OPTN/SRTR 2015 Annual Data Report: Kidney
A Hart, J M Smith, M A Skeans, S K Gustafson, D E Stewart, W S Cherikh, J L Wainright, A Kucheryavaya, M Woodbury, J J Snyder, B L Kasiske, A K Israni, A Hart, J M Smith, M A Skeans, S K Gustafson, D E Stewart, W S Cherikh, J L Wainright, A Kucheryavaya, M Woodbury, J J Snyder, B L Kasiske, A K Israni
Abstract
The first full year of data after implementation of the new kidney allocation system reveals an increase in deceased donor kidney transplants among black candidates and those with calculated panel-reactive antibodies 98%-100%, but a decrease among candidates aged 65 years or older. Data from 2015 also demonstrate ongoing positive trends in graft and patient survival for both deceased and living donor kidney transplants, but the challenges of a limited supply of kidneys in the setting of increasing demand remain evident. While the total number of patients on the waiting list decreased for the first time in a decade, this was due to a combination of a decrease in the number of candidates added to the list and an increase in the number of candidates removed from the list due to deteriorating medical condition, as well as an increase in total transplants. Deaths on the waiting list remained flat, but this was likely because of an increasing trend toward removing inactive candidates too sick to undergo transplant.
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A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates concurrently listed at multiple centers are counted once. Active and inactive patients are included; active status is determined on day 7 after first listing. Includes kidney and kidney-pancreas listings.
Candidates concurrently listed at multiple centers are counted once. Those with concurrent listings and active at any program are considered active. Includes kidney and kidney-pancreas listings.
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Age is determined at the later of listing date or January 1 of the given year. Active and inactive candidates are included.
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included.
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included. CKD, cystic kidney disease; DM, diabetes. HTN, hypertension. GN, glomerulonephritis.
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Time on the waiting list is determined at the earlier of December 31 or removal from the waiting list. Active and inactive candidates are included.
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. From December 5, 2007, through September 30, 2009, CPRA was used if greater than 0; otherwise, the maximum pretransplant PRA was used. Before December 5, 2007, the maximum pretransplant PRA was used unconditionally. CPRA is used after September 30, 2009. C/PRA is the highest value during the year. Active and inactive candidates are included.
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Time on dialysis is determined at the earlier of December 31 or removal from the waiting list. Active and inactive candidates are included.
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included. Willingness to accept a local non-zero HLA mismatch KDPI >85% kidney is for at least one day during the year, beginning in 2014. ECD, expanded criteria donor.
Estimated percentage of prevalent dialysis patients waitlisted for kidney or kidney-pancreas transplant. Percentage calculated as the sum of point prevalent waitlist candidates divided by the sum of point prevalent dialysis patients on December 31 of each year. Dialysis data from the Consolidated Renal Operations in a Web-enabled Network (CROWN) dataset. Age calculated on December 31 of given year.
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. Rates with less than 10 patient-years of exposure are not shown.
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown. GN, glomerulonephritis.
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. From December 5, 2007, through September 30, 2009, CPRA was used if greater than 0; otherwise, the maximum pretransplant PRA was used. Before December 5, 2007, the maximum pretransplant PRA was used unconditionally. CPRA is used after September 30, 2009. Rates with less than 10 patient-years of exposure are not shown.
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.
Adults waiting for any kidney transplant and first listed in 2012. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Removed from list includes all reasons except transplant and death. DD, deceased donor; LD, living donor.
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal.
Candidates listed concurrently in a single DSA are counted once in that DSA, from the time of earliest listing to the time of latest removal; candidates listed in multiple DSAs are counted separately per DSA.
Adults waiting for kidney transplant on December 31 of the given year. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Willingness to accept a KDPI >85% kidney is for at least one day during the year, beginning in 2014. ECD, expanded criteria donor.
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown. Age is determined at the later of listing date or January 1 of the given year.
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown. CKD, cystic kidney disease; DM, diabetes. HTN, hypertension. GN, glomerulonephritis.
