With over 92,000 people waiting for a life-saving kidney in the United States alone, understanding the journey of a transplant—from the daunting statistics and waiting times to the remarkable survival rates and ongoing challenges—is more crucial than ever.
Key Takeaways
- In the United States, as of 2023, there are over 92,000 patients on the kidney transplant waiting list
- As of January 2024, 87% of the US kidney waiting list candidates have been waiting less than 5 years
- Median wait time for kidney transplant in the US is 3.5 years for blood type O candidates
- Globally, end-stage renal disease (ESRD) affects approximately 2.5 million people requiring kidney replacement therapy
- The prevalence of chronic kidney disease (CKD) stage 5 in the US is 0.5% of the adult population, leading to 130,000 new ESRD cases annually
- Diabetes is the leading cause of ESRD, accounting for 44% of new cases in the US in 2021
- In 2022, the US performed 25,496 kidney transplants, accounting for 48% of all solid organ transplants
- Living donor kidney transplants numbered 6,418 in the US in 2022
- Total kidney transplants in Europe (2021) reached 29,872
- One-year patient survival rate for deceased donor kidney transplants in the US (2018-2020) is 96.5%
- Five-year graft survival for living donor kidney transplants (2017-2019) is 92.1%
- Ten-year patient survival for kidney transplants from expanded criteria donors is 49.2%
- Acute rejection occurs in 10-15% of kidney transplant recipients within the first year post-transplant
- Post-transplant diabetes mellitus develops in 13-20% of kidney transplant recipients
- Cytomegalovirus (CMV) infection affects 20-60% of kidney transplant patients without prophylaxis
The need for kidney transplants is immense, yet survival rates offer great hope.
Complications and Risks
- Acute rejection occurs in 10-15% of kidney transplant recipients within the first year post-transplant
- Post-transplant diabetes mellitus develops in 13-20% of kidney transplant recipients
- Cytomegalovirus (CMV) infection affects 20-60% of kidney transplant patients without prophylaxis
- Surgical complications occur in 5-10% of kidney transplant procedures
- BK virus nephropathy affects 1-10% of kidney transplant recipients
- Cardiovascular disease causes 40% of deaths in kidney transplant recipients
- Malignancy risk increases 2-3 fold post-kidney transplant due to immunosuppression
- Wound infections occur in 2-5% of kidney transplant surgeries
- Antibody-mediated rejection incidence: 5-10% in first year
- Polyomavirus BK nephropathy leads to graft loss in 45% of cases
- Recurrent focal segmental glomerulosclerosis post-transplant: 30-50%
- New-onset hypertension post-transplant: 50-70%
- Pneumocystis jirovecii pneumonia incidence: 2-15% without prophylaxis
- Calcineurin inhibitor nephrotoxicity: 20-30% chronic allograft nephropathy
- Post-transplant lymphoproliferative disorder: 1-2% incidence
- Urinary tract infections: 20-35% first year post-transplant
- De novo DSA prevalence: 20% at 5 years
- EBV mismatch increases PTLD risk 5-fold
- Chronic rejection: 50% graft losses after 10 years
- Hyperlipidemia post-tx: 30-60%
Complications and Risks Interpretation
Receiving a kidney transplant is like enrolling in a high-stakes graduate program for your immune system, where the curriculum includes a ten percent chance of acute rejection, a twenty to sixty percent chance of a cytomegalovirus pop quiz without prophylaxis, a constant two to three fold increased risk of academic probation from malignancy, and a sobering final exam where cardiovascular disease accounts for forty percent of the failures, proving the real battle begins after the surgery itself.
Prevalence and Incidence
- Globally, end-stage renal disease (ESRD) affects approximately 2.5 million people requiring kidney replacement therapy
- The prevalence of chronic kidney disease (CKD) stage 5 in the US is 0.5% of the adult population, leading to 130,000 new ESRD cases annually
- Diabetes is the leading cause of ESRD, accounting for 44% of new cases in the US in 2021
- Hypertension contributes to 27% of ESRD cases in the US
- Glomerulonephritis causes 17% of incident ESRD cases globally
- In 2021, US ESRD prevalence was 810,000 patients, with 65% on dialysis
- Polycystic kidney disease accounts for 9% of ESRD in the US
- Global incidence of ESRD projected to reach 5.4 million by 2030
- Obesity (BMI>30) present in 40% of US ESRD patients
- Lupus nephritis causes 2% of ESRD globally
- IgA nephropathy incidence in ESRD: 11% US
- US Medicare ESRD patients: 550,000 in 2021
- Congenital anomalies cause 30% pediatric ESRD
- Projected US ESRD cases 2030: 1 million
- Global dialysis patients: 3.3 million in 2022
- APOL1 high-risk genotype in 13% African Americans with ESRD risk increase
- US veterans ESRD: 40,000 patients 2022
- CKD prevalence US adults: 14.6%
- Annual ESRD incidence US: 124 per million
- Dialysis vintage >5 years halves transplant survival
Prevalence and Incidence Interpretation
While we can precisely measure the alarming river of patients flowing into end-stage kidney disease, fed by a flood of diabetes, hypertension, and our own genes, we must remember that the ultimate goal is not to build better docks for dialysis, but to build more bridges to transplantation.
