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Recent trends in cadaveric renal transplantation
R L Webb1, F K Port, D S Gaylin
1United States Renal Data System Coordinating Center, Washington, DC.
Clinical Transplants
|January 1, 1990
Summary
Cadaveric (deceased donor) transplants plateaued after 1986, with increasing waitlists and a shift towards older recipients. Transplantation rates declined in younger groups but rose for those 50 and over.
Area of Science:
- Nephrology
- Transplantation immunology
- Public health
Background:
- Cadaveric transplantation is a critical treatment for end-stage renal disease.
- Understanding trends in organ donation and recipient demographics is vital for resource allocation and patient outcomes.
Purpose of the Study:
- To analyze temporal trends in cadaveric organ transplantation from 1981 to 1988.
- To examine demographic shifts in recipients and donors.
- To assess changes in transplantation rates across different age groups and patient characteristics.
Main Methods:
- Retrospective analysis of cadaveric transplant data.
- Examination of recipient age distribution and transplantation rates by age group.
- Comparison of demographic characteristics between recipients, donors, and the general population.
- Analysis of repeat versus first-time transplants and HLA matching trends.
Main Results:
- Cadaveric transplants leveled off post-1986, widening the gap between available organs and patient need.
- A significant trend towards older recipients (50+) emerged, with declining rates in younger populations.
- Transplantation rates were highest in pediatric patients, declining with age, with post-1986 declines most pronounced in younger groups.
- Whites and males exhibited higher transplantation rates than Blacks and females, with disparities increasing by recipient age.
- Repeat transplants constituted 15% in 1988, with higher proportions in younger recipients, though overall repeat transplant rates declined relative to first transplants.
- Donors were younger, less often female, and less often Black than the general population, with a trend toward older donors.
- Pre-transplant nephrectomies and splenectomies decreased, while 0 HLA-antigen mismatch transplants showed a slight increase.
Conclusions:
- The cadaveric transplant system faced increasing demand post-1986, with a notable shift towards older recipients.
- Demographic disparities in transplantation rates persist and, in some cases, widen.
- Trends suggest evolving donor characteristics and a slight improvement in immunological matching over time.