Kidney

OPTN/SRTR 2019 Annual Data Report: Kidney

Abstract

Despite the ongoing severe shortage of available kidney grafts relative to candidates in need, data from 2019 reveal some promising trends. After remaining relatively stagnant for many years, the number of kidney transplants has increased each year since 2015, reaching the highest annual count to date of 24,273 in 2019. The number of patients waiting for a kidney transplant in the United States was relatively stable, despite an increase in the number of new candidates added in 2019 and a decrease in patients removed from the waiting list owing to death or deteriorating medical condition. However, these encouraging trends are tempered by ongoing challenges. Nationwide, only a quarter of waitlisted patients receive a deceased-donor kidney transplant within 5 years, and this proportion varies dramatically by donation service area, from 15.5% to 67.8%. The non-utilization (discard) rate of recovered organs remains at 20.1%, despite a dramatic decline in the discard of organs from hepatitis C-positive donors. Non-utilization rates remain particularly high for Kidney Donor Profile Index ≥85% kidneys and kidneys from which a biopsy specimen was obtained. While the number of living-donor transplants increased again in 2019, only a small proportion of the waiting list receives living-donor transplants each year, and racial disparities in living-donor transplant access persist. As both graft and patient survival continue to improve incrementally, the total number of living kidney transplant recipients with a functioning graft is anticipated to exceed 250,000 in the next 1-2 years.

Over the past decade, the total number of pediatric kidney transplants performed has remained stable. Despite numerous efforts, living donor kidney transplant remains low among pediatric recipients with continued racial disparities among recipients. Congenital anomalies of the kidney and urinary tract remain the leading cause of kidney disease. While most deceased donor recipients receive a kidney from a donor with KDPI less than 35%, the majority of pediatric recipients had four or more HLA mismatches. Graft survival continues to improve with superior outcomes for living donor recipients.

Introduction

Kidney transplant provides significantly more quality-of-life and survival benefits than dialysis for the treatment of end-stage kidney disease, but maximizing access to transplant, reducing access disparities, and sustaining long-term allograft survival are ongoing challenges. A national urgency to increase access to kidney transplant received unprecedented support from the federal government in the July 2019 Advancing American Kidney Health Executive Order and ensuing national policy initiatives. The Annual Data Report is an opportunity to assess the state of kidney transplant and examine both positive patterns and unfavorable trends that warrant further monitoring and evaluation. Data are provided on adult and pediatric kidney transplant waiting lists, deceased and living donation, transplants, and outcomes.

Adult Kidney Transplant

Waiting List

In 2019, the number of candidates added to the waiting list surpassed that of 2018 (Figure KI 1, Table KI 5). Despite this increase in waiting list additions, the total number of patients on the list remained essentially stable, as it had for the last 4-5 years, following decades of steady annual increases (Figure KI 2, Table KI 5). The size of the waiting list remained stable, despite an increase in additions, due to an increase in both living and deceased donor transplants. Waiting list removals due to death or deteriorating medical condition declined in 2019 (Table KI 6). The trend of a gradual increase in the age of candidates on the waiting list over the last 10 years persisted (Figure KI 3). Candidates 50-64 years old remained the largest age-group on the waiting list, and the proportion of candidates aged ≥65 years continued to rise (Figure KI 3, Table KI 1). Men continued to comprise about 60% of the waiting list (Figure KI 4). Over the past 10 years, the proportion of Asian and Hispanic candidates gradually increased, accompanied by a decline in the proportion of white candidates (Figure KI 5). The proportion of candidates with a primary diagnosis of diabetes continued to rise, reaching 37.7% in 2019 (Figure KI 6).

Reflecting the increase in waiting list additions, the proportion of candidates prevalent on the wait list and waiting less than 1 year continued to increase in 2019 and now comprises greater than half of waitlisted candidates, while 10.4% on the waitlist on January 1, 2019 have been waiting ≥5 years (Figure KI 7). The proportion of candidates with high body mass index (BMI) also continued to increase, to more than a quarter of waitlisted candidates with a BMI of 30 to <35 kg/m² and 17.8% with a BMI of ≥ 35 kg/m² (Figure KI 8). Encouragingly, the proportion of candidates waitlisted before starting dialysis continued to increase, although 17% of those waitlisted had been on dialysis for 6 or more years (Figure KI 9). More than half of waitlisted candidates had blood type O, which remains the most common type (Figure KI 10). Nearly 12% of candidates had a previous transplant, a slight decline over the past decade (Figure KI 11).

