OPTN/SRTR 2017 Annual Data Report: Kidney

Abstract

Many positive trends in kidney transplantation were notable in 2017. Deceased donor kidney transplant rates and counts continued to rise, the kidney transplant waiting list declined for the third year in a row after decades of growth, and both short- and long-term allograft survival continued to improve year over year. In total, more than 220,000 patients were living in the United States with a functioning allograft. With 3 years of data available since implementation of the new kidney allocation system, better prediction of longer-term results of the allocation policy changes became possible. The data also reveal several areas in need of improvement and attention. Overall, the challenge of providing adequate access to kidney transplant persisted nationally, with additional dramatic regional variation. The proportion of living donor kidney transplants in both adults and children continued to fall, and racial disparities in living donor kidney transplant grew in the past decade.

Introduction

The 2017 Annual Data Report kidney chapter is an opportunity to examine long-term trends in kidney transplantation, as well as short-term changes since implementation of the new kidney allocation system (KAS) in late 2014. Three years of data since KAS implementation allows us to highlight where the kidney transplant community should focus its attention toward ongoing improvement in access, equity, and outcomes in kidney transplantation. The 2017 data show continuing gains in short- and long-term unadjusted allograft survival. The number of adult patients on the waiting list declined for the third year in a row after decades of consistent growth, with a parallel increase in deceased donor kidney transplants. Likewise, the number of deceased donor transplants increased for pediatric candidates, after nearly a decade of stagnation. Pediatric patients continue to experience an overall high rate of deceased donor transplant compared with adults. Short- and long-term outcomes also continued to improve.

However, geographic disparities in access to kidney transplant remained evident, as did racial disparities in living donor kidney transplant and in both living and deceased donor allograft survival. The proportion of adults and children undergoing living donor kidney transplants continued to fall, despite nearly 9000 people either dying or being removed from the waiting list due to deteriorating condition annually. Unlike the adult waiting list, the pediatric waiting list continued to grow, and the deceased donor transplant rate has declined in the past decade, but remains high compared with the rate for adults. Highly sensitized pediatric patients experience nearly the same deceased donor transplant rate as highly sensitized adults, in contrast to other demographic comparisons. As with adults, living donor transplant also declined as a proportion of pediatric kidney transplant.

In summary, the 2017 data show ongoing successes and opportunities to improve as the transplant community continues to work to improve access and outcomes for patients with end-stage kidney disease.

Adult Kidney Transplant

Waiting List

For the third year in a row, after a peak of nearly 100,000 in 2014, the number of patients on the kidney transplant waiting list fell to 92,685 in 2017 (Figure KI 2). Unlike in 2015, when numbers of prevalent inactive candidate decreased but numbers of prevalent active candidates increased, both numbers decreased in 2017. In total, 30,918 adult candidates were added to the list, and 33,891 were removed (Table KI 5). Deceased donor transplants increased from 13,501 in 2016 to 14,077 in 2017 (Table KI 6). The number of new inactive listings continued to trend down since the new KAS, which eliminated the utility of listing as inactive for candidates already on dialysis and undergoing pretransplant workups (Figure KI 1); however, incomplete workup remained the cited reason for inactive listing for nearly two-thirds of new patients on the list (Table KI 1). Unfortunately, death or deteriorating medical condition remained common reasons for removal from the list, accounting for more than a quarter of removals, and reflecting the ongoing organ shortage despite gains in numbers of deceased donor transplants (Table KI 6). Removals for other reasons were also frequent at more than 13.4% of all removals; more specific data on the reasons for removal may be warranted to ensure that clinically relevant trends are not missed.

Determining racial, sex, and geographic disparities in access to the waiting list is difficult given limited data on the proportions of patients in the United States with advanced chronic kidney disease. However, trends in the characteristics are interesting. The proportion of patients aged 65 years or older continued to increase, from 16.2% in 2007 to 23.1% in 2017 (Table KI 2, Figure KI 3). Men continued to outnumber women at 61.1% of the list, a generally stable or slightly increased proportion over more than 10 years. While overall the racial composition changed little, Hispanic patients have comprised a slowly but steadily increasing proportion, more than 20% of the list in 2017 (Figure KI 5, Table KI 2). Proportions of waitlisted candidates with calculated panel-reactive antibodies (cPRA) 98%-100% continued to decline, from 9.4% in 2013 to 8.2% in 2016 and 7.2% in 2017, after increasing annually prior to 2014. This trend likely reflects more transplants for these candidates under the new KAS (Figure KI 8, Table KI 3). Diabetes as a cause of kidney disease continued to increase, to 37.1% of waitlisted candidates (Table KI 3, Figure KI 6). Despite candidates becoming increasingly older with higher prevalence of diabetes and longer dialysis duration, a concerning post-KAS trend was decreasing proportions willing to accept high-kidney-donor-profile-index (KDPI) kidneys, from 49.9% in 2014 to 45.1% in 2017 (Figure KI 10); these proportions had been increasing prior to KAS. The decline was even more dramatic among candidates aged 65 years or older, from 66.9% in 2011 to 59.8% in 2017 (Figure KI 11). The proportion of candidates with at least one prior kidney transplant also declined, from 16.3% on December 31, 2007 to 12.1% in on December 31, 2017 (Table KI 4).

Time on the waiting list showed interesting post-KAS trends in addition to concerning long-term trends. Overall, waiting time increased, with a linear increase in the number of candidates waiting for 5 or more years (Figure KI 7). Given the increased risk of allograft loss with higher waiting time, this trend may slow gains in long-term allograft survival. More than 20% of listed candidates had been on dialysis for at least 6 years before their most recent listing (Figure KI 9). Conversely, the proportion of candidates on the list for less than 1 year decreased post-KAS, possibly reflecting credit for time on dialysis prior to listing.

Deceased donor transplant rates, or transplants per 100 waitlist-years, increased for all patients across age, race, and blood type, but a few notable trends post-KAS warrant discussion. The deceased donor transplant rate increased dramatically for candidates with cPRA 98%-100% in the first year post-KAS, but then leveled off as rates increased for all other cPRA groups (Figure KI 15). After an initially large increase in 2015 for candidates aged 18-34 years, increases since then have been similar to increases for all other age groups (Figure KI 12). Rates for candidates listed for less than 1 year increased markedly after 2014, again likely reflecting more transplants for newly listed candidates who had been on dialysis for many years (Figure KI 17). Finally, while transplant rates remained slightly lower for candidates living in metropolitan vs. nonmetropolitan zip codes (Figure KI 18), rates were lower overall for candidates living 150-<250 nautical miles (NM) from their transplant programs, compared with candidates living either closer than 150NM or 250 NM or further away (Figure KI 19).

Median time to transplant for kidney transplant candidates has not been calculable for more than a decade because half the list had not undergone transplant; as of 2017, only 47.0% of candidates who listed in 2007 had undergone transplant (Figure KI 21). Nationally, for candidates listed in 2014, 42.4% were still waiting in 2017; 21.9% underwent deceased donor transplant, 14.9% underwent living donor transplant, 8.1% died, and 12.7% were removed from the list for other reasons (Figure KI 20). The percentage of patients who underwent deceased donor transplant within 5 years varied from 10.2% to 80.3% across donation service areas (DSAs) (Figure KI 22); waitlist mortality rates also varied, ranging from 1.4 to 9.4 per 100 patient-years across DSAs (Figure KI 29). Overall and by age, race, and diagnosis, mortality rates for listed patients generally decreased over the past 10 years (Figure KI 24, Figure KI 25, Figure KI 26, Figure KI 27, Figure KI 28).

Deceased Donation

Data from 2017 show overall continued increases in numbers of deceased donors, particularly those aged 18-34 years (Figure KI 32, Figure KI 33). Anoxia has surpassed head trauma as the most common cause of donor death (Figure KI 48), likely reflecting the opioid crisis. In 2017, 18.9% of kidneys were discarded, i.e., recovered for transplant and not transplanted (Figure KI 37). Discard rates remained higher for older donors (Figure KI 36) and donors with diabetes (Figure KI 37), but were similar for Public Health Service increased and non-increased risk kidneys (Figure KI 42). Implementation of the new KAS raised concerns about increasing discard rates due to increased geographic sharing and longer cold ischemia times. While the rate of discards appeared to be increasing for the 2 years post-KAS for donors aged 65 years or older or with diabetes (Figure KI 36, Figure KI 37), 2017 rates were similar to 2016 rates. However, the discard rate for high-KDPI (>85%) kidneys appeared to trend upward from 2013 to 2015, then remained flat through 2017 (Figure KI 44).

