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

Figure KI 1. New adult candidates added to the kidney transplant waiting list
Figure KI 2. All adult candidates on the kidney transplant waiting list
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 (years)
Figure KI 8. Distribution of adults waiting for kidney transplant by BMI
Figure KI 9. Distribution of adults waiting for kidney transplant by years on dialysis
Figure KI 10. Distribution of adults waiting for kidney transplant by blood type
Figure KI 11. Distribution of adults waiting for kidney transplant by prior transplant status
Figure KI 12. Adults willing to accept a kidney designated ECD or KDPI > 85% by age
Figure KI 13. Adults willing to accept kidney from HCV+ donor
Figure KI 14. Overall deceased donor kidney transplant rates among adult waitlist candidates
Figure KI 15. Deceased donor kidney transplant rates among adult waitlist candidates by age
Figure KI 16. Deceased donor kidney transplant rates among adult waitlist candidates by race
Figure KI 17. Deceased donor kidney transplant rates among adult waitlist candidates by diagnosis
Figure KI 18. Deceased donor kidney transplant rates among adult waitlist candidates by C/PRA
Figure KI 19. Deceased donor kidney transplant rates among adult waitlist candidates by blood type
Figure KI 20. Deceased donor kidney transplant rates among adult waitlist candidates by time on the waitlist
Figure KI 21. Deceased donor kidney transplant rates among adult waitlist candidates by sex
Figure KI 22. Deceased donor kidney transplant rates among adult waitlist candidates by metropolitan vs. non-metropolitan residence
Figure KI 23. Three-year outcomes for adults waiting for kidney transplant, new listings in 2016
Figure KI 24. Percentage of adults who underwent deceased donor kidney transplant within a given time period of listing
Figure KI 25. Percentage of adults who underwent deceased donor kidney transplant within 5 years of listing, 2014, by DSA
Figure KI 26. Percentage of adults who underwent deceased donor kidney transplant within 5 years of listing, 2014, by state
Figure KI 27. Overall pretransplant mortality rates among adults waitlisted for kidney transplant
Figure KI 28. Pretransplant mortality rates among adults waitlisted for kidney transplant by age
Figure KI 29. Pretransplant mortality rates among adults waitlisted for kidney transplant by race
Figure KI 30. Pretransplant mortality rates among adults waitlisted for kidney transplant by sex
Figure KI 31. Pretransplant mortality rates among adults waitlisted for kidney transplant by diagnosis
Figure KI 32. Pretransplant mortality rates among adults waitlisted for kidney transplant by blood type
Figure KI 33. Pretransplant mortality rates among adults waitlisted for kidney transplant by metropolitan vs. non-metropolitan residence
Figure KI 34. Pretransplant mortality rates among adults waitlisted for kidney transplant, by active/inactive status
Figure KI 35. Pretransplant mortality rates among adults waitlisted for kidney transplant in 2019 by DSA
Figure KI 36. Deaths within six months after removal among adult kidney waitlist candidates, overall
Figure KI 37. Deaths within six months after removal among adult kidney waitlist candidates, by diagnosis group at removal
Figure KI 38. Deaths within six months after removal among adult kidney waitlist candidates, by age

Deceased donation

Figure KI 39. Overall deceased kidney donor count
Figure KI 40. Deceased kidney donor count by age
Figure KI 41. Deceased kidney donor count by HCV status
Figure KI 42. Distribution of deceased kidney donors by age
Figure KI 43. Distribution of deceased kidney donors by sex
Figure KI 44. Distribution of deceased kidney donors by race
Figure KI 45. Distribution of deceased kidney donors by donor HCV status
Figure KI 46. Percent of pediatric donor kidneys allocated to adult recipients, by DSA of donor hospital, 2015-2019
Figure KI 47. Overall rates of kidneys recovered for transplant and not transplanted
Figure KI 48. Rates of kidneys recovered for transplant and not transplanted by donor age
Figure KI 49. Rates of kidneys recovered for transplant and not transplanted by donor diabetes status
Figure KI 50. Rates of kidneys recovered for transplant and not transplanted by donor sex
Figure KI 51. Rates of kidneys recovered for transplant and not transplanted by donor race
Figure KI 52. Rates of kidneys recovered for transplant and not transplanted by donor hypertension status
Figure KI 53. Rates of kidneys recovered for transplant and not transplanted by donor BMI
Figure KI 54. Rates of kidneys recovered for transplant and not transplanted by donor terminal creatinine
Figure KI 55. Rates of kidneys recovered for transplant and not transplanted by donor biopsy status
Figure KI 56. Rates of kidneys recovered for transplant and not transplanted by donor cause of death
Figure KI 57. Rates of kidneys recovered for transplant and not transplanted by donor HCV status
Figure KI 58. Rates of kidneys recovered for transplant and not transplanted, by donor risk of disease transmission
Figure KI 59. Rates of kidneys recovered for transplant and not transplanted by DCD status
Figure KI 60. Rates of kidneys recovered for transplant and not transplanted by KDPI
Figure KI 61. Donor-specific components of the kidney donor risk index
Figure KI 62. Average kidney donor risk index
Figure KI 63. Average kidney donor risk index by biopsy status
Figure KI 64. Cause of death among deceased kidney donors