The proportion of candidates willing to accept a high-Kidney Donor Profile Index (KDPI) kidney was relatively stable in 2019 compared to 2018, following a decline after implementation of the revised Kidney Allocation System (KAS) in December 2014 (Figure KI 12). Still, less than half of candidates aged 50-64 and less than two-thirds of candidates aged ≥65 years were willing to accept these kidneys (Figure KI 12), even though older patients are less likely than younger patients to undergo kidney transplant under the current KAS. Conversely, the proportion of candidates willing to accept a kidney from a hepatitis C virus (HCV)-positive donor steadily increased, correlating with availability of highly effective direct-acting antiviral agents (DAAs) and experience using DAAs to manage anticipated donor-derived infections (Figure KI 13). To date, the information on willingness to accept HCV-positive kidneys does not differentiate between donor HCV antibody (exposed) and nucleic acid (viremic) status.

Overall, deceased-donor kidney transplant (DDKT) rates rose again in 2019, after reaching a nadir in 2014 (Figure KI 14). This increase was noted across all age (Figure KI 15), racial, and ethnic groups (Figure KI 16). DDKT rates have been similar for white, black, and Hispanic patients after implementation of the revised KAS; however, rates remained lower for Asian candidates than for those of other ethnicities (Figure KI 16). DDKT proportions by calculated panel reactive antibody levels (cPRAs) remained dynamic in 2019, after a sharp increase in DDKT rates among patients with cPRAs of 98%-100% immediately after implementation of the revised KAS; the rate subsequently plateaued in this group and was similar to the rates among patients in most other cPRA groups in 2019 (Figure KI 18). The DDKT rate remained slightly higher in patients with cPRAs of 80%-98%, at 20.8 transplants per 100 waitlist-years, compared with 14.4-16.7 transplants per 100 waitlist-years in the other cPRA groups (Figure KI 18). DDKT rates have increased more in blood type AB patients over the past 5 years than in those with blood types A, B, and O (Figure KI 19); rates have not increased in blood type B candidates relative to other blood types despite the revised KAS allowing allocation of A2 and A2B kidneys to B candidates. In 2019, DDKT rates increased across the spectrum of waiting times, although the rise continued to be largest among patients on the waitlist for more than 5 years, likely reflecting the credit, under the KAS revision, allocated for time on dialysis before waitlisting (Figure KI 20). DDKT rates were nearly identical between men and women in 2019 (Figure KI 21) and remained slightly higher among residents of non-metropolitan than metropolitan areas Figure KI 22).

For patients waitlisted in 2016, 36.5% were still waiting in 2019; 23.0% had undergone DDKT,13.5% had undergone living-donor kidney transplant (LDKT), 6.8% died, and 20.1% were removed from the waiting list (Figure KI 23). Among candidates listed in 2018, 16.8% of underwent DDKT within 1 year, and 25.3% of those listed in 2016 underwent DDKT within 3 years. Among candidates listed in 2014, 27.7% underwent DDKT within 5 years, and 34.4 % of those listed in 2009 underwent DDKT within 10 years (Figure KI 24). The median time to transplant for candidates has not been calculable for more than a decade, because 50% of candidates on the waiting list have not undergone transplant since 2008. The proportion of patients listed in 2014 who underwent DDKT within 5 years continued to vary greatly by donation service area (DSA), from 15.5% in locations with long waiting times to 67.8% in regions with shorter waiting times (Figure KI 25). Notably, pretransplant mortality continued a downward trend in 2019, reaching its lowest point in 10 years across age, race and ethnicity, sex, reasons for kidney failure, blood-type and metropolitan/non-metropolitan residence (Figure KI 27, Figure KI 28, Figure KI 29, Figure KI 30, Figure KI 31, Figure KI 32, Figure KI I 33), as well as among both active and inactive waitlisted patients (Figure KI 34). However, waiting list mortality also varied greatly by region, from 1.29 to 7.02 deaths per 100 waitlist-years (Figure KI 35). Deaths within 6 months of removal from the waiting list increased in 2019, but this increase was a return to rates seen in 2016 and before (Figures KI 36, Figure KI 37, Figure KI 38) and, therefore, may not necessarily reflect a change in practices for removing patients deemed too sick to undergo transplant.

