The Annual Report of the OPTN and SRTR Kidney

The 2007 Annual Report of the OPTN and SRTR Kidney and Pancreas Transplantation in the US, 1997-2006: The HRSA Breakthrough Collaboratives and the 58 DSA Challenge Overview • Growth in the number of active patients on the kidney transplant waiting list has slowed. Projections based on the most recent five-year data suggest the total waiting list will grow at a rate of 4,138 registrations per year, whereas the active waiting list will increase at less than one-sixth that rate, or 663 registrations per year. • The last five years have seen a small trend toward improved unadjusted allograft survival for living and deceased donor kidneys. Since 2004 the overall number of pancreas transplants has declined. Among pancreas recipients, those with simultaneous kidneypancreas transplants experienced the highest pancreas graft survival rates. In response to the ongoing shortage of deceased donor organs, the U.S. Health Resources and Services Administration launched the Organ Donation Breakthrough Collaborative in September 2003 and the Organ Transplantation Breakthrough Collaborative (OTBC) in October 2005. The 58 DSA Challenge is prominent among the goals adopted by the OTBC. Its premise: were each of the 58 existing donation service areas to increase the number of kidney transplants performed within their boundaries by 10 per month, an additional 7000 transplants over current annual levels would result. Such an increase could potentially eliminate the national kidney transplantation waiting list by 2030. • Summary Figures The figures on the following four pages are “dashboard” views of the state of kidney and pancreas transplantation. Details on the implications of these figures, and explanations of the methods used in creating them, are included in Chapter IV of this year’s report, available online at www.optn.org and www.ustransplant.org. These sites also include resources for interested readers, including a glossary, technical notes, other chapters on many aspects of organ transplantation, and a wealth of transplant data. The data and analyses reported in the 2007 Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients have been supplied by the United Network for Organ Sharing and the Arbor Research Collaborative for Health under contract with the Department of Health and Human Services. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. Government. The 2007 OPTN/SRTR Annual Report This Annual Report is a publication of the Department of Health and Human Services. It was developed by contract for the Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation. Suggested Citation: 2007 OPTN/SRTR Annual Report 1997-2006. HHS/HRSA/HSB/DOT. This is a U.S. government-sponsored work. There are no restrictions on its use. Kidney Transplantation at a Glance Deceased Donor Tx 50,000 40,000 30,000 20,000 10,000 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Living Donor Tx Kidney Waiting List Number of Transplants and Size of Active Waiting List. There was a very large gap between the number of patients waiting for a transplant and the number receiving a transplant. This gap widened over the decade, meaning that the waiting times from listing to transplant continued to increase. The number of living donor transplants increased until 2004, while the number of deceased donor transplants continued to rise gradually. Source: 2007 OPTN/SRTR Annual Report, Tables 1.7, 5.1a. <18 Years 50-64 Years 100% Age Distribution 80% 60% 40% 20% 0% 1997 2006 18-34 Years 65+ Years 35-49 Years Age Distribution of Recipients and Active Waiting List. In 2006, older candidates (age >50) made up a much larger fraction of patients actively awaiting an organ than a decade earlier. The same pattern was observed for transplant recipients, except that young (age <35) patients showed a greater representation among recipients than on the waiting list. Source: 2007 OPTN/SRTR Annual Report, Tables 5.1a, 5.4a, 5.4b, 5.4c. 1997 2006 Waiting List Recipients Patient Survival 100% Survival (%) 80% 60% 40% 20% 0% 3 mo 1 yr 3 yr 5 yr 3 mo 1 yr Deceased non-ECD Graft Survival Unadjusted Patient and Graft Survival. Living Donor Deceased ECD 3 yr 5 yr 3 mo 1 yr 3 yr 5 yr Follow-up Time Patient survival in recent years has been improving. Five-year patient survival percentages based on transplants during 2000-2005 were clearly higher for recipients of living donor organs (90%) than for recipients of non-ECD organs (83%) or ECD organs (69%). Similarly, living donor organs had the highest five-year graft survival. Source: 2007 OPTN/SRTR Annual Report, Tables 5.10a, 5.10b, 5.10c, 5.14a, 5.14b, 5.14c. Pancreas Transplantation Alone (PTA) at a Glance PTA Transplants 350 300 250 200 150 100 50 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 PTA