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

Figure KI 88. Graft failure among adult deceased donor kidney transplant recipients
Figure KI 89. Death-censored graft failure among adult deceased donor kidney transplant recipients
Figure KI 90. Death with function among adult deceased donor kidney transplant recipients
Figure KI 91. Graft failure among adult living donor kidney transplant recipients
Figure KI 92. Death-censored graft failure among adult living donor kidney transplant recipients
Figure KI 93. Death with function among adult living donor kidney transplant recipients
Figure KI 94. Graft survival among adult deceased donor kidney transplant recipients, 2012-2014, by age
Figure KI 95. Graft survival among adult deceased donor kidney transplant recipients, 2012-2014, by diagnosis
Figure KI 96. Graft survival among adult deceased donor kidney transplant recipients, 2012-2014, by KDPI
Figure KI 97. Graft survival among adult deceased donor kidney transplant recipients, 2012-2014, by DCD status
Figure KI 98. Graft survival among adult deceased donor kidney transplant recipients, 2012-2014, by biopsy status
Figure KI 99. Graft survival among adult deceased donor kidney transplant recipients, 2012-2014, by BMI
Figure KI 100. Graft survival among adult deceased donor kidney transplant recipients, 2012-2014, by metropolitan vs. non-metropolitan recipient residence
Figure KI 101. Graft survival among adult living donor kidney transplant recipients, 2012-2014, by age
Figure KI 102. Graft survival among adult living donor kidney transplant recipients, 2012-2014, by race
Figure KI 103. Graft survival among adult living donor kidney transplant recipients, 2012-2014, by diagnosis
Figure KI 104. Graft survival among adult living donor kidney transplant recipients, 2012-2014, by metropolitan vs. non-metropolitan recipient residence
Figure KI 105. Distribution of eGFR at 12 months posttransplant among adult deceased donor kidney transplant recipients
Figure KI 106. Distribution of eGFR at 12 months posttransplant among adult living donor kidney transplant recipients
Figure KI 107. Recipients alive with a functioning kidney graft on June 30 of the year, by age at transplant
Figure KI 108. Incidence of acute rejection by 1 year posttransplant among adult kidney transplant recipients by age, 2017-2018
Figure KI 109. Incidence of acute rejection by 1 year posttransplant among adult kidney transplant recipients by induction agent, 2017-2018
Figure KI 110. Posttransplant diabetes among adult kidney transplant recipients
Figure KI 111. Posttransplant diabetes within 1 year among adult kidney transplant recipients by BMI at transplant
Figure KI 112. Incidence of PTLD among adult kidney transplant recipients by recipient EBV status at transplant, 2013-2017
Figure KI 113. Patient survival among adult deceased donor kidney transplant recipients, 2012-2014, by age
Figure KI 114. Patient survival among adult deceased donor kidney transplant recipients, 2012-2014, by diagnosis
Figure KI 115. Patient survival among adult deceased donor kidney transplant recipients, 2012-2014, by metropolitan vs. non-metropolitan recipient residence
Figure KI 116. Patient survival among adult deceased donor kidney transplant recipients, 2012-2014, by KDPI
Figure KI 117. Patient survival among adult deceased donor kidney transplant recipients, 2012-2014, by biopsy status
Figure KI 118. Patient survival among adult living donor kidney transplant recipients, 2012-2014, by age
Figure KI 119. Patient survival among adult living donor kidney transplant recipients, 2012-2014, by diagnosis
Figure KI 120. Patient survival among adult living donor kidney transplant recipients, 2012-2014, by race
Figure KI 121. Patient survival among adult living donor kidney transplant recipients, 2012-2014, by metropolitan vs. non-metropolitan recipient residence

