*Purpose: Sex- and gender-based disparities which have shown women to have lower access to kidney transplantation have been reported. In living kidney transplantation (LKT), pregnancy-related sensitization restricts transplantation for women, causing incompatibility with the recipient’s spouse or child as living kidney donors. We compared female kidney recipients with male recipients to investigate the effect of pregnancy and spousal donors in female recipients after desensitization therapy was introduced.

*Methods: A total of 1124 LKTs were performed from 2005 to 2016 in the department of urology of Tokyo Women’s Medical University. All 1124 recipients since 2005, at which all kinds of desensitization therapy was introduced in our center, were divided into four groups as follows: male group (n=749), male recipients; female PG- group (n=161), female recipients without history of pregnancy; female PG+SD+ group (n=118), female recipients with history of pregnancy, with spousal donors; and female PG+SD- group (n=96), female recipients with history of pregnancy, with non-spousal donors.

*Results: The female PG+SD+ group had the highest incidence of positive CDC/FC-XM and positive preformed DSA (15.3% and 39.0%, respectively). The female PG+SD- group had the second highest incidence of positive CDC/FC-XM and positive preformed DSA (6.3% and 22.9%, respectively). The female PG- group and male group had comparable incidence of positive CDC/FC-XM and positive preformed DSA. The rates of Kaplan-Meier cumulative patient survival (death with functioning graft) at 10 years after LKT were 91.5% in the male group, 97.0% in the female PG- group, 95.6% in the female PG+SD- group, and 91.9% in the female PG+SD- group (log-rank test=0.111). The rates of Kaplan-Meier cumulative graft survival (non-death-censored) at 10 years after LKT were 75.1% in the male group, 87.2% in the female PG- group, 88.7% in the female PG+SD- group, and 82% in the female PG+SD- group (log-rank test=0.010). No significant difference in overall death, and death-censored graft failure was found among the four groups. The Kaplan-Meier cumulative acute ABMR-free rates at 1 years after LKT were 93.6% in the male group, 95.6% in the female PG- group, 76.0% in the female PG+SD+ group, and 91.6% in the female PG+SD- group (log-rank test<0.001).The female PG+SD+ group had higher incidence of acute and chronic ABMR than the other three groups. The male group had a higher incidence of PTDM, hypertension, and CVD.

*Conclusions: Our results suggest that we can achieve good clinical outcome in female recipients through desensitization therapy. Patient and graft survival rates were higher in female recipients than in male recipients, with or without significant difference. Our results may indicate the possibility that desensitization demotes sex disparity in LKT.

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