Deceased Donation

In another positive trend, the count of deceased donors from whom at least one kidney was recovered continued to increase in 2019 (Figure KI 39), particularly among donors aged 30 years and older (Figure KI 40). Reflecting the availability of DAAs for HCV, the count and proportion of HCV-positive deceased donors from whom kidneys were recovered also increased in 2019 (Figure KI 41, Figure KI 45). The sex, race, and ethnicity distribution of deceased kidney donors remained largely unchanged over the past decade (Figure KI 43, Figure KI 44). The proportion of deceased-donor kidneys recovered but not transplanted remained at 20.1% in 2019, despite the persistent unmet need for transplants among some candidates on the waiting list (Figure KI 47). Rates of non-utilization were highest for kidneys recovered from donors ≥55 years old (Figure KI 48) and those with diabetes, hypertension, or high BMI (Figure KI 49, Figure KI 52, Figure KI 53). Recovered kidneys from which biopsies were obtained continued to have stable but high rates of discard (Figure KI 55), despite a lack of evidence that biopsy findings correlate well with posttransplant outcomes. The proportion of recovered but discarded HCV-positive kidneys continued to decline sharply starting in 2014; notably, in 2019, HCV-antibody-positive kidneys were discarded at nearly the same rates as HCV-antibody-negative kidneys (Figure KI 57). A slightly lower proportion of kidneys with increased infection risk were discarded than those with standard infection risk, perhaps because kidneys with high infection risk are often otherwise of high quality and low KDPI (Figure KI 58). KDPI >85% kidneys continued to represent most discarded kidneys (Figure KI 60). However, the average Kidney Donor Risk Index (KDRI) of discarded kidneys continued to rise in 2019 (Figure KI 62), suggesting that high-quality kidneys were not being discarded. The proportion of kidneys recovered from patients who died of anoxia continued its linear increase in 2019, amid the ongoing opioid epidemic (Figure KI 64).

Living Donation

After a steady decline in living donation from 2005 to 2014 followed by a plateau, the number of LDKTs increased progressively from 2017 to 2019, reaching the highest annual count to date of 6,867 (Figure KI 74). While reflecting important progress, only a small proportion of the waiting list undergoes LDKT each year. Future years will reveal whether this upward trajectory will continue, although the disruption of LDKT practice related to the COVID-19 pandemic in 2020 must be considered in the assessment of next year’s trends. The proportion of donors aged ≥ 55 years continued to rise, correlating with improved procedural safety and increased concern for the long-term risks of kidney donation in some younger adults (Figure KI 66). In 2019, the proportion of living kidney donors that were female rose to a peak of 65.2% (Figure KI 67). The racial and ethnic composition of living donors in 2019 was stable compared with 2018, with 70.7% white, 14.5% Hispanic, and 8.8% black, although this reflects a decline in the proportion of Black living donors, from 12.0% in 2010 (Figure KI 68). Similar to recent years, 22.8% of living donors were obese, based on BMI >30 kg/m² (Figure KI 72). Reported complications and hospitalizations after living-donor nephrectomy were uncommon (Figure KI 70, Figure KI 71).

Transplants

After remaining relatively stagnant for many years, the number of kidney transplants increased each year starting in 2015, reaching the highest annual count to date of 24,273 in 2019 (Figure KI 73). Increases occurred across recipient age, sex, race, and cause of kidney disease (Figure KI 75, Figure KI 76, Figure KI 77, Figure KI 78). Demographic differences in transplant recipients by organ donor type are notable, including persistent disparities in access to LDKT. While 31.5% of waitlisted candidates were Black (Figure KI 5), Black patients comprised only 13.1% of LDKT recipients, versus 32.8% of DDKT recipients in 2019 (Table KI 8). White patients comprised 37.9% of the waiting list (Figure KI 5) but made up 63.9% of LDKT recipients and 38.0% of DDKT recipients (Table KI 8). Most LDKT recipients (54.0%) had private insurance at the time of transplant, while 67.7% of DDKT recipients were Medicare beneficiaries (Table KI 8). LDKT recipients tended to have less dialysis time and lower cPRAs than DDKT recipients (Table KI 9). Proportions of DDKTs versus LDKTs were similar by metropolitan and non-metropolitan place of residence and distance from transplant centers (Table KI 8) and similar to the proportions of these characteristics among waiting list patients on Dec 31, 2019 (Table KI 1). Nearly 90% of DDKTs and 90.8% of LDKTs were performed in first-time recipients (Table KI 10). In 2019, 7.2% of deceased donors with at least one kidney transplanted were HCV antibody-positive, and 4.5% were HCV nucleic acid-positive (Table KI 11). Among living donors, 0.6% were positive for HCV antibodies (Table KI 12).