The discard rate for biopsied kidneys remained markedly higher than the rate for non-biopsied kidneys; nearly one-third of biopsied kidneys were discarded over the past decade (Figure KI 40). While the overall kidney donor risk index (KDRI) for biopsied kidneys was higher than for non-biopsied kidneys, it declined for biopsied kidneys over the past 10 years, from 1.67 in 2006 to 1.52 in 2017 (Figure KI 47), with a relatively stable rate of discard, suggesting that kidneys discarded based on biopsy could have benefitted some listed candidates. Of similar concern is an ongoing trend toward decreasing KDRI of discarded kidneys (Figure KI 46), a possible unintended consequence of clinical use of KDPI rather than KDRI; KDPI assigns a percentile score of 0-100 based on the previous years’ recovered donor kidneys, which can result in drift. Specifically, if recovery practice nationwide becomes more conservative due to the previous year’s discards, the KDRI of a kidney with KDPI above 85 will be lower than in the prior year.

Living Donation

The total number of living donor transplants, in adults and children, has remained flat since 2011, and represents a declining proportion of all kidney transplants (Figure KI 57). Unrelated and paired donations increased, but related donations declined (Figure KI 49). Living donors have become progressively older, possibly due to concern about long-term risks for younger donors, and female donors continued to outnumber male donors (Figure KI 50, Figure KI 51). The proportion of black living donors declined from 12.6% in 2006 to 8.8% in 2017 (Figure KI 52). The extent of this decrease due to medical contraindications or psychosocial barriers needs further study. Proportions of post-donation complications including readmission at 6 weeks, 6 months, and 1 year were 5.4%, 7.4%, and 8.9%, respectively. However, complication rates at only 12 months were unknown for 11.3% of donors (Figure KI 55), illustrating the need to better ascertain living donor outcomes.

Kidney Transplants

The total number of kidney transplants rose notably in 2016 and 2017. This gain was almost entirely attributable to an increase in deceased donor transplants, as living donor transplants were essentially flat (Figure KI 57). The increase in transplants occurred across most levels of age, sex, race/ethnicity, and diagnosis groups (Figure KI 58, Figure KI 59, Figure KI 60, Figure KI 61). Although deceased-donor transplants among black and Hispanic patients increased notably post-KAS and approached rates for white patients, the rate of increase from 2016 to 2017 was less than the rate of increase for white recipients (Figure KI 13). Encouragingly, numbers of transplant recipients among minority candidates remained higher than pre-KAS (Figure KI 60). Similarly, while transplant rates in patients aged 65 years or older decreased immediately post-KAS, rates have since increased along with those for other age groups (Figure KI 12). However, disparity in access to living donation persists; only 12.5% of living donor kidney transplants in 2017 were performed in black recipients (Table KI 8), while 32.6% of candidates in 2017 were black (Table KI 2). In contrast, 65.9% of transplant recipients were white, though they made up only 36.2% of the waiting list.

Similar to 2016, 43.2% of deceased donor recipients had been on dialysis for at least 5 years, compared with 12.4% of living donor recipients, in 2017. Conversely, the proportion of deceased donor recipients on the waiting list for more than 5 years was 15.3%, decreased from 19.2% in 2016, likely continuing to reflect credit for time on dialysis under the new KAS (Table KI 9, Table KI 10). Consistent with the higher rate of discards for kidneys with KDPI above 85%, the proportion of transplants using high-KDPI kidneys declined from 11.0% in 2006 to 7.8% in 2017 (Figure KI 62). Given that the KDRI for a kidney with KDPI above 85% declined over the same period, this trend again suggests that kidneys that could benefit some candidates may be unnecessarily discarded. Immediately post-KAS, the proportion of deceased donor transplants among candidates with cPRA 98%-100% increased dramatically to 14.6% from 4.8% (Figure 65). This proportion decreased and then leveled off, but remained higher than pre-KAS prevalence at 10.6% (Figure KI 65).

Transplants were performed across a broad range of transplant program sizes, but 2017 saw a jump in the proportion of transplants performed at large volume (≥250/year) programs, from 16.9% in 2016 to 21.0% in 2017 (Figure KI 69). A steady increase in the use of T-cell depleting agents was again noted in 2017, with nearly 75% of recipients receiving immunosuppression induction with T-cell depleting agents (Figure KI 63). Similarly, tacrolimus remained the basis of most regimens, accounting for all but 7% of regimens (Figure KI 64). Approximately 30% of recipients remained on steroid-free regimens (Figure KI 64).

Outcomes

By mid-2017, more than 220,000 recipients were alive with a functioning graft, an increase from nearly 140,000 in 2006 (Figure KI 88). The longstanding improvement in unadjusted short- and long-term deceased donor graft survival continued in 2017; 6-month all-cause and death-censored graft failure for deceased donor recipients in 2016 was nearly half what it was 10 years ago. All-cause graft failure declined from 7.1% in 2006 to 4.3% in 2016, with a similar decline in 6-month death-censored graft failure from 4.1% to 2.4% over the same period. Long-term failure rates improved; 10-year all-cause graft failure for deceased donor recipients in 2007 declined to 49.7% from 57.6% in 2000, and 10-year death-censored graft failure declined from 31.5% to 25.1% (Figure KI 70, Figure KI 71). Graft failure remained significantly lower after living donor kidney transplants, with similarly positive trends: 6-month and 10-year all-cause graft failure only 1.4% and 34.1%. Censoring for death, more than 80% of living donor kidneys transplanted in 2007 were still functioning in 2017 (Figure KI 74).

Deceased donor transplant allograft failure was higher for patients with diabetes or hypertension as cause of kidney failure than for those with cystic disease or glomerulonephritis (Figure KI 76). However, graft survival did not differ for donation-after-circulatory-death versus donation-after-brain-death kidneys (Figure KI 78), or for metropolitan versus non-metropolitan residents (Figure KI 80). Allograft survival was modestly better for deceased donor recipients living 250 NM or farther from the transplant program (Figure KI 81). Not surprisingly, 5-year graft survival differed by KDPI. However, while graft survival for KDPI above 85% was notably lower than for lower KDPI groups at 63.5%, survival for lower KDPI groups differed only modestly (83.1%, 80.9%, 77.0% for KDPI ≤20%, 21%-34%, 35%-85% respectively) (Figure KI 77). Observed 5-year graft survival was lower for biopsied than for non-biopsied kidneys (74.2% versus 80.6%), suggesting more frequent biopsies of kidneys that are medically likely to be of lower quality (Figure KI 79). While still better than deceased donor graft survival, 5-year living donor graft survival was lower for black recipients than for any other racial/ethnic group, at 83.2% compared with 90.2% for Asian and 87-88% for white and Hispanic recipients (Figure KI 83).

Posttransplant diabetes continued to decline, especially among recipients with the highest body mass index (BMI); 1-year incidence in recipients with BMI 35 kg/m² or higher was essentially the same as for recipients with BMI 25-34 kg/m² (Figure KI 91, Figure KI 92). This trend is particularly encouraging given increased use of tacrolimus in lieu of cyclosporine for immunosuppression. Incidence of posttransplant lymphoproliferative disorder (PTLD) remained low overall at 0.6% at 5 years. However, 5-year incidence was higher for recipients who were Epstein-Barr virus (EBV) negative, albeit still low at 1.7% (Figure KI 93).

Patient survival closely mirrored graft survival. Five-year recipient survival was lowest for patients with diabetes (85.5% and 88.0% for deceased and living donor recipients, respectively, Figure KI 95 and Figure KI 101), aged older than 65 years (76.4% and 83.6%, respectively, Figure KI 94 and Figure KI 100), and for those who received a high-KDPI (80.1%, Figure KI 96) or biopsied kidney (85.9%, Figure KI 97). Patient survival after either living or deceased donor transplant did not differ significantly by metropolitan versus non-metropolitan residence or distance to the transplant program.

Pediatric Kidney Transplant

Waiting List

In 2017, the highest number of pediatric candidates were added to the kidney transplant waiting list: 1014, with 367 (36%) added as active status (Figure KI 105). The number of prevalent pediatric candidates (listed at age <18 years and on the list on December 31 of the given year) has been steadily increasing and reached 1,575 on December 31, 2017, with 508 (32%) as active status (Figure KI 106). The most common reason for inactive status among newly listed candidates in 2017 was incomplete work-up (51.9%), followed by living donor candidate status (14.8%), and too well to need transplant (14.7%) (Table KI 13). Over the past decade, the age of pediatric candidates on the waiting list shifted, with an increase in those aged 1-5 and 6-10 years and a decrease in those aged 11-17 years (64.8% to 54.7%) (Table KI 14). Proportions of candidates with congenital anomalies of the kidney and urinary tract (CAKUT) as primary cause of disease increased from 25.7% in 2007 to 37.6% in 2017, and proportions with glomerulonephritis and focal segmental glomerulosclerosis (FSGS) decreased (Table KI 15). For most candidates waiting as of December 31, 2017 (67.5%), cPRA was less than 1% (Table KI 15). The proportion of pediatric candidates waiting for retransplant decreased from 26.8% in 2007 to 13.9% in 2017. Multi-organ listing remained uncommon; only 2.1% of pediatric candidates were awaiting multi-organ transplant at the end of 2017 (Table KI 16). The leading cause of ESRD changed with age; CAKUT was most common in children aged younger than 6 years, and FSGS and glomerulonephritis were more common in older children (Figure KI 113).