Pediatric transplant

Figure KI 122. New pediatric candidates added to the kidney transplant waiting list
Figure KI 123. All pediatric candidates on the kidney transplant waiting list
Figure KI 124. Distribution of pediatric candidates waiting for kidney transplant by age
Figure KI 125. Distribution of pediatric candidates waiting for kidney transplant by race
Figure KI 126. Distribution of pediatric candidates waiting for kidney transplant by diagnosis
Figure KI 127. Distribution of pediatric candidates waiting for kidney transplant by sex
Figure KI 128. Distribution of pediatric candidates waiting for kidney transplant by waiting time
Figure KI 129. Distribution of pediatric candidates waiting for kidney transplant by C/PRA
Figure KI 130. Three-year outcomes for newly listed pediatric candidates waiting for kidney transplant, 2016
Figure KI 131. Overall deceased donor kidney transplant rates among pediatric waitlist candidates
Figure KI 132. Deceased donor kidney transplant rates among pediatric waitlist candidates by age
Figure KI 133. Deceased donor kidney transplant rates among pediatric waitlist candidates by race
Figure KI 134. Deceased donor kidney transplant rates among pediatric waitlist candidates by C/PRA
Figure KI 135. Deceased donor kidney transplant rates among pediatric waitlist candidates by metropolitan vs. non-metropolitan residence
Figure KI 136. Overall pretransplant mortality rates among pediatric candidates waitlisted for kidney
Figure KI 137. Pretransplant mortality rates among pediatric candidates waitlisted for kidney transplant by age
Figure KI 138. Pretransplant mortality rates among pediatric candidates waitlisted for kidney transplant by race
Figure KI 139. Pretransplant mortality rates among pediatric candidates waitlisted for kidney transplant by metropolitan vs. non-metropolitan residence
Figure KI 140. Overall pediatric kidney transplants
Figure KI 141. Pediatric kidney transplants by donor type
Figure KI 142. Pediatric kidney transplants by recipient age
Figure KI 143. Pediatric kidney transplants from living donors by relation
Figure KI 144. Percent of pediatric kidney transplants from living donors by recipient age
Figure KI 145. Number of centers performing pediatric and adult kidney transplants by center's age mix
Figure KI 146. Pediatric kidney recipients at programs that perform 5 or fewer pediatric transplants annually
Figure KI 147. Induction agent use in pediatric kidney transplant recipients
Figure KI 148. Immunosuppression regimen use in pediatric kidney transplant recipients
Figure KI 149. Total HLA A, B, and DR mismatches among pediatric kidney transplant recipients, 2015-2019
Figure KI 150. Distribution of eGFR at 12 months posttransplant among pediatric deceased donor kidney-alone transplant recipients
Figure KI 151. Distribution of eGFR at 12 months posttransplant among pediatric living donor kidney-alone transplant recipients
Figure KI 152. Graft failure among pediatric deceased donor kidney-alone transplant recipients
Figure KI 153. Death-censored graft failure among pediatric deceased donor kidney-alone transplant recipients
Figure KI 154. Death with function among pediatric deceased donor kidney-alone transplant recipients
Figure KI 155. Graft failure among pediatric living donor kidney-alone transplant recipients
Figure KI 156. Death-censored graft failure among pediatric living donor kidney-alone transplant recipients
Figure KI 157. Death with function among pediatric living donor kidney-alone transplant recipients
Figure KI 158. Graft failure among pediatric deceased donor kidney transplant recipients
Figure KI 159. Graft failure among pediatric living donor kidney transplant recipients
Figure KI 160. Graft survival among pediatric deceased donor kidney transplant recipients, 2012-2014, by age
Figure KI 161. Graft survival among pediatric kidney transplant recipients, 2012-2014, by donor type
Figure KI 162. Incidence of acute rejection by 1 year posttransplant among pediatric kidney transplant recipients by age, 2017-2018
Figure KI 163. Incidence of PTLD among pediatric kidney transplant recipients by recipient EBV status at transplant, 2007-2017
Figure KI 164. Patient death among pediatric kidney transplant recipients
Figure KI 165. Overall patient survival among pediatric deceased donor kidney transplant recipients, 2012-2014
Figure KI 166. Patient survival among pediatric deceased donor kidney transplant recipients, 2012-2014, by recipient age

Table List

Waiting list

Table KI 1. Demographic characteristics of adults on the kidney transplant waiting list on December 31, 2009, December 31, 2014 and December 31, 2019
Table KI 2. Clinical characteristics of adults on the kidney transplant waiting list on December 31, 2009, December 31, 2014 and December 31, 2019
Table KI 3. Listing characteristics of adults on the kidney transplant waiting list on December 31, 2009, December 31, 2014 and December 31, 2019
Table KI 4. Reasons for inactive status among new adult kidney transplant listings, 2019
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 in the first year after donoation, 2015-2019, by number of days after donation

Transplant

Table KI 8. Demographic characteristics of adult kidney transplant recipients, 2019
Table KI 9. Clinical characteristics of adult kidney transplant recipients, 2019
Table KI 10. Transplant characteristics of adult kidney transplant recipients, 2019
Table KI 11. Adult deceased donor kidney donor-recipient serology matching, 2017-2019
Table KI 12. Adult living donor kidney donor-recipient serology matching, 2017-2019

Pediatric transplant

Table KI 13. Reasons for inactive status among new pediatric kidney transplant listings, 2019
Table KI 14. Demographic characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2009, December 31, 2014, and December 31, 2019
Table KI 15. Clinical characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2009, December 31, 2014, and December 31, 2019
Table KI 16. Listing characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2009, December 31, 2014, and December 31, 2019
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, 2017-2019
Table KI 20. Clinicial characteristics of pediatric kidney transplant recipients, 2017-2019
Table KI 21. Transplant characteristics of pediatric kidney transplant recipients, 2017-2019
Table KI 22. Pediatric deceased donor kidney donor-recipient serology matching, 2017-2019
Table KI 23. Pediatric living donor kidney donor-recipient serology matching, 2017-2019

Table KI 1. Demographic characteristics of adults on the kidney transplant waiting list on December 31, 2009, December 31, 2014 and December 31, 2019
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date. Distance is computed from candidate's home zip code to the transplant center.

Characteristic	2009, N	2009, Percent	2014, N	2014, Percent	2019, N	2019, Percent
Age: 18-34 years	9061	10.5%	10,106	9.4%	8363	8.3%
Age: 35-49 years	25,098	29.0%	28,110	26.1%	24,329	24.0%
Age: 50-64 years	37,281	43.0%	46,788	43.5%	44,087	43.5%
Age: ≥ 65 years	15,208	17.6%	22,529	21.0%	24,558	24.2%
Sex: Female	36,101	41.7%	43,174	40.1%	38,596	38.1%
Sex: Male	50,547	58.3%	64,359	59.9%	62,741	61.9%
Race/ethnicity: White	33,743	38.9%	39,297	36.5%	35,995	35.5%
Race/ethnicity: Black	29,888	34.5%	36,977	34.4%	32,716	32.3%
Race/ethnicity: Hispanic	15,369	17.7%	20,459	19.0%	20,977	20.7%
Race/ethnicity: Asian	6507	7.5%	9111	8.5%	9871	9.7%
Race/ethnicity: Other/unknown	1141	1.3%	1689	1.6%	1778	1.8%
Geography: Metropolitan	74,209	85.6%	93,117	86.6%	88,630	87.5%
Geography: Non-metro	12,439	14.4%	14,416	13.4%	12,707	12.5%
Distance: < 50 miles	58,079	67.0%	71,404	66.4%	67,196	66.3%
Distance: 50-<100 miles	12,952	14.9%	16,176	15.0%	15,886	15.7%
Distance: 100-<150 miles	6071	7.0%	7799	7.3%	6964	6.9%
Distance: 150-<250 miles	5644	6.5%	7159	6.7%	6225	6.1%
Distance: ≥ 250 miles	3184	3.7%	4509	4.2%	4740	4.7%
Distance: Unknown	718	0.8%	486	0.5%	326	0.3%
All candidates	86,648	100.0%	107,533	100.0%	101,337	100.0%