The proportion of DDKTs classified as low KDPI (0%-<20%) declined over the past 3 years, to 22.6% in 2019, while the proportion of DDKT classified as KDPI 35%-85% rose to 53.3%, and KDPI ≥85% transplant remained stable, at 7.6% (Figure KI 79). The number of simultaneous kidney-liver transplants in adults more than doubled from 354 in 2009 to 723 in 2016, and has remained at that level since 2016 (Figure KI 80). Induction immunosuppression was used in 91.9% of kidney transplants (Figure KI 81). The choice of maintenance immunosuppression at hospital release remained stable, with most patients receiving tacrolimus and mycophenolate mofetil-based regimens (Figure KI 82). Nearly 30% received steroid-free regimens, a relatively stable proportion, over the past decade. As noted previously, the proportion of DDKTs in recipients with cPRAs of 98%-100% increased sharply after the KAS revision and then gradually declined, from 12.5% in 2015 to 7.8% in 2019 (Figure KI 83). As practice volume expanded, the proportion of transplants performed at centers with volume of at least 250 transplants per year grew sharply over the past 5 years, from 13.8% in 2014 to 31.6% in 2019 (Figure KI 87).

Outcomes

Estimated glomerular filtration rate at 12 months, an early surrogate allograft outcome, was 45 mL/min/1.73m² or higher for 65.5% of DDKT recipients (Figure KI 105) and 77.7% of LDKT recipients (Figure KI 106) in 2018. Overall, 7.0% of adult kidney transplant recipients experienced acute rejection by 1 year, including 9.1% of recipients aged 18-34 and 6.1% of recipients ≥65 years (Figure KI 108). Acute rejection at 1 year occurred in 8.4% of those who received interleukin-2 (IL-2)-receptor antibody induction, compared with 6.9% who received T-cell-depleting induction and 6.6% of the small subgroup whose conditions were managed without induction (Figure KI 109).

Death-censored graft failure after DDKT remained stable in 2018 compared with 2017 (Figure KI 89). In the most recent reporting year, 6-month and 1-year LDKT death-censored graft failure was stable, while 3- to 10-year graft survival showed small improvements (Figure KI 92). For both donor types, 5-year graft survival was lowest among patients with diabetes as the cause of kidney disease (Figure KI 95, Figure KI 103). For both donor types, graft survival was similar in recipients who resided in metropolitan compared to non-metropolitan ZIP codes (Figure KI 100, Figure KI 104).

Among DDKTs, 5-year graft survival was 64.6% with KDPI >85% compared with 83.9% with KDPI ≤20%, and 82.1% with KDPI 21%-35% (Figure KI 96). Five-year graft survival did not differ by donor type after circulatory death (Figure KI 97). Graft survival was lower for kidneys from which biopsy specimens were obtained at transplant (Figure KI 98); while selection likely contributes to this difference, as noted previously, the utility of procurement biopsy in informing appropriate organ use warrants further study. Among LDKT recipients, 5-year graft survival was 80.2% in those aged ≥65 years, compared with 90.7% in recipients aged 35-49 years (Figure KI 101). 5-year living donor graft survival was highest among Asians and lowest among Blacks (Figure KI 102).

The total number of kidney transplant recipients alive with a functioning graft, including pediatric recipients, reached 244,000 in 2019, part of a trend that will likely exceed 250,000 in the next 1-2 years (Figure KI 107). Trends in adult patient survival closely mirrored those of graft survival (Figure KI 113, Figure KI 114, Figure KI 115, Figure KI 116, Figure KI 117, Figure KI 118, Figure KI 119, Figure KI 120, Figure KI 121).

