OPTN/SRTR 2023 Annual Data Report: Kidney.

Area of Science:

• Nephrology
• Transplant Surgery
• Public Health

Background:

• Kidney transplantation is a critical treatment for end-stage renal disease.
• The field has navigated challenges including the COVID-19 pandemic and organ allocation policies.
• Understanding annual trends in transplant volume, outcomes, and disparities is vital for improving patient care.

Purpose of the Study:

• To analyze the key trends and outcomes in kidney transplantation in the United States for 2023.
• To identify successes, challenges, and persistent disparities in deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT).
• To evaluate changes in pretransplant mortality, kidney nonuse rates, and graft survival.

Main Methods:

• Analysis of national kidney transplant data from 2023.
• Comparison of 2023 data with previous years to identify trends.
• Examination of transplant rates, waiting times, mortality, nonuse, and graft survival across different demographic and donor characteristics.

Main Results:

• A record 28,142 kidney transplants were performed, driven by an increase in DDKTs.
• Kidney nonuse rates increased to 27.9%, particularly for older donors and those with high kidney donor profile index scores.
• Pretransplant mortality declined, but disparities in LDKT access persisted for non-White and publicly insured patients.
• Five-year graft survival rates favored LDKT over DDKT across all age groups.

Conclusions:

• While 2023 marked a success in total kidney transplants, increased nonuse and persistent LDKT access disparities require attention.
• Declining pretransplant mortality is a positive trend, but variations by donation service area warrant further investigation.
• Strategies to mitigate kidney nonuse and address inequities in LDKT are crucial for advancing kidney transplant outcomes.