OPTN/SRTR 2023 Annual Data Report: Kidney

Abstract

In 2023, the field of kidney transplantation faced both successes and challenges. A record 28,142 total kidney transplants were achieved in the United States, largely due to an increase in deceased donor kidney transplants (DDKTs). While the number of adult candidates listed for DDKT slightly increased, it remained below the level in 2019, with 11.4% of candidates waiting 5 years or more. Across racial and ethnic groups, Black adult candidates had the largest increase in DDKT rate in 2023, in parallel with the Organ Procurement and Transplantation Network policy to modify waiting time (implemented January 5, 2023). Following increases in death rates during the COVID-19 pandemic, pretransplant mortality declined in 2023 across various age, race and ethnicity, sex, and blood type categories, although mortality continued to vary substantially by donation service area. The rate of deceased donor kidneys that were recovered for transplant but not transplanted (nonuse) increased to a notable high of 27.9%, from 26.6% in 2022, with even higher rates for biopsied kidneys (41.4%), those from donors aged 65 years or older (72.2%), and kidneys with a kidney donor profile index of 85% or higher (72.5%). In contrast, nonuse of kidneys recovered from hepatitis C virus nucleic acid test-positive donors declined to 27.2% in 2023, from 43.0% in 2017, likely reflecting more common use of protocols incorporating direct-acting antiviral therapy. Disparities in access to living donor kidney transplant (LDKT) persist and particularly affect non-White and publicly insured patients. Delayed graft function has risen over the past decade, but appears to have plateaued, at 26.1 % overall for adult recipients in 2023. Five-year graft survival rates were 90.0% for LDKT compared with 82.2% for DDKT in recipients aged 18–34 years, and 80.2% for LDKT versus 66.1 % for DDKT in those aged 65 years or older.

1. Introduction

Kidney transplantation offers eligible patients with end-stage kidney disease the best chance for long-term survival without dialysis and at the lowest cost to the health care system. In 2023, a record 28,142 total kidney transplants were done in the United States. However, there are ongoing challenges in improving transplant access, reducing disparities, and enhancing long-term allograft survival, along with efforts toward those goals. In recent years, there has been unprecedented focus on increasing access to kidney transplant, including introducing new payment models for transplant centers and referring providers, as well as regulatory and legislative measures aimed at increasing deceased donor organ procurement, promoting organ use, and removing barriers to living donation. As the effects of the COVID-19 pandemic diminish, attention is shifting toward modernizing the transplant system to enhance performance and efficiency and address racial disparities. Although the number of deceased donor kidney transplants (DDKTs) continues to rise, this progress is countered by increasing rates of kidney nonuse, longer cold ischemia times, and delayed graft function amid broader geographic organ sharing. The rate of living donor kidney transplants (LDKTs) remains low and is marked by sociodemographic disparities.

The Annual Data Report provides a comprehensive review of the current state of kidney transplantation in the United States, highlighting both achievements and concerning trends that require further scrutiny. It includes data on waiting lists for adult and pediatric kidney transplants, as well as information on deceased and living donations, transplant procedures, and outcomes.

2. Adult Kidney Transplant

2.1. Waiting List

The number of adult candidates added to the kidney waiting list increased to 46,661 in 2023, showing recovery from the COVID-19 pandemic-related decline to 37,401 in 2020 and surpassing the pre-pandemic peak of 42,933 in 2019 (Figure KI 1). The total number of adult candidates ever waiting for kidney transplant in 2023 (including those listed at multiple centers) rose slightly to 141,886, compared with 140,124 in 2022, but remained below the 144,058 candidates ever waiting in 2019 (Figure KI 2). There were 4,002 waitlist removals due to death in 2023, a significant decrease from 5,371 in 2021 during the COVID-19 pandemic. However, the 4,855 waitlist removals due to being too sick for transplant in 2023 reflect an ongoing increase from 4,059 in 2021. Removals for other reasons aside from transplant or clinical improvement were also higher in 2023 (Table KI 5). The trend of a gradual increase in the proportion of older candidates on the waiting list over the past decade continued. Candidates aged 50–64 years at listing remained the largest age group (42.3% of listed candidates) in 2023, while the proportion of candidates aged 65 years or older rose slightly to 26.7%. Candidates aged 18–24 years made up only 8.0% of the adult waiting list (Figure KI 3). The sex distribution of the waiting list remained unchanged: 61.9% of adult kidney candidates in 2023 were male (Figure KI 4). Since 2012, the proportions of Asian, Hispanic, and Multiracial candidates on the kidney waiting list have generally increased slightly, but the distributions have been relatively stable in recent years, with a slight ongoing decline in the proportion of White candidates (36.8% in 2023 versus 37.1% in 2022; Figure KI 5). The distribution of primary kidney failure diagnoses in 2023 remained stable, with diabetes (38.7%) and hypertension (20.1%) as the most common causes. The proportion of candidates with other/unknown causes of kidney failure showed a slight ongoing increase to 18.8% (Figure KI 6).

Figure KI 1: New adult candidates added to the kidney transplant waiting list.

A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing. Includes kidney and kidney-pancreas listings.

Figure KI 2: All adult candidates on the kidney transplant waiting list.

Adult candidates on the list at any time during the year. Candidates listed at more than one center are counted once per listing. Includes kidney and kidney-pancreas candidates.

Table KI 5: Removal reason among adult kidney transplant candidates.

Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.

Removal reason	2021	2022	2023
Removal reason
Deceased donor transplant	18829	19854	21200
Living donor transplant	5714	5634	6022
Transplant outside US	39	58	75
Patient died	5371	4717	4002
Patient refused transplant	282	296	294
Improved, transplant not needed	217	269	329
Too sick for transplant	4059	4503	4855
Other	8280	9327	10049
Changed to kidney-pancreas list	242	219	239
Still on waiting list	28	17	20

Figure KI 3: Distribution of adults waiting for kidney transplant by age.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure KI 4: Distribution of adults waiting for kidney transplant by sex.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure KI 5: Distribution of adults waiting for kidney transplant by race and ethnicity.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure KI 6: Distribution of adults waiting for kidney transplant by diagnosis.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

In 2023, the proportion of adult candidates on the waiting list with a waiting time of less than 1 year rose to 37.9%, up from 36.1% in 2022 and 34.2% in 2021. Meanwhile, 11.4% of candidates on the waiting list at some point in 2023 had been waiting for 5 years or longer, a proportion that has declined since 2017 (Figure KI 7). The proportion of waitlisted candidates with a high body mass index (BMI) also continued to increase slightly in 2023, with 19.3% having a BMI of 35 kg/m² or greater, while a stable 27.5% had a BMI of 30-<35 kg/m² (Figure KI 8). The proportion of candidates waitlisted before starting dialysis showed an ongoing, encouraging increase to 27.4% in 2023, although 14.9% of those waitlisted had been on dialysis for 6 or more years (Figure KI 9). The distribution of candidates across blood type groups remained stable in 2023, with 52.8% of waitlisted kidney candidates having blood type O (Figure K 110). The proportion of candidates with a previous transplant was 10.8% in 2023, reflecting a gradual decline from 14.8% in 2012 (Figure KI 11).

Figure KI 7: Distribution of adults waiting for kidney transplant by waiting time (years).

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Candidates listed in the given year are considered to have been listed less than 1 year. Active and inactive candidates are included.

Figure KI 8: Distribution of adults waiting for kidney transplant by BMI.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included. BMI, body mass index.

Figure KI 9: Distribution of adults waiting for kidney transplant by years on dialysis.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Time on dialysis is computed as time from minimum of first end-stage renal disease service date or most recent graft failure to listing date or January 1 of the given year. Active and inactive candidates are included.

Figure KI 110: Distribution of pediatric candidates waiting for kidney transplant by age.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year. The 18+ category is for candidates who turned age 18 while waiting.

Figure KI 11: Distribution of adults waiting for kidney transplant by prior transplant status.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

In 2023, the proportion of adult candidates willing to accept a kidney with a high kidney donor profile index (KDPI) score declined slightly across all age groups, continuing a downward trend that began after the revised kidney allocation system (KAS) was implemented in December 2014. Willingness to accept high-KDPI kidneys was higher among older candidates, but only 48.4% of those aged 50–64 years and 63.3% of those aged 65 years or older were willing to accept them in 2023 (Figure KI 12). In contrast, the proportion of candidates willing to accept a kidney from a donor who is hepatitis C virus (HCV) antibody positive has continued to increase sharply, and even surpassed the unwilling proportion by reaching 51.0% in 2023 (Figure KI 13). This increase follows the availability of highly effective direct-acting antiviral agents and the growing experience in using these regimens to manage anticipated donor-derived infections.

Figure KI 12: Adults willing to accept a kidney designated ECD or KDPI >= 85% by age.

Adults waiting for kidney transplant on December 31 of the given year. Candidates listed at more than one center are counted once per listing. Willingness to accept ECD kidney at time of listing or willingness to accept a local non-zero HLA mismatch KDPI >=85% kidney at the later of listing date or January 1 of the given year, beginning in 2014. ECD, expanded-criteria donor; KDPI, kidney donor profile index.

Figure KI 13: Adults willing to accept kidney from HCV+ donor.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Willingness to accept HCV+ organ at time of listing. HCV, hepatitis C virus.

Rates of DDKT among adult waitlist candidates continued to rise in 2023, following a low point in 2014 (Figure KI 14). Candidates aged 18–34 years have the highest transplant rates, but their rate did not increase in 2023. Increased DDKT rates were observed for those aged 35 years or older, with a notable increase for candidates aged 65 years or older, reaching the same rate as among candidates aged 35–49 years (Figure KI 15). DDKT rates rose across racial and ethnic groups, with Black candidates having the highest DDKT rate in 2023 at 26.1 transplants per 100 patient-years (Figure K 116). This trend corresponds with changes in waiting time credit based on estimated glomerular filtration rate (eGFR) for Black candidates in the allocation policy. The DDKT rates also increased across primary diagnoses of kidney failure (Figure KI 17). Additionally, DDKT rates rose across all calculated panel-reactive antibody (cPRA) levels in 2023, with sharp increases among those with cPRA of 80%−<98%, reaching 34.3 transplants per 100 patient-years, and those with cPRA of 98%−100%, reaching 21.0 transplants per 100 patient-years (Figure KI 18). DDKT rates increased across all candidate blood type groups in 2023, peaking at 44.3 transplants per 100 patient-years for those with blood type AB (Figure K 119). In 2023, DDKT rates increased for candidates with waiting times of less than 5 years, reaching a high of 19.5 transplants per 100 patient-years for those with 3-<5 years of waiting time and 28.4 transplants per 100 patient-years for those waiting less than 1 year (Figure KI 20). By sex, DDKT rates remained slightly higher in female candidates compared with male candidates in 2023, a trend since 2016 (Figure KI 21).

