Background
Kidney transplantation is the treatment of choice for a minority of patients with end-stage renal disease (ESRD). Most adult patients with ESRD are never referred for evaluation for transplantation, and have a 70% 5-year mortality on dialysis. Marked improvements in early graft survival and long-term graft function have made kidney transplantation a more cost-effective alternative to dialysis.
Since 1988, over 455,000 kidney transplants have been performed in the United States.
During 2018, a record number of kidney transplants were performed in the US, including 21,167 kidney-alone and 836 kidney plus at least one additional organ. Of those transplants, 6442 were identified as originating from living-donors (29.3%) and 15,561 (70.7%) from deceased-donors.
In 2017, more than 220,000 patients were alive and with a functioning transplanted kidney; currently, more than 90,000 adult patients are waiting for kidney transplants.
Before the advent of immunosuppression, kidney transplantation was limited to identical twins and was not applicable to the vast majority of patients with ESRD. The introduction of combined azathioprine-steroid therapy in 1963 produced encouraging results and became the mainstay of immunosuppression. Although this therapy improved the results of transplantation, acute rejection and complications associated with steroid therapy persisted.
The introduction of cyclosporine in 1983 significantly improved the outcomes of all solid-organ transplants by reducing the risk of rejection. Further innovations, including anti–T cell antibodies (both monoclonal and polyclonal preparations), as well as other maintenance immunosuppressants (eg, tacrolimus, mycophenolate, sirolimus), have made a significant impact on both patient and graft survival. Currently, 1-year patient and graft survival rates exceed 90% in most transplant centers.
For patient education information, see Kidney Transplant and the Mayo Clinic’s kidney transplant information Web page.