OPTN/SRTR 2024 Annual Data Report: Kidney.

In 2024, the field of kidney transplantation faced both notable successes and ongoing challenges. A record 27,660 kidney transplants were performed in the United States, an achievement driven largely by deceased donor kidney transplant (DDKT) growth, although with only a modest increase from 27,351 kidney transplants in 2023. The number of adult candidates listed for kidney transplant rose to 143,982 (approaching the prepandemic peak of 2019), with 10.7% of candidates waiting 5 years or longer. Transplant counts increased across Black, Hispanic, Asian, and Multiracial recipients, with the largest gains in DDKT rates among Black patients, following the Organ Procurement and Transplantation Network's January 2023 policy change to modify waiting time for candidates affected by race-inclusive estimated glomerular filtration rate calculations. After increases in mortality during the COVID-19 pandemic, pretransplant death rates generally declined in 2024 across age, race and ethnicity, sex, and blood type, although substantial geographic variation persisted by donation service area. At the same time, the proportion of deceased donor kidneys recovered for transplant but not transplanted rose to 29.3%, with even higher rates for biopsied kidneys (40.8%), those from donors aged 65 years or older (68.9%), and kidneys with a kidney donor profile index of 85% or greater (69.5%). In contrast, nonuse of kidneys from hepatitis C virus-positive donors (antibody positive/nucleic acid test negative) declined to 32.2% in 2024 from 49.5% in 2016, in parallel with broader use of direct-acting antiviral therapy protocols. Disparities in access to living donor kidney transplant (LDKT) remain and particularly affect non-White and publicly insured patients. Rates of delayed graft function, which had risen steadily over the past decade, appear to have plateaued at 26.7% overall for adult recipients in 2024. Long-term outcomes continue to favor living donor kidneys, with 5-year graft survival of 89.9% for LDKT versus 82.5% for DDKT among recipients aged 18-34 years, and 79.8% versus 66.1% among those aged 65 years or older for transplants in 2017-2019. In 2024, the number of pediatric candidates added to the kidney transplant waiting list reached its highest point at 1,232. The total number of pediatric kidney transplants performed increased to a new high of 832 in 2024; 601 (72.2%) were DDKTs and 231 (27.8%) were LDKTs. This increase was driven by growth in pediatric DDKT; the annual number of pediatric LDKTs has been steady since 2013.