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Abstract: PO2542

The Natural History of Waitlist Candidates in the United States

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • 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
Background

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.

Methods

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.

Results

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).

Conclusion

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.

Funding

  • NIDDK Support