Rates of living donor kidney transplantation have been declining in the United States since 2003. Tremendous variation exists in the rate of living donor transplantation by transplant center. Some centers, such as pediatric centers, have very high rates while other very low rates. We sought to understand how pervasive the decrease in living donor transplant rates in individual transplant centers has been by comparing two eras of listings, 2001-2005 (ERA1) and 2006-2010 (ERA2).

All waitlisted candidates, including pediatric listings and recipients of living donor kidneys listed on day of transplant, were identified in the SRTR database between 2001 and 2010. For the analysis, only centers with at least 20 listings during the study period and listings in both eras were included in the analysis (242 of 269 centers). The outcome of interest was living donor transplant within 2.5 years of listing. 278,145 candidates met inclusion criteria (ERA1 125,555 and ERA2 152,590). Among this group the overall rate of living donor transplantation, calculated as the number of living donor transplants in 2.5 years divided by the total number of listings, decreased from 0.237 to 0.186. This translated into an absolute reduction in living donor transplantation from 29,721 in ERA1 to 28,447 in ERA2. Of the 242 centers analyzed, 46 (19.0%) had an increase in the rate of living donor transplant between the two eras while 196 remained unchanged or decreased. Of the 46 centers that had an improved rate, only 23 showed an increase in the number of listings between the two eras (average increase 43.1%) while the other 23 saw a contraction in the number of listings between the two eras (average decrease 24.8%). Among the centers that remained unchanged or decreased (196 centers), 144 centers had an increase in listings by an average of 35.2%. The remaining 52 centers had a decrease in the number of listing by an average of 19.6%. Our analysis indicates that only 23 of the 242 programs analyzed were both growing their lists and improving living donor transplant rates (9.5%).

Our findings suggest that most kidney transplant programs are experiencing problems finding living donors. Analyzing the high performing centers to determine best practices may help other centers improve their living donor transplant rates.

CITATION INFORMATION: Keith D, Nishio Lucar A, Vranic G. Center Level Analysis of Changes in Living Donor Transplant Rates in the United States. Am J Transplant. 2016;16 (suppl 3).

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