Trends in Kidney Transplantation over the Past Decade
- 319 Downloads
Kidney transplantation offers patients with end-stage renal disease the greatest potential for increased longevity and enhanced quality of life; however, the demand for kidneys far exceeds the available supply. This has led to an increase in the number of people on waiting lists and an increase in waiting time. In the US, the overall median wait time was 2.85 years in 2004. The projected median waiting time for adult patients awaiting a deceased donor kidney in 2006 is 4.58 years. The renal transplant community has pursued multiple avenues in an attempt to increase the donor pool, but this remains a major challenge. In the last decade, the number of live donor kidney transplants performed in the US and Canada has doubled and represents just over 40% of all donor kidneys. Among deceased donor kidneys, the largest percentage increases were seen in expanded criteria donor and donation after cardiac death kidneys. In the last decade, the age distribution among donors, and among patients on waiting lists or receiving a renal transplant, has shifted towards older age groups. There have been dramatic shifts in baseline immunosuppression with increased usage of induction agents and the nearly universal replacement of azathioprine by mycophenolate. Additionally, tacrolimus use has increased from 13% to 79% at discharge, while ciclosporin (cyclosporine) use has fallen from 76% to 15%. Although 1-year graft survival rates are excellent, only modest improvements have been observed in long-term graft survival rates in the last decade. Thus, efforts have shifted from improving early graft outcomes to altering the natural course of late graft failure. Death of transplant recipients from cardiovascular disease, infection and cancer remains an important limitation in kidney transplantation. Continued success in kidney transplantation will require increased numbers of donors, both living and deceased, as well as reduction in the primary causes of late transplant loss, namely premature patient death with a functioning graft and chronic allograft nephropathy.
KeywordsSirolimus Kidney Transplant Recipient Donor Kidney Deceased Donor Chronic Allograft Nephropathy
The author would like to thank Dr Cathryn Jarvis, Dr Isabella Steffensen and Science & Medicine Canada for assistance with this manuscript. The preparation of this manuscript was supported by an unrestricted grant from Wyeth Canada. Dr Knoll has received honoraria and participated in clinical trials funded by Astellas, Novartis and Wyeth.
- 3.U.S. Renal Data System, USRDS 2006 Annual Data Report. Atlas of end-stage renal disease in the United States. Bethesda (MD): National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2006 [online]. Available from URL: http://www.usrds.org/adr.htm [Accessed 2007 May 10]
- 5.Canadian Organ Replacement Register (CORR), 2005. e-Statistics report on transplant, waiting list and donor statistics. 2005 summary statistics, January 1 to December 31, 2005. Ottawa: The Society; 2005 [online]. Available from URL: http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=reports_corrstats2005c_e [Accessed 2007 Feb 2]
- 6.Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients (OPTN/SRTR), 2006. 2006 OPTN/SRTR Annual Report. The U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients [online]. Available from URL: http://www.ustransplant.org/annual_reports/current/default.htm [Accessed 2007 Mar 6]
- 7.UNOS. Organ distribution: allocation of deceased kidneys. UNOS Policy 3.5.1. Definition of expanded criteria donor and standard donor. Richmond (VA): United Network for Organ Sharing, 2006 [online]. Available from URL: http://www.unos.org [Accessed 2007 Sep 14]
- 8.Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients [OPTN/SRTR], 2005. 2005 OPTN/SRTR Annual Report. The U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients [online]. Available from URL: http://www.ustransplant.org/annual_reports/current/default.htm [Accessed 2007 Jan 6]
- 12.Webster AC, Lee VW, Chapman JR, et al. Target of rapamycin inhibitors (TOR-I; sirolimus and everolimus) for primary immunosuppression in kidney transplant recipients. Cochrane Database Syst Rev 2006 Apr; 19(2): CD004290Google Scholar
- 17.Holdaas H, Fellstrom B, Jardine AG, et al. Assessment of LEscol in Renal Transplantation (ALERT) Study Investigators. Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo-controlled trial. Lancet 2003 Jun 14; 361(9374): 2024–31Google Scholar
- 26.Sierka K, Kumar MSA, Heifets M, et al. Successful minimization of immunosuppression (IM) and conversion to sirolimus (SLR) in kidney transplants recipients with post transplant lymphoproliferative disease (PTLD) and de novo nonskin malignancies (DNSM) [abstract no. 1331]. Am J Transplant 2004 Mar; 4 Suppl. 8: 523Google Scholar