Kidney transplantation in the US: an analysis of the OPTN/UNOS registry.

As of January 14, 2011, 112,707 individuals were listed for kidney transplant. In the past 5 years the yearly average of deceased donor and living donor kidney-only transplants was 10,052 and 6,153, respectively. Compared with a previous decade, one-, 3- and 5-year graft survival rates for deceased donor kidney transplants increased 5%, 6%, and 6%, respectively. Long-term graft survival has not really improved over the past 2 decades. During the past decade, the percentage of kidneys from deceased donors over age 60 transplanted in patients of the same age group increased (from 29% to 60%) over the previous decade. The number of kidney transplants through paired-exchange donation was 109 in 2007. In 2010, that number almost quadrupled to 421. The number of unrelated living donors (LD) has also increased dramatically over the past decade, accounting for 28% of all LD transplants in 2010, and being the major source of LD kidney transplants since 2008. The combination of male donor and female recipient yielded the highest short- and long-term graft survival rates. Female donor and male recipient had the lowest short- and long-term graft survival rates. The risk of graft loss with female donor and male recipient was 23% higher than with male donor and female recipient. For re-transplants, risk of graft loss was 48% higher in patients who received no induction than in those who received IL-2RA + steroid. The impact of HLA mismatch on graft survival rates has declined, but it remains significant. There is still a 10% decrease in the 5-year graft survival from zero MM (77%) to 5&6 MM (67%) in the more recent years. National sharing of zero HLA-mismatched kidneys to sensitized adults with PRA > 20% has increased the transplant opportunity for more highly sensitized patients, nevertheless it will also indirectly decreased the benefits in survival that zero HLA-mismatches provides to about 6% of the kidney transplant population each year who were not sensitized. As of June 2011, 198,314 kidney transplant recipients were alive with a functioning graft.