Pediatric Kidney Transplant

Waiting List

In 2019, 1030 pediatric candidates were added to the kidney transplant waiting list (Figure KI 122). The number of prevalent pediatric candidates (listed before age 18 years) has been steadily increasing and reached 2579 in 2019 (Figure KI 123). By age, candidates aged 12-17 years accounted for the largest proportion of those waiting, at 58.4%, compared to those aged 6-11 years at 20.7%, and younger than 6 years at 20.9% (Figure KI 124). Over the past decade, the age of pediatric waitlist candidates has shifted, with a slight increase for those aged 1-5 and 6-10 years and a slight decrease for those aged 11-17 years (Figure KI 124, Table KI 14). Proportions of candidates with congenital anomalies of the kidney and urinary tract (CAKUT) as primary cause of disease increased from 27.2% in 2009 to 37.2% in 2019, and proportions with glomerulonephritis and focal segmental glomerulosclerosis (FSGS) decreased (Table KI 15). Almost 70% of pediatric candidates waiting as of December 31, 2019, had a cPRA less than 1% (Table KI 15). The proportion of pediatric candidates waiting for re-transplant decreased over the decade from 26.6% in 2009 to 13.4% in 2019 (Table KI 16). Multi-organ listing remained uncommon; only 1.4% of pediatric candidates were awaiting multi-organ transplant at the end of 2019 (Table KI 16).

Sixty-five percent of pediatric candidates on the waiting list had been waiting for less than 1 year (Figure KI 128). Of the 1024 candidates removed from the waiting list in 2019 (Table KI 17), 610 (59.6%) received a deceased donor kidney, 262 (25.6%) received a living donor kidney, 18 (1.8%) died, 6 (0.1%) were removed from the list because their condition improved, and 10 (0.1%) were considered too sick to undergo transplant (Table KI 18). Among patients newly listed in 2016, 51.7% underwent deceased donor transplant within 3 years, 24.5% underwent living donor transplant, 14.2% were still waiting, 8.3% were removed from the list for other reasons, and 1.3% died (Figure KI 130). The rate of deceased donor transplant among pediatric waitlisted candidates decreased over the past decade to 38.5 transplants per 100 waitlist-years in 2019, compared with a peak of 52.0 transplants per 100 waitlist-years in 2009 (Figure KI 131). Post-KAS, transplant rates changed based on recipient age (Figure KI 132). In 2019, transplant rates were highest for candidates aged 6-11 years (48.8 per 100 waitlist-years), followed by candidates aged 1-5 years (37.4), 12-17 years (36.0), and younger than 1 year (15.0), though the rate among candidates younger than 1 is variable due to small numbers of transplants performed on this age group (Figure KI 132). The KAS priority for highly sensitized candidates continued to result in higher transplant rates than pre-KAS for highly sensitized pediatric candidates in 2019 (Figure KI 134). In contrast to mortality among candidates waiting for other organs, pretransplant mortality among pediatric kidney transplant candidates remained low: 1.2 deaths per 100 waitlist-years in 2019 (Figure KI 136).

Transplant

The total number of pediatric kidney transplants performed remained steady in 2019 at 763 (Figure KI 140). The continued decrease in living donor kidney transplants is of great concern of the pediatric community. In 2019, only 32% of pediatric kidney transplants were from living donors (Figure KI 141). The number of related living donors decreased dramatically over the past decade, but the number of unrelated directed transplants performed in pediatric candidates reached its highest at 73 in 2019 (Figure KI 143). Children aged younger than 6 years made up the largest group of living donor kidney recipients (47.0%) (Figure KI 144).

In 2019, 34 programs were performing only pediatric kidney transplants, compared with 135 performing only adult transplants and 59 performing transplants in both adults and children (Figure KI 145). In 2019, 15.1% of transplants in candidates aged younger than 18 years were performed at programs with volume of five or fewer pediatric transplants in that year (Figure KI 146). Most pediatric recipients who underwent transplant between 2017 and 2019 were aged 11-17 years, 61.4% among deceased donor recipients and 49.3% among living donor recipients (Table KI 19). The racial distribution differed for deceased and living donor transplant recipients; 69.7% of living donor recipients were white, 8.5% were black, 16.5% were Hispanic, and 3.3% were Asian. In contrast, 36.6% of deceased donor recipients were white, 22.6% were black, 32.7% were Hispanic, and 4.7% were Asian (Table KI 19). Private insurance was more common among living donor recipients (55.3%) and Medicare/Medicaid among deceased donor recipients (66.7%, Table KI 19). Most deceased donor recipients (95.8%) underwent transplant with a kidney from a donor with KDPI less than 35% (Table KI 21). The majority of pediatric recipients of a deceased donor kidney, 84%, had four or more HLA mismatches compared with only 27% of living donor recipients (Figure KI 149).

