*Purpose: Despite its superior outcomes relative to chronic dialysis, living kidney transplantation are less likely to occur in female in Japan. The aim of this study was to understand sex differences in the context of potential barriers to living donor.

*Methods: This is a retrospective single center study of living donor kidney transplant recipients and donors who received 2013 to 2018 (n=130 cases). We analyzed their background and decision-making process of living donor kidney transplantation. Chi square and multiple logistic regression methods were used to determine factors associated with the decision.

*Results: Forty-nine recipients (37.7%) and 74 donors (54.4%) were female. Age of recipients was 45±15 (8-73) y.o. and donors were 57±10 (30-81) y.o.. Who donated kidney were wives (n=33, 25.4%), husbands (n=25, 19.2%), mothers (n=30, 23.1%), fathers (n=26, 20.0%) and others (n=16, 12.3%). Males were less likely to become a living donor if there was no decision support about kidney transplantation by medical staff (p=0.04). On the other hand, if transplant-familiar nephrologists and nurses supported end-stage renal disease patients and potential living donors during the decision-making process, such sex disparity was disappeared (women versus men odds ratio, 0.47; 95% confidence interval, 0.23 to 0.97, p=0.03).

*Conclusions: In order to enhance equal access to living donor kidney transplantation, it is important to make collaborative effort to develop transplant-familiar nephrologists to support decision-making about renal-replacement therapy in Japan.

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