Table KI 2. Clinical characteristics of adults on the kidney transplant waiting list on December 31, 2009, December 31, 2014 and December 31, 2019
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date. CKD, cystic kidney disease; GN, glomerulonephritis. *Diabetes status based on diagnosis and comorbid conditions.

Characteristic	2009, N	2009, Percent	2014, N	2014, Percent	2019, N	2019, Percent
Diagnosis: Diabetes	27,537	31.8%	37,849	35.2%	38,822	38.3%
Diagnosis: Hypertension	21,707	25.1%	26,020	24.2%	21,523	21.2%
Diagnosis: GN	12,814	14.8%	15,556	14.5%	14,477	14.3%
Diagnosis: CKD	7374	8.5%	9012	8.4%	8726	8.6%
Diagnosis: Other	17,216	19.9%	19,096	17.8%	17,789	17.6%
Diabetes*	35,538	41.0%	48,011	44.6%	47,442	46.8%
Blood type: A	24,643	28.4%	30,542	28.4%	27,676	27.3%
Blood type: B	14,117	16.3%	17,733	16.5%	16,921	16.7%
Blood type: AB	2504	2.9%	2979	2.8%	2534	2.5%
Blood type: O	45,384	52.4%	56,279	52.3%	54,206	53.5%
CPRA: < 1%	39,661	45.8%	64,843	60.3%	63,049	62.2%
CPRA: 1-< 20%	13,376	15.4%	9172	8.5%	9484	9.4%
CPRA: 20-< 80%	14,552	16.8%	16,027	14.9%	16,515	16.3%
CPRA: 80-< 98%	6838	7.9%	6619	6.2%	5458	5.4%
CPRA: 98-100%	7657	8.8%	10,049	9.3%	6729	6.6%
CPRA: Unknown	4564	5.3%	823	0.8%	102	0.1%
All candidates	86,648	100.0%	107,533	100.0%	101,337	100.0%

Table KI 3. Listing characteristics of adults on the kidney transplant waiting list on December 31, 2009, December 31, 2014 and December 31, 2019
Candidates waiting for transplant on December 31 of the given year, regardless of first listing date. 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	2009, N	2009, Percent	2014, N	2014, Percent	2019, N	2019, Percent
Transplant history: First	72,518	83.7%	92,014	85.6%	89,426	88.2%
Transplant history: Retransplant	14,130	16.3%	15,519	14.4%	11,911	11.8%
Wait time: < 1 year	29,146	33.6%	31,657	29.4%	33,298	32.9%
Wait time: 1-< 2 years	20,192	23.3%	24,519	22.8%	21,788	21.5%
Wait time: 2-< 3 years	14,176	16.4%	17,450	16.2%	14,528	14.3%
Wait time: 3-< 4 years	8805	10.2%	11,795	11.0%	10,553	10.4%
Wait time: 4-< 5 years	5302	6.1%	8061	7.5%	7279	7.2%
Wait time: ≥ 5 years	9027	10.4%	14,051	13.1%	13,891	13.7%
Will accept KDPI*>85%	39,564	45.7%	53,872	50.1%	46,145	45.5%
Tx type: Kidney alone	83,739	96.6%	104,293	97.0%	98,237	96.9%
Tx type: Kidney-pancreas	2337	2.7%	2140	2.0%	1844	1.8%
Tx type: Kidney-liver	465	0.5%	913	0.8%	983	1.0%
Tx type: Kidney-heart	95	0.1%	172	0.2%	254	0.3%
Tx type: Other	12	0.0%	15	0.0%	19	0.0%
All candidates	86,648	100.0%	107,533	100.0%	101,337	100.0%

Table KI 4. Reasons for inactive status among new adult kidney transplant listings, 2019
Candidates first listed as inactive. Each listing is counted separately. LD, living donor.

Reasons for inactive status	N	Percent
Candidate work-up incomplete	6952	68.7%
Too well	729	7.2%
Insurance issues	727	7.2%
Too sick	671	6.6%
Candidate choice	318	3.1%
Weight inappropriate	262	2.6%
Candidate for LD transplant only	220	2.2%
Transplant pending	122	1.2%
Medical non-compliance	53	0.5%
Unknown	33	0.3%
Inappropriate substance abuse	20	0.2%
COVID-19 Precaution	6	0.1%
Candidate could not be contacted	4	0.0%
Removal pending data correction	1	0.0%

Table KI 5. Kidney transplant waitlist activity among adults
Candidates listed at more than one center are counted once per listing. 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	2017	2018	2019
Patients at start of year	104,145	101,348	100,998
Patients added during year	36,725	40,157	42,934
Patients removed during year	39,451	40,439	42,579
Patients at end of year	101,419	101,066	101,353

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	2017	2018	2019
Deceased donor transplant	14,194	14,942	16,754
Living donor transplant	5559	6145	6605
Transplant outside US	79	59	64
Patient died	4671	4451	4130
Patient refused transplant	532	455	396
Improved, transplant not needed	224	197	205
Too sick for transplant	4746	4435	4259
Other	9446	9755	10,166

Table KI 7. Living kidney donor deaths in the first year after donoation, 2015-2019, by number of days after donation
Living kidney donors. Number of deaths reported to OPTN or Social Security Administration. Donation-related deaths are included in the Medical category.

