OPTN/SRTR 2016 Annual Data Report: Kidney

Abstract

Data from 2016 show ongoing positive trends in short-and long-term allograft survival, and a decrease in the number of active listed candidates for the first time in more than a decade, with a concomitant increase in deceased donor kidney transplants. Transplant rates that had changed dramatically for some groups after implementation of the new kidney allocation system in 2014 are stabilizing, allowing for evaluation of new steady states and trends. Many challenges remain in adult kidney transplantation, including stagnant rates of living donor transplant, geographic disparities in access to transplant, racial disparities in living donor transplant, and overall a continuing demand for kidneys that far outpaces the supply. For pediatric recipients, a decline in the proportion of living donor transplants is of concern. In 2016, only 34.2% of pediatric transplants were from living donors, compared with 47.2% in 2005. The number of related donors decreased dramatically over the past decade, and the number of unrelated directed transplants performed in pediatric candidates remained low (50).

In-Hospital Mortality and Major Adverse Cardiovascular Events after Kidney Transplantation in the United States

“…Preoperative evaluation of KT patients focuses extensively on the detection and management of coronary artery disease, yet AMI was far less frequent than the development of HF. Thus, despite the increasing burden of CVD risk factors such as age, diabetes, and dialysis vintage in potential KT recipients [4], the overall absolute rates of in-hospital AMI following KT have remained low and stable over time as a result of heightened awareness and proactive management of coronary artery disease. Additionally, nontraditional risk factors such as malnutrition (weight loss prior to KT) and the presence of PH significantly increased the risk of perioperative MACEs after KT because the dominant component of MACEs was HF.…”

“…Data on donor kidney quality, cold and warm ischemia time, and incidence of postoperative delayed graft function were not available in this database and may be variables that influence MACE outcomes post KT. Finally, the proportion of cadaveric versus living donor KTs was not available in the NIS; however, given that cadaveric KT rates make up the majority of the renal allografts transplanted in the United States [4], our data are likely representative of MACE and in-hospital mortality outcomes from this donor type. Since the incidence of delayed graft function could not be ascertained using this database, it may potentially confound the rates of HF after KT.…”

“…The expected burden of CVD after KT is expected to continue to rise, based on national trends reported in transplantation registries. Specifically, the 2016 annual Organ Procurement and Transplantation Network report on KT showed that the KT waitlist continued to age, with ongoing increases in the proportions of candidates aged 50–74 years [4]. The proportion of candidates with diabetes as a cause of ESKD increased to 36.2% of waitlisted candidates, and > 20% of listed candidates had been on dialysis for at least 6 years from their most recent listing [4].…”

Use of Hepatitis C Positive Organs: Patient Attitudes in Urban Chicago

“…Organ waitlists, particularly kidney and liver, continue to grow; the kidney waitlist has increased by 600% in 30 years, but donations remain relatively static [1]. Patients in need of organs continue to die on the waitlists, with 13% of liver transplant candidates dying from 2013 to 2016 while on the waitlist, and mortality rates for kidney transplant candidates in 2016 varying from 0 to 12.7 per 100 patientyears depending on the donation service area [2,3]. In addition to organ shortages, hepatitis C virus (HCV) positivity, in patients and grafts, has historically been another factor preventing transplant candidates from receiving an organ in some cases.…”

Description of a clinical case of synchronous cancer in the native and graft kidneys

“…Начиная с 1960-х годов в мировую практику бы-ло введено выполнение иммунодепрессивной терапии у реципиентов, что позволило значительно повысить жизнеспособность трансплантата. Так, в настоящее время сообщается об успешном 5-летнем функцио-нировании пересаженной почки у 85,7 % реципи-ентов, получивших трансплантат от живых доноров, и у 73,5 % реципиентов, которым была пересажена трупная почка, на фоне выполняемой терапии, угне-тающей иммунитет реципиента [2]. Тем не менее про-ведение иммуносупрессивной терапии у данной кате-гории пациентов приводит к возникновению побочных эффектов, таких как инфекционные ослож-нения, сердечно-сосудистые заболевания, возникно-вение злокачественных новообразований.…”