Global Perspective on Kidney Transplantation: United States

Kidney transplantation is the gold standard treatment for ESKD, of fering supe rior survival and quality of life compared with dialysis. The first successful kidney transplant in the United States was performed by Dr. Joseph Murray in 1954, and transplantation has expanded steadily in the United States after the Uniform Anatomic Gift Act passed in 1968 permitted US adults to donate their organs. The purpose of this review is to report on the current status of kidney transplantation in adults in the United States, with special emphasis on post-transplant outcomes and barriers to transplant. Unlike other solid organ transplants, such as liver and heart, allocation of kidneys is primarily on the basis of waiting time rather than severity of illness. Candidates also receive points for prior living donation, higher calculated panel reactive antigen score, and degree of human leukocyte antigen-DR mismatch; the higher the allocation score, the higher the position is on the waitlist. Patients in the United States are eligible for waitlisting once their eGFR reaches ≤20 ml/min per 1.73 m2. Allocation policies were significantly revised in December 2014, allowing patients to accrue waiting time either when they were listed or when they initiated dialysis, whichever is earliest, in an attempt to reduce disparities in early referral for kidney transplant, which disproportionately affected non-White patients (1). Deceased donor kidney allocation underwent an additional major change in March 2021 in an attempt to improve geographic disparities in access to transplant, moving from arbitrarily defined Donation Service Area boundaries to “proximity circles” from the deceased donor organ. There are 256 kidney transplant programs in the United States. Candidates referred by their nephrologist for a transplant undergo a rigorous medical and psychosocial evaluation and, if approved, they are placed on a national waitlist regulated by the Organ Procurement and Transplantation …