ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: PO2542

The Natural History of Waitlist Candidates in the United States

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Massie, Allan, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Estimates of time to deceased-donor transplantation (DDKT) generally fail to take into account the competing risks of mortality. Understanding the natural history of KT registrants - their chance of DDKT/LDKT/death based on individual characteristics - can inform referrals for transplantation, counseling for transplant candidates, and allocation policy.


Using SRTR data on 186,174 waitlist registrants 12/2014-12/2019, we modeled time to DDKT, LDKT, or waitlist mortality in a competing-risks framework, overall and for clinically relevant subgroups of patients (based on candidate age, sex, race, ABO blood type, PRA). Competing-risks regression was used to model individual n-year chance of DDKT/LDKT/mortality based on candidate characteristics.


Among all candidates, 5-year cumulative incidence of LDKT/DDKT/mortality/other removal was 17.3%/34.4%/15.7/18.1% respectively. 85% of LDKT recipients received LDKT within 2 years of listing. Pediatric registrants had substantially higher incidence of DDKT than waitlist mortality (61.7% vs 1.1%), but adults had higher combined of waitlist mortality/other removal DDKT, particularly patients above age 65 (44.4% vs 32.3%) (Figure). Center-level 5-year incidence of LDKT (DDKT) 1.3%-44.8% (4.4%-82.6%) (Figure 2).


Despite a focus in the transplant community on small differences in one-year posttransplant outcomes and a reluctance to transplant kidneys with slightly worse expected outcomes, most adult patients wait >5 years for a kidney, incurring substantial waitlist mortality risk. High incidence of waitlist mortality will only be remedied through aggressive efforts to increase the living and deceased donor organ pool.


  • NIDDK Support