Of the 971 pediatric candidates removed from the waiting list in 2017, 617 (63.5%) received a deceased donor kidney, 255 (26.3%) received a living donor kidney, 17 (1.8%) died, 15 (1.5%) were considered too sick to undergo transplant, and 6 (0.6%) were removed from the list because their condition improved (Table KI 17, Table KI 18). Among patients newly listed in 2014, 56.3% underwent deceased donor transplant within 3 years, 23.3% underwent living donor transplant, 15.4% were still waiting, 3.9% were removed from the list for other reasons, and 1.2% died (Figure KI 114). The rate of deceased donor transplant among pediatric waitlisted candidates decreased over the past decade and plateaued at 40 transplants per 100 active waitlist-years for the past several years, compared with a peak of 63 in 2006 (Figure KI 115). Considering changes post-KAS implementation, transplant rates varied by age; rates increased for ages younger than 6 and 11-17 years and decreased for ages 6-10 years. In 2017, transplant rates were highest for candidates aged 11-17 years (55.6 per 100 active waitlist-years), followed by ages younger than 6 years (43.9), the age group that previously had the lowest transplant rate among all pediatric candidates. As expected, transplant rates remained higher than pre-KAS rates for highly sensitized (≥98%) patients, reflecting KAS’ priority for these candidates; the transplant rate increased from 6.6 transplants per 100 waitlist-years in 2014 to 14.8 in 2017 (Figure KI 116). Transplant rates for pediatric candidates with cPRA 80%-97% initially declined to 17.1 post-KAS, but increased to 25.4 in 2017 (Figure KI 116), similar to rates in the adult population. In contrast to mortality among candidates waiting for other organs, pretransplant mortality among pediatric candidates waiting for kidney transplant was low: 2.0 per 100 waitlist-years in 2016-2017, but varying by age; the rate was 2.0 for ages younger than 6 and 6-10 years, and 0.9 for ages 11-17 years (Figure KI 119).

Transplant

The total number of pediatric kidney transplants remained steady at just under 750 in 2017 (Figure KI 122). A slow decline continued in the proportion of living donor kidney transplants in pediatric recipients; only 31.5% of pediatric transplants were from living donors in 2017. The number of related living donors decreased dramatically over the past decade (Figure KI 123), and the number of unrelated directed transplants performed in pediatric candidates remained low (54 in 2017) (Figure KI 123). Children aged younger than 6 years made up the largest group of living donor kidney recipients (41.3%) (Figure KI 124).

In 2017, 33 programs were performing only pediatric kidney transplants, compared with 132 performing only adult transplants and 58 performing transplants in both adults and children (Figure KI 125). In 2017, only 5.9% of transplants in candidates aged younger than 10 years were performed at programs with volumes of five or fewer pediatric transplants in that year (Figure KI 126). Most pediatric recipients who underwent transplant between 2015 and 2017 were aged 11-17 years, 61.2% among deceased donor recipients and 51.9% among living donor recipients (Table KI 19). A higher proportion of living donor transplants were performed in recipients aged 1-5 years; this group accounted for 30.5% of pediatric living donor transplants and 19.3% of pediatric deceased donor transplants (Table KI 19).The racial distribution differed for deceased and living donor transplant recipients; a higher proportion of living donor than deceased donor recipients were white (68.1% vs. 40.0%). Private insurance was more common among living donor recipients and Medicare/Medicaid among deceased donor recipients. Most deceased donor recipients (93.6%) underwent transplant with a kidney from a donor with KDPI less than 35% (Table KI 21).

The combination of a donor who was positive for cytomegalovirus and a pediatric recipient who was negative occurred in 38.4% of deceased donor transplants and in 30.8% of living donor transplants (Table KI 22, Table KI 23). The combination of a donor who was positive for EBV and a recipient who was negative occurred in 36.2% of deceased donor transplants and in 50.6% of living donor transplants.

Immunosuppressive Medication Use

Use of T-cell depleting agents continued to increase, reaching 65.9% in 2017. IL-2-RA therapy use remained steady at 33.8% (Figure KI 127). In 2017, the most common initial immunosuppression regimens were tacrolimus, MMF, and steroids in 57.6% of recipients, followed by tacrolimus and MMF in 32.9% (Figure KI 128). T-cell depleting agents were more common with increasing cPRA and IL-2-RA use with decreasing cPRA (Figure KI 129).

Outcomes

All-cause graft failure after kidney-alone deceased donor transplant in pediatric recipients was 2.0% at 6 months and 2.3% at 1 year for transplants in 2015-2016, 11.1% at 3 years for transplants in 2013-2014, 16.2% at 5 years for transplants in 2011-2012, and 41.7% at 10 years for transplants in 2007-2008 (Figure KI 132). Corresponding graft failure after living donor transplant was 1.4% at 6 months and 1.8% at 1 year for transplants in 2015-2016, 5.0% at 3 years for transplants in 2013-2014, 10.2% at 5 years for transplants in 2011-2012, and 30.0% at 10 years for transplants in 2007-2008 (Figure KI 135). For the cohort of recipients who underwent transplant in 2008-2012, graft survival was highest for living donor recipients aged younger than 11 years (91.5% at 5 years) and lowest for deceased donor recipients aged 11-17 years (76.5% at 5 years) (Figure KI 138). In the 2015-2016 cohort, the overall incidence of acute rejection was 12.2% with some variation by age: highest for ages younger than 6 (13.5%) and lowest for ages 6-10 years (9.7%) (Figure KI 139). Short-term renal function, measured by eGFR, improved substantially over the past decade. The proportion of recipients with eGFR 90 mL/min/1.73 m² or higher at 12 months posttransplant increased from 15% in 2006 to 27.7% in 2016 (Figure KI 131). In the 2016 cohort, 72.7% of recipients had CKD stage 1-2 at 1 year posttransplant, with eGFR 60 mL/min/1.73 m² or higher. Incidence of PTLD among EBV-negative recipients was 3.0% at 5 years posttransplant, compared with 0.7% among EBV-positive recipients (Figure KI 141). Overall 5-year patient survival among pediatric kidney transplant recipients in 2008-2012 was very high at 98.2% (Figure KI 142).

Figure List

Waiting list

Figure KI 1. New adult candidates added to the kidney transplant waiting list
Figure KI 2. Adults listed for kidney transplant on December 31 each year
Figure KI 3. Distribution of adults waiting for kidney transplant by age
Figure KI 4. Distribution of adults waiting for kidney transplant by sex
Figure KI 5. Distribution of adults waiting for kidney transplant by race
Figure KI 6. Distribution of adults waiting for kidney transplant by diagnosis
Figure KI 7. Distribution of adults waiting for kidney transplant by waiting time
Figure KI 8. Distribution of adults waiting for kidney transplant by C/PRA
Figure KI 9. Distribution of adults waiting for kidney transplant by time on dialysis
Figure KI 10. Distribution of adults waiting for kidney transplant by willingness to accept ECD or KDPI > 85% kidney
Figure KI 11. Adults willing to accept a kidney designated ECD or KDPI > 85% by age
Figure KI 12. Deceased donor kidney transplant rates among adult waitlist candidates by age
Figure KI 13. Deceased donor kidney transplant rates among adult waitlist candidates by race
Figure KI 14. Deceased donor kidney transplant rates among adult waitlist candidates by diagnosis
Figure KI 15. Deceased donor kidney transplant rates among adult waitlist candidates by C/PRA
Figure KI 16. Deceased donor kidney transplant rates among adult waitlist candidates by blood type
Figure KI 17. Deceased donor kidney transplant rates among adult waitlist candidates by time on the waitlist
Figure KI 18. Deceased donor kidney transplant rates among waitlist candidates by metropolitan vs. non-metropolitan residence
Figure KI 19. Deceased donor kidney transplant rates among waitlist candidates by distance from listing center
Figure KI 20. Three-year outcomes for adults waiting for kidney transplant, new listings in 2014
Figure KI 21. Percentage of adults who underwent deceased donor kidney transplant within a given time period of listing
Figure KI 22. Percentage of adults who underwent deceased donor kidney transplant within 5 years of listing in 2012 by DSA
Figure KI 23. Percentage of adults who underwent deceased donor kidney transplant within 5 years of listing in 2012 by state
Figure KI 24. Pretransplant mortality rates among adults waitlisted for kidney transplant by age
Figure KI 25. Pretransplant mortality rates among adults waitlisted for kidney transplant by race
Figure KI 26. Pretransplant mortality rates among adults waitlisted for kidney transplant by diagnosis
Figure KI 27. Pretransplant mortality rates among adults waitlisted for kidney by metropolitan vs. non-metropolitan residence
Figure KI 28. Pretransplant mortality rates among adults waitlisted for kidney, by distance from listing center
Figure KI 29. Pretransplant mortality rates among adults waitlisted for kidney transplant in 2017, by DSA
Figure KI 30. Deaths within six months after removal among adult kidney waitlist candidates, by diagnosis group at removal
Figure KI 31. Deaths within six months after removal among adult kidney waitlist candidates, by age at removal

