Schlieper G, Ivens K, Voiculescu A, Luther B, Sandmann W, Grabensee B
Department of Nephrology and Rheumatology, Heinrich Heine University, Düsseldorf, Germany.
Clin Transplant. 2001 Apr;15(2):100-5. doi: 10.1034/j.1399-0012.2001.150204.x.
More frequently there is the need for renal transplantation of older patients. Against the background of an increasing number of old donors and recipients, Eurotransplant Leiden started the Eurotransplant Senior Program (ESP) 'old for old' in 1999. The ESP works with donors and recipients both over 65 yr. The kidneys are transplanted with short cold ischaemia time regardless of the human leukocyte antigen (HLA) compatibility. Compatibility of blood groups, negative crossmatch and less than 5% cytotoxic antibodies are required. First experiences from 10 patients at Heinrich Heine University hospital are reported here. The course of 10 transplanted patients is described from January 1999 until November 1999 (28.4+/-15.8 wk). Age of donor and recipient, cause of dialysis and concomitant diseases from recipients, function of the transplanted kidney and complications are analysed. Immunosuppression consisted initially of cyclosporin A, mycophenolic acid and steroids. The results of these 10 patients were compared to 14 patients who were transplanted according to the ordinary Eurotransplant criteria (Eurotransplant Kidney Allocation System) in the same period of time. Kidneys from six donors (70.5+/-3.3 yr) were transplanted to 10 different recipients (66.9+/-2.2 yr). The control group consisted of 14 patients (47.6+/-14.4 yr) who received kidneys from 14 donors (48.3+/-10.1 yr). One double kidney transplantation was performed in the senior group, i.e. two kidneys from a marginal donor were transplanted to one recipient ('two in one'). In the ESP group, cold ischaemia time was reduced by 5 h and mean of HLA mismatches was more than doubled. Mean length of hospitalisation of ESP and control groups was 47.2+/-28.2 and 34.2+/-11.6 d, respectively. Intraoperatively, no complications were seen, post-operative care was performed on a normal ward. ESP patients suffered more often from delayed graft function, which led to further need for haemodialysis for 11.2 d. Finally, 9 of 10 patients acquired a satisfactory renal graft function. A total of 13 biopsies were performed in eight cases. Altogether seven acute rejections in 6 patients were found (four interstitial, one vascular, one interstitial+vascular, one clinical). The 9 patients with sufficient renal graft function were discharged with a mean serum creatinine level of 2.3+/-0.5 mg/dL (control: 1.9+/-0.8 mg/dL). Comparing these 10 recipients to a control group consisting of 14 patients, the results are comparable and encouraging. In conclusion, the short-term results of the ESP are promising. Nevertheless, the post-operative care requires more attention due to several complications. Though the HLA compatibility was not considered, all rejections were coped with effectively. Quality of life was improved.
老年患者对肾移植的需求日益增加。在老年供体和受体数量不断增多的背景下，莱顿欧洲移植组织于1999年启动了“老年对老年”的欧洲移植老年项目（ESP）。ESP针对65岁以上的供体和受体开展工作。肾脏移植时冷缺血时间较短，不考虑人类白细胞抗原（HLA）相容性。要求血型相容、交叉配血阴性且细胞毒性抗体低于5%。本文报告了海因里希·海涅大学医院10例患者的初步经验。描述了1999年1月至1999年11月（28.4±15.8周）10例移植患者的病程。分析了供体和受体的年龄、受体的透析原因及伴随疾病、移植肾的功能和并发症。免疫抑制最初包括环孢素A、霉酚酸和类固醇。将这10例患者的结果与同期按照普通欧洲移植标准（欧洲移植肾脏分配系统）进行移植的14例患者进行比较。6名供体（70.5±3.3岁）的肾脏被移植给10名不同的受体（66.9±2.2岁）。对照组由14例患者（47.6±14.4岁）组成，他们接受了14名供体（48.3±10.1岁）的肾脏。老年组进行了1例双肾移植，即来自边缘供体的两个肾脏移植给一名受体（“二合一”）。在ESP组中，冷缺血时间减少了5小时，HLA错配平均数增加了一倍多。ESP组和对照组的平均住院时间分别为47.2±28.2天和34.2±11.6天。术中未出现并发症，术后在普通病房护理。ESP患者移植肾功能延迟恢复的情况更常见，这导致进一步需要进行11.2天的血液透析。最后，10例患者中有9例获得了满意的移植肾功能。8例患者共进行了13次活检。共发现6例患者出现7次急性排斥反应（4次间质型、1次血管型、1次间质+血管型、1次临床型）。9例移植肾功能良好的患者出院时平均血清肌酐水平为2.3±0.5mg/dL（对照组：1.9±0.8mg/dL）。将这10名受体与由14例患者组成的对照组进行比较，结果具有可比性且令人鼓舞。总之，ESP的短期结果很有前景。然而，由于多种并发症，术后护理需要更多关注。尽管未考虑HLA相容性，但所有排斥反应均得到有效处理。生活质量得到了改善。
