Kidney transplantation in the transgender population: Lights and shadows

Transgender individuals are gradually increasing in worldwide. Hormonal therapies may impact cardiovascular mortality, kidney function and transplant stability, the inverse is also true: immunosuppressive agents, particularly high-dose glucocorticoids used to treat acute rejection episodes, may adversely affect mental health, potentially complicating gender-affirming treatment. We aim to provide a comprehensive summary of the status of kidney transplantation in transgender individuals. A comprehensive search was conducted using MeSH keywords, including: "transgender," "kidney function," "hormone therapy," "renal transplantation." One investigator screened articles for eligibility within the PubMed, MEDLINE, Google Scholar databases. A total of 36 full-text articles were systematically analyzed based on predefined inclusion criteria. The analysis revealed available data, though limited to case-level evidence, support the safety and efficacy of kidney transplantation in transgender individuals receiving gender-affirming hormone therapy (GAHT). Continued hormone therapy is not only medically feasible but essential for the well-being and identity affirmation of transgender patients. Treatment plans must be personalized, taking into account comorbid psychiatric conditions, medication side effect profiles, and the patient's goals related to physical appearance and gender identity. Preoperative evaluation should include thorough endocrinologic and psychiatric assessment, and postoperative care should be guided by ongoing collaboration between transplant teams, endocrinologists, and mental health specialists. The presence of GAHT should not preclude transplantation but rather prompt careful, individualized assessment and interdisciplinary management. Establishing standardized protocols and inclusive clinical pathways will be key to ensuring that transgender patients receive equitable and affirming access to life-saving kidney transplantation.