Deceased donation

Figure KI 32. Deceased kidney donor count by age
Figure KI 33. Distribution of deceased kidney donors by age
Figure KI 34. Distribution of deceased kidney donors by race
Figure KI 35. Percent of pediatric kidney donors allocated to adult recipients
Figure KI 36. Rates of kidneys recovered for transplant and not transplanted by donor age
Figure KI 37. Rates of kidneys recovered for transplant and not transplanted by donor diabetes status
Figure KI 38. Rates of kidneys recovered for transplant and not transplanted by donor hypertension status
Figure KI 39. Rates of kidneys recovered for transplant and not transplanted by donor terminal creatinine
Figure KI 40. Rates of kidneys recovered for transplant and not transplanted by donor biopsy status
Figure KI 41. Rates of kidneys recovered for transplant and not transplanted by donor cause of death
Figure KI 42. Rates of kidneys recovered for transplant and not transplanted, by donor risk of disease transmission
Figure KI 43. Rates of kidneys recovered for transplant and not transplanted by DCD status
Figure KI 44. Rates of kidneys recovered for transplant and not transplanted by KDPI
Figure KI 45. Donor-specific components of the kidney donor risk index
Figure KI 46. Average kidney donor risk index
Figure KI 47. Average kidney donor risk index by biopsy status
Figure KI 48. Cause of death among deceased kidney donors

Living donation

Figure KI 49. Kidney transplants from living donors by donor relation
Figure KI 50. Living kidney donors by age
Figure KI 51. Living kidney donors by sex
Figure KI 52. Living kidney donors by race
Figure KI 53. Intended living kidney donor procedure type
Figure KI 54. Rehospitalization in the first 6 weeks, 6 months, and 1 year among living kidney donors, 2012-2016
Figure KI 55. Kidney complications among living kidney donors, 2012-2016
Figure KI 56. BMI among living kidney donors

Transplant

Figure KI 57. Total kidney transplants
Figure KI 58. Total kidney transplants by age
Figure KI 59. Total kidney transplants by sex
Figure KI 60. Total kidney transplants by race
Figure KI 61. Total kidney transplants by diagnosis
Figure KI 62. Kidney transplants by kidney donor profile index (KDPI)
Figure KI 63. Induction agent use in adult kidney transplant recipients
Figure KI 64. Immunosuppression regimen use in adult kidney transplant recipients
Figure KI 65. C/PRA at time of kidney transplant in adult deceased donor recipients
Figure KI 66. C/PRA at time of kidney transplant in adult living donor recipients
Figure KI 67. Total HLA A, B, and DR mismatches among adult kidney transplant recipients, 2013-2017
Figure KI 68. Annual adult kidney transplant center volumes, by percentile
Figure KI 69. Distribution of adult kidney transplants by annual center volume

Outcomes

Figure KI 70. Graft failure among adult deceased donor kidney transplant recipients
Figure KI 71. Death-censored graft failure among adult deceased donor kidney transplant recipients
Figure KI 72. Death with function among adult deceased donor kidney transplant recipients
Figure KI 73. Graft failure among adult living donor kidney transplant recipients
Figure KI 74. Death-censored graft failure among adult living donor kidney transplant recipients
Figure KI 75. Death with function among adult living donor kidney transplant recipients
Figure KI 76. Graft survival among adult deceased donor kidney transplant recipients, 2012, by diagnosis
Figure KI 77. Graft survival among adult deceased donor kidney transplant recipients, 2012, by KDPI
Figure KI 78. Graft survival among adult deceased donor kidney transplant recipients, 2012, by DCD status
Figure KI 79. Graft survival among adult deceased donor kidney transplant recipients, 2012, by biopsy status
Figure KI 80. Graft survival among adult deceased donor kidney transplant recipients, 2012, by metropolitan vs. non-metropolitan recipient residence
Figure KI 81. Graft survival among adult deceased donor kidney transplant recipients, 2012, by recipients' distance from transplant center
Figure KI 82. Graft survival among adult living donor kidney transplant recipients, 2012, by age
Figure KI 83. Graft survival among adult living donor kidney transplant recipients, 2012, by race
Figure KI 84. Graft survival among adult living donor kidney transplant recipients, 2012, by diagnosis
Figure KI 85. Graft survival among adult living donor kidney transplant recipients, 2012, by metropolitan vs. non-metropolitan recipient residence
Figure KI 86. Graft survival among adult living donor kidney transplant recipients, 2012, by recipients' distance from transplant center
Figure KI 87. Distribution of eGFR at 6 months posttransplant among adult kidney transplant recipients
Figure KI 88. Recipients alive with a functioning kidney graft on June 30 of the year, by age at transplant
Figure KI 89. Incidence of acute rejection by 1 year posttransplant among adult kidney transplant recipients by age, 2015-2016
Figure KI 90. Incidence of acute rejection by 1 year posttransplant among adult kidney transplant recipients by induction status, 2015-2016
Figure KI 91. Posttransplant diabetes among adult kidney transplant recipients
Figure KI 92. Posttransplant diabetes within 1 year among adult kidney transplant recipients by BMI at transplant
Figure KI 93. Incidence of PTLD among adult kidney transplant recipients by recipient EBV status at transplant, 2011-2015
Figure KI 94. Patient survival among adult deceased donor kidney transplant recipients, 2012, by age
Figure KI 95. Patient survival among adult deceased donor kidney transplant recipients, 2012, by diagnosis
Figure KI 96. Patient survival among adult deceased donor kidney transplant recipients, 2012, by KDPI
Figure KI 97. Patient survival among adult deceased donor kidney transplant recipients, 2012, by biopsy status
Figure KI 98. Patient survival among adult deceased donor kidney transplant recipients, 2012, by metropolitan vs. non-metropolitan recipient residence
Figure KI 99. Patient survival among adult deceased donor kidney transplant recipients, 2012, by recipients' distance from transplant center
Figure KI 100. Patient survival among adult living donor kidney transplant recipients, 2012, by age
Figure KI 101. Patient survival among adult living donor kidney transplant recipients, 2012, by diagnosis
Figure KI 102. Patient survival among adult living donor kidney transplant recipients, 2012, by race
Figure KI 103. Patient survival among adult living donor kidney transplant recipients, 2012, by metropolitan vs. non-metropolitan recipient residence
Figure KI 104. Patient survival among adult living donor kidney transplant recipients, 2012, by recipients' distance from transplant center

