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ABSTRACT A shortage of kidneys for transplant remains a major problem for patients with end-stage renal disease. The number of candidates on the waiting list continues to increase each year, while organ donation numbers remain flat. Thus, transplant rates for adult wait-listed candidates continue to decrease. However, pretransplant mortality rates also show a decreasing trend. Many kidneys recovered for transplant are discarded, and discard rates are increasing. Living donation rates have been essentially unchanged for the past decade, despite introduction of desensitization, non-directed donations, and kidney paired donation programs. For both living and deceased donor recipients, early posttransplant results have shown ongoing improvement, driven by decreases in rates of graft failure and return to dialysis. Immunosuppressive drug use has changed little, except for the Food and Drug Administration approval of belatacept in 2011, the first approval of a maintenance immunosuppressive drug in more than a decade. Pediatric kidney transplant candidates receive priority under the Share 35 policy. The number of pediatric transplants peaked in 2005, and decreased to a low of 760 in 2011. Graft survival and short-term renal function continue to improve for pediatric recipients. Posttransplant lymphoproliferative disorder is an important concern, occurring in about one-third of pediatric recipients.
This transplant impacted my life and the lives of my friends, family and community. I am especially grateful to be able to raise my son, to take him out of foster care and give him a good home and loving family.
Towana, kidney/pancreas recipient
Perhaps the most striking highlight of the 2010 and 2011 data is how little has changed. Organ donation numbers are relatively flat and the waiting list continues to grow. The shortage of kidneys remains a major problem for patients with end-stage renal disease (ESRD). Thus, there are attempts to increase the donor pool, and the kidney donor profile index (KDPI), which reflects the overall quality of deceased donor kidneys, continues to increase, especially for expanded criteria donors (ECD) (Figures 2.11, 2.12).
Figure KI 2.11 . Mean kidney donor profile index (KDPI) Patients receiving a kidney-only, deceased-donor transplant. Donors with a missing value for height, weight, or creatinine are excluded. KDPI is based on donor factors only; the percentiles are derived by mapping to the 2011 population of kidneys recovered for transplant.
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Figure KI 2.12 . Kidney donor profile index (KDPI) scores for ECD & SCD kidneys, 2010 All deceased donors whose kidney was transplanted in the given year, by SCD/ECD status. Each transplanted kidney is counted separately. Donors with a missing value for height, weight, or creatinine are excluded. KDPI is based on donor factors only; the percentiles are derived by mapping to the 2011 population of kidneys recovered for transplant.
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