Estimating the Benefit of Transplant Over Dialysis in Candidates Over 55 Years.

Background: 'Life Years from Transplant' (LYFT) is a measure of the predicted difference between the expected lifespan with and without a kidney transplant. The metric was originally proposed in 1999; since then, demographics of the kidney transplant candidate population have materially changed.

Methods: Using contemporary SRTR data, we propose more sophisticated methods for estimating LYFT with a focus on older kidney transplant candidates, a growing sector of the current candidate pool. We examine trends in predicted LYFT from 1995 to 2020.

Results: We show that among older patients on the deceased donor waitlist, transplant remains a better option compared with dialysis (overall LYFT=5 years). LYFT trends have diminished modestly (by <1 life year) over time, in part related to efforts to enhance access to transplantation through intercurrent policy changes.

Conclusions: Updated LYFT estimates remain informative clinical measures that can support patient-centered decision making. However less homogenous metrics with meaningful disaggregation are needed to inform institutional evaluation and policy change. Models should be repeatedly evaluated as demographics of the candidate pool evolve.