Pediatric transplant

Figure KI 105. New pediatric candidates added to the kidney transplant waiting list
Figure KI 106. Pediatric candidates listed for kidney transplant on December 31 each year
Figure KI 107. Distribution of pediatric candidates waiting for kidney transplant by age
Figure KI 108. Distribution of pediatric candidates waiting for kidney transplant by race
Figure KI 109. Distribution of pediatric candidates waiting for kidney transplant by diagnosis
Figure KI 110. Distribution of pediatric candidates waiting for kidney transplant by sex
Figure KI 111. Distribution of pediatric candidates waiting for kidney transplant by waiting time
Figure KI 112. Distribution of pediatric candidates waiting for kidney transplant by C/PRA
Figure KI 113. Primary cause of ESRD in pediatric candidates waiting for kidney transplant by age, 2011-2015
Figure KI 114. Three-year outcomes for newly listed pediatric candidates waiting for kidney transplant, 2014
Figure KI 115. Deceased donor kidney transplant rates among pediatric waitlist candidates by age
Figure KI 116. Deceased donor kidney transplant rates among pediatric waitlist candidates by C/PRA
Figure KI 117. Deceased donor kidney transplant rates among pediatric waitlist candidates by metropolitan vs. non-metropolitan residence
Figure KI 118. Deceased donor kidney transplant rates among pediatric waitlist candidates by distance from listing center
Figure KI 119. Pretransplant mortality rates among pediatrics waitlisted for kidney transplant by age
Figure KI 120. Pretransplant mortality rates among pediatrics waitlisted for kidney transplant by metropolitan vs. non-metropolitan residence
Figure KI 121. Pretransplant mortality rates among pediatrics waitlisted for kidney transplant by distance from listing center
Figure KI 122. Pediatric kidney transplants by donor type
Figure KI 123. Pediatric kidney transplants from living donors by relation
Figure KI 124. Percent of pediatric kidney transplants from living donors by recipient age
Figure KI 125. Number of centers performing pediatric and adult kidney transplants by center's age mix
Figure KI 126. Pediatric kidney recipients at programs that perform 5 or fewer pediatric transplants annually
Figure KI 127. Induction agent use in pediatric kidney transplant recipients
Figure KI 128. Immunosuppression regimen use in pediatric kidney transplant recipients
Figure KI 129. Induction use by C/PRA among pediatric kidney transplant recipients, 2013-2017
Figure KI 130. Total HLA A, B, and DR mismatches among pediatric kidney transplant recipients, 2013-2017
Figure KI 131. Distribution of eGFR at 12 months posttransplant among pediatric kidney-alone transplant recipients
Figure KI 132. Graft failure among pediatric deceased donor kidney-alone transplant recipients
Figure KI 133. Death-censored graft failure among pediatric deceased donor kidney-alone transplant recipients
Figure KI 134. Death with function among pediatric deceased donor kidney-alone transplant recipients
Figure KI 135. Graft failure among pediatric living donor kidney-alone transplant recipients
Figure KI 136. Death-censored graft failure among pediatric living donor kidney-alone transplant recipients
Figure KI 137. Death with function among pediatric living donor kidney-alone transplant recipients
Figure KI 138. Graft survival among pediatric kidney transplant recipients by age and donor type, 2008-2012
Figure KI 139. Incidence of acute rejection by 1 year posttransplant among pediatric kidney transplant recipients by induction status, 2015-2016
Figure KI 140. Incidence of acute rejection by 1 year posttransplant among pediatric kidney transplant recipients by age, 2015-2016
Figure KI 141. Incidence of PTLD among pediatric kidney transplant recipients by recipient EBV status at transplant, 2004-2014
Figure KI 142. Patient survival among pediatric kidney transplant recipients, 2008-2012, by recipient age and donor type

Table List

Waiting list

Table KI 1. Reasons for inactive status among new adult kidney transplant listings, 2017
Table KI 2. Demographic characteristics of adults on the kidney transplant waiting list on December 31, 2007, December 31, 2012 and December 31, 2017
Table KI 3. Clinical characteristics of adults on the kidney transplant waiting list on December 31, 2007, December 31, 2012 and December 31, 2017
Table KI 4. Listing characteristics of adults on the kidney transplant waiting list on December 31, 2007, December 31, 2012 and December 31, 2017
Table KI 5. Kidney transplant waitlist activity among adults
Table KI 6. Removal reason among adult kidney transplant candidates

Living donation

Table KI 7. Living kidney donor deaths, 2013-2017, by number of days after donation

Transplant

Table KI 8. Demographic characteristics of adult kidney transplant recipients, 2017
Table KI 9. Clinical characteristics of adult kidney transplant recipients, 2017
Table KI 10. Transplant characteristics of adult kidney transplant recipients, 2017
Table KI 11. Adult deceased donor kidney donor-recipient serology matching, 2013-2017
Table KI 12. Adult living donor kidney donor-recipient serology matching, 2013-2017

Pediatric transplant

Table KI 13. Reasons for inactive status among new pediatric kidney transplant listings, 2016
Table KI 14. Demographic characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2007, December 31, 2012, and December 31, 2017
Table KI 15. Clinical characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2007, December 31, 2012, and December 31, 2017
Table KI 16. Listing characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2007, December 31, 2012, and December 31, 2017
Table KI 17. Kidney transplant waitlist activity among pediatric candidates
Table KI 18. Removal reason among pediatric kidney transplant candidates
Table KI 19. Demographic characteristics of pediatric kidney transplant recipients, 2015-2017
Table KI 20. Clinicial characteristics of pediatric kidney transplant recipients, 2015-2017
Table KI 21. Transplant characteristics of pediatric kidney transplant recipients, 2015-2017
Table KI 22. Pediatric deceased donor kidney donor-recipient serology matching, 2013-2017
Table KI 23. Pediatric living donor kidney donor-recipient serology matching, 2013-2017

Table KI 1 Reasons for inactive status among new adult kidney transplant listings, 2017
Candidates first listed as inactive. Each listing is counted separately. LD, living donor.

Reasons for inactive status	N	Percent
Candidate work-up incomplete	5205	65.7%
Too sick	619	7.8%
Insurance issues	603	7.6%
Too well	493	6.2%
Weight inappropriate	263	3.3%
Candidate for LD transplant only	263	3.3%
Candidate choice	219	2.8%
Transplant pending	135	1.7%
Medical non-compliance	58	0.7%
Unknown	42	0.5%
Inappropriate substance abuse	19	0.2%
Candidate could not be contacted	5	0.1%
Physician/surgeon unavailable	3	0.0%

Table KI 2 Demographic characteristics of adults on the kidney transplant waiting list on December 31, 2007, December 31, 2012 and December 31, 2017
Candidates waiting for transplant on December 31, 2007, December 31, 2012, and December 31, 2017, regardless of first listing date; multiple listings are collapsed.

Characteristic	2007, N	2007, Percent	2012, N	2012, Percent	2017, N	2017, Percent
Age: 18-34 years	7852	10.9%	8836	9.5%	7672	8.3%
Age: 35-49 years	21,892	30.4%	24,857	26.8%	22,663	24.5%
Age: 50-64 years	30,639	42.5%	40,526	43.6%	40,900	44.1%
Age: ≥ 65 years	11,681	16.2%	18,664	20.1%	21,450	23.1%
Sex: Female	30,280	42.0%	37,767	40.7%	36,093	38.9%
Sex: Male	41,784	58.0%	55,116	59.3%	56,592	61.1%
Race/ethnicity: White	28,133	39.0%	35,085	37.8%	33,545	36.2%
Race/ethnicity: Black	25,148	34.9%	31,615	34.0%	30,258	32.6%
Race/ethnicity: Hispanic	12,487	17.3%	17,520	18.9%	18,751	20.2%
Race/ethnicity: Asian	5252	7.3%	7251	7.8%	8569	9.2%
Race/ethnicity: Other/unknown	1044	1.4%	1412	1.5%	1562	1.7%
Geography: Metropolitan	61,408	85.2%	79,953	86.1%	80,795	87.2%
Geography: Non-metro	10,656	14.8%	12,930	13.9%	11,890	12.8%
Distance: < 50 miles	50,133	69.6%	64,294	69.2%	64,331	69.4%
Distance: 50-<100 miles	10,226	14.2%	12,940	13.9%	13,452	14.5%
Distance: 100-<150 miles	4697	6.5%	6230	6.7%	5874	6.3%
Distance: 150-<250 miles	4279	5.9%	5782	6.2%	5540	6.0%
Distance: ≥ 250 miles	1946	2.7%	3057	3.3%	3153	3.4%
Distance: Unknown	783	1.1%	580	0.6%	335	0.4%
All candidates	72,064	100.0%	92,883	100.0%	92,685	100.0%

Table KI 3 Clinical characteristics of adults on the kidney transplant waiting list on December 31, 2007, December 31, 2012 and December 31, 2017
Candidates waiting for transplant on December 31, 2007, December 31, 2012, and December 31, 2017, regardless of first listing date; multiple listings are collapsed. CKD, cystic kidney disease; GN, glomerulonephritis. *Diabetes status based on diagnosis and comorbid conditions.