Cause	0-30 days	31-90 days	91-365 days
Suicide	0	1	3
Accident/homicide	0	0	7
Overdose	0	1	0
Medical	2	0	1
Cancer	0	0	0
Unknown	0	1	1
TOTAL	2	3	12

Table KI 8. Demographic characteristics of adult kidney transplant recipients, 2019
Kidney transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.

Characteristic	Deceased, N	Deceased, Percent	Living, N	Living, Percent	All, N	All, Percent
Age: 18-34 years	1795	10.6%	1153	17.4%	2948	12.5%
Age: 35-49 years	4322	25.6%	1758	26.5%	6080	25.9%
Age: 50-64 years	6920	41.0%	2429	36.7%	9349	39.8%
Age: ≥ 65 years	3847	22.8%	1286	19.4%	5133	21.8%
Sex: Female	6694	39.6%	2464	37.2%	9158	39.0%
Sex: Male	10,190	60.4%	4162	62.8%	14,352	61.0%
Race/ethnicity: White	6414	38.0%	4232	63.9%	10,646	45.3%
Race/ethnicity: Black	5535	32.8%	867	13.1%	6402	27.2%
Race/ethnicity: Hispanic	3302	19.6%	1019	15.4%	4321	18.4%
Race/ethnicity: Asian	1329	7.9%	411	6.2%	1740	7.4%
Race/ethnicity: Other/unknown	304	1.8%	97	1.5%	401	1.7%
Insurance: Private	3957	23.4%	3579	54.0%	7536	32.1%
Insurance: Medicare	11,433	67.7%	2598	39.2%	14,031	59.7%
Insurance: Medicaid	1085	6.4%	299	4.5%	1384	5.9%
Insurance: Other government	370	2.2%	122	1.8%	492	2.1%
Insurance: Unknown	39	0.2%	28	0.4%	67	0.3%
Geography: Metropolitan	14,546	86.2%	5687	85.8%	20,233	86.1%
Geography: Non-metro	2338	13.8%	939	14.2%	3277	13.9%
Distance: < 50 miles	11,081	65.6%	4322	65.2%	15,403	65.5%
Distance: 50-<100 miles	2668	15.8%	1085	16.4%	3753	16.0%
Distance: 100-<150 miles	1310	7.8%	475	7.2%	1785	7.6%
Distance: 150-<250 miles	957	5.7%	361	5.4%	1318	5.6%
Distance: ≥ 250 miles	797	4.7%	349	5.3%	1146	4.9%
Distance: Unknown	71	0.4%	34	0.5%	105	0.4%
All recipients	16,884	100.0%	6626	100.0%	23,510	100.0%

Table KI 9. Clinical characteristics of adult kidney transplant recipients, 2019
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	5727	33.9%	1663	25.1%	7390	31.4%
Diagnosis: Hypertension	3824	22.6%	1019	15.4%	4843	20.6%
Diagnosis: GN	2576	15.3%	1539	23.2%	4115	17.5%
Diagnosis: CKD	1707	10.1%	1128	17.0%	2835	12.1%
Diagnosis: Other	3050	18.1%	1277	19.3%	4327	18.4%
Blood type: A	5883	34.8%	2542	38.4%	8425	35.8%
Blood type: B	2341	13.9%	912	13.8%	3253	13.8%
Blood type: AB	905	5.4%	282	4.3%	1187	5.0%
Blood type: O	7755	45.9%	2890	43.6%	10,645	45.3%
Dialysis time: None	2126	12.6%	2161	32.6%	4287	18.2%
Dialysis time: < 1 year	1290	7.6%	1431	21.6%	2721	11.6%
Dialysis time: 1-< 3 years	3370	20.0%	1627	24.6%	4997	21.3%
Dialysis time: 3-< 5 years	3375	20.0%	556	8.4%	3931	16.7%
Dialysis time: ≥ 5 years	6723	39.8%	851	12.8%	7574	32.2%
CPRA: < 1%	9977	59.1%	4818	72.7%	14,795	62.9%
CPRA: 1-< 20%	1480	8.8%	629	9.5%	2109	9.0%
CPRA: 20-< 80%	2798	16.6%	910	13.7%	3708	15.8%
CPRA: 80-< 98%	1230	7.3%	194	2.9%	1424	6.1%
CPRA: 98-100%	1399	8.3%	73	1.1%	1472	6.3%
CPRA: Unknown	0	0.0%	2	0.0%	2	0.0%
All recipients	16,884	100.0%	6626	100.0%	23,510	100.0%