The combination of a donor who was positive for cytomegalovirus and a pediatric recipient who was negative occurred in 37.7% of deceased donor transplants (Table KI 22) and in 30.7% of living donor transplants (Table KI 23). The combination of a donor who was positive for Epstein-Barr virus (EBV) and a pediatric recipient who was negative occurred in 38.2% Table KI 22) of deceased donor transplants and in 52.5% of living donor transplants (Table KI 23).

Immunosuppressive Medication Use

Almost all (95.6%) pediatric kidney transplant recipients reported some induction use in 2019 (Figure KI 147). The most common maintenance immunosuppression regimens at hospital discharge were tacrolimus, MMF, and steroids in 59.5% of recipients, followed by tacrolimus and MMF in 33.2% (Figure KI 148).

Outcomes

All-cause graft failure after kidney-alone deceased donor transplant in pediatric recipients was 1.2% at 6 months and 1.6% at 1 year for transplants in 2017-2018, 6.3% at 3 years for transplants in 2015-2016, 15.8% at 5 years for transplants in 2013-2014, and 35.4% at 10 years for transplants in 2009-2010 (Figure KI 153). Corresponding graft failure after living donor transplant was 0.8% at 6 months and 0.8% at 1 year for transplants in 2017-2018, 3.3% at 3 years for transplants in 2015-2016, 5.7% at 5 years for transplants in 2013-2014, and 25.0% at 10 years for transplants in 2009-2010 (Figure KI 156). For the cohort of recipients who underwent transplant in 2012-2014, 1- and 5-year graft survival was 95.7% and 83.2% for deceased donor recipients and 96.9% and 91.4% for living donor recipients (Figure KI 161). In the 2017-2018 cohort, the overall incidence of acute rejection within the first year was 11.1%, with some variation by age: lowest for those aged 6-10 years (8.2%) (Figure KI 162). Short-term renal function, measured by eGFR, improved substantially over the past decade. Proportions of living donor and deceased donor recipients from 2018 with eGFR 90 mL/min/1.73 m² or higher at 12 months posttransplant were 26.7% (increased from 19.7% in 2008) and 31.9% (increased from 22.3%), respectively (Figure KI 151, Figure KI 150). Incidence of posttransplant lymphoproliferative disorder among EBV-negative recipients from 2007-2017 was 3.5% at 5 years posttransplant, compared with 0.8% among EBV-positive recipients (Figure KI 163). Overall 5-year patient survival among pediatric deceased donor kidney transplant recipients in 2012-2014 was very high, at 97.1% (Figure KI 165) with little variability by age (Figure KI 166).

Figure List

Waiting list

Deceased donation

Living donation

Figure KI 65. Number of living kidney transplants by donor relation
Figure KI 66. Living kidney donors by age
Figure KI 67. Living kidney donors by sex
Figure KI 68. Living kidney donors by race
Figure KI 69. Intended living kidney donor procedure type
Figure KI 70. Rehospitalization among living kidney donors, 2014-2018
Figure KI 71. Kidney complications among living kidney donors, 2014-2018
Figure KI 72. BMI among living kidney donors

Transplant

Figure KI 73. Overall kidney transplants
Figure KI 74. Total kidney transplants by donor type
Figure KI 75. Total kidney transplants by age
Figure KI 76. Total kidney transplants by sex
Figure KI 77. Total kidney transplants by race
Figure KI 78. Total kidney transplants by diagnosis
Figure KI 79. Kidney transplants by kidney donor profile index (KDPI)
Figure KI 80. Total kidney-liver transplants by adult vs. pediatric age groups
Figure KI 81. Induction agent use in adult kidney transplant recipients
Figure KI 82. Immunosuppression regimen use in adult kidney transplant recipients
Figure KI 83. Peak C/PRA at time of kidney transplant in adult deceased donor recipients
Figure KI 84. Peak C/PRA at time of kidney transplant in adult living donor recipients
Figure KI 85. Total HLA A, B, and DR mismatches among adult kidney transplant recipients, 2015-2019
Figure KI 86. Annual adult kidney transplant center volumes by percentile
Figure KI 87. Distribution of adult kidney transplants by annual center volume

Outcomes

Pediatric transplant

Table List