Figure KI 14: Overall deceased donor kidney transplant rates among adult waitlist candidates.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure KI 15: Deceased donor kidney transplant rates among adult waitlist candidates by age.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure KI 116: Distribution of pediatric candidates waiting for kidney transplant by blood type.

Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure KI 17: Deceased donor kidney transplant rates among adult waitlist candidates by diagnosis.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure KI 18: Deceased donor kidney transplant rates among adult waitlist candidates by cPRA.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. cPRA is determined at the later of listing date or January 1 of the given year. Missing indicates no unacceptable antigens were reported. cPRA, calculated panel-reactive antibody.

Figure KI 119: Overall deceased donor kidney transplant rates among pediatric waitlist candidates.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure KI 20: Deceased donor kidney transplant rates among adult waitlist candidates by time on the waiting list.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure KI 21: Deceased donor kidney transplant rates among adult waitlist candidates by sex.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

For adults newly waitlisted in 2018–2020, 29.9% were still waiting 3 years after listing; 30.8% had undergone DDKT, 13.5% had undergone LDKT, 6.8% had died, and 19.1% had been removed from the waiting list (Figure KI 22). The proportion of patients who underwent DDKT within 3 months rose to a high of 12.3% among those listed in 2022, while the percentage who underwent DDKT within 3 years also continued to rise, reaching 32.9% for those listed in 2020 (Figure KI 23). (Note that in deceased donor kidney allocation, match-run priority is primarily based on candidate duration otorgan failure, which can include both time on the list and time on dialysis prior to listing. OPTN policy refers to this duration as “waiting time”; in the Annual Data Report, “waiting time” refers only to time since listing.)

Figure KI 22: Three-year outcomes for adults waiting for kidney transplant, new listings in 2018–2020.

Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor; LD, living donor.

Figure KI 23: Percentage of adults who underwent deceased donor kidney transplant within a given period of listing.

Candidates listed at more than one center are counted once per listing.

Following increases in mortality rates during the COVID-19 pandemic, pretransplant mortality declined in 2023 to 5.0 deaths per 100 patient-years, compared with 6.2 deaths per 100 patient-years in 2021 (Figure KI 24), with decreases across race and ethnicity (Figure KI 26) and sex (Figure KI 27). Pretransplant mortality in 2023 was lowest in those aged 18–34 years and remained stable in that group while declining in older age groups (Figure KI 25). By blood type, pretransplant mortality was lowest in patients with blood type AB and remained stable in that group while declining among patients with other blood types (Figure KI 29). Pretransplant mortality declined in all diagnosis groups, and those with glomerulonephritis or cystic kidney disease continued to have the lowest mortality rates (Figure KI 28). Pretransplant mortality continued to vary substantially by donation service area, ranging from 2.0 to 7.3 deaths per 100 patient-years (Figure KI 30).

Figure KI 24: Overall pretransplant mortality rates among adults waitlisted for kidney transplant.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure KI 26: Pretransplant mortality rates among adults waitlisted for kidney transplant by race and ethnicity.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure KI 27: Pretransplant mortality rates among adults waitlisted for kidney transplant by sex.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure KI 25: Pretransplant mortality rates among adults waitlisted for kidney transplant by age.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure KI 29: Pretransplant mortality rates among adults waitlisted for kidney transplant by blood type.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure KI 28: Pretransplant mortality rates among adults waitlisted for kidney transplant by diagnosis.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure KI 30: Pretransplant mortality rates among adults waitlisted for kidney transplant in 2023 by DSA.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. DSA, donation service area.

Death within 6 months of removal from the waiting list (for removal reasons other than transplant or death) declined in 2023 for adult candidates from a peak in 2020 (Figure KI 31). Considered by diagnosis group, mortality after waitlist removal declined slightly from 2022 to 2023 for those with diabetes, glomerulonephritis, or cystic kidney disease but increased slightly in those with hypertension and those with other/unknown causes of kidney failure (Figure KI 32). By age, death within 6 months of waitlist removal rose slightly among both younger and older adult candidates, while declining slightly in those aged 35–64 years (Figure KI 33). By race and ethnicity, death within 6 months of waitlist removal rose for Asian, Black, Native American, and slightly for White candidates but declined for Hispanic and Multiracial candidates (Figure KI 34). In 2023, death within 6 months of waitlist removal declined slightly among female candidates but increased among male candidates (Figure KI 35).

Figure KI 31: Deaths within 6 months after removal among adult kidney waitlist candidates, overall.

Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure KI 32: Deaths within 6 months after removal among adult kidney waitlist candidates, by diagnosis group at removal.

Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure KI 33: Deaths within 6 months after removal among adult kidney waitlist candidates, by age.

Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. Age is determined at removal.

Figure KI 34: Deaths within 6 months after removal among adult kidney waitlist candidates, by race and ethnicity.

Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure KI 35: Deaths within 6 months after removal among adult kidney waitlist candidates, by sex.

Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

2.2. Transplants

The upward trajectory in total adult kidney transplants was modestly slowed by the COVID-19 pandemic in 2020, then continued to rise, reaching a high of 27,351 in 2023 (Figure KI 37). This trend was driven by growth in DDKT, which rose to a high of 21,303 in 2023 (Figure KI 38), predominantly from donors with KDPI of less than 85% (Figure KI 44). In 2023, the proportion of adult DDKT from donors classified as KDPI less than 20% showed a slight decrease, to 24.2%, while most DDKTs were from KDPI 35%-<85% donors (51.6%), and only 6.3% of DDKTs were from donors with KDPI of 85% or greater (Figure KI 44). Considered by recipient age, kidney transplant counts increased most in recipients aged 50–64 years and those aged 65 years or older (Figure KI 39). Adult kidney transplant counts rose across racial and ethnic groups, with the largest increase in Black patients (Figure KI 41). Growth in total kidney transplants in 2023 was similar by recipient sex (Figure KI 40). Kidney transplant counts increased across diagnosis groups in 2023, especially in patients with diabetic kidney failure, in parallel with larger representation of patients with diabetes on the waiting list (Figure KI 42). In 2023, most growth in adult kidney transplant occurred in patients without prior transplant (Figure KI 43). In 2023, 89.8% of DDKTs and 90.7% of LDKTs were performed in first-time recipients (Table KI 8).

Figure KI 37: Overall adult kidney transplants.

All adult kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 38: Adult kidney transplants by donor type.

Adult kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 44: Kidney transplants by KDPI.

All adult recipients of deceased donor kidneys, including multiorgan transplant recipients. Conversion of kidney donor risk index to KDPI is done using the OPTN KDPI Mapping Tables. For donors recovered January through May, the cohort 2 years prior was used to assign KDPI; for donors recovered June through December, the cohort 1 year prior was used to assign KDPI. Kidneys recovered en bloc are counted once. KDPI, kidney donor profile index.

Figure KI 39: Adult kidney transplants by age.

Adult kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 41: Adult kidney transplants by race and ethnicity.

Adult kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 40: Adult kidney transplants by sex.

Adult kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 42: Adult kidney transplants by diagnosis.

Adult kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 43: Adult kidney transplants by prior transplant status.

Adult kidney transplant recipients, including retransplant and multiorgan recipients.

Table KI 8: Transplant characteristics of adult kidney transplant recipients, 2023.

Kidney transplant recipients, including retransplant recipients. DCD status and KDPI scores apply to deceased donor transplants only. DBD, donation after brain death; DCD, donation after circulatory death; KDPI, kidney donor profile index.

	Deceased		Living		All
Characteristic	N	Percent	N	Percent	N	Percent
Waiting time (years)
<1 day	5	0	16	0.3	21	0.1
1 day-<1 year	11105	52.1	3861	63.8	14966	54.7
1-<3	5221	24.5	1728	28.6	6949	25.4
3-<5	2960	13.9	343	5.7	3303	12.1
5+	2012	9.4	100	1.7	2112	7.7
KDPI
0-<20%	4883	22.9	0	0	4883	17.9
20-<35%	4092	19.2	0	0	4092	15
35-<85%	10865	51	0	0	10865	39.7
85–100%	1456	6.8	0	0	1456	5.3
Missing	7	0	6048	100	6055	22.1
Donation after circulatory death
DBD	13988	65.7	0	0	13988	51.1
DCD	7315	34.3	0	0	7315	26.7
Living donor	0	0	6048	100	6048	22.1
Previous transplant for recipients
No prior transplant	19136	89.8	5487	90.7	24623	90
Prior transplant	2167	10.2	561	9.3	2728	10
Organs transplanted
Kidney only	19244	90.3	6047	100	25291	92.5
Kidney-pancreas	809	3.8	0	0	809	3
Kidney-liver	797	3.7	0	0	797	2.9
Heart-kidney	421	2	0	0	421	1.5
Kidney-lung	21	0.1	0	0	21	0.1
Intestine-pancreas-liver-kidney	1	0	0	0	1	0
Other	10	0	1	0	11	0
All recipients
All recipients	21303	100	6048	100	27351	100

Disparities in access to LDKT continued in 2023. While 31.0% of adult waitlisted candidates as of December 31, 2023, were Black (Table KI 1), Black patients made up only 11.8% of LDKT recipients, versus 36.6% of DDKT recipients, in 2023 (Table KI 6). White patients made up 35.7% of the waiting list in 2023 (Table KI 1) and constituted 33.8% of DDKT recipients and 61.0% of LDKT recipients (Table KI 6). Most LDKT recipients (54.1%) had private insurance at the time of transplant in 2023, compared with 27.3% of DDKT recipients; 61.7% of DDKT recipients were Medicare beneficiaries compared with 37.8% of LDKT recipients (Table KI 6). LDKT recipients tended to have less dialysis time and lower cPRA levels than DDKT recipients. In 2023, 33.0% of LDKT recipients underwent transplant without having had dialysis, compared with 13.9% of DDKT recipients (Table KI 7).

Table KI 1: Demographic characteristics of adults on the kidney transplant waiting list on December 31, 2013, December 31, 2018, and December 31, 2023.

Candidates waiting for transplant on December 31 of the given year, regardless of first listing date. Distance is computed from candidate’s home zip code to the transplant center. Age is determined on December 31 of the year.