Table KI 10. Transplant characteristics of adult kidney transplant recipients, 2019
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)	121	0.7%	145	2.2%	266	1.1%
Wait time: < 1 year	7445	44.1%	4082	61.6%	11,527	49.0%
Wait time: 1-< 3 years	4174	24.7%	1829	27.6%	6003	25.5%
Wait time: 3-< 5 years	2631	15.6%	400	6.0%	3031	12.9%
Wait time: ≥ 5 years	2513	14.9%	170	2.6%	2683	11.4%
KDPI: ≤ 20%	3824	22.7%
KDPI: 21-34%	2769	16.4%
KDPI: 35-85%	9005	53.3%
KDPI: > 85%	1284	7.6%
DCD status: DBD	12,774	75.7%
DCD status: DCD	4110	24.3%
DGF: None	11,966	70.9%	6428	97.0%	18,394	78.2%
DGF: Yes	4918	29.1%	198	3.0%	5116	21.8%
Transplant history: First	15,055	89.2%	6018	90.8%	21,073	89.6%
Transplant history: Retransplant	1829	10.8%	608	9.2%	2437	10.4%
Tx type: Kidney only	15,074	89.3%	6626	100.0%	21,700	92.3%
Tx type: Kidney-pancreas	867	5.1%	0	0.0%	867	3.7%
Tx type: Kidney-liver	704	4.2%	0	0.0%	704	3.0%
Tx type: Kidney-heart	213	1.3%	0	0.0%	213	0.9%
Tx type: Kidney-lung	13	0.1%	0	0.0%	13	0.1%
Tx type: Other	13	0.1%	0	0.0%	13	0.1%
All recipients	16,884	100.0%	6626	100.0%	23,510	100.0%

Table KI 11. Adult deceased donor kidney donor-recipient serology matching, 2017-2019
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. Donor HCV NAT data are shown by recipient HCV antibody status. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBsAg, hepatitis B surace antigen; HCV, hepatitis C virus; HIV, human immunodeficiency virus; NAT, nucleic acid test.

Donor	Recipient	CMV	EBV	HBsAg	HCV antibody	HCV NAT
D-	R-	13.5%	0.7%	97.7%	88.6%	90.9%
D-	R+	25.7%	7.8%	1.4%	3.4%	3.8%
D-	R unk	0.2%	0.5%	0.7%	0.8%	0.8%
D+	R-	18.2%	6.0%	0.1%	5.1%	2.8%
D+	R+	41.4%	82.2%	0.0%	2.0%	1.6%
D+	R unk	0.4%	2.6%	0.0%	0.1%	0.1%
D unk	R-	0.2%	0.0%	0.1%	0.0%	0.0%
D unk	R+	0.3%	0.1%	0.0%	0.0%	0.0%
D unk	R unk	0.0%	0.0%	0.0%	0.0%	0.0%

Table KI 12. Adult living donor kidney donor-recipient serology matching, 2017-2019
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. Donor HCV NAT data are shown by recipient HCV antibody status. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; HIV, human immunodeficiency virus; NAT, nucleic acid test.

Donor	Recipient	CMV	EBV	HBsAg	HCV antibody	HCV NAT
D-	R-	25.2%	1.2%	96.2%	94.4%	87.2%
D-	R+	20.7%	6.9%	0.9%	1.8%	1.6%
D-	R unk	0.3%	0.2%	0.6%	0.9%	0.8%
D+	R-	17.9%	7.1%	0.4%	0.6%	0.1%
D+	R+	32.6%	81.3%	0.0%	0.0%	0.0%
D+	R unk	0.5%	1.5%	0.0%	0.0%	0.0%
D unk	R-	1.3%	0.2%	1.9%	2.2%	9.9%
D unk	R+	1.6%	1.5%	0.0%	0.0%	0.2%
D unk	R unk	0.0%	0.1%	0.0%	0.0%	0.1%

Table KI 13. Reasons for inactive status among new pediatric kidney transplant listings, 2019
Candidates first listed as inactive. Each listing is counted separately. LD, living donor.

Reasons for inactive status	N	Percent
Candidate work-up incomplete	346	52.4%
Candidate for LD transplant only	104	15.8%
Too well	102	15.5%
Candidate choice	43	6.5%
Too sick	34	5.2%
Insurance issues	9	1.4%
Weight inappropriate	9	1.4%
Medical non-compliance	8	1.2%
Transplant pending	3	0.5%
COVID-19 Precaution	1	0.2%
Candidate could not be contacted	1	0.2%

Table KI 14. Demographic characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2009, December 31, 2014, and December 31, 2019
Candidates aged younger than 18 years waiting for transplant on December 31 of given year, regardless of first listing date. Age calculated at snapshot. Candidates listed as children who turned 18 before the cohort date are excluded. Distance is computed from candidate's home zip code to the transplant center.

Characteristic	2009, N	2009, Percent	2014, N	2014, Percent	2019, N	2019, Percent
Age: < 1 year	6	0.8%	3	0.3%	1	0.1%
Age: 1-5 years	137	17.4%	227	22.7%	222	21.3%
Age: 6-10 years	140	17.8%	191	19.1%	217	20.8%
Age: 11-17 years	503	64.0%	581	58.0%	604	57.9%
Sex: Female	325	41.3%	430	42.9%	406	38.9%
Sex: Male	461	58.7%	572	57.1%	638	61.1%
Race/ethnicity: White	298	37.9%	415	41.4%	433	41.5%
Race/ethnicity: Black	203	25.8%	217	21.7%	207	19.8%
Race/ethnicity: Hispanic	251	31.9%	302	30.1%	286	27.4%
Race/ethnicity: Asian	24	3.1%	51	5.1%	83	8.0%
Race/ethnicity: Other/unknown	10	1.3%	17	1.7%	35	3.4%
Geography: Metropolitan	697	88.7%	871	86.9%	911	87.3%
Geography: Non-metro	89	11.3%	131	13.1%	133	12.7%
Distance: < 50 miles	503	64.0%	633	63.2%	675	64.7%
Distance: 50-<100 miles	126	16.0%	147	14.7%	160	15.3%
Distance: 100-<150 miles	67	8.5%	86	8.6%	64	6.1%
Distance: 150-<250 miles	52	6.6%	70	7.0%	84	8.0%
Distance: ≥ 250 miles	35	4.5%	54	5.4%	56	5.4%
Distance: Unknown	3	0.4%	12	1.2%	5	0.5%
All candidates	786	100.0%	1002	100.0%	1044	100.0%

