The UNOS Renal Transplant Registry: Review of the Last Decade.
Kidney transplantation has become a preferred treatment for end-stage renal disease (ESRD) as transplant recipients enjoy freedom from dialysis and improvement in both quality and quantity of life. More patients are being placed on the transplant waiting list, although the waiting list patients still only represent a very small fraction of ESRD patients. The characteristics of both waitlisted and transplanted patients have changed considerably in the last decade, as the ESRD population has aged and waiting list times have increased. Over the last 10 years, we have witnessed an increasingly severe shortage of kidney donors. Even with increasing efforts of the transplant community to expand the donor pool by including larger numbers of high risk deceased donor transplants, the overall number of kidney transplants has remained relatively stable. Those who do receive transplants, however, benefit from excellent transplant outcomes. The use of paired exchange/chain transplant donors has increased the living donor pool significantly and with outstanding results. Belatacept, a costimulation blockage drug, represents a new class of transplant immunosuppression. It has been used sparingly in the first few years of its approval. Most kidney transplant patients are still maintained on immunosuppressive agents that were approved almost two decades ago. In the next decade, we will certainly continue to deal with an organ shortage as the number of eligible and waitlisted patients is likely to increase. Effective and efficient organ allocation policies will be increasingly necessary to address this scarcity. Optimizing the transplant candidate work-up, improving maintenance of waitlisted patients, and providing optimal post-transplant medical care will be vital to the continued success of kidney transplantation.
Mark
M
Andre
Edmund
E
Huang
Matthew
M
Everly
Suphamai
S
Bunnapradist
D000368:Aged; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000639:trends; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000639:trends*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists
D007166:Immunosuppressive Agents