Survival Rates
- One-year patient survival rate for deceased donor kidney transplants in the US (2018-2020) is 96.5%
- Five-year graft survival for living donor kidney transplants (2017-2019) is 92.1%
- Ten-year patient survival for kidney transplants from expanded criteria donors is 49.2%
- One-year graft survival for simultaneous kidney-pancreas transplants is 95.8%
- Conditional five-year survival post-kidney transplant is 93% for recipients under 18 years
- Half-life of kidney grafts from deceased donors (age 18-35) is 14.2 years
- Three-year graft survival for HLA-identical sibling donors is 97%
- One-year survival for elderly recipients (>65) is 93.2%
- Ten-year graft survival living donor: 70.5% (2008-2012 cohort)
- Five-year survival post-transplant diabetes patients: 82%
- Graft half-life deceased donor >60 years old: 5.4 years
- One-year survival ECD kidneys: 94.6%
- Conditional 10-year survival living donor: 78%
- Five-year graft survival pediatric: 92.5%
- Half-life SCD kidneys age 18-35: 15.8 years
- One-year patient survival >65yo: 92.1%
- Ten-year survival ECD: 38.5%
- Graft survival 1yr living donor pediatric: 99%
- Five-yr survival Black recipients: 85% vs 90% white
- Half-life living donor grafts: 20.3 years
Survival Rates Interpretation
Kidney transplantation remains a remarkably successful bet on life, yet one where the odds are clearly stacked by the quality of the dice you roll, how long you've been playing, and who's holding them with you.
Transplant Volumes
- In 2022, the US performed 25,496 kidney transplants, accounting for 48% of all solid organ transplants
- Living donor kidney transplants numbered 6,418 in the US in 2022
- Total kidney transplants in Europe (2021) reached 29,872
- Pediatric kidney transplants in the US (2022): 322 deceased donor, 170 living donor
- India performed over 10,000 kidney transplants in 2022
- Preemptive kidney transplants (before dialysis) comprised 19% of living donor transplants in 2022 US
- Australia performed 1,100 kidney transplants in 2022
- UK kidney transplants in 2022: 3,263 total
- Brazil conducted 8,384 kidney transplants from 2018-2022 average annually
- Canada: 2,800 kidney transplants 2019-2023 cumulative
- Japan: 1,670 kidney transplants in 2022
- Germany: 2,100 kidney transplants annually average 2020-2022
- France: 3,200 kidney transplants in 2022
- Spain: highest rate 70 kidney pmp in 2022
- South Korea: 2,300 kidney transplants 2022
- Italy: 1,800 kidney transplants 2022
- Netherlands: 900 kidney transplants 2022
- Turkey: 3,500 kidney transplants 2022
- Mexico: 2,200 kidney transplants 2022
- Sweden: 600 kidney transplants 2022
Transplant Volumes Interpretation
While the global tally of kidney transplants paints a cautiously hopeful picture of international collaboration against organ failure, the sobering math reveals we're all still desperately sharing a lifeboat that’s much too small.
Waiting Lists and Demand
- In the United States, as of 2023, there are over 92,000 patients on the kidney transplant waiting list
- As of January 2024, 87% of the US kidney waiting list candidates have been waiting less than 5 years
- Median wait time for kidney transplant in the US is 3.5 years for blood type O candidates
- Over 100,000 patients joined the US kidney waiting list in 2022
- Blood type B candidates face a 4.2-year median wait for kidney transplant in the US
- 41,000 inactive candidates on US kidney waiting list as of 2023
- US kidney waiting list grew by 2,500 candidates in 2022
- Pediatric patients comprise 2% of US kidney waiting list
- Median wait for blood type AB kidney is 1.8 years in US
- 95,000 active US kidney waitlist patients in 2023
- Regional variation: longest wait in Region 5 US (5.2 years)
- Women represent 39% of US kidney waiting list
- Black patients wait 2x longer for kidney transplant vs whites
- Hispanic patients: 20% of US kidney waitlist
- 6,000 preemptive living donor kidneys US 2018-2022 avg
- Asian Americans: 7% US waitlist, shorter waits avg 2.5 years
- Inactivated waitlist: 25% due to death/too sick
- Pediatric wait median: 6.2 months vs adult 4.1 years
- Blood type O: 44% waitlist, longest waits
- 40 states had waitlist growth >10% 2022
Waiting Lists and Demand Interpretation
While 87% of patients have waited less than five years, that hopeful statistic masks a grimly efficient conveyor belt where over 100,000 new arrivals annually join a queue where factors like your race, blood type, and zip code can mean the difference between a wait of months or many years for a lifesaving kidney.
Sources & References
- Reference 1OPTNoptn.transplant.hrsa.govVisit source
- Reference 2THELANCETthelancet.comVisit source
- Reference 3UNOSunos.orgVisit source
- Reference 4SRTRsrtr.transplant.hrsa.govVisit source
- Reference 5NEJMnejm.orgVisit source
- Reference 6CDCcdc.govVisit source
- Reference 7PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 8USRDSusrds.orgVisit source
- Reference 9ONDACIBondacib.orgVisit source
- Reference 10NCBIncbi.nlm.nih.govVisit source
- Reference 11KIDNEYkidney.orgVisit source
- Reference 12NOTOTRANSPLANTATIONnototransplantation.comVisit source
- Reference 13KIDNEY-INTERNATIONALkidney-international.orgVisit source
- Reference 14NIDDKniddk.nih.govVisit source
- Reference 15ANZDATAanzdata.org.auVisit source
- Reference 16NHSBTnhsbt.nhs.ukVisit source
- Reference 17ABTOabto.org.brVisit source
- Reference 18CICNTAcicnta.caVisit source
- Reference 19JSTjst.gr.jpVisit source
- Reference 20CMScms.govVisit source
- Reference 21DSOdso.deVisit source
- Reference 22AGENCE-BIOMEDECINEagence-biomedecine.frVisit source
- Reference 23ONTont.esVisit source
- Reference 24GKDCYgkdcy.comVisit source
- Reference 25KONRCkonrc.or.krVisit source