Table KI 15. Clinical characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2009, December 31, 2014, and December 31, 2019
Candidates aged younger than 18 years waiting for transplant on December 31 of the given year, regardless of first listing date. 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	2009, N	2009, Percent	2014, N	2014, Percent	2019, N	2019, Percent
Diagnosis: FSGS	116	14.8%	93	9.3%	84	8.0%
Diagnosis: GN	78	9.9%	85	8.5%	63	6.0%
Diagnosis: CAKUT	214	27.2%	372	37.1%	388	37.2%
Diagnosis: Other	378	48.1%	452	45.1%	509	48.8%
Blood type: A	237	30.2%	310	30.9%	304	29.1%
Blood type: B	134	17.0%	153	15.3%	167	16.0%
Blood type: AB	18	2.3%	29	2.9%	27	2.6%
Blood type: O	397	50.5%	510	50.9%	546	52.3%
CPRA: < 1%	401	51.0%	643	64.2%	730	69.9%
CPRA: 1-< 20%	90	11.5%	66	6.6%	81	7.8%
CPRA: 20-< 80%	106	13.5%	147	14.7%	138	13.2%
CPRA: 80-< 98%	72	9.2%	52	5.2%	37	3.5%
CPRA: 98-100%	61	7.8%	88	8.8%	58	5.6%
CPRA: Unknown	56	7.1%	6	0.6%	0	0.0%
All candidates	786	100.0%	1002	100.0%	1044	100.0%

Table KI 16. Listing characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2009, December 31, 2014, and December 31, 2019
Candidates aged younger than 18 years waiting for transplant on December 31 of the given year, regardless of first listing date. Candidates listed as children who turned 18 before the cohort date are excluded.

Characteristic	2009, N	2009, Percent	2014, N	2014, Percent	2019, N	2019, Percent
Transplant history: First	577	73.4%	798	79.6%	904	86.6%
Transplant history: Retransplant	209	26.6%	204	20.4%	140	13.4%
Wait time: < 1 year	443	56.4%	559	55.8%	542	51.9%
Wait time: 1-< 2 years	170	21.6%	232	23.2%	233	22.3%
Wait time: 2-< 3 years	88	11.2%	98	9.8%	120	11.5%
Wait time: 3-< 4 years	38	4.8%	42	4.2%	50	4.8%
Wait time: 4-< 5 years	30	3.8%	30	3.0%	47	4.5%
Wait time: ≥ 5 years	17	2.2%	41	4.1%	52	5.0%
Tx type: Kidney alone	771	98.1%	976	97.4%	1029	98.6%
Tx type: Kidney-pancreas	2	0.3%	0	0.0%	0	0.0%
Tx type: Kidney-liver	8	1.0%	19	1.9%	12	1.1%
Tx type: Kidney-heart	2	0.3%	4	0.4%	2	0.2%
Tx type: Other	3	0.4%	3	0.3%	1	0.1%
All candidates	786	100.0%	1002	100.0%	1044	100.0%

Table KI 17. Kidney transplant waitlist activity among pediatric candidates
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	2017	2018	2019
Patients at start of year	1463	1533	1548
Patients added during year	1083	1047	1030
Patients removed during year	1012	1031	1024
Patients at end of year	1534	1549	1554

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	2017	2018	2019
Deceased donor transplant	605	577	610
Living donor transplant	251	297	262
Transplant outside US	0	1	0
Patient died	15	24	18
Patient refused transplant	3	0	3
Improved, transplant not needed	6	10	6
Too sick for transplant	14	9	10
Other	118	113	115

Table KI 19. Demographic characteristics of pediatric kidney transplant recipients, 2017-2019
Pediatric kidney transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.

Characteristic	Deceased, N	Deceased, Percent	Living, N	Living, Percent	All, N	All, Percent
Age: 1-5 years	282	18.6%	234	31.2%	516	22.8%
Age: 6-10 years	303	20.0%	146	19.5%	449	19.8%
Age: 11-17 years	932	61.4%	370	49.3%	1302	57.4%
Sex: Female	626	41.3%	277	36.9%	903	39.8%
Sex: Male	891	58.7%	473	63.1%	1364	60.2%
Race/ethnicity: White	557	36.7%	523	69.7%	1080	47.6%
Race/ethnicity: Black	343	22.6%	64	8.5%	407	18.0%
Race/ethnicity: Hispanic	496	32.7%	124	16.5%	620	27.3%
Race/ethnicity: Asian	72	4.7%	25	3.3%	97	4.3%
Race/ethnicity: Other/unknown	49	3.2%	14	1.9%	63	2.8%
Insurance: Private	387	25.5%	415	55.3%	802	35.4%
Insurance: Medicare	375	24.7%	120	16.0%	495	21.8%
Insurance: Medicaid	637	42.0%	179	23.9%	816	36.0%
Insurance: Other government	102	6.7%	26	3.5%	128	5.6%
Insurance: Unknown	16	1.1%	10	1.3%	26	1.1%
Geography: Metropolitan	1267	83.5%	626	83.5%	1893	83.5%
Geography: Non-metro	250	16.5%	124	16.5%	374	16.5%
Distance: < 50 miles	929	61.2%	449	59.9%	1378	60.8%
Distance: 50-<100 miles	239	15.8%	126	16.8%	365	16.1%
Distance: 100-<150 miles	147	9.7%	59	7.9%	206	9.1%
Distance: 150-<250 miles	112	7.4%	60	8.0%	172	7.6%
Distance: ≥ 250 miles	79	5.2%	48	6.4%	127	5.6%
Distance: Unknown	11	0.7%	8	1.1%	19	0.8%
All recipients	1517	100.0%	750	100.0%	2267	100.0%

