INTRODUCTION Pregnancy-induced sensitization (PIS) is a barrier to the transplantation of women and contributes significantly to gender disparity in transplantation. We hypothesized that this barrier is greatest for living donor kidney transplant (LDKT) candidates given the potential for specific sensitization to children and spouses who may donate. The frequency with which women are excluded from LDKT because of PIS is currently unknown. METHODS To better quantify the barrier posed by PIS for female LDKT recipients, we performed a retrospective intention-to-treat analysis of potential living donor (LD) utilization in male and female LDKT candidates at our tertiary care center (2007-2013). We compared donor type, histocompatibility, and transplant frequency between three groups of listed LDKT candidates segregated by gender and pregnancy history without other sensitizing events [Men (M)=142; Women with a history of pregnancy (P)=72; and Women without pregnancy history (Nulligravidas) (N)=20]. RESULTS All three groups had equivalent initial LD access with respect to number of crossmatched LDs. The most frequent LD candidate type was an unrelated LD. While men and women were crossmatched with comparable frequency with offspring and spouses, histocompatibility with these donors was significantly different between the groups. Consequently, 17% of women with a history of pregnancy lost access to any living donor after histocompatibility testing [v 0% (N) v 1% (M); p<.001], which contributed to differences in successful LDKT rate [M=87%; N=100%; P=71%; p=.06]. CONCLUSION Men and women have similar initial LD access, but PIS prevents successful LDKT in almost 20% of women with a history of pregnancy. Our data delineate the specific contribution of this biologic barrier to gender disparity in transplantation given that women without this biologic barrier have comparable LDKT success to men.

CITATION INFORMATION: Porrett P, Bromberger B, Hashmi S, Morrison A, Sawinski D. Pregnancy Excludes Women from Successful Living Donor Transplantation. Am J Transplant. 2016;16 (suppl 3).

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