	2013		2018		2023
Characteristic	N	Percent	N	Percent	N	Percent
Age (years)
18–34 years	9946	9.5	8317	8.2	7321	7.7
35–49	27820	26.6	24604	24.3	22050	23.3
50–64	45401	43.4	44226	43.7	41010	43.3
65+	21548	20.6	24019	23.7	24420	25.8
Sex
Female	42358	40.5	38793	38.3	35848	37.8
Male	62357	59.5	62373	61.7	58953	62.2
Race and ethnicity
Asian	8515	8.1	9717	9.6	9322	9.8
Black	35757	34.1	32912	32.5	29344	31
Hispanic	19739	18.9	20401	20.2	20484	21.6
Multiracial	448	0.4	776	0.8	879	0.9
Native American	1175	1.1	964	1	862	0.9
White	39081	37.3	36396	36	33816	35.7
Unreported	0	0	0	0	94	0.1
Miles between candidate and center
<50 miles	69570	66.4	66997	66.2	62499	65.9
50-<100	15497	14.8	15539	15.4	14862	15.7
100-<150	7517	7.2	7069	7	6586	6.9
150-<250	6941	6.6	6444	6.4	5585	5.9
250+	4468	4.3	4628	4.6	4738	5
Missing	722	0.7	489	0.5	531	0.6
All candidates
All candidates	104715	100	101166	100	94801	100

Table KI 6: Demographic characteristics of adult kidney transplant recipients, 2023.

Kidney transplant recipients, including retransplant recipients. Distance is computed from recipient’s home zip code to the transplant center.

	Deceased		Living		All
Characteristic	N	Percent	N	Percent	N	Percent
Recipient age (years)
18–34 years	2067	9.7	939	15.5	3006	11
35–49	5086	23.9	1585	26.2	6671	24.4
50–64	8631	40.5	2228	36.8	10859	39.7
65+	5519	25.9	1296	21.4	6815	24.9
Sex
Female	8538	40.1	2247	37.2	10785	39.4
Male	12765	59.9	3801	62.8	16566	60.6
Race and ethnicity
Asian	1735	8.1	463	7.7	2198	8
Black	7806	36.6	716	11.8	8522	31.2
Hispanic	4164	19.5	1083	17.9	5247	19.2
Multiracial	203	1	60	1	263	1
Native American	189	0.9	35	0.6	224	0.8
White	7200	33.8	3690	61	10890	39.8
Unreported	6	0	1	0	7	0
Insurance
Private	5826	27.3	3271	54.1	9097	33.3
Medicare	13139	61.7	2289	37.8	15428	56.4
Medicaid	1687	7.9	346	5.7	2033	7.4
Other/unknown	651	3.1	142	2.3	793	2.9
Miles between recipient and center
<50 miles	14140	66.4	3900	64.5	18040	66
50-<100	3349	15.7	923	15.3	4272	15.6
100-<150	1447	6.8	416	6.9	1863	6.8
150-<250	1034	4.9	325	5.4	1359	5
250+	1160	5.4	412	6.8	1572	5.7
Missing	173	0.8	72	1.2	245	0.9
All recipients
All recipients	21303	100	6048	100	27351	100

Table KI 7: Clinical characteristics of adult kidney transplant recipients, 2023.

Kidney transplant recipients, including retransplant recipients. Missing cPRA indicates no unacceptable antigens were reported. cPRA, calculated panel-reactive antibody.

	Deceased		Living		All
Characteristic	N	Percent	N	Percent	N	Percent
Diagnosis
Diabetes	7421	34.8	1619	26.8	9040	33.1
Hypertension	4770	22.4	924	15.3	5694	20.8
Glomerulonephritis	3102	14.6	1370	22.7	4472	16.4
Cystic kidney disease	1869	8.8	954	15.8	2823	10.3
Other/unknown	4141	19.4	1181	19.5	5322	19.5
Blood type
A	7149	33.6	2303	38.1	9452	34.6
AB	1041	4.9	280	4.6	1321	4.8
B	3176	14.9	846	14	4022	14.7
0	9937	46.6	2619	43.3	12556	45.9
Years of dialysis
None	2955	13.9	1994	33	4949	18.1
<1 year	2132	10	1287	21.3	3419	12.5
1-<3	4837	22.7	1606	26.6	6443	23.6
3-<5	4124	19.4	468	7.7	4592	16.8
5+	7255	34.1	693	11.5	7948	29.1
cPRA
<1% or missing	11791	55.3	4117	68.1	15908	58.2
1-<20%	2122	10	665	11	2787	10.2
20-<80%	3820	17.9	1019	16.8	4839	17.7
80-<98%	2044	9.6	189	3.1	2233	8.2
98–100%	1526	7.2	58	1	1584	5.8
All recipients
All recipients	21303	100	6048	100	27351	100

The proportion of adult DDKT recipients with peak cPRA levels of 98%−100% increased sharply after the 2014 KAS revision and then gradually declined, from 12.5% in 2015 to 6.1% in 2022, with a slight increase to 7.2% in 2023. Following the March 2021 KAS250 revision, there was an increase in the proportion of DDKT recipients with cPRA of 80%-<98%: in 2020, 7.0%; in 2021, 10.4%; then in 2023, a slight decline to 9.6% (Figure KI 49). By comparison, only 1.0% of LDKT recipients in 2023 had peak cPRA levels of 98%−100%, while most LDKT recipients (68.1 %) had peak cPRA levels of <1 % (Figure Kl 50). Sensitization was more common among adult recipients of paired LDKT, with 2.3% having cPRA of 98%−100% and 8.0% having cPRA of 80%-<98% (Figure KI 51). By donor type, 23.9% of DDKTs and 42.0% of LDKTs were performed with three or fewer HLA mismatches, including zero HLA mismatches in less than 5% of both DDKTs and LDKTs (Figure KI 48).

Figure KI 49: Peak cPRA at time of kidney transplant in adult deceased donor recipients.

Peak cPRA is used. Missing indicates no unacceptable antigens were reported. cPRA, calculated panel-reactive antibody.

Figure KI 50: Peak cPRA at time of kidney transplant in adult living donor recipients.

Peak cPRA is used. Missing indicates no unacceptable antigens were reported. cPRA, calculated panel-reactive antibody.

Figure KI 51: Peak cPRA at time of kidney transplant in adult paired living donor recipients.

Peak cPRA is used. Missing indicates no unacceptable antigens were reported. cPRA, calculated panel-reactive antibody.

Figure KI 48: Total HLA A, B, and DR mismatches among adult kidney transplant recipients, 2019–2023.

Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2023. Unk, unknown.

Induction immunosuppression was used in 93.0% of adult kidney transplants in 2023, reflecting a small but continued increase in proportion since 2020 (Figure KI 45). This trend was driven by growing use of T-cell-depleting induction agents alone (75.2% of recipients), while 16.4% received interleukin-2 receptor antibodies (IL2Ab) alone and 1.5% were reported as receiving both agents (Figure KI 46). Most patients received tacrolimus and mycophenolate-based regimens during the initial transplant hospitalization period: 68.8% received triple therapy (tacrolimus, mycophenolate, and steroids) and 24.7% received tacrolimus and mycophenolate without reported steroid use (Figure KI 47).

Figure KI 45: Induction agent use in adult kidney transplant recipients.

Immunosuppression at transplant reported to the OPTN.

Figure KI 46: Type of induction agent use in adult kidney transplant recipients.

Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure KI 47: Immunosuppression regimen use in adult kidney transplant recipients.

Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

2.3. Outcomes

Delayed graft function, defined as dialysis within the first 7 days posttransplant, has trended higher over the past decade, but appears to have plateaued, at 26.1% overall in 2023 in adults (Figure KI 52). The eGFR at 12 months, calculated using the 2021 race-free Chronic Kidney Disease-Epidemiology Collaboration creatinine-based equation, an early surrogate allograft outcome, was 45 mL/min/1.73 m² or higher for 64.9% of DDKT recipients in 2022, reflecting a slight downtrend from 67.8% in 2016 (Figure KI 65). Among LDKT recipients, 80.6% had 12-month eGFR of 45 mL/min/1.73 m² or higher in 2022, a slight decline from 82.6% in 2016 (Figure KI 66). Acute rejection rates continued to trend lower across age groups. For transplants performed in 2022, acute rejection by 1 year was highest in recipients aged 18–34 years at 8.0% and lowest in recipients aged 65 years or older at 5.1% (Figure KI 67). Acute rejection at 1 year occurred in 7.1 % of those who received both IL2Ab and T-cell-depleting induction (Figure KI 68), likely in part reflecting regimen changes in patients with early complications. For other regimens, acute rejection at 1 year was reported in 5.7% of those who received IL2Ab induction alone, 6.0% who received T-cell-depleting induction alone, and 4.7% of those whose transplants were managed without induction. Posttransplant lymphoproliferative disorder was uncommon in adult kidney transplant recipients, reported in 1.9% and 0.5% of Epstein-Barr virus (EBV)-negative and EBV-positive recipients, respectively, at 5-years posttransplant (Figure KI 69).

Figure KI 52: Delayed graft function among adult kidney transplant recipients.

All adult recipients of kidneys. Delayed graft function is defined as dialysis administered within the first 7 days posttransplant. DGF, delayed graft function.

Figure KI 65: Distribution of eGFR at 12 months posttransplant among adult deceased donor kidney transplant recipients.

Glomerular filtration rate (mL/min/1.73 m²) estimated using the race-free 2021 Chronic Kidney Disease-Epidemiology Collaboration equation, and computed by SRTR for patients alive with graft function at 12 months posttransplant. eGFR, estimated glomerular filtration rate.

Figure KI 66: Distribution of eGFR at 12 months posttransplant among adult living donor kidney transplant recipients.

Glomerular filtration rate (mL/min/1.73 m²) estimated using the race-free 2021 Chronic Kidney Disease-Epidemiology Collaboration equation, and computed by SRTR for patients alive with graft function at 12 months posttransplant. eGFR, estimated glomerular filtration rate.

Figure KI 67: Incidence of acute rejection by 1 year posttransplant among adult kidney transplant recipients by age.

Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

Figure KI 68: Incidence of acute rejection by 1 year posttransplant among adult kidney transplant recipients by induction agent.

Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure KI 69: Incidence of PTLD among adult kidney transplant recipients by recipient EBV status at transplant, 2012–2018.

Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Among adult DDKT recipients, 5-year graft survival was lowest among older (versus younger) recipients: 66.1% among recipients aged 65 years or older compared with 82.2% among recipients aged 18–34 years (Figure KI 53). Compared with graft survival among White recipients, 5-year DDKT graft survival was higher among Asian, Hispanic, and Multiracial recipients but lower among Black and Native American recipients (Figure KI 54). Graft survival was lower among male recipients (versus female recipients; Figure KI 55) and recipients with diabetes as the cause of kidney failure (versus other causes; Figure KI 56). Compared with recipients with BMI of 18.5-<25 kg/m² at transplant, 5-year graft survival showed a graded decline in those with higher BMI levels (Figure KI 60). Five-year DDKT graft survival was 62.9% for allografts with KDPI of 85% or greater, compared with 84.6%, 81.2%, and 74.8% for those with KDPI of <20%, KDPI 20%-<35%, and KDPI 35%-<85%, respectively (Figure KI 57). Five-year graft survival was only slightly lower for donation after circulatory death (DCD) transplants compared with donation after brain death transplants (75.8% versus 77.4%; Figure KI 58). Graft survival was lower after transplant of kidneys that underwent a procurement biopsy compared to kidneys transplanted without biopsy (73.1% versus 80.9%; Figure KI 59), although, given the high nonuse rate of biopsied kidneys (Figure KI 96) and the uncertain predictive value of biopsy beyond clinical factors, the utility of procurement biopsy in informing appropriate organ use is a topic of ongoing debate.¹

Figure KI 53: Graft survival among adult deceased donor kidney transplant recipients, 2016–2018, by age.

Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 54: Graft survival among adult deceased donor kidney transplant recipients, 2016–2018, by race and ethnicity.

Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 55: Graft survival among adult deceased donor kidney transplant recipients, 2016–2018, by sex.

Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 56: Graft survival among adult deceased donor kidney transplant recipients, 2016–2018, by diagnosis.

Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 60: Graft survival among adult deceased donor kidney transplant recipients, 2016–2018, by BMI.

Graft survival estimated using unadjusted Kaplan-Meier methods. BMI, body mass index.

Figure KI 57: Graft survival among adult deceased donor kidney transplant recipients, 2016–2018, by KDPI.

Graft survival estimated using unadjusted Kaplan-Meier methods. Conversion of kidney donor risk index to KDPI is done using the OPTN KDPI Mapping Tables. For donors recovered January through May, the cohort 2 years prior was used to assign KDPI; for donors recovered June through December, the cohort 1 year prior was used to assign KDPI. KDPI, kidney donor profile index.

Figure KI 58: Graft survival among adult deceased donor kidney transplant recipients, 2016–2018, by DCD status.

Graft survival estimated using unadjusted Kaplan-Meier methods. DBD, donation after brain death; DCD, donation after circulatory death.

Figure KI 59: Graft survival among adult deceased donor kidney transplant recipients, 2016–2018, by biopsy status.

Graft survival estimated using unadjusted Kaplan-Meier methods. Kidneys are classified as biopsied if either of the donor’s kidneys was biopsied.

Figure KI 96: Percent of kidneys recovered for transplant and not transplanted by donor biopsy status.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant. Kidneys are classified as biopsied if either of the donor’s kidneys was biopsied.

Among adult LDKT recipients, 5-year graft survival was 80.2% in recipients aged 65 years or older, compared with 90.0% in recipients aged 18–34 years (Figure KI 61). Compared with graft survival in White recipients, 5-year LDKT graft survival was higher among Asian and Hispanic recipients and lower among Black, Multiracial, and Native American recipients (Figure KI 62). Five-year LDKT graft survival was lower in recipients with diabetic kidney failure compared with recipients with other disease causes (Figure KI 64), and similar in female and male recipients (Figure KI 63).

Figure KI 61: Graft survival among adult living donor kidney transplant recipients, 2016–2018, by age.

Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 62: Graft survival among adult living donor kidney transplant recipients, 2016–2018, by race and ethnicity.

Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 64: Graft survival among adult living donor kidney transplant recipients, 2016–2018, by diagnosis.

Graft survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 63: Graft survival among adult living donor kidney transplant recipients, 2016–2018, by sex.

Graft survival estimated using unadjusted Kaplan-Meier methods.

Trends in adult posttransplant patient survival generally paralleled the trends observed in kidney graft survival. Five years posttransplant, 70.1 % of DDKT recipients and 81.9% of LDKT recipients aged 65 years or older were alive, compared with 95.7% and 97.9% of those aged 18–34 years, respectively (Figure KI 70 and Figure KI 76). Patient survival after DDKT was higher in female recipients than male recipients (Figure KI 72). Compared with patient survival among White recipients, 5-year patient survival after DDKT and LDKT were higher among Asian, Black, Hispanic, and Multiracial recipients, but lower among Native American recipients; however, across racial and ethnic groups, patient survival was higher after LKDT compared with DDKT (Figure KI 71 and Figure KI 78). Five-year patient survival was lowest among recipients with diabetes as the cause of kidney disease, at 76.8% for DDKT recipients and 85.8% for LDKT recipients (Figure KI 73 and Figure KI 77). Patient survival among DDKT recipients showed graded decline with donor KDPI score, from 91.2% in recipients of KDPI 0-<20% kidneys to 71.7% in recipients of kidneys with KDPI of 85% or greater (Figure KI 74). Patient survival was also lower in recipients of grafts that had undergone a procurement biopsy compared with recipients of grafts that were not biopsied (Figure KI 75).

Figure KI 70: Patient survival among adult deceased donor kidney transplant recipients, 2016–2018, by age.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 76: Patient survival among adult living donor kidney transplant recipients, 2016–2018, by age.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 72: Patient survival among adult deceased donor kidney transplant recipients, 2016–2018, by sex.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 71: Patient survival among adult deceased donor kidney transplant recipients, 2016–2018, by race and ethnicity.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 78: Patient survival among adult living donor kidney transplant recipients, 2016–2018, by race and ethnicity.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 73: Patient survival among adult deceased donor kidney transplant recipients, 2016–2018, by diagnosis.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 77: Patient survival among adult living donor kidney transplant recipients, 2016–2018, by diagnosis.

Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 74: Patient survival among adult deceased donor kidney transplant recipients, 2016–2018, by KDPI.

Patient survival estimated using unadjusted Kaplan-Meier methods. Conversion of kidney donor risk index to KDPI is done using the OPTN KDPI Mapping Tables. For donors recovered January through May, the cohort 2 years prior was used to assign KDPI; for donors recovered June through December, the cohort 1 year prior was used to assign KDPI. KDPI, kidney donor profile index.

Figure KI 75: Patient survival among adult deceased donor kidney transplant recipients, 2016–2018, by biopsy status.

Patient survival estimated using unadjusted Kaplan-Meier methods. Kidneys are classified as biopsied if either of the donor’s kidneys was biopsied.

3. Donation

3.1. Deceased Donation

The counts of deceased donors (adult and pediatric) from whom at least one kidney was recovered for transplant continued to rise in 2023 (Figure KI 79), particularly among donors aged 36 years or older (Figure KI 80). The proportion of deceased donors aged 35 years or younger declined to 31.1% in 2023, from 34.0% in 2022, whereas the proportion aged 50 years or older increased to 41.0% in 2023, from 37.9% in 2022 (Figure KI 82). The racial and ethnic distribution of deceased kidney donors remained largely unchanged over the past decade, with 66.7% White donors in 2023 (Figure KI 84), and the predominance of male deceased donors in 2023 (62.0%) was stable compared with 2022 (Figure KI 83). The counts of HCV antibody-positive deceased donors from whom kidneys were recovered was stable in 2023 (Figure KI 81), slowing the prior trend of more rapid increase over the past decade. In 2023, 4.8% of deceased kidney donors were HCV positive with a nucleic acid test (NAT+), a decline from a peak of 6.6% in 2020, while 5.2% were HCV positive with NAT-/Ab+, a slight increase from 4.9% in 2022 (Figure KI 85). The proportion of DCD kidney donors continued to rise, reaching 37.3% in 2023 (Figure KI 86). Among causes of death, the proportion of deceased kidney donors who died of anoxia continued to increase, to 49.5% in 2023 (Figure KI 87), in the context of the ongoing opioid epidemic.

Figure KI 79: Overall deceased kidney donor count.

Count of deceased donors from whom at least one kidney was recovered for transplant.

Figure KI 80: Deceased kidney donor count by age.

Count of deceased donors from whom at least one kidney was recovered for transplant.

Figure KI 82: Distribution of deceased kidney donors by age.

Deceased donors from whom at least one kidney was recovered for transplant.

Figure KI 84: Distribution of deceased kidney donors by race and ethnicity.

Deceased donors from whom at least one kidney was recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

Figure KI 83: Distribution of deceased kidney donors by sex.

Deceased donors from whom at least one kidney was recovered for transplant.

Figure KI 81: Deceased kidney donor count by HCV status.

Count of deceased donors from whom at least one kidney was recovered for transplant. Donor HCV status was based on an antibody test. HCV, hepatitis C virus.

Figure KI 85: Distribution of deceased kidney donors by donor HCV status.

Deceased donors from whom at least one kidney was recovered for transplant. Donor HCV status was based on NAT and antibody tests. Ab, antibody; HCV, hepatitis C virus; NAT, nucleic acid test.

Figure KI 86: Distribution of deceased kidney donors by DCD status.

Deceased donors whose kidneys were recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.

Figure KI 87: Cause of death among deceased kidney donors.

Deceased donors with at least one kidney recovered for transplant. Each donor is counted once. CVA, cerebrovascular accident.

Overall, in 2023, the proportion of deceased donor kidneys recovered for transplant and not transplanted (nonuse rate) continued to rise to a notable high of 27.9%, compared with 26.6% in 2022 and 18.7% in 2012 (Figure KI 88), in the context of the broader geographic organ distribution but also with substantial variation by donor characteristics. Nonuse rates were highest for kidneys recovered from donors aged 65 years or older, reaching 72.2% in 2023 (Figure KI 89). The nonuse rate was also higher for kidneys recovered from donors with diabetes (Figure KI 90), hypertension (Figure KI 93), or elevated BMI (with a graded increase for BMI level above 25 kg/m²; Figure KI 94), compared with donors without each of these characteristics, respectively. In 2023, nonuse was slightly higher for kidneys recovered from Black and Asian donors (30.2% and 30.0%, respectively) compared with White donors (28.4%), while nonuse was lower for kidneys recovered from Hispanic donors and those of Other race and ethnicity (Figure KI 92). Kidneys recovered for transplant that were biopsied continued to have increasing nonuse rates, up to 41.4% in 2023 (Figure KI 96). Kidney nonuse was similarly elevated at 43.8% among kidneys recovered from donors with serum creatinine of 1.5 mg/dL or higher (Figure KI 95).

Figure KI 88: Overall percent of kidneys recovered for transplant and not transplanted.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant.

Figure KI 89: Percent of kidneys recovered for transplant and not transplanted by donor age.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant.

Figure KI 90: Percent of kidneys recovered for transplant and not transplanted by donor diabetes status.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant.

Figure KI 93: Percent of kidneys recovered for transplant and not transplanted by donor hypertension status.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant.

Figure KI 94: Percent of kidneys recovered for transplant and not transplanted by donor BMI.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant. BMI, body mass index.

Figure KI 92: Percent of kidneys recovered for transplant and not transplanted by donor race and ethnicity.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

Figure KI 95: Percent of kidneys recovered for transplant and not transplanted by donor terminal creatinine.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant.