Characteristic	2007, N	2007, Percent	2012, N	2012, Percent	2017, N	2017, Percent
Diagnosis: Diabetes	22,554	31.3%	32,334	34.8%	34,368	37.1%
Diagnosis: Hypertension	17,901	24.8%	23,078	24.8%	20,940	22.6%
Diagnosis: GN	10,707	14.9%	13,059	14.1%	13,040	14.1%
Diagnosis: CKD	5991	8.3%	7702	8.3%	7950	8.6%
Diagnosis: Other	14,911	20.7%	16,710	18.0%	16,387	17.7%
Diabetes*	28,878	40.1%	41,205	44.4%	42,796	46.2%
Blood type: A	20,535	28.5%	26,800	28.9%	26,007	28.1%
Blood type: B	11,661	16.2%	14,837	16.0%	15,296	16.5%
Blood type: AB	2057	2.9%	2658	2.9%	2463	2.7%
Blood type: O	37,811	52.5%	48,588	52.3%	48,919	52.8%
CPRA: < 1%	33,593	46.6%	54,932	59.1%	56,164	60.6%
CPRA: 1-< 20%	13,104	18.2%	8279	8.9%	9072	9.8%
CPRA: 20-< 80%	12,939	18.0%	13,810	14.9%	15,249	16.5%
CPRA: 80-< 98%	6000	8.3%	5920	6.4%	5354	5.8%
CPRA: 98-100%	5028	7.0%	8499	9.2%	6634	7.2%
CPRA: Unknown	1400	1.9%	1443	1.6%	212	0.2%
All candidates	72,064	100.0%	92,883	100.0%	92,685	100.0%

Table KI 4 Listing characteristics of adults on the kidney transplant waiting list on December 31, 2007, December 31, 2012 and December 31, 2017
Candidates waiting for transplant on December 31, 2007, December 31, 2012, and December 31, 2017, regardless of first listing date; and multiple listings are collapsed. KDPI, kidney donor profile index. *Prior to 2014, includes willingness to accept expanded criteria donor (ECD) kidney. KDPI >85% is local non-zero HLA mismatch only.

Characteristic	2007, N	2007, Percent	2012, N	2012, Percent	2017, N	2017, Percent
Transplant history: First	60,319	83.7%	79,342	85.4%	81,495	87.9%
Transplant history: Retransplant	11,745	16.3%	13,541	14.6%	11,190	12.1%
Wait time: < 1 year	24,281	33.7%	26,430	28.5%	24,935	26.9%
Wait time: 1-< 2 years	16,663	23.1%	19,976	21.5%	18,608	20.1%
Wait time: 2-< 3 years	11,099	15.4%	15,721	16.9%	14,129	15.2%
Wait time: 3-< 4 years	7187	10.0%	10,894	11.7%	11,188	12.1%
Wait time: 4-< 5 years	4479	6.2%	7018	7.6%	8402	9.1%
Wait time: ≥ 5 years	8355	11.6%	12,844	13.8%	15,423	16.6%
Will accept KDPI*>85%	32,051	44.5%	44,465	47.9%	43,424	46.9%
Tx type: Kidney alone	69,437	96.4%	89,933	96.8%	89,936	97.0%
Tx type: Kidney-pancreas	2206	3.1%	2083	2.2%	1642	1.8%
Tx type: Kidney-liver	348	0.5%	731	0.8%	876	0.9%
Tx type: Kidney-heart	69	0.1%	126	0.1%	207	0.2%
Tx type: Other	4	0.0%	10	0.0%	24	0.0%
All candidates	72,064	100.0%	92,883	100.0%	92,685	100.0%

Table KI 5 Kidney transplant waitlist activity among adults
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.

Waiting list state	2015	2016	2017
Patients at start of year	99,322	98,018	95,658
Patients added during year	30,215	30,854	30,918
Patients removed during year	31,466	33,167	33,891
Patients at end of year	98,071	95,706	92,685

Table KI 6 Removal reason among adult kidney transplant candidates
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.

Removal reason	2015	2016	2017
Deceased donor transplant	12,279	13,501	14,077
Living donor transplant	5331	5334	5536
Transplant outside US	49	77	67
Patient died	4983	4862	4414
Patient refused transplant	518	471	524
Improved, transplant not needed	208	193	212
Too sick for transplant	4078	4345	4505
Other	4020	4384	4556

Table KI 7 Living kidney donor deaths, 2013-2017, by number of days after donation
Living kidney donors. Numbers of deaths reported to OPTN or the Social Security Administration. Donation-related deaths are included in the Medical category.

Cause	0-30 days	31-90 days	91-365 days
Suicide	1	1	1
Accident/homicide	0	0	8
Overdose	0	1	1
Medical	3	0	1
Cancer	0	0	0
Unknown	0	1	0
Total	4	3	11

Table KI 8 Demographic characteristics of adult kidney transplant recipients, 2017
Adult kidney transplant recipients, including retransplants.

Characteristic	Deceased, N	Deceased, Percent	Living, N	Living, Percent	All, N	All, Percent
Age: 18-34 years	1646	11.5%	947	17.0%	2593	13.0%
Age: 35-49 years	3932	27.5%	1589	28.5%	5521	27.8%
Age: 50-64 years	5973	41.7%	2131	38.2%	8104	40.7%
Age: ≥ 65 years	2762	19.3%	909	16.3%	3671	18.5%
Sex: Female	5641	39.4%	2101	37.7%	7742	38.9%
Sex: Male	8672	60.6%	3475	62.3%	12,147	61.1%
Race/ethnicity: White	5620	39.3%	3676	65.9%	9296	46.7%
Race/ethnicity: Black	4677	32.7%	697	12.5%	5374	27.0%
Race/ethnicity: Hispanic	2681	18.7%	806	14.5%	3487	17.5%
Race/ethnicity: Asian	1074	7.5%	350	6.3%	1424	7.2%
Race/ethnicity: Other/unknown	261	1.8%	47	0.8%	308	1.5%
Insurance: Private	3219	22.5%	3142	56.3%	6361	32.0%
Insurance: Medicare	9868	68.9%	2071	37.1%	11,939	60.0%
Insurance: Medicaid	918	6.4%	271	4.9%	1189	6.0%
Insurance: Other government	290	2.0%	74	1.3%	364	1.8%
Insurance: Unknown	18	0.1%	18	0.3%	36	0.2%
Geography: Metropolitan	12,289	85.9%	4758	85.3%	17,047	85.7%
Geography: Non-metro	2024	14.1%	818	14.7%	2842	14.3%
Distance: < 50 miles	9475	66.2%	3677	65.9%	13,152	66.1%
Distance: 50-<100 miles	2246	15.7%	916	16.4%	3162	15.9%
Distance: 100-<150 miles	1095	7.7%	411	7.4%	1506	7.6%
Distance: 150-<250 miles	788	5.5%	280	5.0%	1068	5.4%
Distance: ≥ 250 miles	656	4.6%	262	4.7%	918	4.6%
Distance: Unknown	53	0.4%	30	0.5%	83	0.4%
All recipients	14,313	100.0%	5576	100.0%	19,889	100.0%

Table KI 9 Clinical characteristics of adult kidney transplant recipients, 2017
Adult kidney transplant recipients, including retransplants. CKD, cystic kidney disease; GN, glomerulonephritis.

Characteristic	Deceased, N	Deceased, Percent	Living, N	Living, Percent	All, N	All, Percent
Diagnosis: Diabetes	4512	31.5%	1252	22.5%	5764	29.0%
Diagnosis: Hypertension	3377	23.6%	913	16.4%	4290	21.6%
Diagnosis: GN	2316	16.2%	1392	25.0%	3708	18.6%
Diagnosis: CKD	1421	9.9%	993	17.8%	2414	12.1%
Diagnosis: Other	2687	18.8%	1026	18.4%	3713	18.7%
Blood type: A	5071	35.4%	2214	39.7%	7285	36.6%
Blood type: B	1914	13.4%	738	13.2%	2652	13.3%
Blood type: AB	740	5.2%	231	4.1%	971	4.9%
Blood type: O	6588	46.0%	2393	42.9%	8981	45.2%
Dialysis time: None	1566	10.9%	1834	32.9%	3400	17.1%
Dialysis time: < 1 year	1054	7.4%	1244	22.3%	2298	11.6%
Dialysis time: 1-< 3 years	2663	18.6%	1387	24.9%	4050	20.4%
Dialysis time: 3-< 5 years	2851	19.9%	421	7.6%	3272	16.5%
Dialysis time: ≥ 5 years	6179	43.2%	690	12.4%	6869	34.5%
CPRA: < 1%	8218	57.4%	3976	71.3%	12,194	61.3%
CPRA: 1-< 20%	1337	9.3%	579	10.4%	1916	9.6%
CPRA: 20-< 80%	2256	15.8%	776	13.9%	3032	15.2%
CPRA: 80-< 98%	1151	8.0%	180	3.2%	1331	6.7%
CPRA: 98-100%	1350	9.4%	58	1.0%	1408	7.1%
CPRA: Unknown	1	0.0%	7	0.1%	8	0.0%
All recipients	14,313	100.0%	5576	100.0%	19,889	100.0%

Table KI 10 Transplant characteristics of adult kidney transplant recipients, 2017
Adult kidney transplant recipients, including retransplants. DBD, donation after brain death; DCD, donation after circulatory death; KDPI, kidney donor profile index. DCD status and KDPI scores apply to deceased donor transplants only.

