NKF Publishes Recommendations to Move Thousands of Patients from Dialysis to Transplant

New York, NY—July 27, 2021The National Kidney Foundation (NKF) releases today a position paper developed by 16 experts in nephrology and transplantation from 13 institutions that plots a path for research and innovation to address the most pressing barriers to kidney transplant access, organ availability, and long-term allograft survival in the United States. 

This ambitious agenda seeks to direct research investment to optimize equity, efficiency, and patient-centered outcomes and maximize the benefits of transplantation in our country. Today, while nearly 100,000 people are on the waitlist for a kidney transplant, only 22,817 Americans received a kidney transplant in 2020.

“While kidney transplantation provides the best treatment option for kidney failure to thousands of patients each year, the goal of universal access to this treatment remains elusive,” said lead author Krista L. Lentine, MD, PhD, Saint Louis University Center for Abdominal Transplantation. “Addressing the priorities outlined in this research agenda has the potential to transform kidney patient care by expanding opportunities for safe living donation, improving waitlist access and transplant readiness, maximizing use of available deceased donor organs, and extending graft longevity.”

To assess the knowledge gaps amenable to more research, NKF convened an expert panel to develop a research agenda aimed at advancing access to kidney transplantation for all patients who could benefit, with attention to reducing/eliminating racial and ethnic disparities and supporting the goal of “one transplant for life” for organ recipients. 

Participants, including nephrologists, surgeons, NKF leadership, patients, held a roundtable on December 13, 2019, in New York City. Through facilitated discussions, the panel developed seven priorities for research innovations and 23 recommendations, which form the basis of the paper published today in the American Journal of Kidney Diseases with open access to the public.  

Research recommendations developed by the panel center on seven key priorities:

  1. Expand living-donor kidney transplantation.
  2. Improve management and readiness of the kidney waitlist.
  3. Reduce the number of kidneys removed for transplant but never used.
  4. Increase organ acceptance using novel technology.
  5. Preserve, resuscitate, or evaluate kidney allografts before implantation.
  6. Sustain one transplant for life.
  7. Optimize transplantation for pediatric recipients.

Recommended research targets are directed at key challenges within each priority, and span dimensions of educational interventions, decision science, molecular diagnostics, artificial intelligence (AI) and clinical trials. For example, given that approximately 20 percent of kidneys are discarded after recovery, the authors recommend research targets including studies of patient and clinician-directed education to foster understanding of the benefits of kidneys at-risk for discard, biomarkers and machine learning systems to support organ acceptance decisions, and novel preservation solutions and ex vivo interventions to preserve and resuscitate vulnerable organ before implantation.

“One of our top priorities at NKF is to make transplantation available to everyone who needs or wants a transplant,” said co-author and NKF Chief Executive Officer Kevin Longino, who is also a kidney transplant patient. “These recommendations will help frame our research and funding initiatives to accelerate innovation and create the solutions we need to make transplantation a reality for all.” 

Statement coauthors also include NKF Board members Mathew Cooper, MD, Holly Kramer, MD, MPH, NKF Stephen Pastan, MD, NKF Chief Medical Officer Joseph Vassalotti, MD, NKF Senior Vice President of Scientific Operations Jessica Joseph, Sumit Mohan, MD, MPH, Peter P. Reese, MD, MSCE, Alan Leichtman, MD, Francis L. Delmonico, MD, Gabriel M. Danovitch, MD, Christian P Larsen, MD, PhD, Lyndsay Harshman, MD, MS, Alexander Wiseman, MD, and David A. Axelrod, MD, MBA.

To access the paper, please go to https://www.ajkd.org/article/S0272-6386(21)00628-4/fulltext

Kidney Disease Facts

In the United States, 37 million adults are estimated to have chronic kidney disease (CKD)—and approximately 90 percent don’t know they have it.  1 in 3 adults in the U.S. is at risk for chronic kidney disease.  Risk factors for kidney disease include: diabeteshigh blood pressureheart diseaseobesity, and family history. People who are Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander are at increased risk for developing the disease. Black or African American people are almost 4 times more likely than Whites to have kidney failure. Hispanic or Latino people are 1.3 times more likely than non-Hispanic or non-Latino people to have kidney failure.

About the National Kidney Foundation

The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney disease in the U.S. For more information about NKF, visit www.kidney.org.