Nonuse of kidneys recovered from HCV-positive donors with NAT-/Ab+ declined to 30.6% in 2023, from 49.5% in 2016, while nonuse of kidneys recovered from HCV-positive donors with NAT+ declined to 27.2% in 2023, from 43.0% in 2017 (Figure KI 98), contrasting with rising nonuse of kidneys recovered from HCV-negative donors with NAT-/Ab-. These data indicate that clinicians and patients are becoming more comfortable with the low transmission risk from NAT-/Ab+ organs,² and with treatment options following transplant from NAT+ donors. A lower proportion of kidneys from donors with risk factors for blood-borne disease transmission as defined by the US Public Health Service Guideline were not used than kidneys from donors without these risk factors in 2023 (21.4% versus 29.3%) (Figure KI 99), perhaps because kidneys with these risk factors are often from younger donors and otherwise of high quality with low KDPI scores. In 2023, the nonuse rate of kidneys with KDPI of 85% or greater reached a high of 72.5% (Figure KI 101). The impact on kidney nonuse of OPTN board-approved changes in KDPI to remove race and HCV status in 2024 will be evaluated in the coming years. In 2023, the nonuse rate of kidneys from DCD donors rose to 34.8% (Figure KI 100). Kidney nonuse also increased across donor causes of death and was highest at 41.7% for kidneys recovered from donors who died of cerebrovascular accident/stroke (Figure KI 97).

Figure KI 98: Percent of kidneys recovered for transplant and not transplanted by donor HCV status.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant. Donor HCV status was based on NAT and antibody tests. Ab, antibody; HCV, hepatitis C virus; NAT, nucleic acid test.

Figure KI 99: Percent of kidneys recovered for transplant and not transplanted, by donor risk of disease transmission.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant. “Risk factors” refers to risk criteria for acute transmission of human immunodeficiency virus, hepatitis B virus, or hepatitis C virus from the US Public Health Service Guideline.

Figure KI 101: Percent of kidneys recovered for transplant and not transplanted by KDPI.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant, by KDPI classification. Conversion of kidney donor risk index to KDPI is done using the OPTN KDPI Mapping Tables. For donors recovered January through May, the cohort 2 years prior was used to assign KDPI; for donors recovered June through December, the cohort 1 year prior was used to assign KDPI. KDPI, kidney donor profile index.

Figure KI 100: Percent of kidneys recovered for transplant and not transplanted by DCD status.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.

Figure KI 97: Percent of kidneys recovered for transplant and not transplanted by donor cause of death.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant. CVA, cerebrovascular accident.

3.2. Living Donation

Following a recent peak in the number of living kidney donors at 6,856 in 2019, the number decreased to 5,226 in 2020 during the COVID-19 pandemic, and subsequently has trended upward to 6,226 in 2023 (Figure KI 102). In 2023, directed and distantly related (defined as a biological relation other than a parent, child, half sibling, or full sibling) living kidney donations declined compared with counts in 2022, while counts of paired kidney donation and living donations from spouses, relatives, and others were higher, with 20.6% from donor exchanges (Figure KI 102). As noted above, only a small proportion of individuals on the waiting list receives an LDKT each year, despite government initiatives to reduce financial barriers to living donation and to encourage early LDKT.³

Figure KI 102: Number of living kidney donors by donor relation.

As reported on the OPTN Living Donor Registration Form.

In 2023, the proportion of living kidney donors aged 55 years or older rose slightly, while the proportion aged 39 years or younger declined slightly, with young adult living donors aged 18–29 years reaching a low of 12.6% (Figure KI 103). Living donors aged 40–54 years continued to make up the most common donor age group. In 2023, the proportion of female living kidney donors remained stably high, at 63.5% (Figure KI 104). The racial and ethnic composition of living donors in 2023 (68.7% White, 16.9% Hispanic, 7.2% Black, 5.2% Asian, 2.1 % Other) was relatively stable compared with 2022 (Figure KI 105). Of note, this reflects a general decrease in the proportion of Black living donors, from 11.2% in 2013 (Figure KI 105). The proportion of living donors with BMI greater than 30 kg/m² was stable in 2023 (23.9%) compared with 2022 (23.6%) (Figure KI 107). Most living donation surgeries in 2023 were intended as laparoscopic hand-assisted (57.4%) or pure laparoscopic procedures (40.8%) (Figure KI 106).

Figure KI 103: Living kidney donors by age.

As reported on the OPTN Living Donor Registration Form.

Figure KI 104: Living kidney donors by sex.

As reported on the OPTN Living Donor Registration Form.

Figure KI 105: Living kidney donors by race and ethnicity.

As reported on the OPTN Living Donor Registration Form. The Other race category is composed of Native American and Multiracial categories.

Figure KI 107: BMI among living kidney donors.

Donor height and weight reported on the OPTN Living Donor Registration Form. BMI, body mass index.

Figure KI 106: Intended living kidney donor procedure type.

As reported on the OPTN Living Donor Registration Form.

4. Pediatric Kidney Transplant

4.1. Waiting List

In 2023, the number of pediatric candidates added to the kidney transplant waiting list reached its highest point at 1,177 (Figure KI 108). The number of prevalent pediatric candidates (listed before age 18 years) had a 34.4% increase: 2,956 in 2023 from 2,199 in 2012 (Figure KI 109). By age, candidates aged 12 years or older accounted for the largest proportion of those waiting, at 36.4%, compared with those aged 6–11 years (18.5%) and aged 0–5 years (15.4%) (Figure KI 110). In terms of race and ethnicity, White candidates accounted for the largest group (41.8%) on the kidney transplant waiting list, followed by Hispanic (28.6%), Black (18.5%), Asian (6.5%), Multiracial (3.0%), and Native American (1.0%) candidates (Figure KI 111). The proportion of Black candidates has decreased since 2013 (Table KI 11). Over the past decade, the distributions of age, sex, and geographic distance to transplant center have remained largely unchanged (Table KI 11). The proportion of candidates with congenital anomalies of the kidney and urinary tract as primary cause of disease has increased, while the proportions with glomerulonephritis and focal segmental glomerulosclerosis (FSGS) have decreased (Table KI 12). Most pediatric candidates waiting as of December 31, 2023, had a cPRA level less than 1% (65.3%), an increase since 2013, and there has been a decrease in the proportion of sensitized candidates with cPRA of 80% or greater, to 10.0% in 2023 (Table KI 12). The proportion of pediatric candidates waiting for retransplant decreased over the past decade: 17.2% in 2023 from 30.2% in 2013 (Table KI 13).

Figure KI 108: New pediatric candidates added to the kidney transplant waiting list.

A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and were subsequently relisted are considered new. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure KI 109: All pediatric candidates on the kidney transplant waiting list.

Candidates listed at more than one center are counted once per listing; age determined at first listing.

Figure KI 111: Distribution of pediatric candidates waiting for kidney transplant by race and ethnicity.

Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.

Table KI 11: Demographic characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2013, December 31, 2018, and December 31, 2023.

Candidates younger than 18 years at listing waiting for transplant on December 31 of the given year, regardless of first listing date. Age is determined on December 31 of the year. The 18+ category is for candidates who turned age 18 while waiting. Distance is computed from candidate’s home zip code to the transplant center.

	2013		2018		2023
Characteristic	N	Percent	N	Percent	N	Percent
Age (years)
0–5 years	183	13.6	216	13.9	254	13.5
6–11	237	17.6	315	20.3	318	16.9
12–17	495	36.8	548	35.4	648	34.5
18+	430	32	470	30.3	657	35
Sex
Female	519	38.6	598	38.6	730	38.9
Male	826	61.4	951	61.4	1147	61.1
Race and ethnicity
Asian	66	4.9	97	6.3	127	6.8
Black	354	26.3	350	22.6	346	18.4
Hispanic	360	26.8	446	28.8	549	29.2
Multiracial	16	1.2	24	1.5	57	3
Native American	9	0.7	20	1.3	20	1.1
White	540	40.1	612	39.5	766	40.8
Unreported	0	0	0	0	12	0.6
Miles between candidate and center
<50 miles	875	65.1	1031	66.6	1212	64.6
50-<100	219	16.3	209	13.5	295	15.7
100-<150	107	8	112	7.2	143	7.6
150-<250	84	6.2	113	7.3	124	6.6
250+	47	3.5	77	5	95	5.1
Missing	13	1	7	0.5	8	0.4
All candidates
All candidates	1345	100	1549	100	1877	100

Table KI 12: Clinical characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2013, December 31, 2018, and December 31, 2023.

Candidates younger than 18 years at listing waiting for transplant on December 31 of the given year, regardless of first listing date. Missing cPRA indicates no unacceptable antigens were reported. CAKUT, congenital anomalies of the kidney and urinary tract; cPRA, calculated panel-reactive antibody; FSGS, focal segmental glomerulosclerosis.

	2013		2018		2023
Characteristic	N	Percent	N	Percent	N	Percent
Pediatric diagnosis
FSGS	170	12.6	151	9.7	166	8.8
Glomerulonephritis	144	10.7	129	8.3	151	8
CAKUT	426	31.7	553	35.7	647	34.5
Other/unknown	604	44.9	716	46.2	912	48.6
NA	1	0.1	0	0	1	0.1
Blood type
A	411	30.6	467	30.1	592	31.5
AB	41	3	44	2.8	55	2.9
B	228	17	245	15.8	291	15.5
0	665	49.4	793	51.2	939	50
cPRA
<1% or missing	809	60.1	1058	68.3	1226	65.3
1-<20%	77	5.7	108	7	186	9.9
20-<80%	166	12.3	182	11.7	277	14.8
80-<98%	104	7.7	86	5.6	75	4
98–100%	189	14.1	115	7.4	113	6
All candidates
All candidates	1345	100	1549	100	1877	100

Table KI 13: Listing characteristics of pediatric candidates on the kidney transplant waiting list on December 31, 2013, December 31, 2018, and December 31, 2023.

Candidates younger than 18 years at listing waiting for transplant on December 31 of the given year, regardless of first listing date.

