*Purpose: The Executive Order on Advancing American Kidney Health aims to treat 80% of all kidney failure patients with transplantation or home dialysis but no targets for transplantation were advanced.

*Methods: We studied incident kidney failure patients 18-70 years of age in the United States between 2015 and 2016 to determine the proportion treated by transplantation by state of residence. Patients were followed from the date of first chronic kidney failure treatment for 3.5 years for the outcome of transplantation from any donor source with death treated as a competing risk.

*Results: The figure shows the incidence of transplantation overall and stratified by patient age. In each age group, the incidence of transplantation in the 10 states with the highest use of transplantation is shown to indicate a feasible target for transplantation. The incidence in states with intermediate use and and lowest use of transplantation is shown to demonstrate the opportunity to increase transplantation. Only 11% of patients aged 18-70 years were treated with transplantation within the first 3.5 years of developing kidney failure with 19% of patients in the top ten performing states and 7% in the bottom ten performing states treated with transplantation. Treatement with transplantation was inversely related to patient age: 18-40 years (overall 23%, top 10 states 39%, bottom ten states 14%); 41-60 years (overall 12%, top 10 states 21%, bottom 10 states 7%); 61-70 years (overall 7%, top 10 states 12%, bottom 10 states 4%).

*Conclusions: We conclude that a realistic target for treatment with transplantation among patients aged 18-70 years is 20% after 3.5 years of a kidney failure diagnosis.

« Back to 2021 American Transplant Congress