Response to Letters to the Editor Re: Kidney transplantation and donation in the transgender population: a single-institution case series.

We appreciate the two thoughtful responses to our manuscript describing the first case series of transgender kidney transplant recipients and donors. Jue, et al., and Greene, et al., both highlight the importance of accurately assessing renal function in transgender patients. Specifically, they call attention to the effect of gender on estimated glomerular filtration rate (eGFR), and its influence on medication dosing as well as access to deceased donor organs. As they suggest, a transgender patient's reported eGFR may be based upon the gender assigned to them at birth, legal gender, or the gender they identify with. This could lead to misrepresentation of patients' renal function, with important implications. In certain circumstances, such as the one described by Greene, et al., the patient incurred a significant delay in placement on a transplant list and hence time to transplant. As the authors point out, there are no published recommendations on how eGFR calculations should be approached in transgender individuals.