	2013		2018		2023
Characteristic	N	Percent	N	Percent	N	Percent
Waiting time (years)
<1 year	602	44.8	656	42.3	756	40.3
1-<2	266	19.8	328	21.2	349	18.6
2-<3	146	10.9	190	12.3	215	11.5
3-<5	145	10.8	199	12.8	255	13.6
5+	186	13.8	176	11.4	302	16.1
Previous transplant
No prior transplant	939	69.8	1240	80.1	1554	82.8
Prior transplant	406	30.2	309	19.9	323	17.2
All candidates
All candidates	1345	100	1549	100	1877	100

The distribution of waiting time among pediatric candidates on the kidney transplant waiting list (active and inactive) has remained similar over the past decade, with almost 50% of candidates waiting for less than 1 year (Figure KI 114). Looking at the cPRA levels of pediatric candidates on the waiting list in 2023, 65.5% of candidates had a cPRA of less than 1 %, while the remainder were as follows: 10.3% (cPRA 1%-<20%), 15.1 % (cPRA 20%-<80%), 3.9% (cPRA 80%-<98%), and 5.2% (cPRA 98%−100%) (Figure KI 115). In the past decade, there has been a 75.9% increase in the proportion of pediatric candidates on the waiting list who were not on dialysis, to 52.5% in 2023 from 29.8% in 2012 (Figure KI 117). Of the 1,079 candidates removed from the waiting list in 2023, 653 (60.5%) received a deceased donor kidney, 267 (24.7%) received a living donor kidney, 14 (1.3%) died, 10 (0.9%) were considered too sick to undergo transplant, and 5 (0.5%) were removed from the list because their condition improved (Table KI 14 and Table KI 15). Among patients newly listed in 2018–2020, 51.6% underwent DDKT within 3 years, 23.5% underwent LDKT, 16.7% were still waiting, 7.0% were removed from the list for other reasons, and 1.2% died (Figure KI 118). There has been a 16.1% decrease in the rate of DDKT among pediatric waitlist candidates in the past decade: 36.2 transplants per 100 patient-years in 2023 compared with 43.2 transplants per 100 patient-years in 2012 (Figure KI 119). In 2023, transplant rates were relatively similar for all pediatric age groups: 47.6, 47.3, and 43.9 transplants per 100 patient-years for age 0–5 years, age 6–11 years, and age 12–17 years, respectively, compared with 14.3 transplants per 100 patient-years among candidates who had turned age 18 by the start of the year (Figure KI 120). By race and ethnicity, the highest transplant rates were among Black (42.6 transplants per 100 patient-years), Other (includes Multiracial and Native American; 40.7 transplants per 100 patient-years), and Hispanic candidates (39.4 transplants per 100 patient-years), followed by Asian (34.1 transplants per 100 patient-years) and White candidates (30.8 transplants per 100 patient-years) (Figure KI 121). Transplant rates varied by cPRA, with the highest rates in 2023 among candidates with cPRA of less than 1% at 39.0 transplants per 100 patient-years. The priority for candidates with high immunologic sensitivity continued to result in higher transplant rates compared with historical rates. Candidates with cPRAof 80%-<98% had a 67.2% increase (32.7 transplants per 100 patient-years in 2023, from 19.6 in 2012) and those in the 98%−100% category had a 138.6% increase (14.0 transplants per 100 patient-years in 2023, from 5.9 in 2012) (Figure KI 122). Transplant rates varied by blood type; in 2023, the rate was 52.9 transplants per 100 patient-years among candidates with type AB, followed by 38.2, 34.4, and 30.4 transplants per 100 patient-years among candidates with type O, type A, and type B, respectively (Figure Kl 123). Pretransplant mortality was at its lowest point in the past decade, at 1.0 deaths per 100 patient-years in 2023 (Figure KI 124).

Figure KI 114: Distribution of pediatric candidates waiting for kidney transplant by waiting time.

Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Candidates listed in the given year are considered to have been listed less than 1 year. Active and inactive candidates are included.

Figure KI 115: Distribution of pediatric candidates waiting for kidney transplant by cPRA.

Candidates waiting for transplant at anytime in the given year. Candidates listed at more than one center are counted once per listing. cPRA is determined at the earliest of transplant, death, removal, or December 31 of the year. Missing indicates no unacceptable antigens were reported. Active and inactive candidates are included. cPRA, calculated panel-reactive antibody.

Figure KI 117: Distribution of pediatric candidates waiting for kidney transplant by years on dialysis.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Time on dialysis is computed as time from minimum of first end-stage renal disease service date or most recent graft failure to listing date or January 1 of the given year. Active and inactive candidates are included.

Table KI 14: Kidney transplant waitlist activity among pediatric candidates.

Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multiorgan transplants are included.

Waiting list state	2021	2022	2023
Waiting list state
Patients at start of year	1695	1698	1779
Patients added during year	1087	1099	1177
Patients removed during year	1084	1018	1079
Patients at end of year	1698	1779	1877

Table KI 15: Removal reason among pediatric kidney transplant candidates.

Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.

Removal reason	2021	2022	2023
Removal reason
Deceased donor transplant	692	591	653
Living donor transplant	257	230	267
Patient died	20	24	14
Patient refused transplant	6	5	3
Improved, transplant not needed	4	9	5
Too sick for transplant	9	13	10
Other	96	146	127

Figure KI 118: Three-year outcomes for newly listed pediatric candidates waiting for kidney transplant, 2018–2020.

Pediatric candidates who joined the waiting list in 2018–2020. Candidates listed at more than one center are counted once per listing. DD, deceased donor; LD, living donor.

Figure KI 120: Deceased donor kidney transplant rates among pediatric waitlist candidates by age.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. The 18+ category is for candidates who turned age 18 while waiting.

Figure KI 121: Deceased donor kidney transplant rates among pediatric waitlist candidates by race and ethnicity.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure KI 122: Deceased donor kidney transplant rates among pediatric waitlist candidates by cPRA.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. cPRA is determined at the later of listing date or January 1 of the given year. Missing indicates no unacceptable antigens were reported. cPRA, calculated panel-reactive antibody.

Figure KI 123: Deceased donor kidney transplant rates among pediatric waitlist candidates by blood type.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure KI 124: Overall pretransplant mortality rates among pediatric candidates waitlisted for kidney.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

4.2. Transplants

The total number of pediatric kidney transplants performed in 2023 increased to 791, from its lowest point of 705 in 2022 (Figure KI 129); 550 (69.5%) were DDKTs and 241 (30.5%) were LDKTs (Figure KI 130). The latter value of 241 represents a 16% decrease in the number of pediatric LDKTs over the past decade (from 287 in 2012), and it is notable that the distribution of the relationship of the living donor to the recipient has changed over time. The number of related living donors had a 37.1% decrease to 122 transplants in 2023 (from 194 in 2012), the unrelated directed category had a 75.9% increase to 51 transplants in 2023 (from 29 in 2012), and the paired donation category remains very low but did have an 83.3% increase to 22 transplants in 2023 (from 12 in 2012) (Figure KI 134). Of interest, children aged 12–17 years had the highest proportion of LDKT (45.2%), followed by those aged 0–5 years (30.3%) and 6–11 years (24.5%) (Figure KI 137). Looking at donor age, 59.9% of pediatric recipients received a kidney from a donor aged 18–35 years, followed by donor age 36–49 years (23.8%), donor age 12–17 years (11.4%), and donor age 6–11 years (3.2%). Only 1.8% of pediatric transplants were performed with a donor aged 0–5 years or 50 years or older (Figure KI 133). Preemptive (transplant before starting dialysis) pediatric DDKTs have steadily increased since 2016: 26.2% of pediatric DDKTs in 2023 versus 15.0% in 2016 (Figure KI 135), corresponding to the increase in preemptive listings (Figure KI 117).

Figure KI 129: Overall pediatric kidney transplants.

All pediatric kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 130: Pediatric kidney transplants by donor type.

All pediatric kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 134: Number of living donor pediatric kidney transplants by donor relation.

As reported on the OPTN Living Donor Registration Form. All pediatric kidney transplant recipients, including retransplant, and multiorgan recipients.

Figure KI 137: Percent of pediatric kidney transplants from living donors by recipient age.

All pediatric living kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 133: Pediatric kidney transplants by donor age.

All pediatric kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 135: Percent of pediatric deceased donor kidney transplants by years on dialysis.

All pediatric recipients of deceased donor kidneys, including multiorgan transplant recipients. Time on dialysis is computed as time from minimum of first end-stage renal disease service date or most recent graft failure to transplant date.

In 2023, there were 33 programs performing only pediatric kidney transplants (here, meaning age 0–17 years and a small number up to age 21 years), 139 performing only adult transplants (18 years or older), 57 performing mixed transplants (in both adults and children of any age), and 4 functionally adult programs (performing 80% or more transplants in adults and the remainder in adolescents aged 15–17 years); compared with 2012, these values represent a 17.9% increase, a 15.8% increase, a 17.4% decrease, and a 73.3% decrease, respectively (Figure KI 138). For transplant center volume, 13.3% of transplants in recipients younger than 18 years were performed at programs with a volume of five or fewer pediatric transplants in 2023 (Figure KI 139). Almost half (49.7%) of all pediatric recipients who underwent transplant in 2023 were aged 12–17 years: 51.6% of pediatric DDKT recipients and 45.2% of pediatric LDKT recipients (Table KI 16). The racial and ethnic distributions were notably different for DDKT and LDKT recipients. For LDKT recipients, 66.4% were White, 17.8% were Hispanic, 7.5% were Black, 4.6% were Asian, and 2.9% were Multiracial. In contrast, for DDKT recipients, 35.5% were White, 30.7% were Hispanic, 22.7% were Black, 6.2% were Asian, 3.3% were Multiracial, and 1.3% were Native American (Table KI 16). Private insurance was more common among LDKT recipients (58.9%), and Medicare or Medicaid was more common among DDKT recipients (66.2%) (Table KI 16). Most DDKT recipients (96.9%) underwent transplant with a kidney from a donor with KDPI less than 35% (Table KI 18). Most DDKT recipients (81.9%) had four or more HLA mismatches compared with only 31.6% of LDKT recipients (Figure KI 143). Multiorgan transplant remained uncommon; 4.0% of pediatric candidates received multiorgan transplant in 2023, with kidney-liver transplant being the most common (Table KI 18).

Figure KI 138: Number of centers performing pediatric and adult kidney transplants by center age mix.

Adult centers performed transplants only for recipients aged 18 years or older. Functionally adult centers performed transplants for 80% adults or more, and the remainder were children aged 15–17 years. Mixed included adults and children of any age groups. Pediatric centers performed transplants for recipients aged 0–17 years, and a small number of adults up to age 21 years.

Figure KI 139: Pediatric kidney recipients at programs that perform five or fewer pediatric transplants annually.

Age groups are cumulative.

Table KI 16: Demographic characteristics of pediatric kidney transplant recipients, 2023.

Pediatric kidney transplant recipients, including retransplant recipients. Distance is computed from recipient’s home zip code to the transplant center.

	Deceased		Living		All
Characteristic	N	Percent	N	Percent	N	Percent
Recipient age (years)
0–5 years	115	20.9	73	30.3	188	23.8
6–11	151	27.5	59	24.5	210	26.5
12–17	284	51.6	109	45.2	393	49.7
Sex
Female	225	40.9	93	38.6	318	40.2
Male	325	59.1	148	61.4	473	59.8
Race and ethnicity
Asian	34	6.2	11	4.6	45	5.7
Black	125	22.7	18	7.5	143	18.1
Hispanic	169	30.7	43	17.8	212	26.8
Multiracial	18	3.3	7	2.9	25	3.2
Native American	7	1.3	0	0	7	0.9
White	195	35.5	160	66.4	355	44.9
Unreported	2	0.4	2	0.8	4	0.5
Insurance
Private	142	25.8	142	58.9	284	35.9
Medicare	120	21.8	23	9.5	143	18.1
Medicaid	244	44.4	66	27.4	310	39.2
Other/unknown	44	8	10	4.1	54	6.8
Miles between recipient and center
<50 miles	334	60.7	154	63.9	488	61.7
50-<100	100	18.2	37	15.4	137	17.3
100-<150	38	6.9	17	7.1	55	7
150-<250	40	7.3	23	9.5	63	8
250+	33	6	10	4.1	43	5.4
Missing	5	0.9	0	0	5	0.6
All recipients
All recipients	550	100	241	100	791	100

Table KI 18: Transplant characteristics of pediatric kidney transplant recipients, 2023.

