OPTN/SRTR 2019 Annual Data Report: Kidney

Abstract

Despite the ongoing severe shortage of available kidney grafts relative to candidates in need, data from 2019 reveal some promising trends. After remaining relatively stagnant for many years, the number of kidney transplants has increased each year since 2015, reaching the highest annual count to date of 24,273 in 2019. The number of patients waiting for a kidney transplant in the United States was relatively stable, despite an increase in the number of new candidates added in 2019 and a decrease in patients removed from the waiting list owing to death or deteriorating medical condition. However, these encouraging trends are tempered by ongoing challenges. Nationwide, only a quarter of waitlisted patients receive a deceased‐donor kidney transplant within 5 years, and this proportion varies dramatically by donation service area, from 15.5% to 67.8%. The non‐utilization (discard) rate of recovered organs remains at 20.1%, despite adramatic decline in the discard of organs from hepatitis C‐positive donors. Non‐utilization rates remain particularly high for Kidney Donor Profile Index ≥85% kidneys and kidneys from which a biopsy specimen was obtained. While the number of living‐donor transplants increased again in 2019, only a small proportion of the waiting list receives living‐donor transplants each year, and racial disparities in living‐donor transplant access persist. As both graft and patient survival continue to improve incrementally, the total number of living kidney transplant recipients with a functioning graft is anticipated to exceed 250,000 in the next 1‐2 years. Over the past decade, the total number of pediatric kidney transplants performed has remained stable. Despite numerous efforts, living donor kidney transplant remains low among pediatric recipients with continued racial disparities among recipients. Congenital anomalies of the kidney and urinary tract remain the leading cause of kidney disease. While most deceased donor recipients receive a kidney from a donor with KDPI less than 35%, the majority of pediatric recipients had four or more HLA mismatches. Graft survival continues to improve with superior outcomes for living donor recipients.

Commentary: A word of caution (and a note of optimism)

“…Not surprisingly, kidney transplant rates in the study timeline are far below the rates reported for the general population of patients on the waiting list. 2 The current data do not support indiscriminate access to renal transplantation for these patients but underline that a significant survival advantage still exists: transplantation remains effective in cases considered to be potential candidates, despite major aortic disease. Careful clinical appreciation is nonetheless essential and should be declined according to the type of disease and its potential anatomical consequences (ie, extent of residual aortic dissection after repair of the thoracic segment).…”

An Integrated Transcriptomic Approach to Identify Molecular Markers of Calcineurin Inhibitor Nephrotoxicity in Pediatric Kidney Transplant Recipients

“…Other reports have demonstrated more intense immune responsiveness among pediatric recipients, suggesting that the immunological milieu for the allograft may be affected by age [ 36 , 41 , 42 ]. Furthermore, children are prioritized to receive deceased donor kidneys with lower kidney donor profile index (KDPI) scores (<35%), and thus, the quality of the graft may influence gene expression [ 8 ]. Furthermore, the need for sensitive markers of allograft injury may be greater among children given that adult-sized grafts may mask damage that is not accompanied by an increase in serum creatinine [ 41 ].…”

“…Yet despite significant advancements in short-term outcomes [ 5 , 6 , 7 ], long-term outcomes remain suboptimal. Currently, patient survival is approximately 90% at 10 years post-transplant, but only 50–60% of allografts survive this long [ 7 , 8 , 9 ]. The mismatch between patient and graft longevity presents challenges for both pediatric patients and transplant centers, since repeat transplant not only increases the likelihood of morbidity and mortality for the child but also reduces the supply of donor organs available to other transplant candidates.…”

“…The mismatch between patient and graft longevity presents challenges for both pediatric patients and transplant centers, since repeat transplant not only increases the likelihood of morbidity and mortality for the child but also reduces the supply of donor organs available to other transplant candidates. Currently, 13.4% of pediatric kidney transplant waitlist candidates await a second transplant [ 8 ].…”

The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation

“…The number of patients requiring repeat kidney transplants is increasing [1,2]. According to the most recent OPTN/SRTR 2019 Annual Data Report, 16.3% (2009), 14.4% (2014), and 11.8% (2019) of the patients on the waiting list had a history of a previous transplant [3]. Traditionally, these patients are considered to have a high immunological risk for early acute rejection and graft loss [4].…”