{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:57:13Z","timestamp":1772992633736,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":54,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Transplantation"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The composition of the U.S. deceased kidney donor pool is undergoing a major shift. While the past decade saw an increase in younger, overdose\u2010death donors associated with favorable transplant outcomes, recent years have marked a decline in these donors. Concurrently, there has been a rise in higher\u2010risk donor characteristics\u2014namely, older age, more comorbidities, such as hypertension and diabetes, and increased reliance on donation after circulatory death (DCD). These trends may significantly affect transplant outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from the Organ Procurement and Transplantation Network (OPTN) on 101,550 deceased kidney donors (2018\u2013Q1 2025) and 108,611 single kidney transplants (2018\u2013mid\u20102024). Donor trends were assessed using segmented regression analysis. Graft survival was evaluated using Kaplan\u2013Meier survival curves and multivariable Cox proportional hazards models, adjusting for donor, recipient, and transplant characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overdose\u2010death donors declined from 16.7% in 2022 to 10.5% by Q1 2025. Simultaneously, DCD donors rose to nearly 50% of all deceased donors. The proportion of older donors and high\u2010KDPI kidneys also increased. Kaplan\u2013Meier analysis showed a decrease in unadjusted death\u2010censored graft survival in 2024 compared to 2018\u20132022 (97.0% vs. 97.6%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). In adjusted Cox models, donor factors\u2014DCD status, older age, hypertension, diabetes, and prolonged cold ischemia\u2014were independently associated with graft loss.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The U.S. kidney donor pool is shifting toward higher\u2010risk profiles, with early signs of declining graft survival. Strategies to optimize organ preservation and allocation will be essential to maintain transplant outcomes amid these changing donor trends.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/joot\/3352344","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T14:08:11Z","timestamp":1772978891000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Evolving Kidney Donor Pool Shaping Outcomes in Graft Survival"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4714-3725","authenticated-orcid":false,"given":"Kaufman Daniel","family":"M.","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6935-0012","authenticated-orcid":false,"given":"Perkins James","family":"D.","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5507-9719","authenticated-orcid":false,"given":"Bakthavatsalam","family":"Ramasamy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3279-2930","authenticated-orcid":false,"given":"Leca","family":"Nicolae","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5435-737X","authenticated-orcid":false,"given":"Sibulesky","family":"Lena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"e_1_2_9_1_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02782.x"},{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.7326\/m17-2451"},{"key":"e_1_2_9_3_2","article-title":"National 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