In response to the promotion of sex and gender integration in health-related research, we conducted a scoping review evaluating to what extent sex and gender were considered in the transplantation literature.
We searched Medline and Embase for manuscripts published between January 1946 and October 2016. Two reviewers independently selected manuscripts describing clinical research on stem cells, tissues, or solid organ transplantation with ≥20 participants, which mentioned “sex” and/or “gender” in the title or abstract. For each eligible manuscript, 2 of 5 reviewers extracted data on study design, population (transplant candidates, recipients, donors), transplant type, and study outcomes. We evaluated whether the terms “sex” and “gender” were applied according to their correct definitions and how these variables were handled at the level of study design and analysis.
Of 7565 search results, 2107 manuscripts met the inclusion criteria. Sex and gender were applied interchangeably in more than half of the studies (57.5%). Rarely were sex or gender, when applied correctly, considered in the primary study question (13.3% and 25.0%, respectively). The majority of the studies considered these variables as confounders (74.6% for sex and 68.2% for gender), and a minority considered them as effect measure modifiers (2.8% for sex and 5.0% for gender).
Despite a growing awareness of the need to integrate sex and gender in health research, education is required to ensure accurate and meaningful consideration of these concepts. We outline strategies for integrating sex and gender in allotransplantation and donation research during study design and analysis.
1 Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.
2 Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada.
3 Department of Medicine, McGill University Health Centre Research Institute, Montreal, QC, Canada.
4 Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, QC, Canada.
5 Canadian National Transplant Research Program, Canada.
6 Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada.
7 Department of Pediatrics, Montreal Children’s Hospital of the McGill University Health Centre, McGill University, Montreal, QC, Canada.
8 Division of Clinical Epidemiology, McGill University Health Centre Research Institute, Montreal, QC, Canada.
9 Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
10 Metabolic Disorders and Complications, Research Institute of McGill University Health Centre, Montreal, QC, Canada.
11 Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.
12 Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada.
Received 18 December 2018. Revision received 15 April 2019.
Accepted 26 May 2019.
C.L. and R.S.-P. participated in concept and design. C.L., K.C., V.S.S., C.C., T.M., and R.S.-P. participated in data acquisition and extraction, analysis, or interpretation of data. C.L. and R.S.-P. participated in drafting of the article. L.W., B.J.F., and L.P. participated in the critical revision of the manuscript for intellectual content.
The authors declare no funding or conflicts of interest.
Correspondence: Ruth Sapir-Pichhadze, MD, PhD, FRCPC, Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, 5252 De Maisonneuve Blvd, Office 3E.13, Montreal, QC H4A 3S5, Canada. (email@example.com).