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Preface

Preface for the OPTN/SRTR 2015 Annual Data Report

This Annual Data Report of the US Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR) is the twenty-fifth annual report and is based on data pertaining to the period 2004-2015. The title OPTN/SRTR 2015 Annual Data Report reflects the fact that the report covers the most recent complete year of transplants, those performed in 2015.

This publication was developed for the US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation, by the SRTR contractor, the Minneapolis Medical Research Foundation (MMRF), and the OPTN contractor, United Network for Organ Sharing (UNOS), under contracts HHSH25020150009C and 234-2005-37011C, respectively.

As the SRTR contractor, MMRF, through its Chronic Disease Research Group (CDRG), determined which data to present, conducted the required analyses, created the figures and tables, and drafted the text. As the OPTN contractor, UNOS reviewed the draft report and contributed to the content. This report is available at http://srtr.transplant.hrsa.gov. Individual chapters, as well as the report as a whole, may be downloaded.

Overview and Highlights

This Annual Data Report includes chapters on kidney, pancreas, liver, intestine, heart, and lung transplantation, a chapter presenting economic data (including data on Medicare payments), a chapter on deceased organ donation, and a special chapter on the new kidney allocation system. The organ-specific chapters include information on such topics as the waiting list, deceased donor organ donation, living donor organ donation, transplant, immunosuppression, outcomes, and pediatric transplant. When possible, similar data and formats are used for each chapter. However, this is not always possible because some data are not pertinent to all organs.

Graphical presentation of the data is emphasized: more than 300 figures, tables, and maps are included in the various chapters. They may be copied and pasted into slides from the HTML files on srtr.transplant.hrsa.gov. The data behind the graphics are downloadable from http://srtr.transplant.hrsa.gov in a spreadsheet format.

Maps in this report present data divided into quintiles. Below is a sample map. In this example, approximately one-fifth of all data points have a value of 58.5 or above. Ranges include the number at the lower end of the range, and exclude that at the upper end (e.g., the second range here is 25.8 to < 36.5). Numbers in the first and last boxes are the minimum and maximum of observed data.


Percentage of adults who underwent deceased donor kidney transplant within 5 years of listing in 2010 by DSA

Example Map. Approximately one-fifth of all data points have a value of 58.5 or above. Ranges include the number at the lower end of the range, and exclude that at the upper end (e.g., the second range here is 25.8 to <36.5). Numbers in the first and last boxes are the minimum and maximum of observed data.

Maps by donation service area (DSA) use DSA boundaries in effect at the end of 2015. Some DSAs include non-contiguous areas. If a DSA has no transplant program for a given organ, or no listings during the map's time frame, it is labeled "No data" on the map and shaded accordingly.

Milesone Dates in the Production of This Report

Data were cut: April 2016.
Data were analyzed: May 2016.

Methods

PRA and CPRA

For kidney and pancreas transplant recipients prior to December 1, 2007, panel-reactive antibody (PRA) at the time of transplant is the value of the most recently recorded PRA. If that value is missing, we use the peak historical PRA value known at the time of transplant. From December 2007 through October 2009, we incorporate calculated PRA (CPRA) if its value is greater than zero. Otherwise, we revert to the peak historical PRA value. From October 2009 to present, we use the CPRA value if it exists; otherwise we revert to the peak historical PRA value. CPRA may be equal to 0. A similar approach is used for PRA and CPRA among kidney and pancreas candidates.

For liver, intestine, heart, and lung transplant recipients, PRA at the time of transplant is the value of the most recently recorded PRA. If that value is missing, we use the peak historical PRA value known at the time of transplant.

Incidence

Incidence of posttransplant outcomes (diabetes, posttransplant lymphoproliferative disorder, etc.) is computed using competing risk methods. Outcomes observations are not censored at death. In prior years, most outcomes were censored at death, providing an artificially increased incidence of the outcome under consideration.

Graft Failure

Unless otherwise specified, "graft failure" refers to graft failure due to any cause, including death and retransplant. For kidney failure, this also includes return to maintenance dialysis. "Graft survival" similarly refers to the absence of all-cause graft failure. Graft failure is computed using competing risk methods.

Alive with Function

For a given year and organ type, counts of recipients alive with function include all recipients of that organ who underwent transplant prior to June 30 of the given year and who have no evidence of graft loss or death. Multi-organ recipients are counted once per organ. A heart-lung recipient, for example, is included in the counts of heart recipients and of lung recipients alive with function. A kidney-alone recipient who underwent transplant in January 2001 and who lost graft function in November 2010 is counted as alive with function every year from 2001 through 2010. Recipients who are lost to follow-up are assumed to be alive with a functioning graft until evidence, usually a death date, contradicts this assumption.

