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http://www.usrds.org/2014/view/v2_06.aspx?zoom_highlight=living+donorChapter 6: Transplantation
Introduction
During calendar year 2012, 17,305 kidney transplants, including kidney-alone and kidney plus at least one additional organ, were performed in the United States. Of these kidney transplants, 5,617 were identified as coming from living donors and 11,535 from deceased donors. Overall, there were 340 fewer kidney transplants in 2012 than in 2011. Although the number of kidney transplants has in general remained stable since 2005, ranging from a high of 18,072 in 2006, to a low of 17,305 in 2012, the cumulative number of recipients living with a functioning kidney transplant continues to grow, reaching 186,303 in 2012, a 3.6 percent increase over 2011.
The kidney transplant waiting list continues to increase, with a seven percent increase from 2011 to 2012, reaching 81,981 candidates on December 31, 2012, of which 83 percent were awaiting their first kidney transplant and 17 percent were listed for repeat kidney transplantation. On December 31, 2012, 35,288 (43 percent) candidates were wait-listed in Status 7 (inactive status) and 46,693 (57 percent) candidates were active. With fewer than 18,000 transplants performed in 2012, the active waiting list is 2.7 times larger than the supply of donor kidneys, representing a continuing challenge.
Sixteen percent of new candidates in 2011 were added to the waiting list or received a deceased or living donor transplant within one year of ESRD initiation. Among candidates newly wait-listed for either a first or repeat kidney-alone transplant in 2009, the median waiting time to transplant was 3.6 years.
The probability of first-year all-cause graft failure (return to dialysis, repeat transplantation, or death with a functioning transplant) for deceased donor kidney transplant recipients in 2011 was 7.7 percent, which improved from 9.1 percent in 2000. When graft failure is looked at as its separate components, the probability of either returning to dialysis or undergoing repeat transplantation was 4.7 percent, while that of death was 3.7 percent. These probabilities were substantially lower in living donor transplant recipients, at 3.3 percent for all-cause graft failure, 1.8 percent for returning to dialysis or repeat transplantation, and 1.3 percent for death. For recipients of a deceased donor transplant in 2007, the probability of five-year all-cause graft failure fell to 29 percent compared to 30 percent in the prior year. Corresponding five-year graft failure rates remained the same as the previous year for living donor transplant recipients, at 17 percent.
The percent of acute rejection during the first year was highest in 1996 among both deceased (51 percent) and living (52 percent) donor recipients. It declined over the next decade, and stabilized in 2006 at 12 and 10 percent for deceased and living donor recipients, respectively. Since 2004, the percent of reported biopsy-proven rejection during the first year post-transplant has been 7-9 percent for both deceased and living donor recipients.
The unadjusted transplant rate per 100 dialysis patient years is falling while the percent of prevalent dialysis patients wait-listed for a kidney has been rising (Figure 6.1.a). Probable contributing causes include a higher prevalent dialysis population; longer survival of ESRD patients on dialysis; initiation of older and perhaps more ill dialysis patients who are not suitable candidates for transplantation; and the growing mismatch between donor supply and demand which in turn leads to longer kidney transplant waiting times. Waiting list counts and median waiting time to transplantation for both first and repeat kidney transplant candidates continue to grow (Figure 6.1.b). Many candidates waiting for repeat kidney transplantation were sensitized against a portion of the potential kidney donor pool as a consequence of their initial transplant. Thus, as expected, waiting times for those seeking a repeat kidney transplant are longer than those observed for candidates wait-listed for a first kidney transplant. The total number of kidney transplants has leveled off over the past decade (Figure 6.1.c). During this period, a small overall increase in deceased donation has balanced a small decrease in living donation. The latter is driven in part by changes in pediatric allocation policy that direct deceased donor kidneys from donors under the age of 35 years to children. Introduction of this policy was associated with a decrease in living donation to children. As noted above, the total number of recipients with functioning living and deceased donor kidney transplants continues to grow (Figure 6.1.d).
Topic: UNITED STATES RENAL DATA SYSTEM 2014 Annual Data Report (Read 5836 times)