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.
Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.
Deceased donors with at least one kidney recovered for transplant. Donors whose kidneys were recovered en-bloc are counted once, and donors whose kidneys were recovered separately are counted twice.
Deceased donors with at least one kidney recovered for transplant. Donors whose kidneys were recovered en-bloc are counted once, and donors whose kidneys were recovered separately are counted twice.
Numerator: Deceased donors aged http://www.naphsis.org/programs/vital-statistics-data-research-request-process). Donors whose kidneys were recovered en-bloc are counted once, and donors whose kidneys were recovered separately are counted twice.
Percentages of kidneys not transplanted out of all kidneys recovered for transplant. Kidneys recovered en-bloc are counted once, and kidneys recovered separately are counted twice.
Percentages of kidneys not transplanted out of all kidneys recovered for transplant. Kidneys recovered en-bloc are counted once, and kidneys recovered separately are counted twice.
Percentages of kidneys not transplanted out of all kidneys recovered for transplant. Kidneys recovered en-bloc are counted once, and kidneys recovered separately are counted twice.
Percentages of kidneys not transplanted out of all kidneys recovered for transplant. Kidneys recovered en-bloc are counted once, and kidneys recovered separately are counted twice.
Percentages of kidneys not transplanted out of all kidneys recovered for transplant. Kidneys recovered en-bloc are counted once, and kidneys recovered separately are counted twice.
Percentages of kidneys not transplanted out of all kidneys recovered for transplant. Kidneys recovered en-bloc are counted once, and kidneys recovered separately are counted twice. CNS, central nervous system; CVA, cerebrovascular accident.
Percentages of kidneys not transplanted out of all kidneys recovered for transplant. Kidneys recovered en-bloc are counted once, and kidneys recovered separately are counted twice. DBD, donation after brain death; DCD, donation after circulatory death.
Percentages of kidneys not transplanted out of all kidneys recovered for transplant, by KDPI classification. The reference population for the KDRI to KDPI conversion is all deceased donor kidneys recovered for transplant in the US in 2015. Kidneys recovered en-bloc are counted once. KDPI, kidney donor profile index; KDRI, kidney donor risk index.
Donors with at least one transplanted kidney. The donor-specific components of the kidney donor risk index are shown, except for donor height and hepatitis C virus status. CVA, cerebrovascular accident; DCD, donation after circulatory death; SCr, serum creatinine.
Kidneys recovered for transplant. Kidney donor risk index is computed using only donor-specific components.
Deceased donors whose kidneys were transplanted. Each donor is counted once. CNS, central nervous system; CVA, cerebrovascular accident.
As reported on the OPTN Living Donor Registration Form.
As reported on the OPTN Living Donor Registration Form.
As reported on the OPTN Living Donor Registration Form.
As reported on the OPTN Living Donor Registration Form.
As reported on the OPTN Living Donor Registration Form.
Cumulative hospital readmission. The 6-week time point is recorded at the earliest of discharge or 6 weeks after donation.
Complications reported on the OPTN Living Donor Registration and Living Donor Follow-up Forms at each time point. Complications include readmission, reoperation, vascular complications, and other complications requiring intervention. Multiple complications may be reported at any time point.
Donor height and weight reported on the OPTN Living Donor Registration Form.
All kidney transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.
All kidney transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.
All kidney transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.
All kidney transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.
All kidney transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients. GN, glomerulonephritis; CKD, cystic kidney disease.
All adult recipients of deceased donor kidneys, including multi-organ transplants. The reference population for the KDRI to KDPI conversion is all deceased donor kidneys recovered for transplant in the US in 2015. Kidneys recovered en-bloc are counted once. KDPI, kidney donor profile index; KDRI, kidney donor risk index.
Immunosuppression at transplant reported to the OPTN. IL2-RA, interleukin-2 receptor antagonist.
Immunosuppression at transplant reported to the OPTN.
