The OPTN/UNOS Renal Transplant Registry 2003.

The number of living donor kidney transplants reported to the OPTN/UNOS Registry more than doubled during the decade from 1992-2002, from 2,535 to 6,236, with the largest increases in transplants from offspring to their parents and from spouses and other genetically unrelated donors. Despite the rise in more HLA-incompatible living donors, 5-year graft survival rates among recipients transplanted between 1998-2002 were 78.5% and 77.5% for spouse and other unrelated donor grafts, respectively, and were comparable to that for one-haplotype-matched sibling transplants (80.7%). The number of deceased donor kidneys transplanted has remained static at less than 7,000 per year including about 850 (12%) from expanded criteria donors. The 5-year graft survival rate for ECD kidneys was 52.2% compared with 69.9% for standard criteria donor kidneys transplanted between 1998-2002. More than 1,000 patients aged 70-75 were transplanted during this period with 5-year graft survival rates of 50% or less when they received a deceased donor kidney. Nearly 40% of graft losses in this older group were due to death with a functioning graft, however, 25% reportedly died when their graft failed, suggesting a high rate of problems among older recipients. Early acute rejection episodes reduced both short- (10%+ at one year) and long-term (20-30% reduction in graft half-life) survival among first transplant recipients. However, when the serum creatinine level at discharge was <2.5 mg/dl, the early rejection had little if any effect on short- or long-term outcome. Time on dialysis before transplantation was an important determinant of first graft survival, with 5-year graft survival differences of about 10% comparing those transplanted within the first year with those who were on dialysis 4 or more years, regardless of the type of donor kidney. More than 60% of living donor kidney recipients were transplanted within 2 years of starting dialysis, compared with fewer than 20% of those who received a deceased donor kidney. Efforts to reduce cold ischemia times for ECD kidneys have been modestly successful, even before implementation of the new allocation system in November 2002. The percentage of ECD kidneys transplanted within 12 hours increased from 18% in 2001 to 25% in 2003 and the percentage with more than 24 hours of cold ischemia fell from 28% in 2001 to 20% in 2003. Prolonged ischemia of 42 hours was associated with a 5% lower 4-year survival rate of ECD kidneys compared with those transplanted within 12 hours.