Rates by Subgroup

When rates are shown by subgroup (i.e., sex, race, primary cause of disease), the numerator and denominator are computed exclusively within those groups. For example, for pretransplant mortality by race group, the numerator for each race group is the number of deaths in that race group during the interval described. The denominator is the total waiting time within each race group in that same time interval. With the exception of age, when a characteristic is subject to change over time (i.e., MELD, PRA), a single candidate may contribute waiting time to several categories in a single year. In the case of transplant or death, the event will only be counted in the category at which it occurred (i.e., while candidate had PRA&ge80). Age is only assessed once a year; therefore, a candidate will contribute all of his or her waiting time to a single age category in a given yearly rate calculation, but may change age categories over time. For example, a waitlisted candidate who was aged 34 years on January 1, 2002, would be included in the 18-34 year age group in 2002, but if that candidate was still listed in 2004, he or she would be included in the 35-49 year age group.

Donor Risk Index

The kidney donor risk index (KDRI) and pancreas donor risk index (PDRI) are measures of donor quality based on donor factors.

KDRI1=exp{-0.0194 x [if age < 18yrs] x [age - 18yrs] + 0.0128 x [age - 40yrs] + 0.0107 x [if age > 50yrs] x [age - 50yrs] + 0.179 x [if African-American] + 0.126 x [if hypertensive] + 0.130 x [if diabetic] + 0.220 x [serum creatitine -1mg/dL] - 0.209 x [if serum creatinine > 1.5mg/dL] x [serum creatinine - 1.5mg/dL] + 0.0881 x [if cause of death = cerebrovascular accident] - 0.0464 x [(height - 170cm)/10] - 0.0199 x [if weight < 80 kg] x [(weight-80kg)/5] + 0.133 x [if DCD] + 0.240 x [if HCV+]}

PDRI2=exp{-0.1379 x [if female] - 0.03446 x [if age < 20yrs] x [age - 20yrs] + 0.02615 x [age - 28yrs] + 0.1949 x [if creatinine > 2.5mg/dL] + 0.2395 x [if African-American race] + 0.1571 x [if Asian race] - 0.0009863 x [BMI - 24] + 0.03327 x [if BMI > 25] x [BMI - 25] - 0.006074 x [height - 173cm] + 0.3317 x [if DCD] + 0.2102 x [if cause of death = cerebrovascular accident]}

Complete versions of these indices also include transplant factors, but the donor-specific indices we show in this report are limited to donor-specific factors. To convert the KDRI to a cumulative percentage scale (i.e., the kidney donor profile index [KDPI]), we used a reference population of all deceased donor kidneys recovered for transplant in the US in 2015. Kidneys recovered en bloc were counted once.

1Rao PS, Schaubel DE, Guidinger MK, Andreoni KA, Wolfe RA, Merion RM, Port FK, Sung RS. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation. 2009; 88(2): 231-236.

2Axelrod DA , Sung RS, Meyer KH, Wolfe RA , Kaufman DB. Systematic evaluation of pancreas allograft quality, outcomes and geographic variation in utilization. Am J Transplant. 2010; 10: 837-845.

Notes

Population Reported

Figure titles indicate adult or pediatric populations; if not specified, data include all patients of all ages. For lung data, patients aged 12 years or older are grouped with adults; figure titles specify the age ranges.

Unless otherwise specified, data in each organ-specific chapter include both isolated transplants and multi-organ transplants of the given type. For example, patients on the kidney transplant waiting list include those listed for an isolated kidney, kidney-pancreas, or any other organ combination that includes kidney.

Waitlist populations are reported at the person level. If a patient is listed at more than one center, we concatenate those records from the time of earliest listing to the time of latest removal. Patients listed, removed, (usually due to transplant), and subsequently relisted are counted separately per concatenated listing.

Age

Adult patients are defined as those aged 18 years or older for all organs except lung; lung allocation policy treats patients aged 12 years or older and adults similarly. For waitlist figures, age is defined at the time of first listing unless otherwise specified.

Race/ethnicity

Multi-racial patients are defined as other/unknown. When a given race group is not shown, it is included with other/unknown.

Expanded criteria donor kidneys

Data on willingness to accept an expanded criteria donor (ECD) kidney are available from 2003.

Pancreas data

Pancreas data encompass the three types of pancreas waiting lists or transplants: simultaneous kidney-pancreas (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA). Pancreata used for islet transplant are excluded.

MELD Score

MELD scores shown in figures and tables are allocation MELD scores, not calculated MELD scores, unless otherwise specified.

Lung allocation score

The lung allocation score (LAS) became available in 2005. Data by LAS are presented using the most recent LAS before December 31 of each year. In the case of transplant recipients, data by LAS are presented using the LAS at the time of transplant.

Data Requests

Requests for data can be made to SRTR at http://www.srtr.org or to OPTN at http://optn.transplant.hrsa.gov.

