Transplant Statistics: Annual Report

Data Highlights
Waiting List And Transplant Data

Overall Waiting List Characteristics

The OPTN waiting list for cadaveric organs consisted of 76,115 waiting list registrations on the last day of 2000, representing a 10% increase from 69,054 at the end of 1999 (Table 1.3). Overall, the size of the waiting lists more than tripled between 1991 and 2000.

These totals reflect the number of registrations, which is greater than the number of individuals on the waiting list, since an individual patient may be listed at different centers for the same organ type or for multiple organs. At the end of 2000, the percentage of individual patients with listings at different centers for the same organ was less than 1% for heart, heart-lung, intestine, and pancreas; less than 2% for lung and liver; and less than 6% for kidney and kidney-pancreas. Over the last 10 years, the percentages of patients with multiple listings have generally remained the same. Exceptions to this trend include liver and kidney-pancreas; liver has doubled and kidney-pancreas has tripled.

The age distribution has shifted toward older ages among waiting list registrants. For example, 32% of all waiting list registrants were aged 50 and older in 1991 compared with 50% in 2000 (Table 1.4). The percentage of those aged 18-34 has decreased from 24% in 1991 to 13% in 2000. In addition, the percentage of waiting list registrants aged 65 or older increased about 2.5 times, from 4% in 1991 to 10% in 2000. The percentages of pediatric registrants (age category 0-17) have declined steadily from a high of 4% in 1991 to a low of 3% in 2000, although their counts continued to increase. Figure 8 shows registrant age for the kidney, liver, heart, and lung waiting lists in 2000.

Among waiting list registrants from all the organ-specific lists over the last 10 years, there has been little variation in the percentage of registrants by race/ethnicity, gender, blood type, and residency. There has been an increase in the percentage of waiting list registrants awaiting a repeat transplant, from 11% in 1991 to 14% in 2000 (Table 1.4).

The overall Annual Death Rate (ADR) per 1,000 patient years at risk for waiting list registrants has improved considerably in the last decade, from 126.7 in 1991 to 83.6 in 2000 (Table 1.7). Substantial declines in the ADR are noticeable for pancreas, liver, heart, and lung registrants, with an increase in ADR for kidney candidates.

Overall Transplants and Recipient Characteristics

The total number of single- and multi-organ transplants increased by 45% between 1991 and 2000 from 15,687 to 22,773 (Table 1.8). Cadaveric transplants increased by 29% while living donor transplants more than doubled from 2,424 to 5,692 over the last decade. Between 1999 and 2000 there was a 6% increase in transplants overall and a 19% increase in living donor transplants. This overall change is driven by a 6% growth in kidney transplants, a 5% growth in liver transplants, and a 20% increase in pancreas transplants. In 2000, the total number of transplanted intestines was more than nine times the number in 1991. In contrast, the number of heart-lung transplants has declined, from a peak of 71 in 1994 to 47 in 2000.

The numbers and combinations of multi-organ transplants (other than kidney-pancreas and heart-lung) are shown in (Table 1.9). Kidney-liver, kidney-heart, and liver-intestine transplants constituted 88% of multi-organ transplants in 2000. The number of kidney-liver transplants has more than doubled over the last decade, from 43 in 1991 to 89 in 2000, and the number of liver-intestine transplants has shown over a fourfold increase, jumping from eight in 1991 to 34 in 2000.

In general, recipients were older and slightly more ethnically diverse in 2000 than in 1991 (Table 1.10). For example, recipients between the ages of 18-34 made up 24% of all recipients in 1991 but only 15% in 2000. During the same time period, the percentage of those aged 50 and older increased from 32% to 44% of all recipients. Non-White recipients increased from 20% of all recipients in 1991 to 22% in 2000, while the percentage of non-White waiting list patients remained nearly unchanged at 33% (Table 1.4). The percentage of waiting list patients who were reported as Hispanic increased from 8% to 12% while the percentage of transplants to Hispanic recipients increased from 8% to 11%. The percentage of recipients with a prior transplant was 12% in 2000, and has varied between 16% and 11% over the past 10 years. Figure 9 shows recipient age group for cadaveric kidney, cadaveric liver, heart, and lung in 2000. Figure 10 shows the percentage of all transplant recipients, by race and ethnicity, for 2000.

Overall Graft and Patient Survival Rates

The survival rate data presented in this report are not risk adjusted for the many factors that influence transplant outcomes. Therefore, it is inappropriate to infer that the variables shown (e.g., donor age or recipient blood type) by themselves cause the differences shown in outcomes.

Graft survival refers to a graft (i.e., an organ) that is still functioning at a certain time point following a transplant. Patient survival describes whether a transplant recipient is still alive at a certain time point following the transplant. In this report, short-term survival is defined as survival at one or three months or at one year posttransplant; long-term survival is defined as survival at three or five years posttransplant. The higher the survival rates, the better the graft or patient survival.

Overall one-year graft and patient survival rates for most organs improved between 1990 and 1999 (Table 1.11 and 1.12). The greatest improvements in graft survival were seen for pancreas transplants and for kidney and pancreas grafts from kidney-pancreas transplants.

Patient survival rates were higher than graft survival rates, though there was little difference for the thoracic organs (Table 1.12). Patient survival rates in kidney and pancreas transplantation were much higher than graft survival rates due to the availability of dialysis and insulin therapies after transplant failure.

One-year cadaveric graft failure decreased between 1995 and 1999 for kidneys (12% to 11%), pancreas (29% to 16%), and liver (22% to 20%, (Table 1.11)). One-year graft survival has not improved since 1995 for heart, lung, intestine, or heart-lung transplants. Over the same time period, patient survival rates after cadaveric transplant did not improve substantially for any organ type except pancreas and declined for heart-lung.

Figure 11depicts one- and five-year graft survival rates for kidney, pancreas, and kidney-pancreas transplant recipients. Figure 12 shows graft survival rates at one and five years for liver, intestine, heart, lung, and heart-lung transplant recipients.

Center-Specific Tables

New this year to the Annual Report are center-specific risk-adjusted graft and patient survival tables, appearing in Appendix A. These tables report data that were included in the Center-Specific Reports published on the SRTR Web site (www.ustransplant.org) in July of 2001. More current center-specific data, updated every six months, are available on that Web site.