Backround: Kidney transplantation confers a significant survival benefit to its recipients. Our objective was to reassess this survival benefit in light of improving outcomes on dialysis and the stagnant long-term survival after kidney transplantation.

Methods: We studied a cohort of 768,214 candidates listed in the Organ Procurement and Transplantation Network for kidney transplantation between 1987 and 2016; 372,876 of the candidates (49%) were transplanted. We divided the study period in to approximately four year cohorts. Kaplan-Meier and Multivariable Cox regression analysis was used. We also used competing risk analysis to confirm our waitlist analysis.

Results: Waitlist survival for kidney transplantation has improved steadily over the study period. 5-year survival on the waiting list was 53.8% in 1988, 50.3% in 2000, and 78.3% in 2012 (p<0.001). The mean age at listing had increased from 41.6 in 1988 to 51.6 in 2015 (p<0.001) while the transplant rate has decreased by nearly 100% from 1988 to 2015. In adjusted analysis, candidates listed for kidney transplant from 2006-2010 had a 60% decreased chance of dying on the waiting list compared to 1987-1995, those listed from 2011-2016 had a nearly 80% reduction in risk.

Conclusions: We have demonstrated consistent improvement in kidney transplant waitlist survival over the past two decades despite listing sicker and older candidates and a declining transplant rate. The survival outcomes on the waiting list are approaching survival after kidney transplantation.

CITATION INFORMATION: Rana A., Murthy B., O'Mahony C., Goss J. Waitlist Survival is Approaching Survival after Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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