Waiting List Number of Transplants and Size of Active Waiting List. The number of patients on the waiting list for a pancreas transplant alone had been decreasing since 2003, but it rose slightly in 2006. The number of PTA transplants per year was relatively stable. Source: 2007 OPTN/SRTR Annual Report, Tables 1.7, 6.1a. <18 Years 100% 80% 60% 40% 20% 0% 18-34 Years 35-49 Years 50-64 Years 65+ Years Age Distribution of Recipients and Active Waiting List. For PTA, more pediatric candidates were wait-listed and more received a transplant in 2006 than in 1997. At the same time, the fraction of recipients over age 50 grew. Pediatric diabetic patients rarely have kidney failure before age 18, but they are candidates for PTA. Source: 2007 OPTN/SRTR Annual Report, Tables 6.1a, 6.4. Age Distribution 1997 2006 1997 2006 Waiting List Recipients Deceased Donor 100% 80% Survival (%) 60% 40% 20% 0% 3 mo Patient Survival Graft Survival Unadjusted Patient and Graft Survival. For PTA transplants, patient survival in recent years has been excellent; such recipients do not usually have advanced kidney failure. The five-year patient survival rate was 90%. Graft survival was considerably lower because patient survival included time after graft failure while patients received insulin or retransplantation. Source: 2007 OPTN/SRTR Annual Report, Tables 6.10, 6.14. 1 yr Follow-up Time 3 yr 5 yr Pancreas After Kidney (PAK) Transplantation at a Glance PAK Transplants 600 500 400 300 200 100 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 PAK Waiting List Number of Transplants and Size of Active Waiting List. As with PTA, the number of patients on the waiting list for a PAK transplant decreased since 2003. The number receiving a transplant matched the number of candidates at the end of 2004, 2005, and 2006. The number of PAK transplants decreased further from its highest level of the decade in 2004. Source: 2007 OPTN/SRTR Annual Report, Tables 1.7, 7.1a. <18 Years 100% 80% 60% 40% 20% 0% 18-34 Years 35-49 Years 50-64 Years 65+ Years Age Distribution of Recipients and Active Waiting List. For PAK, more patients over 50 were wait-listed and received a transplant in 2006 than in 1997. At the same, time fewer candidates and recipients were in the 18-34 age group. (Since recipients were mostly type 1 diabetics, the ages below 18 and above 65 were virtually unrepresented.) Recipients included transplants from both living and deceased donors. Source: 2007 OPTN/SRTR Annual Report, Tables 7.1a, 7.4. Age Distribution 1997 2006 1997 2006 Waiting List Recipients Deceased Donor 100% 80% Survival (%) 60% 40% 20% 0% 3 mo Patient Survival Graft Survival Unadjusted Patient and Graft Survival. For PAK transplants, patient survival was similar to that seen for simultaneous kidney-pancreas transplant recipients. Five-year patient survival was 84%. Graft survival was considerably lower because patient survival included time after graft failure while patients received treatment with insulin or retransplantation. Source: 2007 OPTN/SRTR Annual Report, Tables 7.10, 7.14. 1 yr Follow-up Time 3 yr 5 yr Simultaneous Pancreas-Kidney (SPK) Transplantation at a Glance SPK Transplants 2500 2000 1500 1000 500 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 SPK Waiting List Number of Transplants and Size of Active Waiting List. SPK accounts for the large majority of all pancreas transplants. Numbers of this procedure were stable over the decade. The gap between the number of patients waiting for a transplant and the number receiving a transplant dropped substantially since 2000. Source: 2007 OPTN/SRTR Annual Report, Tables 1.7, 8.1a. <18 Years 100% 80% 60% 40% 20% 0% 18-34 Years 35-49 Years 50-64 Years 65+ Years Age Distribution of Recipients and Active Waiting List. For SPK transplantation, patients over age 50 made up greater fractions of both candidates and recipients in 2006 than in 1997. At the same time, fewer candidates and recipients were in the 18-34 age group. (Since recipients were mostly type 1 diabetics, the ages below 18 and above 65 were virtually unrepresented.) Recipients included transplants from both living and deceased donors. Source: 2007 OPTN/SRTR Annual Report, Tables 8.1a, 8.4. Age Distribution 1997 2006 1997 2006 Waiting List Recipients Patient Survival 100% 80% Survival (%) 60% 40% 20% 0% 3 mo Graft Survival (Kidney) Graft Survival (Pancreas) Unadjusted Patient and Graft Survival. Patient survival has improved for SPK recipients in recent years. All SPK transplants were from deceased donors and their five-year patient survival was 86%. Graft survival was lower because patient survival included time after graft failure while patients received treatment with insulin or retransplantation. Source: 2007 OPTN/SRTR Annual Report, Tables 8.10, 8.14. 1 yr Follow-up Time 3 yr 5 yr