Characteristic	Deceased, N	Deceased, Percent	Living, N	Living, Percent	All, N	All, Percent
Wait time: None (preemptive)	118	0.8%	79	1.4%	197	1.0%
Wait time: < 1 year	5669	39.6%	3496	62.7%	9165	46.1%
Wait time: 1-< 3 years	3720	26.0%	1503	27.0%	5223	26.3%
Wait time: 3-< 5 years	2621	18.3%	382	6.9%	3003	15.1%
Wait time: ≥ 5 years	2185	15.3%	116	2.1%	2301	11.6%
KDPI: ≤ 20%	3230	22.6%
KDPI: 21-34%	2304	16.1%
KDPI: 35-85%	7665	53.6%
KDPI: > 85%	1114	7.8%
DCD status: DBD	11,480	80.2%
DCD status: DCD	2833	19.8%
Transplant history: First	12,573	87.8%	5041	90.4%	17,614	88.6%
Transplant history: Retransplant	1740	12.2%	535	9.6%	2275	11.4%
All recipients	14,313	100.0%	5576	100.0%	19,889	100.0%

Table KI 11 Adult deceased donor kidney donor-recipient serology matching, 2013-2017
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HB, hepatitis B; HCV, hepatitis C virus; HIV, human immunodeficiency virus.

Donor	Recipient	CMV	EBV	HB core	HB surf. ant.	HCV	HIV
D-	R-	13.4%	0.6%	82.2%	97.2%	91.4%	94.2%
D-	R+	25.9%	6.3%	8.0%	1.8%	3.9%	1.1%
D-	R unk	0.3%	0.8%	6.4%	0.9%	1.2%	4.1%
D+	R-	17.8%	7.7%	2.7%	0.0%	0.6%	0.0%
D+	R+	41.6%	78.3%	0.6%	0.0%	2.8%	0.0%
D+	R unk	0.5%	6.2%	0.2%	0.0%	0.0%	0.0%
D unk	R-	0.1%	0.0%	0.0%	0.1%	0.0%	0.5%
D unk	R+	0.4%	0.1%	0.0%	0.0%	0.0%	0.0%
D unk	R unk	0.0%	0.0%	0.0%	0.0%	0.0%	0.0%

Table KI 12 Adult living donor kidney donor-recipient serology matching, 2013-2017
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HB, hepatitis B; HCV, hepatitis C virus; HIV, human immunodeficiency virus.

Donor	Recipient	CMV	EBV	HB core	HB surf. ant.	HCV	HIV
D-	R-	24.9%	1.9%	82.4%	94.9%	95.3%	38.8%
D-	R+	21.1%	7.1%	3.6%	1.1%	1.9%	0.2%
D-	R unk	0.2%	0.4%	8.6%	0.9%	1.1%	0.9%
D+	R-	17.2%	7.5%	1.5%	0.5%	0.4%	0.0%
D+	R+	34.1%	75.9%	0.4%	0.0%	0.0%	0.0%
D+	R unk	0.3%	4.0%	0.1%	0.0%	0.0%	0.0%
D unk	R-	0.9%	0.4%	2.3%	2.5%	1.1%	57.4%
D unk	R+	1.2%	1.6%	0.1%	0.0%	0.0%	0.3%
D unk	R unk	0.1%	1.3%	1.0%	0.1%	0.1%	2.4%

Table KI 13 Reasons for inactive status among new pediatric kidney transplant listings, 2016
Candidates first listed as inactive. Each listing is counted separately. LD, living donor.

Reasons for inactive status	N	Percent
Candidate work-up incomplete	346	51.9%
Candidate for LD transplant only	99	14.8%
Too well	98	14.7%
Candidate choice	45	6.7%
Too sick	29	4.3%
Weight inappropriate	17	2.5%
Medical non-compliance	14	2.1%
Insurance issues	12	1.8%
Transplant pending	7	1.0%

Table KI 14 Demographic characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2007, December 31, 2012, and December 31, 2017
Candidates aged younger than 18 years waiting for transplant on December 31 of given year, regardless of first listing date; multiple listings are collapsed. Age calculated at snapshot. Candidates listed as children who turned 18 before the cohort date are excluded.

Characteristic	2007, N	2007, Percent	2012, N	2012, Percent	2017, N	2017, Percent
Age: < 1 year	5	0.6%	5	0.6%	3	0.3%
Age: 1-5 years	127	16.4%	175	20.8%	243	22.9%
Age: 6-10 years	141	18.2%	160	19.0%	236	22.2%
Age: 11-17 years	502	64.8%	502	59.6%	581	54.7%
Sex: Female	333	43.0%	339	40.3%	409	38.5%
Sex: Male	442	57.0%	503	59.7%	654	61.5%
Race/ethnicity: White	316	40.8%	347	41.2%	423	39.8%
Race/ethnicity: Black	177	22.8%	222	26.4%	226	21.3%
Race/ethnicity: Hispanic	247	31.9%	232	27.6%	321	30.2%
Race/ethnicity: Asian	23	3.0%	26	3.1%	68	6.4%
Race/ethnicity: Other/unknown	12	1.5%	15	1.8%	25	2.4%
Geography: Metropolitan	670	86.5%	705	83.7%	913	85.9%
Geography: Non-metro	105	13.5%	137	16.3%	150	14.1%
Distance: < 50 miles	505	65.2%	529	62.8%	680	64.0%
Distance: 50-<100 miles	131	16.9%	130	15.4%	163	15.3%
Distance: 100-<150 miles	59	7.6%	74	8.8%	83	7.8%
Distance: 150-<250 miles	44	5.7%	58	6.9%	79	7.4%
Distance: ≥ 250 miles	30	3.9%	39	4.6%	52	4.9%
Distance: Unknown	6	0.8%	12	1.4%	6	0.6%
All candidates	775	100.0%	842	100.0%	1063	100.0%

Table KI 15 Clinical characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2007, December 31, 2012, and December 31, 2017
Candidates aged younger than 18 years waiting for transplant on December 31, 2007, December 31, 2012, and December 31, 2017, regardless of first listing date; multiple listings are collapsed. Candidates listed as children who turned 18 before the cohort date are excluded. FSGS, focal segmental glomerulosclerosis; GN, glomerulonephritis; CAKUT, congenital anomalies of the kidney and urinary tract.

Characteristic	2007, N	2007, Percent	2012, N	2012, Percent	2017, N	2017, Percent
Diagnosis: FSGS	111	14.3%	77	9.1%	89	8.4%
Diagnosis: GN	76	9.8%	78	9.3%	60	5.6%
Diagnosis: CAKUT	199	25.7%	260	30.9%	400	37.6%
Diagnosis: Other	389	50.2%	427	50.7%	514	48.4%
Blood type: A	237	30.6%	280	33.3%	308	29.0%
Blood type: B	117	15.1%	127	15.1%	186	17.5%
Blood type: AB	26	3.4%	22	2.6%	23	2.2%
Blood type: O	395	51.0%	413	49.0%	546	51.4%
CPRA: < 1%	433	55.9%	541	64.3%	717	67.5%
CPRA: 1-< 20%	98	12.6%	54	6.4%	109	10.3%
CPRA: 20-< 80%	105	13.5%	105	12.5%	139	13.1%
CPRA: 80-< 98%	60	7.7%	64	7.6%	41	3.9%
CPRA: 98-100%	47	6.1%	73	8.7%	56	5.3%
CPRA: Unknown	32	4.1%	5	0.6%	1	0.1%
All candidates	775	100.0%	842	100.0%	1063	100.0%

Table KI 16 Listing characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2007, December 31, 2012, and December 31, 2017
Candidates aged younger than 18 years waiting for transplant on December 31, 2007, December 31, 2012, and December 31, 2017, regardless of first listing date; multiple listings are collapsed. Candidates listed as children who turned 18 before the cohort date are excluded.

