Spotlight paper in Transplant International: Dr. Amanda Vinson
The CDTRP would like to congratulate Dr. Amanda Vinson, Assistant professor of Nephrology and Renal Transplant in Halifax, for her recent publication entitled: “Representation of Women in Contemporary Kidney Transplant Trials” in Transplant International!
We asked Amanda a few questions about the study that you can read below.
What are the key findings of the study on the representation of women in kidney transplant trials?
This study shows that as a whole, women are seemingly better represented in kidney transplant trials than in other areas of medicine. 33.7% of trial participants were women, but when accounting for the fact nearly 60% of kidney transplant recipients worldwide are men, this equates to appropriate trial participation relative to kidney transplant prevalence in women. However, when we examine representation by trial focus, women remain underrepresented in trials focussing on immunosuppression or transplant rejection.
What impact does the underrepresentation of women in kidney transplant trials have on the quality of care and outcomes for female patients?
Unfortunately, without adequate representation of women in kidney transplant trials examining immunosuppression or transplant rejection risk, we cannot be confident that trial results are appropriate for women. Men and women (males and females) have a very different immune response to kidney transplant, and metabolize immunosuppressive drugs differently. Therefore extrapolating data that was generated in a predominantly male population to be applied to women with a transplant may not be appropriate.
What are the implications of the study’s findings for researchers, clinicians, and policymakers working in the field of kidney transplantation?
I think that this study highlights the fact that although we are seemingly doing better at including women in kidney transplant trials as a whole, there is still work to be done. In order to generate evidence in kidney transplant patients that applies to both men and women, participants of all genders must be represented in clinical transplant trials with appropriate sex stratification in analysis and reporting of results.
How can researchers ensure equal representation of women and minorities in clinical trials to gather data that reflects the diversity of the population being treated?
Some strategies to improve the representation of women in kidney transplant trials may include ensuring the use of gender sensitive recruitment and communication tools, targeted recruitment of women and gender diverse participants, and the inclusion of more women and gender diverse researchers on study teams, patient advisory boards, and in leadership positions for regulatory agencies and pharmaceutical companies.
What are the next steps and how could the CDTRP support the future directions of this work?
I think the most important thing to do is ensure researchers are aware of the under representation of women in kidney transplant trials, particularly in areas examining immunosuppression or rejection risk. This awareness may lead to more targeted efforts to include women in future research studies. Even if challenges exist despite enhanced recruitment efforts, researchers should strive to include sex stratified analyses in all studies where appropriate. I think CDTRP has been an excellent support for women in transplantation. For example, you have provided me with an unrelated grant to examine access to transplant for women in Nova Scotia/Canada and clearly have an interest in gender equity as a program. Asking about gender/sex specific implications from grant applicants (as you currently do) is excellent. I think future direction really comes through education and awareness, which you are helping with through news letter publications such as this one.
Women are often underrepresented in clinical trials. It is unclear if this applies to trials in kidney transplant (KT) and whether the intervention or trial focus influences this. In this study, the weighted participation-to-prevalence ratio (PPR) for women enrollees in KT trials was determined for leading medical transplant or kidney journals between 2018 and 2023 using meta-regression overall and in three sensitivity analyses by: 1) Whether the intervention involved immunosuppression; 2) Area of trial focus; rejection, cardiometabolic, infection, lifestyle, surgical; 3) Whether the intervention was medical/surgical or social/behavioral. Overall, 33.7% of participants in 24 trials were women. The overall pooled PPR for the included trials was 0.80, 95% CI 0.76–0.85, with significant heterogeneity between trials (I2 56.6%, p-value < 0.001). Women had a lower PPR when the trial involved immunosuppression (PPR 0.77, 95% CI 0.72–0.82) than when it did not (PPR 0.86, 95% CI 0.80–0.94) and were less likely to participate in trials with a medical/surgical versus behavioral intervention; the lowest PPR for women was in studies examining rejection risk (PPR 0.75, 95% CI 0.70–0.81). There is better representation of women in KT trials compared to other medical disciplines, however women remain underrepresented in transplant trials examining immunosuppression and rejection.
About Dr. Amanda Vinson
Dr. Amanda Vinson is an assistant professor of Nephrology and Renal Transplant in Halifax, Nova Scotia. She received her medical degree from the University of British Columbia and completed Internal Medicine, Nephrology and a subsequent Renal Transplant fellowship at Dalhousie University. She went on to complete a thesis-based Master’s Degree in Clinical Epidemiology at the Harvard Chan School of Public Health in Boston, MA. Her thesis explored kidney donor-recipient pairing and associated post-transplant outcomes. Dr. Vinson joined the Dalhousie Division of Nephrology in 2017 as a clinician-researcher. Her research interests include studying predictors of kidney graft and patient survival following transplant, with a focus on strategic matching of kidney donors and recipients to maximize outcomes. She has a special interest in disparities in access to care and the effects of sex and gender in kidney transplantation. She has been both an expert panelist and an invited lecturer on the topic nationally and internationally.