Table KI 20. Clinicial characteristics of pediatric kidney transplant recipients, 2017-2019
Pediatric 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	195	12.9%	78	10.4%	273	12.0%
Diagnosis: GN	135	8.9%	61	8.1%	196	8.6%
Diagnosis: CAKUT	472	31.1%	269	35.9%	741	32.7%
Diagnosis: Other	715	47.1%	342	45.6%	1057	46.6%
Blood type: A	441	29.1%	284	37.9%	725	32.0%
Blood type: B	178	11.7%	113	15.1%	291	12.8%
Blood type: AB	55	3.6%	23	3.1%	78	3.4%
Blood type: O	843	55.6%	330	44.0%	1173	51.7%
Dialysis time: None	388	25.6%	301	40.1%	689	30.4%
Dialysis time: < 1 year	337	22.2%	191	25.5%	528	23.3%
Dialysis time: 1-< 3 years	479	31.6%	175	23.3%	654	28.8%
Dialysis time: 3-< 5 years	147	9.7%	28	3.7%	175	7.7%
Dialysis time: ≥ 5 years	166	10.9%	55	7.3%	221	9.7%
CPRA: < 1%	1115	73.5%	544	72.5%	1659	73.2%
CPRA: 1-< 20%	142	9.4%	84	11.2%	226	10.0%
CPRA: 20-< 80%	195	12.9%	98	13.1%	293	12.9%
CPRA: 80-< 98%	33	2.2%	15	2.0%	48	2.1%
CPRA: 98-100%	32	2.1%	7	0.9%	39	1.7%
CPRA: Unknown	0	0.0%	2	0.3%	2	0.1%
All recipients	1517	100.0%	750	100.0%	2267	100.0%

Table KI 21. Transplant characteristics of pediatric kidney transplant recipients, 2017-2019
Pediatric 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)	8	0.5%	31	4.1%	39	1.7%
Wait time: < 1 year	1050	69.2%	558	74.4%	1608	70.9%
Wait time: 1-< 3 years	366	24.1%	134	17.9%	500	22.1%
Wait time: 3-< 5 years	75	4.9%	22	2.9%	97	4.3%
Wait time: ≥ 5 years	18	1.2%	5	0.7%	23	1.0%
KDPI: ≤ 20%	1182	77.9%
KDPI: 21-34%	272	17.9%
KDPI: 35-85%	62	4.1%
KDPI: > 85%	1	0.1%
DCD status: DBD	1444	95.2%
DCD status: DCD	73	4.8%
DGF: None	1407	92.7%	727	96.9%	2134	94.1%
DGF: Yes	110	7.3%	23	3.1%	133	5.9%
Transplant history: First	1393	91.8%	701	93.5%	2094	92.4%
Transplant history: Retransplant	124	8.2%	49	6.5%	173	7.6%
Tx type: Kidney only	1442	95.1%	750	100.0%	2192	96.7%
Tx type: Kidney-pancreas	2	0.1%	0	0.0%	2	0.1%
Tx type: Kidney-liver	59	3.9%	0	0.0%	59	2.6%
Tx type: Kidney-heart	10	0.7%	0	0.0%	10	0.4%
Tx type: Other	4	0.3%	0	0.0%	4	0.2%
All recipients	1517	100.0%	750	100.0%	2267	100.0%

Table KI 22. Pediatric deceased donor kidney donor-recipient serology matching, 2017-2019
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. CMV, cytomegalovirus; EBV, Epstein-Barr virus.

Donor	Recipient	CMV	EBV
D-	R-	25.9%	6.0%
D-	R+	14.7%	7.4%
D-	R unk	0.6%	0.1%
D+	R-	37.7%	38.2%
D+	R+	19.8%	47.2%
D+	R unk	0.5%	1.1%
D unk	R-	0.5%	0.0%
D unk	R+	0.4%	0.0%
D unk	R unk	0.0%	0.0%

Table KI 23. Pediatric living donor kidney donor-recipient serology matching, 2017-2019
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. CMV, cytomegalovirus; EBV, Epstein-Barr virus.

Donor	Recipient	CMV	EBV
D-	R-	36.9%	5.3%
D-	R+	8.5%	3.6%
D-	R unk	0.1%	0.1%
D+	R-	30.7%	52.5%
D+	R+	17.6%	33.3%
D+	R unk	0.5%	1.5%
D unk	R-	4.1%	2.3%
D unk	R+	1.5%	1.3%
D unk	R unk	0.0%	0.0%