*Purpose: Obesity and female gender have been associated with decreased access to kidney transplant. We sought to use contemporary data to examine the likelihood of waitlisting and transplant for obese women with end stage renal disease (ESRD).

*Methods: We performed a retrospective cohort study with long-term follow up, using the U.S. Renal Data System, of incident ESRD patients from 2012-2014 who had no contraindication to transplant and were not waitlisted within 90 days at the time of first dialysis service date. We used Cox proportional hazards regression to investigate the likelihood of waitlisting and subsequently transplant for women, stratified by BMI.

*Results: We identified 217,320 waitlist-eligible ESRD patients. Of this cohort, men comprised 58.3% and women 41.7%. Women were found to be less likely to be placed on the wait-list compared to men across all BMI categories>18.5 kg/m², with the disparity growing more pronounced at higher BMI; BMI 18.5-34.9 aHR 0.86 (95%CI 0.84-0.88), BMI 35.0-39.9 aHR 0.71 (95%CI 0.67-0.75), BMI 40.0-44.9 aHR 0.68 (95%CI 0.62-0.75), BMI 45+ aHR 0.55 (95%CI 0.48-0.62). Once wait-listed, the likelihood for achieving transplantation was not significantly different between genders across the BMI categories; BMI 18.5-34.9 aHR 1.07 (95%CI 1.03-1.11), BMI 35.0-39.9 aHR 0.94 (95%CI 0.85-1.05), BMI 40.0-44.9 aHR 1.11 (95%CI 0.95-1.3), BMI 45+ aHR 1.07 (95%CI 0.86-1.33).

*Conclusions: Women, especially with obesity, are less likely to be placed on the deceased donor kidney transplant waitlist compared to men. However, once waitlisted, the opportunity for subsequent transplant appears comparable to men of the same BMI category. Further research should focus on identification of barriers to referral and evaluation of obese, female patients with ESRD.

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