Characteristic	2007, N	2007, Percent	2012, N	2012, Percent	2017, N	2017, Percent
Transplant history: First	567	73.2%	647	76.8%	915	86.1%
Transplant history: Retransplant	208	26.8%	195	23.2%	148	13.9%
Wait time: < 1 year	449	57.9%	479	56.9%	605	56.9%
Wait time: 1-< 2 years	165	21.3%	176	20.9%	198	18.6%
Wait time: 2-< 3 years	90	11.6%	75	8.9%	107	10.1%
Wait time: 3-< 4 years	37	4.8%	30	3.6%	64	6.0%
Wait time: 4-< 5 years	22	2.8%	31	3.7%	37	3.5%
Wait time: ≥ 5 years	12	1.5%	51	6.1%	52	4.9%
Tx type: Kidney alone	759	97.9%	819	97.3%	1041	97.9%
Tx type: Kidney-pancreas	1	0.1%	0	0.0%	0	0.0%
Tx type: Kidney-liver	11	1.4%	17	2.0%	16	1.5%
Tx type: Kidney-heart	3	0.4%	3	0.4%	4	0.4%
Tx type: Other	1	0.1%	3	0.4%	2	0.2%
All candidates	775	100.0%	842	100.0%	1063	100.0%

Table KI 17 Kidney transplant waitlist activity among pediatric candidates
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.

Waiting list state	2015	2016	2017
Patients at start of year	1485	1516	1497
Patients added during year	977	953	1049
Patients removed during year	946	971	971
Patients at end of year	1516	1498	1575

Table KI 18 Removal reason among pediatric kidney transplant candidates
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.

Removal reason	2015	2016	2017
Deceased donor transplant	586	598	617
Living donor transplant	261	273	255
Transplant outside US	1	0	0
Patient died	20	28	17
Patient refused transplant	2	1	3
Improved, transplant not needed	8	7	6
Too sick for transplant	12	23	15
Other	56	41	58

Table KI 19 Demographic characteristics of pediatric kidney transplant recipients, 2015-2017
Kidney transplant recipients, including retransplants.

Characteristic	Deceased, N	Deceased, Percent	Living, N	Living, Percent	All, N	All, Percent
Age: < 1 year	1	0.1%	2	0.3%	3	0.1%
Age: 1-5 years	284	19.3%	222	30.5%	506	23.0%
Age: 6-10 years	285	19.4%	126	17.3%	411	18.7%
Age: 11-17 years	900	61.2%	378	51.9%	1278	58.1%
Sex: Female	639	43.5%	288	39.6%	927	42.2%
Sex: Male	831	56.5%	440	60.4%	1271	57.8%
Race/ethnicity: White	588	40.0%	496	68.1%	1084	49.3%
Race/ethnicity: Black	331	22.5%	69	9.5%	400	18.2%
Race/ethnicity: Hispanic	425	28.9%	124	17.0%	549	25.0%
Race/ethnicity: Asian	79	5.4%	25	3.4%	104	4.7%
Race/ethnicity: Other/unknown	47	3.2%	14	1.9%	61	2.8%
Insurance: Private	394	26.8%	414	56.9%	808	36.8%
Insurance: Medicare	423	28.8%	127	17.4%	550	25.0%
Insurance: Medicaid	542	36.9%	150	20.6%	692	31.5%
Insurance: Other government	91	6.2%	29	4.0%	120	5.5%
Insurance: Unknown	20	1.4%	8	1.1%	28	1.3%
Geography: Metropolitan	1241	84.4%	606	83.2%	1847	84.0%
Geography: Non-metro	229	15.6%	122	16.8%	351	16.0%
Distance: < 50 miles	895	60.9%	437	60.0%	1332	60.6%
Distance: 50-<100 miles	236	16.1%	117	16.1%	353	16.1%
Distance: 100-<150 miles	159	10.8%	61	8.4%	220	10.0%
Distance: 150-<250 miles	105	7.1%	57	7.8%	162	7.4%
Distance: ≥ 250 miles	60	4.1%	46	6.3%	106	4.8%
Distance: Unknown	15	1.0%	10	1.4%	25	1.1%
All recipients	1470	100.0%	728	100.0%	2198	100.0%

Table KI 20 Clinicial characteristics of pediatric kidney transplant recipients, 2015-2017
Kidney transplant recipients, including retransplants. Diagnosis categories follow North American Pediatric Renal Trials and Collaborative Studies recommendations. FSGS, focal segmental glomerulosclerosis; GN, glomerulonephritis; CAKUT, congenital anomalies of the kidney and urinary tract.

Characteristic	Deceased, N	Deceased, Percent	Living, N	Living, Percent	All, N	All, Percent
Diagnosis: FSGS	190	12.9%	76	10.4%	266	12.1%
Diagnosis: GN	152	10.3%	61	8.4%	213	9.7%
Diagnosis: CAKUT	497	33.8%	278	38.2%	775	35.3%
Diagnosis: Other	631	42.9%	313	43.0%	944	42.9%
Blood type: A	453	30.8%	274	37.6%	727	33.1%
Blood type: B	178	12.1%	106	14.6%	284	12.9%
Blood type: AB	56	3.8%	27	3.7%	83	3.8%
Blood type: O	783	53.3%	321	44.1%	1104	50.2%
Dialysis time: None	342	23.3%	306	42.0%	648	29.5%
Dialysis time: < 1 year	311	21.2%	179	24.6%	490	22.3%
Dialysis time: 1-< 3 years	494	33.6%	174	23.9%	668	30.4%
Dialysis time: 3-< 5 years	157	10.7%	18	2.5%	175	8.0%
Dialysis time: ≥ 5 years	166	11.3%	51	7.0%	217	9.9%
CPRA: < 1%	1069	72.7%	532	73.1%	1601	72.8%
CPRA: 1-< 20%	137	9.3%	72	9.9%	209	9.5%
CPRA: 20-< 80%	200	13.6%	96	13.2%	296	13.5%
CPRA: 80-< 98%	30	2.0%	13	1.8%	43	2.0%
CPRA: 98-100%	34	2.3%	10	1.4%	44	2.0%
CPRA: Unknown	0	0.0%	5	0.7%	5	0.2%
All recipients	1470	100.0%	728	100.0%	2198	100.0%

Table KI 21 Transplant characteristics of pediatric kidney transplant recipients, 2015-2017
Kidney transplant recipients, including retransplants. DBD, donation after brain death; DCD, donation after circulatory death; DGF, delayed graft function; KDPI, kidney donor profile index. DCD status and KDPI scores apply to deceased donor transplants only.

Characteristic	Deceased, N	Deceased, Percent	Living, N	Living, Percent	All, N	All, Percent
Wait time: None (preemptive)	11	0.7%	51	7.0%	62	2.8%
Wait time: < 1 year	999	68.0%	540	74.2%	1539	70.0%
Wait time: 1-< 3 years	371	25.2%	119	16.3%	490	22.3%
Wait time: 3-< 5 years	72	4.9%	14	1.9%	86	3.9%
Wait time: ≥ 5 years	17	1.2%	4	0.5%	21	1.0%
KDPI: ≤ 20%	1003	68.2%
KDPI: 21-34%	374	25.4%
KDPI: 35-85%	92	6.3%
KDPI: > 85%	1	0.1%
DCD status: DBD	1417	96.4%
DCD status: DCD	53	3.6%
DGF: None	1343	91.4%	703	96.6%	2046	93.1%
DGF: Yes	127	8.6%	25	3.4%	152	6.9%
Tx type: Kidney only	1410	95.9%	728	100.0%	2138	97.3%
Tx type: Kidney-pancreas	1	0.1%	0	0.0%	1	0.0%
Tx type: Kidney-liver	48	3.3%	0	0.0%	48	2.2%
Tx type: Other	11	0.7%	0	0.0%	11	0.5%
Transplant history: First	1338	91.0%	680	93.4%	2018	91.8%
Transplant history: Retransplant	132	9.0%	48	6.6%	180	8.2%
All recipients	1470	100.0%	728	100.0%	2198	100.0%

Table KI 22 Pediatric deceased donor kidney donor-recipient serology matching, 2013-2017
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus.

Donor	Recipient	CMV	EBV
D-	R-	24.7%	4.8%
D-	R+	14.9%	7.2%
D-	R unk	0.3%	0.3%
D+	R-	38.4%	36.2%
D+	R+	20.2%	48.8%
D+	R unk	0.4%	2.5%
D unk	R-	0.5%	0.0%
D unk	R+	0.6%	0.1%

Table KI 23 Pediatric living donor kidney donor-recipient serology matching, 2013-2017
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus.

Donor	Recipient	CMV	EBV
D-	R-	38.0%	6.7%
D-	R+	6.7%	3.0%
D-	R unk	0.5%	0.2%
D+	R-	30.8%	50.6%
D+	R+	20.5%	34.4%
D+	R unk	1.0%	2.8%
D unk	R-	1.7%	1.3%
D unk	R+	0.8%	0.8%
D unk	R unk	0.1%	0.2%