Pediatric kidney transplant recipients, including retransplant recipients. DCD status and KDPI scores apply to deceased donor transplants only. DBD, donation after brain death; DCD, donation after circulatory death; DGF, delayed graft function; KDPI, kidney donor profile index.

	Deceased		Living		All
Characteristic	N	Percent	N	Percent	N	Percent
Waiting time (years)
<1 day	0	0	3	1.2	3	0.4
1 day-<1 year	394	71.6	190	78.8	584	73.8
1-<3	129	23.5	43	17.8	172	21.7
3-<5	22	4	5	2.1	27	3.4
5+	5	0.9	0	0	5	0.6
KDPI
0-<20%	415	75.5	0	0	415	52.5
20-<35%	118	21.5	0	0	118	14.9
35-<85%	17	3.1	0	0	17	2.1
Missing	0	0	241	100	241	30.5
Donation after circulatory death
DBD	528	96	0	0	528	66.8
DCD	22	4	0	0	22	2.8
Living donor	0	0	241	100	241	30.5
Previous transplant for recipients
No prior transplant	502	91.3	227	94.2	729	92.2
Prior transplant	48	8.7	14	5.8	62	7.8
Organs transplanted
Kidney only	518	94.2	241	100	759	96
Kidney-liver	28	5.1	0	0	28	3.5
Heart-kidney	2	0.4	0	0	2	0.3
Intestine-pancreas-liver-kidney	2	0.4	0	0	2	0.3
All recipients
All recipients	550	100	241	100	791	100

Figure KI 143: Total HLA A, B, and DR mismatches among pediatric kidney transplant recipients, 2019–2023.

Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2023. Unk, unknown.

The combination of a donor who was positive for cytomegalovirus and a pediatric recipient who was negative occurred in 37.1% of DDKTs in 2021–2023 (Table KI 19). The combination of a donor who was positive for EBV and a pediatric recipient who was negative occurred in 37.2% of DDKTs (Table KI 19).

Table KI 19: Pediatric deceased donor kidney donor-recipient serology matching, 2021–2023.

Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. CMV, cytomegalovirus; EBV, Epstein-Barr virus; unk, unknown.

Donor	Recipient	CMV	EBV
Donor
D-	R-	27.35	7.08
D-	R+	12.94	6.53
D-	R unk	1.4	0.18
D+	R-	37.12	37.24
D+	R+	18.68	46.09
D+	R unk	1.22	2.38
D unk	R-	0.79	0.18
D unk	R+	0.49	0.24
D unk	R unk	0	0.06

4.3. Immunosuppressive Medication Use

Almost all (93.4%) pediatric kidney transplant recipients had some induction use reported in 2023 (Figure KI 140); 66.6% T-cell-depleting agent use only, 22.0% IL2Ab use only, and 4.8% a combination of IL2Ab and T-cell-depleting agent use (Figure KI 141). The most common immunosuppression regimens prescribed during the initial transplant hospitalization period were tacrolimus, a mycophenolate agent, and steroids in 55.9% of recipients, followed by tacrolimus and mycophenolate in 35.3% (Figure KI 142).

Figure KI 140: Induction agent use in pediatric kidney transplant recipients.

Immunosuppression at transplant reported to the OPTN.

Figure KI 141: Type of induction agent use in pediatric kidney transplant recipients.

Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure KI 142: Immunosuppression regimen use in pediatric kidney transplant recipients.

Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

4.4. Outcomes

The rate of delayed graft function was 6.9% for pediatric DDKT recipients and 2.5% for pediatric LDKT recipients in 2023 and has been stable in both over the past decade (Figure KI 144 and Figure KI 145). Short-term kidney function, measured by eGFR, has also remained stable over the past decade. Proportions of LDKT and DDKT recipients from 2022 with eGFR of 60 mL/min/1.73 m² or higher at 12 months posttransplant were 69.0% and 66.3%, respectively (Figure KI 146 and Figure KI 147). Graft failure after DDKT in pediatric recipients was 2.8% at 6 months and 4.0% at 1 year for transplants in 2022, 7.7% at 3 years for transplants in 2020,12.4% at 5 years for transplants in 2018, and 35.4% at 10 years for transplants in 2013 (Figure KI 148). Corresponding graft failure after LDKT was 3.0% at 6 months and 3.0% at 1 year for transplants in 2022, 5.0% at 3 years for transplants in 2020, 8.8% at 5 years for transplants in 2018, and 19.7% at 10 years for transplants in 2013 (Figure KI 149). For the cohort of recipients who underwent transplant in 2016–2018, 1-, 3-, and 5-year graft survival were 97.6%, 93.6%, and 86.9% for DDKT recipients and 99.1%, 96.4%, and 93.1% for LDKT recipients, respectively (Figure KI 150). Graft survival varied by age; the highest 5-year graft survival among pediatric DDKT recipients was in those aged 6–11 years (92.4%) and lowest among those aged 1217 years (83.5%) (Figure KI 151). Of note, the adolescent group aged 12–17 years started off with the highest 1-year graft survival among all ages but this shifted at approximately 2 years posttransplant. Looking at graft survival by recipient diagnosis, 5-year graft survival ranged from 90.2% (congenital anomalies of the kidney and urinary tract) to 81.0% (FSGS) to 80.8% (glomerulonephritis) (Figure KI 152). For graft survival in DDKT recipients by KDPI, 5-year graft survival was similar for recipients of kidneys with KDPI of 0%-<20% (86.9%) and 20%-<35% (87.8%), with a small decrease among those with KDPI 35%-<85% (83.1%) (Figure KI 153). Graft outcomes varied by donor age; the lowest 5-year DDKT graft survival of 76.2% was among recipients of kidneys from donors aged 0–5 years (Figure KI 154). In the 2022 recipient cohort, the overall incidence of acute rejection within the first year ranged from 9.6% among patients aged 6–11 years and 9.7% among patients aged 12–17 years to 14.1% among patients aged 0–5 years (Figure KI 155). Incidence of posttransplant lymphoproliferative disorder among EBV-negative recipients from 2012–2018 was 4.2% at 5-years posttransplant, compared with 0.8% among EBV-positive recipients (Figure KI 157). Overall, 5-year patient survival among pediatric DDKT recipients in 2016–2018 was 97.3% (Figure KI 159), with little variability by recipient age: 96.5% (age 0–5 years), 97.5% (age 6–11 years), and 97.5% (age 12–17 years) (Figure KI 160). Patient survival in this cohort did not vary by etiology of kidney disease (Figure KI 161). Among pediatric LDKT recipients in 2016–2018, 5-year patient survival was 98.6% (Figure KI 162), again with little variability by age (Figure KI 163). Survival was slightly lower for LDKT recipients with FSGS (96.1%) compared with other diagnoses (Figure KI 164).

Figure KI 144: Delayed graft function among pediatric deceased donor kidney transplant recipients.

All pediatric recipients of deceased donor kidneys. Delayed graft function is defined as dialysis administered within the first 7 days posttransplant. DGF, delayed graft function.

Figure KI 145: Delayed graft function among pediatric living donor kidney transplant recipients.

All pediatric recipients of living donor kidneys. Delayed graft function is defined as dialysis administered within the first 7 days posttransplant. DGF, delayed graft function.

Figure KI 146: Distribution of eGFR at 12 months posttransplant among pediatric deceased donor kidney transplant recipients.

Glomerular filtration rate (mL/min/1.73 m²) estimated using the bedside Schwartz equation, and computed by SRTR for patients alive with graft function at 12 months posttransplant. Equation: eGFR = 0.413*Height(cm)/Creatinine (mg/dL). eGFR, estimated glomerular filtration rate.

Figure KI 147: Distribution of eGFR at 12 months posttransplant among pediatric living donor kidney transplant recipients.

Glomerular filtration rate (mL/min/1.73 m²) estimated using the bedside Schwartz equation, and computed by SRTR for patients alive with graft function at 12 months posttransplant. Equation: eGFR = 0.413*Height(cm)/Creatinine (mg/dL). eGFR, estimated glomerular filtration rate.

Figure KI 148: Graft failure among pediatric deceased donor kidney transplant recipients.

All pediatric recipients of deceased donor kidneys, including multiorgan transplant recipients. Estimates are unadjusted, computed using Kaplan-Meier methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. All-cause graft failure is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.

Figure KI 149: Graft failure among pediatric living donor kidney transplant recipients.

All pediatric recipients of living donor kidneys, including multiorgan transplant recipients. Estimates are unadjusted, computed using Kaplan-Meier methods. Recipients are followed to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 6 months, 1, 3, 5, or 10 years posttransplant. All-cause graft failure is defined as any of the prior outcomes prior to 6 months, 1, 3, 5, or 10 years, respectively.

Figure KI 150: Graft survival among pediatric kidney transplant recipients, 2016–2018, by donor type.

Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 151: Graft survival among pediatric deceased donor kidney transplant recipients, 2016–2018, by age.

Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 152: Graft survival among pediatric deceased donor kidney transplant recipients, 2016–2018, by diagnosis.

Recipient survival estimated using unadjusted Kaplan-Meier methods. Diagnosis categories follow North American Pediatric Renal Trials and Collaborative Studies recommendations. Active and inactive candidates are included. CAKUT, congenital anomalies of the kidney and urinary tract; FSGS, focal segmental glomerulosclerosis.

Figure KI 153: Graft survival among pediatric deceased donor kidney transplant recipients, 2016–2018, by KDPI.

Recipient survival estimated using unadjusted Kaplan-Meier methods. Conversion of kidney donor risk index to KDPI is done using the OPTN KDPI Mapping Tables. For donors recovered January through May, the cohort 2 years prior was used to assign KDPI; for donors recovered June through December, the cohort 1 year prior was used to assign KDPI. KDPI, kidney donor profile index.

Figure KI 154: Graft survival among pediatric deceased donor kidney transplant recipients, 2016–2018, by donor age.

Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 155: Incidence of acute rejection by 1 year posttransplant among pediatric kidney transplant recipients by age.

Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

Figure KI 157: Incidence of PTLD among pediatric kidney transplant recipients by recipient EBV status at transplant, 2012–2018.

Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure KI 159: Overall patient survival among pediatric deceased donor kidney transplant recipients, 2016–2018.

Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 160: Patient survival among pediatric deceased donor kidney transplant recipients, 2016–2018, by recipient age.

Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 161: Patient survival among pediatric deceased donor kidney transplant recipients, 2016–2018, by diagnosis.

