*Purpose: Men (vs. women) are more likely to be waitlisted or receive a kidney transplant. Whether gender disparities exist in earlier transplant steps (i.e., referral) is less well known. In this study, we aimed to: 1) quantify gender disparities in transplant referral; and 2) examine if gender disparities in transplant referral are modified by age, race, or obesity, in a Southeastern US population.

*Methods: Adults (18-80 years; n=39,923) initiating dialysis in Georgia, North Carolina, or South Carolina (2012-2016) from the US Renal Data System, were linked to the Early Transplant Access Registry, with follow-up through December 2017. Using a mixed-effects Cox Proportional Hazards model adjusted for several patient characteristics, we assessed the association between gender and referral within 12 months, including interaction terms for age, race/ethnicity, and obesity.

*Results: Overall, 29.1% and 33.8% of women and men, respectively, were referred within 12-months. In fully adjusted models, women (vs. men) were 12% less likely to be referred (HR: 0.88; 95% CI: 0.84−0.91). Women (vs. men) aged 45-64 and 65-80 years were 0.90 (0.85−0.95) and 0.76 (0.70−0.83) less likely to be referred (Figure). Women (vs. men) of non-Hispanic White and non-Hispanic Black race were 0.79 (0.73−0.84) and 0.93 (0.86−0.98) less likely to be referred. For other race (Hispanic, other) and age (18-44) subgroups, and all obesity subgroups, no gender differences in referral rates were observed.

*Conclusions: In the Southeast, women are less likely to be referred for a transplant and this disparity is specific to older and non-Hispanic Black and White women. These findings have important implications for known gender disparities in upstream (i.e., waitlisting) transplant steps and in the design of interventions to reduce gender disparities in transplant.

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