Introduction and Methods

Over the past decades there have been numerous clinical advances and policy changes affecting candidates for kidney transplantation. Our aim was to evaluate outcomes over time for the candidate population. We examined adult (18+) solitary kidney transplant candidates in the US listed 2000-2014 using the SRTR database. We examined time to death(both censored and uncensored at time of waitlist removal), transplantation and waitlist removal for reasons of 'too sick' or 'other'. We adjusted models for clinical and demographic characteristics and examined potential modifying effects.

Results

There were 478,842 candidates placed on the waiting list during the study period. Of these, 19.8% died prior to transplantation, 42% received a transplant (67% from a deceased donor) and 22% were removed from the waiting list for reasons other than death or transplantation. The primary results indicated dramatic declines in one-year and long-term mortality rates, declines in transplant rates and significant increases in removal from the wait list. Progressive changes were evident for each outcome in adjusted models including a 0.56(95%CI, 0.53-0.60) adjusted hazard ratio (AHR), for mortality, AHR=0.73(0.70-0.76) for time to transplant and AHR=1.74(1.61-1.87) for wait list removal in 2014 relative to 2000. Declines in mortality were more pronounced among candidates that were minorities, longer dialysis duration and diabetics. The risk index (based on cumulative risk burden at listing) significantly declined over time suggesting baseline risk of candidates has reduced.

Conclusions

Over the past fifteen years, there has been dramatic progressive changes in the prognosis of adult candidates placed on the solitary kidney transplant waiting list in the US. These changes are likely impacted by candidate selection criteria, regulatory oversight and general improvements in outcomes and treatment for candidates and ESRD patients. These trends are important considerations for prospective policy development, evaluation of practice patterns determining candidate selection and the impact on access to care.

CITATION INFORMATION: Schold J, Poggio E, Buccini L, Flechner S, Augustine J, Goldfarb D. Dramatic Shifts in Prognosis, Outcomes and Baseline Risk Among Wait Listed Kidney Transplant Candidates in the United States. Am J Transplant. 2017;17 (suppl 3).

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