Immunosuppression at transplant reported to the OPTN. Mycophenolate includes mycophenolate mofetil and mycophenolate sodium.
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant. mTOR, mammalian target of rapamycin.
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant.
From December 5, 2007, through September 30, 2009, CPRA was used if greater than 0; otherwise, the maximum pretransplant PRA was used. Before December 5, 2007, the maximum pretransplant PRA was used unconditionally. CPRA is used after September 30, 2009, unless it is missing; if it is missing, the maximum pretransplant PRA is used. Kidney-alone transplants only.
From December 5, 2007, through September 30, 2009, CPRA was used if greater than 0; otherwise, the maximum pretransplant PRA was used. Before December 5, 2007, the maximum pretransplant PRA was used unconditionally. CPRA is used after September 30, 2009, unless it is missing; if it is missing, the maximum pretransplant PRA is used. Kidney-alone transplants only.
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2015.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. All-cause graft failure (GF) is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. Death-censored graft failure (DCGF) is defined as a return to dialysis, reported graft failure, or kidney retransplant.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. Death with function (DWF) is defined as death without prior graft failure, return to dialysis, or retransplant.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. All-cause graft failure (GF) is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. Death-censored graft failure (DCGF) is defined as a return to dialysis, reported graft failure, or kidney retransplant.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. Death with function (DWF) is defined as death without prior graft failure, return to dialysis, or retransplant.
Graft survival estimated using unadjusted Kaplan-Meier methods. CKD, cystic kidney disease; GN, glomerulonephritis.
Graft survival estimated using unadjusted Kaplan-Meier methods. The reference population for the KDRI to KDPI conversion is all deceased donor kidneys recovered for transplant in the US in 2015. KDPI, kidney donor profile index.
Graft survival estimated using unadjusted Kaplan-Meier methods. DCD, donation after circulatory death; DBD, donation after brain death.
Graft survival estimated using unadjusted Kaplan-Meier methods.
Graft survival estimated using unadjusted Kaplan-Meier methods.
Graft survival estimated using unadjusted Kaplan-Meier methods. CKD, cystic kidney disease; GN, glomerulonephritis.
GFR (mL/min/1.73 m2) estimated using the Chronic Kidney Disease Epidemiology Collaboration equation, and computed for patients alive with graft function at discharge.
GFR (mL/min/1.73 m2) estimated using the Chronic Kidney Disease Epidemioogy Collaboration equation, and computed for patients alive with graft function at 6 months posttransplant.
Recipients are assumed to be alive with function unless a death or graft failure is recorded. A recipient may experience a graft failure and be removed from the cohort, undergo retransplant, and re-enter the cohort.
Acute rejection is defined as a record of acute or hyperacute rejection, as reported on the OPTN Transplant Recipient Registration or Transplant Recipient Follow-up Form. Only the first rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier competing risk method.
Percentage of adult deceased donor kidney recipients who were nondiabetic at transplant and developed diabetes posttransplant. Posttransplant diabetes is reported on the Transplant Recipient Follow-up Form. Death and graft failure are treated as competing events.
Percentage of adult deceased donor kidney recipients who were nondiabetic at transplant and developed diabetes posttransplant. Posttransplant diabetes is reported on the Transplant Recipient Follow-up Form. Death and graft failure are treated as competing events.
Cumulative incidence is estimated using the Kaplan-Meier competing risk method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered. CKD, cystic kidney disease; GN, glomerulonephritis.
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered. The reference population for the KDRI to KDPI conversion is all deceased donor kidneys recovered for transplant in the US in 2015. KDPI, kidney donor profile index.
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered. CKD, cystic kidney disease; GN, glomerulonephritis.
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.
A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates concurrently listed at multiple centers are counted once. Active and inactive patients are included. Age determined at listing.
Candidates concurrently listed at multiple centers are counted once. Those with concurrent listings and active at any program are considered active. Active status is determined on day 7 after first listing; age determined at first listing.
