Death on the kidney waiting list--good candidates or not?

The waiting list for a kidney or simultaneous pancreas-kidney transplant is growing, and waiting times are getting longer. As a consequence, transplant candidates are dying while waiting for a transplant. In a retrospective analysis, we studied whether patients on our list who died while waiting were good candidates. From January 1, 2002, through September 30, 2004, 85 candidates on our list died. Of these, 71% were waiting for a first transplant; 62% had a current panel-reactive antibody (PRA) level of 0%. Of the 85 candidates who died, the mean (+/-SD) age was 53 +/- 11 years; mean waiting time from listing to death, 979 +/- 749 days. The most common cause of death was cardiovascular disease. Many of those candidates who died while waiting were young, first-transplant candidates with a low PRA level. But only limited information was available; prospective studies are necessary to determine whether or not they were, in fact, good candidates.