Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN; Saint Louis University Center for Abdominal Transplantation, SSM-Saint Louis University Hospital, St. Louis, MO.
Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN; Department of Pediatrics, University of Washington, Seattle, WA.
Am J Transplant. 2023 Feb;23(2 Suppl 1):S21-S120. doi: 10.1016/j.ajt.2023.02.004.
The year 2021 marked both successes and challenges for the field of kidney transplantation, in the context of the ongoing COVID-19 pandemic and broader geographic organ distribution. The total number of kidney transplants in the United States reached a record count of 25,487, driven by growth in deceased donor kidney transplants. The total number of candidates listed for deceased donor kidney transplant rose slightly in 2021 but remained below 2019 listing levels, with nearly 10% of candidates having been waiting 5 years or longer. Pretransplant mortality declined slightly among candidates of Black, Hispanic, and other races, in parallel with increasing numbers of Black and Hispanic transplant recipients. In the context of broader organ sharing, there is growing disparity in pretransplant mortality among non-metropolitan compared with metropolitan residents. The proportion of deceased donor kidneys recovered but not used for transplant (nonuse rate) rose to a high of 24.6% overall, with greater nonuse among biopsied kidneys (35.9%), kidneys from donors aged 55 years or older (51.1%), and kidneys with kidney donor profile index (KDPI) of 85% or greater (66.6%). Nonuse of kidneys from donors who are hepatitis C virus (HCV) antibody positive only slightly exceeded that of HCV antibody-negative donors. Disparities in access to living donor kidney transplant persists, especially for non-White and publicly insured patients. Delayed graft function continues an upward trend and occurred in 24% of adult kidney transplants in 2021. Five-year graft survival after living compared with deceased donor transplant was 88.6% versus 80.7% for recipients aged 18-34 years, and 82.1% versus 68.0% for recipients aged 65 years or older. The total number of pediatric kidney transplants performed increased to 820 in 2021, the highest number since 2010. Despite numerous efforts, living donor kidney transplant remains low among pediatric recipients, with continued racial disparities. The rate of deceased donor transplants among pediatric candidates recovered in 2021 from a low in 2020. Congenital anomalies of the kidney and urinary tract remain the leading primary kidney disease diagnosis among pediatric candidates. Most pediatric deceased donor recipients receive a kidney from a donor with KDPI less than 35%. Graft survival continues to improve, with superior outcomes for living donor transplant recipients.
2021 年，在持续的 COVID-19 大流行和更广泛的地域器官分配背景下，肾移植领域取得了成功，也面临着挑战。美国的肾移植总数达到了 25487 例的历史新高，这主要得益于已故供体肾移植的增长。2021 年，已故供体肾移植的候选人数略有上升，但仍低于 2019 年的登记水平，近 10%的候选者已经等待了 5 年或更长时间。黑人和西班牙裔以及其他种族的候选者的移植前死亡率略有下降，与此同时，黑人和西班牙裔的移植受者人数也在增加。在更广泛的器官共享背景下，与大都市居民相比，非大都市居民的移植前死亡率存在越来越大的差距。用于移植但未使用的已故供体肾脏（未使用率）总体上升至 24.6%的高位，活检肾脏（35.9%）、55 岁或以上供体的肾脏（51.1%）和 KDPI 为 85%或更高的肾脏（66.6%）的未使用率更高。仅丙型肝炎病毒（HCV）抗体阳性供体的肾脏未使用率略高于 HCV 抗体阴性供体。活体供者肾移植的机会仍然存在差距，特别是对非白人和公共保险患者。延迟移植物功能障碍继续呈上升趋势，2021 年成人肾移植中有 24%发生这种情况。18-34 岁患者中，活体供者与已故供者移植后 5 年移植物存活率分别为 88.6%和 80.7%，65 岁或以上患者分别为 82.1%和 68.0%。2021 年，接受儿童肾移植的总人数增加到 820 例，为 2010 年以来的最高水平。尽管做出了诸多努力，但活体供者肾移植在儿童受者中仍然很低，且存在持续的种族差异。2021 年，儿童候选者中的已故供体移植率从 2020 年的低点有所恢复。儿童候选者中，肾脏和泌尿道先天畸形仍然是主要的原发性肾脏疾病诊断。大多数儿童已故供体受者接受的肾脏来自 KDPI 小于 35%的供体。移植物存活率继续提高，活体供者移植受者的预后更好。
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