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Age is determined at the later of listing date or January 1 of the given year. Active and inactive candidates are included.
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included.
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Diagnosis categories follow North American Pediatric Renal Trials and Collaborative Studies recommendations. Active and inactive candidates are included. FSGS, focal segmental glomerulosclerosis; GN, glomerulonephritis; CAKUT, congenital anomalies of the kidney and urinary tract.
Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Time on the waiting list is determined at the earlier of December 31 or removal from the waiting list. Active and inactive candidates are included.
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. From December 5, 2007, through September 30, 2009, CPRA was used if greater than 0; otherwise, the maximum pretransplant PRA was used. Before December 5, 2007, the maximum pretransplant PRA was used unconditionally. CPRA is used after September 30, 2009. C/PRA is the highest value during the year. Active and inactive candidates are included.
Candidates who joined the list 2011–2015. Candidates concurrently listed at more than one center are counted once. Patients who were listed, underwent transplant, and were relisted during the time period are counted more than once. Age is computed at earliest listing date. FSGS, focal segmental glomerulosclerosis; GN, glomerulonephritis; CAKUT, congenital anomalies of the kidney and urinary tract.
Pediatric candidates who joined the kidney or kidney-pancreas waitlist in 2012. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor; LD, living donor.
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active waiting in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. Rates with less than 10 patient-years of exposure are not shown. The age category 18 years or older includes candidates listed when pediatrics but still on the list in the given year.
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active waiting in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. Rates with less than 10 patient-years of exposure are not shown.
All pediatric kidney transplant recipients, including retransplant, and multi-organ recipients.
Relationship of living donor to recipient is as indicated on the OPTN Living Donor Registration Form.
All pediatric living kidney transplant recipients, including retransplant, and multi-organ recipients.
Adult centers transplanted only recipients aged 18 years or older. Functionally adult centers transplant 80% adults or more, and the remainder were children aged 15–17 years. Mixed included adults and children of any age groups. Child only centers transplanted recipeints aged 0–17 years, and small number of adults up to age 21 years.
Immunosuppression at transplant reported to the OPTN. IL2-RA, interleukin-2 receptor antagonist.
Immunosuppression at transplant reported to the OPTN.
Immunosuppression at transplant reported to the OPTN. Mycophenolate includes mycophenolate mofetil and mycophenolate sodium.
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant. mTOR, mammalian target of rapamycin.
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant.
IL2-RA, interleukin-2 receptor antagonist.
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2015.
GFR (mL/min/1.73 m2) estimated using the bedside Schwartz equation, and computed for patients alive with graft function at discharge. Equation: eGFR = 0.413*Height(cm)/Creatinine (mg/dL).
GFR (mL/min/1.73 m2) estimated using the bedside Schwartz equation, and computed for patients alive with graft function at 12 months posttransplant. Equation: eGFR = 0.413*Height(cm)/Creatinine (mg/dL).
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. All-cause graft failure (GF) is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. Death-censored graft failure (DCGF) is defined as a return to dialysis, reported graft failure, or kidney retransplant.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. Death with function (DWF) is defined as death without prior graft failure, return to dialysis, or retransplant.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. All-cause graft failure (GF) is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. Death-censored graft failure (DCGF) is defined as a return to dialysis, reported graft failure, or kidney retransplant.
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. Death with function (DWF) is defined as death without prior graft failure, return to dialysis, or retransplant.
Graft survival estimated using unadjusted Kaplan-Meier methods. DD, deceased donor; LD, living donor.
Acute rejection is defined as a record of acute or hyperacute rejection, as reported on the OPTN Transplant Recipient Registration Form or Transplant Recipient Follow-up Form. Only the first rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier competing risk method.
Cumulative incidence is estimated using the Kaplan-Meier competing risk method. Posttransplant lymphoproliferative disorder (PTLD) is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus.
Recipient survival estimated using unadjusted Kaplan-Meier methods. DD, deceased donor; LD, living donor.
Source: PubMed