Websites

http://www.srtr.org a public website containing transplant program-specific reports, organ procurement organization (OPO)-specific reports, summary tables, archives of past reports, timelines for future reports, risk-adjustment models, methods, basic references for researchers who use SRTR data files, links to the current and past Annual Data Reports and their supporting documentation and data tables, answers to frequently asked questions, and other information.

https://securesrtr.transplant.hrsa.gov is a secure website that provides access to the prerelease program- and OPO-specific reports, survival spreadsheets, and other useful information. All individual authorized users from transplant programs and OPOs have their own unique logins for the secure site.

http://unos.org is a public website containing information on donation and transplantation, data collection instruments, data reports, education materials for patients and transplant professionals, policy development, and other information. This website also links to the OPTN website.

http://optn.transplant.hrsa.gov is a public website containing news, information, and resources about transplantation and donation, including transplant data reports; policy development; and related boards and committees. It also contains allocation calculators, a calendar of events, answers to frequently asked questions, and other information.

Contact Information

Patient Inquiries

888-894-6361 (toll free)

Research Inquiries

OPTN/UNOS requests: 804-782-4876 (phone); 804-782-4994 (fax)

SRTR data requests: 877-970-SRTR (toll free); 612-873-1644 (fax)

Media Inquiries

301-443-3376 (HRSA/Office of Communications)
804-782-4730 (OPTN)
877-970-SRTR (SRTR)

Federal Program Inquiries

HHS/HRSA/HSB/DoT
5600 Fishers Lane
Parklawn Bldg, Eighth Floor West
Rockville, MD 20857
301-443-7577

Abbreviations

BMI body mass index
CAKUT congenital anomalies of the kidney and urinary tract
CDC Centers for Disease Control and Prevention
CDRG Chronic Disease Research Group
CKD cystic kidney disease
CMV cytomegalovirus
COPD chronic obstructive pulmonary disease
CPRA calculated panel reactive antibody
DBD donation after brain death
DCD donation after circulatory death
DD deceased donor
DM diabetes mellitus
DoT Division of Transplantation
DSA donation service area
EBV Epstein-Barr virus
ECD expanded criteria donor
ECMO extracorporeal membrane oxygenation
ESRD end-stage renal disease
eGFR estimated glomerular filtration rate
FSGS focal segmental glomerulosclerosis
GN glomerulonephritis
HHS Health and Human Services
HIV human immunodeficiency virus
HLA human leukocyte antigen
HMO health maintenance organization
HRSA Health Resources and Services Administration
HSB Healthcare Systems Bureau
HTN hypertension
ICU intensive care unit
KAS kidney allocation system
KDPI kidney donor profile index
KDRI kidney donor risk index
LAS lung allocation score
LD living donor
LVAD left ventricular assist device
MELD model for end-stage liver disease
mTOR mammalian target of rapamycin
OPO organ procurement organization
OPTN Organ Procurement and Transplantation Network
ORPD organs recovered per donor
OTPD organs transplanted per donor
PAK pancreas after kidney transplant
PELD pediatric end-stage liver disease
PDRI pancreas donor risk index
PRA panel-reactive antibody
PTA pancreas transplant alone
PTLD posttransplant lymphoproliferative disorder
SCD standard criteria donor
SGS short-gut syndrome
SPK simultaneous pancreas-kidney transplant
SRTR Scientific Registry of Transplant Recipients
TAH total artificial heart
UNOS United Network for Organ Sharing
VAD ventricular assist device





The publication was produced for the U.S. Department of Health and Human Services, Health Resources and Services Administration, by the Minneapolis Medical Research Foundation (MMRF) and by the United Network for Organ Sharing (UNOS) under contracts HHSH250201500009C and 234-2005-37011C, respectively.

This publication lists non-federal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by the U.S. Department of Health and Human Services (HHS) or the Health Resources and Services Administration (HRSA). Neither HHS nor HRSA endorses the products or services of the listed resources.

OPTN/SRTR 2015 Annual Data Report is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Data are not copyrighted and may be used without permission if appropriate citation information is provided.

Pursuant to 42 U.S.C. § 1320b-10, this publication may not be reproduced, reprinted, or redistributed for a fee without specific written authorization from HHS.

Suggested Citations
Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2015 Annual Data Report. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration; 2016.
Abbreviated citation: OPTN/SRTR 2015 Annual Data Report. HHS/HRSA.

Publications based on data in this report or supplied on request must include a citation and the following statement: The data and analyses reported in the 2015 Annual Data Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients have been supplied by the United Network for Organ Sharing and the Minneapolis Medical Research Foundation under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. Government.

This report is available at http://srtr.transplant.hrsa.gov. Individual chapters, as well as the report as a whole, may be downloaded.