OPTN/SRTR 2017 Annual Data Report: Introduction

Introduction for the OPTN/SRTR 2017 Annual Data Report

This introduction provides a brief overview of trends in waitlist and transplant activity for solid organs in the United States. Explanations of trends vary substantially by organ type, and details can be found in the respective organ-specific Annual Data Report chapters. The 2017 Annual Data Report covers transplants through December 31, 2017. Its production was delayed due to a period of incomplete death data during 2017; analyses could not begin until data were complete.

Trends in Kidney Transplantation

In 2017, encouraging trends continued regarding supply and demand for kidney transplants, with increases in total, deceased donor, and living donor transplants, and a noteworthy decline in the number of active candidates listed for deceased donor transplant since 2015 (Figure INT 1). Between 2006 and 2014, the number of active candidates grew by 26.8%, an annual rate of 3.0%. However, a 2.1% decline occurred between 2015 and 2016, and a 1.5% decline between 2016 and 2017. These declines in numbers of patients on the deceased donor waiting list were due to more transplants performed and not to fewer patients added. Indeed, between 2016 and 2017, the number of new patients (active and inactive) added to the waiting list grew by 0.5% (Figure INT 3).

The number of kidney transplants, including recipients of all ages and kidneys transplanted with another organ, grew by 3.9% between 2016 and 2017, from 19,858 to 20,638 (Figure INT 5). This increase was due to a 4.2% increase in deceased donor transplants, from 14,229 to 14,826, and a 3.3% increase in living donor transplants, from 5629 to 5812. Reasons for the increase in deceased donor transplants are speculative, but it is likely due in part to deaths from the opioid epidemic causing increased availability of deceased donor organs. However, this would not explain the encouraging increase in living donor transplants. Again, the demand for kidney transplants, as reflected in the numbers of additions to the deceased donor waiting list, has changed little.

Although the increase in kidney transplants is encouraging, many candidates remain on the waiting list, despite the fact that many kidneys recovered for transplant are not transplanted (Figure INT 7). The proportion of kidneys recovered and not transplanted trended gradually upward between 2006 and 2016, and in 2016 a record 20.0% of recovered kidneys were not transplanted. Between 2016 and 2017, this proportion declined by 5.2%, to 18.9%. However, measures likely can still be taken to find candidates suitable for many if not most of the kidneys that are currently not transplanted.

Patient survival after kidney transplant exceeds survival after all other organ transplants except pancreas (Figure INT 8). Among all kidney transplant recipients in 2008-2012, 1-year patient survival was 97.3%; however, 5-year patient survival was 89.7%, indicating room for improvement.

Trends in Pancreas Transplantation

Pancreas transplant is the only type of solid organ transplant that has consistently declined over the past several years. Between 2008 and 2017, numbers of active candidates on the waiting list for simultaneous kidney-pancreas (SPK) transplant declined by 30.5%, from 1235 to 858, and on the waiting list for pancreas without kidney transplant by 49.5%, from 434 to 219 (Figure INT 2). Numbers of additions to the waiting lists also declined over the same time period, by 20.4% from 1472 to 1171 for simultaneous kidney-pancreas, and by 48.6% from 710 to 365 for pancreas transplant alone (Figure INT 4). Between 2016 and 2017 small decreases occurred in the numbers listed for SPK (2.2%) and pancreas transplant alone (12.4%), while the numbers added to the waiting list increased 4.6% for SPK and decreased 2.7% for pancreas transplant alone. Numbers of pancreas transplants declined every year between 2008 and 2014, from 1229 to 954. Since 2014, the number of pancreas transplants has remained relatively stable, and was 1002 in 2017 (Figure INT 6). Numbers of pancreata recovered but not transplanted have declined, reflecting declines in demand (Figure INT 7). Patient survival after pancreas transplant in 2017 was virtually identical to patient survival after kidney transplant (Figure INT 8).

Trends in Liver Transplantation

Liver transplant, the second most common type of solid organ transplant in the US, is another success story. The number of candidates on the waiting list declined by 4.8% between 2016 and 2017 (Figure INT 1), despite a 1.3% increase in the number of additions to the list (Figure INT 3). The number of liver transplants increased by 3.1% between 2016 and 2017, and 8082 in 2017 was a record number; numbers of liver transplants declined between 2006 and 2012 by 5.9% from 6651 to 6256, but increased by 25.2% between 2013 and 2017, from 6455 to 8082 (Figure INT 5). The increase between 2016 and 2017 was due to increases in deceased donor (by 2.9%, from 7496 to 7715) and living donor (by 6.4%, from 345 to 367) transplants. The most living donor liver transplants since 2001 occurred in 2017. Percentages of deceased donor livers recovered but not transplanted have declined steadily, from 11.2% in 2008 to 8.9% in 2017 (Figure INT 7). Patient survival after liver transplant between 2008 and 2012 was 89.3% at 1 year and 76.5% at 5 years (Figure INT 8).

Trends in Intestine Transplantation

The number of intestine transplants remained small in 2017, with 109 performed, the lowest number since 106 in 2012 (Figure INT 6). Patient survival after intestine transplant between 2008 and 2012 was 75.2% at 1 year and 55.5% at 5 years (Figure INT 8).

Trends in Heart Transplantation

Numbers of candidates on the heart transplant waiting list grew considerably until 2014, but has been relatively stable since (Figure INT 2). Between 2016 and 2017, the waiting list declined by 4.2%. Numbers of transplants (Figure INT 6) have increased markedly, more than keeping pace with additions to the waiting list (Figure INT 4); transplants increased by 49.5% from 2190 in 2008 to 3273 in 2017. Patient survival after heart transplants performed between 2008 and 2012 was 90.0% at 1 year and 78.6% at 5 years (Figure INT 8).

Trends in Lung Transplantation

Increases in numbers of lung transplants matched the pace of increases in numbers of heart transplants, and both exceeded the pace of increases in numbers of transplants of other organs. Between 2008 and 2017, the number of lung transplants increased by 64.7%, from 1505 to 2478 (Figure INT 6), and between 2016 and 2017 by 5.7%. The number of active candidates on the lung transplant waiting list at year-end grew by 2.5% over the past decade (Figure INT 2), while the number of active and inactive new additions increased by 48.0% over the same period (Figure INT 4). The proportion of lungs recovered for transplant but not transplanted increased between 2016 and 2017, but remained relatively low, 6.8% in 2017 (Figure INT 7).

Summary

Remarkable increases in solid organ transplants occurred in the US over the past 5 years, including increases in kidney, liver, heart, and lung transplants. Numbers of pancreas and intestinal transplants remained relatively low, but generally met the demand of declining numbers on the respective waiting lists. The increases in transplants are mostly due to increases in deceased donor transplants, although an increase in living donor kidney transplants is also encouraging. The number of deceased donor kidneys recovered for transplant but not transplanted remains a challenge.

Figure List

Intro