Recipient survival estimated using unadjusted Kaplan-Meier methods. Diagnosis categories follow North American Pediatric Renal Trials and Collaborative Studies recommendations. CAKUT, congenital anomalies of the kidney and urinary tract; FSGS, focal segmental glomerulosclerosis.

Figure KI 162: Overall patient survival among pediatric living donor kidney transplant recipients, 2016–2018.

Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 163: Patient survival among pediatric living donor kidney transplant recipients, 2016–2018, by recipient age.

Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure KI 164: Patient survival among pediatric living donor kidney transplant recipients, 2016–2018, by diagnosis.

Recipient survival estimated using unadjusted Kaplan-Meier methods. Diagnosis categories follow North American Pediatric Renal Trials and Collaborative Studies recommendations. CAKUT, congenital anomalies of the kidney and urinary tract; FSGS, focal segmental glomerulosclerosis.

Figure KI 10: Distribution of adults waiting for kidney transplant by blood type.

Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure KI 16: Deceased donor kidney transplant rates among adult waitlist candidates by race and ethnicity.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure KI 19: Deceased donor kidney transplant rates among adult waitlist candidates by blood type.

Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure KI 36: Overall kidney transplants.

All kidney transplant recipients, including adult and pediatric, retransplant, and multiorgan recipients.

Figure KI 91: Percent of kidneys recovered for transplant and not transplanted by donor sex.

Percentages of kidneys not transplanted out of all kidneys recovered for transplant.

Figure KI 112: Distribution of pediatric candidates waiting for kidney transplant by diagnosis.

Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Diagnosis categories follow North American Pediatric Renal Trials and Collaborative Studies recommendations. Active and inactive candidates are included. CAKUT, congenital anomalies of the kidney and urinary tract; FSGS, focal segmental glomerulosclerosis.

Figure KI 113: Distribution of pediatric candidates waiting for kidney transplant by sex.

Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure KI 125: Pretransplant mortality rates among pediatric candidates waitlisted for kidney transplant by age.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. The 18+ category is for candidates who turned age 18 while waiting.

Figure KI 126: Pretransplant mortality rates among pediatric candidates waitlisted for kidney transplant by race and ethnicity.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure KI 127: Pretransplant mortality rates among pediatric candidates waitlisted for kidney transplant by diagnosis.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Diagnosis categories follow North American Pediatric Renal Trials and Collaborative Studies recommendations. Active and inactive candidates are included. CAKUT, congenital anomalies of the kidney and urinary tract; FSGS, focal segmental glomerulosclerosis.

Figure KI 128: Pretransplant mortality rates among pediatric candidates waitlisted for kidney transplant by cPRA.

Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. cPRA is determined at the later of listing date or January 1 of the given year. Missing indicates no unacceptable antigens were reported. cPRA, calculated panel-reactive antibody.

Figure KI 131: Pediatric kidney transplants by recipient age.

All pediatric kidney transplant recipients, including retransplant and multiorgan recipients.

Figure KI 132: Pediatric kidney transplants by diagnosis.

All pediatric kidney transplant recipients, including retransplant, and multiorgan recipients. Diagnosis categories follow North American Pediatric Renal Trials and Collaborative Studies recommendations. Active and inactive candidates are included. CAKUT, congenital anomalies of the kidney and urinary tract; FSGS, focal segmental glomerulosclerosis.

Figure KI 136: Percent of pediatric kidney transplants by KDPI.

All pediatric recipients of deceased donor kidneys, including multiorgan transplant recipients. Conversion of kidney donor risk index to KDPI is done using the OPTN KDPI Mapping Tables. For donors recovered January through May, the cohort 2 years prior was used to assign KDPI; for donors recovered June through December, the cohort 1 year prior was used to assign KDPI. Kidneys recovered en bloc are counted once. KDPI, kidney donor profile index.

Figure KI 156: Incidence of acute rejection by 1 year posttransplant among pediatric kidney transplant recipients by induction agent use.

Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method. Immunosuppression at transplant reported to the OPTN.

Figure KI 158: Patient death among pediatric kidney transplant recipients.

All pediatric recipients of deceased donor kidneys, including multiorgan transplant recipients. Estimates are unadjusted, computed using Kaplan-Meier methods.

Table KI 2: Clinical characteristics of adults on the kidney transplant waiting list on December 31, 2013, December 31, 2018, and December 31, 2023.

Candidates waiting for transplant on December 31 of the given year, regardless of first listing date. Diabetes status based on diagnosis and comorbid conditions. Missing cPRA indicates no unacceptable antigens were reported. cPRA, calculated panel-reactive antibody.

	2013		2018		2023
Characteristic	N	Percent	N	Percent	N	Percent
Diagnosis
Diabetes	36385	34.7	38060	37.6	37205	39.2
Hypertension	25699	24.5	21971	21.7	19218	20.3
Glomerulonephritis	15239	14.6	14753	14.6	12709	13.4
Cystic kidney disease	8704	8.3	8957	8.9	8205	8.7
Other/unknown	18687	17.8	17424	17.2	17464	18.4
NA	1	0	1	0	0	0
Blood type
A	29989	28.6	27731	27.4	25343	26.7
AB	2877	2.7	2596	2.6	2288	2.4
B	17120	16.3	16915	16.7	15292	16.1
0	54729	52.3	53924	53.3	51878	54.7
cPRA
<1% or missing	64808	61.9	62394	61.7	56463	59.6
1-<20%	7821	7.5	9615	9.5	9986	10.5
20-<80%	15337	14.6	16479	16.3	18068	19.1
80-<98%	6970	6.7	5917	5.8	4611	4.9
98–100%	9779	9.3	6761	6.7	5673	6
All candidates
All candidates	104715	100	101166	100	94801	100

Table KI 3: Listing characteristics of adults on the kidney transplant waiting list on December 31, 2013, December 31, 2018, and December 31, 2023.

Candidates waiting for transplant on December 31 of the given year, regardless of first listing date.

	2013		2018		2023
Characteristic	N	Percent	N	Percent	N	Percent
Waiting time (years)
<1 year	32215	30.8	31575	31.2	34136	36
1-<2	23341	22.3	20369	20.1	21407	22.6
2-<3	16530	15.8	15301	15.1	13912	14.7
3-<5	19386	18.5	18962	18.7	14858	15.7
5+	13243	12.6	14959	14.8	10488	11.1
Previous transplant
No prior transplant	89153	85.1	88928	87.9	84428	89.1
Prior transplant	15562	14.9	12238	12.1	10373	10.9
All candidates
All candidates	104715	100	101166	100	94801	100

Table KI 4: Kidney transplant waitlist activity among adults.

Candidates listed at more than one center are counted once per listing. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multiorgan transplants are included.

Waiting list state	2021	2022	2023
Waiting list state
Patients at start of year	97244	95940	95225
Patients added during year	41766	44184	46661
Patients removed during year	43061	44894	47085
Patients at end of year	95949	95230	94801

Table KI 9: Adult deceased donor kidney donor-recipient serology matching, 2021–2023.

Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. Donor HCV NAT data are shown by recipient HCV antibody status. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; NAT, nucleic acid test; unk, unknown.

Donor	Recipient	CMV	EBV	HBsAg	HCV antibody	HCV NAT
Donor
D-	R-	12.66	0.45	96.36	84.55	88.85
D-	R+	24.94	7.01	1.38	3.03	3.25
D-	R unk	0.68	0.34	2.01	2.18	2.28
D+	R-	18.18	4.73	0.18	9.45	5.13
D+	R+	41.41	83.45	0.01	0.56	0.33
D+	R unk	1.03	3.8	0.01	0.23	0.13
D unk	R-	0.31	0.01	0.06	0	0.03
D unk	R+	0.77	0.2	0	0	0
D unk	R unk	0.02	0.01	0	0	0

Table KI 10: Adult living donor kidney donor-recipient serology matching, 2021–2023.

Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. Donor HCV NAT data are shown by recipient HCV antibody status. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; NAT, nucleic acid test; unk, unknown.

Donor	Recipient	CMV	EBV	HBsAg	HCV antibody	HCV NAT
Donor
D-	R-	23.76	0.96	92.29	91.04	84.46
D-	R+	21.14	7.94	0.92	1.59	1.48
D-	R unk	0.7	0.22	3.62	3.9	3.3
D+	R-	16.72	5.58	0.49	0.74	0.09
D+	R+	31.63	79.83	0.01	0.03	0.01
D+	R unk	0.71	2.81	0	0.01	0.01
D unk	R-	2.19	0.18	2.17	2.13	9.37
D unk	R+	2.61	1.88	0.03	0.05	0.18
D unk	R unk	0.54	0.6	0.48	0.5	1.12

Table KI 17: Clinical characteristics of pediatric kidney transplant recipients, 2023.

Pediatric kidney transplant recipients, including retransplant recipients. Diagnosis categories follow North American Pediatric Renal Trials and Collaborative Studies recommendations. Missing cPRA indicates no unacceptable antigens were reported. CAKUT, congenital anomalies of the kidney and urinary tract; cPRA, calculated panel-reactive antibody; FSGS, focal segmental glomerulosclerosis.

	Deceased		Living		All
Characteristic	N	Percent	N	Percent	N	Percent
Diagnosis
FSGS	55	10	18	7.5	73	9.2
Glomerulonephritis	39	7.1	14	5.8	53	6.7
CAKUT	183	33.3	97	40.2	280	35.4
Other/unknown	273	49.6	112	46.5	385	48.7
Blood type
A	164	29.8	114	47.3	278	35.1
AB	23	4.2	11	4.6	34	4.3
B	66	12	30	12.4	96	12.1
0	297	54	86	35.7	383	48.4
Years of dialysis
None	144	26.2	74	30.7	218	27.6
<1 year	130	23.6	73	30.3	203	25.7
1-<3	174	31.6	66	27.4	240	30.3
3-<5	48	8.7	13	5.4	61	7.7
5+	54	9.8	15	6.2	69	8.7
CPRA
<1% or missing	367	66.7	162	67.2	529	66.9
1-<20%	58	10.5	34	14.1	92	11.6
20-<80%	93	16.9	37	15.4	130	16.4
80-<98%	22	4	5	2.1	27	3.4
98–100%	10	1.8	3	1.2	13	1.6
All recipients
All recipients	550	100	241	100	791	100

Table KI 20: Pediatric living donor kidney donor-recipient serology matching, 2021–2023.

Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. CMV, cytomegalovirus; EBV, Epstein-Barr virus; unk, unknown.

Donor	Recipient	CMV	EBV
Donor
D-	R-	35.99	6.49
D-	R+	9.59	2.36
D-	R unk	0.88	0
D+	R-	31.56	57.08
D+	R+	16.22	31.56
D+	R unk	1.47	1.77
D unk	R-	3.1	0.15
D unk	R+	0.88	0.29
D unk	R unk	0.29	0.29