Trends in Deceased Donor Kidney Availability and Utilization in the Kingdom of Saudi Arabia.

OBJECTIVES: We investigated trends in deceased donor kidney availability and utilization in Saudi Arabia, wait list changes, and recipient characteristics.

MATERIALS AND METHODS: Ten-year registry data from the Saudi Center for Organ Transplantation were analyzed, including consent/discard rates, numbers of kidneys from deceased donors versus expanded criteria and standard criteria donors, wait list characteristics, dialysis characteristics, and causes of chronic kidney disease.

RESULTS: Annual mean number of deceased donor transplants remained almost constant over the 10-year period (mean of 129). Use of kidneys from expanded criteria donors increased (from 16%-28%), which was associated with higher frequency of delayed graft function (36.2% vs 16%; P = .002) and acute rejection (5.4% vs 19.6%; P = .001) versus kidneys from standard criteria donors. Donor consent rate (34%) and cold ischemic time (12.3 hours) remained constant. Numbers of patients on wait lists remained fairly constant (mean of 2825), although those on dialysis on wait lists decreased from 24% to 17% (P < .0001). Overall wait list numbers remained level or even dropped despite increased patients on dialysis (from 7%-10% annually). Between 2008 and 2016, prevalence of patients > 65 and > 75 years rose by 4.2% and 2.4% and prevalence of diabetes mellitus in patients on dialysis increased by 59.2%. Of kidneys consented in 2016, 14.7% were not recovered, mainly because of sudden cardiac arrest (60%). Of total transplanted kidneys, proportion from deceased donors decreased from 51% (2008-2010) to 22.1% (2014-2016). Only 13% of recipients were older than 55 years, although they comprised 25% of the dialysis population, with patients < 18 years (comprising 2.2% of the dialysis population) receiving 15% of kidneys.

CONCLUSIONS: Deceased donor transplants remained almost constant; however, their proportion of total transplanted kidneys decreased, while transplants with extended criteria kidneys increased. Wait list totals decreased, with relatively less elderly patients and more children being transplanted.