Previous analysis by our group showed living donor (LD) transplant rates peaked between 2002 and 2004 and declined thereafter. We sought to understand if this was a pervasive phenomenon or confined to certain subgroups of candidates.

We analyzed all adult candidates for kidney or kidney pancreas transplant or recipients receiving a LD transplant without listing between 2001 and 2010 in the SRTR database. The 268 179 unique candidate listings identified were grouped into two cohorts encompassing 5 year eras, 2001 to 2005 and 2006 to 2010, with follow-up to August 31, 2013. Subgroup analyses were performed for age, race/ethnicity, gender, etiology of kidney disease, insurance status, and educational attainment between the two eras by both Cox proportional hazards modeling for time to LD transplant and binary logistic regression for LD transplant within 2.5 years of listing. Each model included the above covariates and additional covariates of ABO type, PRA, initial list status (active vs. inactive), dialysis status at listing, number of kidney transplants pursued, first OPO of listing, concomitant pancreas listing, and era but excluding the subgroup covariate. Table 1 shows the era declines by subgroup for the logistic regression. Sensitivity analyses by Cox regression were similar. The declines in LD transplant were pervasive and cut across all subgroups analyzed.

Our data suggests that the decline in LD transplant rates is a pervasive phenomenon and not confined to specific groups that could be easily targeted. Whether this is due to changing attitudes toward living donation by candidates or potential donors, due to evolution of transplant center donor selection practices, or due to declining health in the US population could not be ascertained.

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