The average waiting time for a kidney transplant is becoming longer. In 2003, 43 percent of patients had been waiting for more than 2 years, whereas only 29 percent of patients had been waiting for more than 2 years in 1994 (Danovitch et al., 2005). In 2003, almost 11 percent had been waiting more than 5 years. Longer waiting times are particularly a problem for minority patients awaiting kidney transplantation (Table 2-7). For example, for African Americans added to the waiting list in 1999, the waiting time has been twice as long as that for white individuals (Danovitch et al., 2005). It is hoped that the changes in human leukocyte antigen (HLA) matching criteria made by UNOS (described below) will contribute to reduced waiting times.

Another concern is the number of retransplantations needed. In 2004, 7,969 individuals on the waiting list for a kidney transplant (17.4 percent of the waiting list) had received a previous kidney or kidney/pancreas transplant (HRSA and SRTR, 2006). There are a number of reasons for graft failure and the need for retransplantation, some of which cannot be prevented, while others such as noncompliance with immunosuppressive medications can be partially addressed through increased insurance coverage for these medications and improved patient education (IOM, 2000).

There is evidence of the benefit of preemptive kidney transplantation (before the patient begins dialysis) for some patients (Becker et al., 2006); however, only 13 percent of kidney recipients in 2003 received preemptive kidney transplants, and these were primarily through living-donor transplants (Danovitch et al., 2005).

The number of kidney transplants has increased since 1994, to a great extent because of increases in the numbers of living donations. In 2005, 39.8 percent of kidney transplants resulted from living donations, and

TABLE 2-7 Kidney Transplant Waiting List Registrations, 2001 to 2002

Ethnicity

Number of Registrations Added to Waiting List

Percentage Receiving Transplants After 1 Year on Waiting List

Percentage Receiving Transplants After 2 Years on Waiting List

White

24,336

18.1

32.2

African American

13,340

10.6

20.5

Hispanic

6,546

11.1

22.6

Asian

2,396

9.2

18.6

American Indian-Native Alaskan

485

11.3

22.1

Pacific Islander

340

7.2

18.9

SOURCE: OPTN (2006).



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