 2005-15 and calculated the difference in the annual change in LKD between males and females using data from UNOS and examined this as a function of income and race. Median household income was determined at the zipcode level by linking with the 2000 Census.

Results:

The decline in LKD between 2005-15 was greater in males vs females (mean change/yr ± SD was -71/yr ± 7 in males vs -38/yr ±14 in females). The mean difference in the annual change between male and female LKD was -33 ± 12/year (p= 0.02).

The table shows the mean LKD change/yr in males and females and the mean difference in the change/yr between males and females, by median household income and race.

Surprisingly, the difference in LKD between males and females was largest in the highest income quintile (female LKD increased and male LKD decreased). LKD declined similarly in males and females in the lowest income quintile. The rate of decline in LKD was not different in Black males and females, but stratified analyses (by race and income categories) revealed that these race differences were driven by differences in income between black and white donors.

Conclusion: LKD has declined more in males vs females resulting in a widening gender gap in LKD. This effect was most dominant in the highest income quintile where LKD declined in men, but increased in women. This highlights the need to understand financial disincentives to LKD in both low AND high income populations as a function of gender.

CITATION INFORMATION: Lesage J, Gill J, Rose C, Joffres Y, Gill J. More Rapid Decline in Male VS Female Living Kidney Donations (LKD) Varies by Income. Am J Transplant. 2017;17 (suppl 3).

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