Oniscu Gabriel C, Brown Helen, Forsythe John L R
The Royal Infirmary of Edinburgh, 1 Lauriston Place, Edinburgh EH3 9YW, UK.
Nephrol Dial Transplant. 2004 Apr;19(4):945-51. doi: 10.1093/ndt/gfh022.
Patients >60 years old represent 66% of all new patients starting renal replacement therapy in Scotland. The aim of this study was to investigate whether or not transplantation provides any survival benefit in this group of patients.
325 patients >60 years old listed for transplantation in Scotland between 1 January 1989 and 31 December 1999 were followed up until 31 December 2000. Sociodemographic, comorbidity, listing and transplant data were obtained from the national renal and transplant databases and case-notes review. Survival was compared between those who received a transplant and those who were listed but did not receive a transplant by the end of the follow-up period. Mann-Whitney, chi(2), Fisher's exact and log-rank tests were used where appropriate.
Of the 325 patients listed, 128 (39.4%) received a first transplant within the study period and the remaining 197 (60.6%) continued to undergo dialysis. The transplant recipients were younger at listing (P<0.0001), lived closer to the transplant centre (P = 0.043) and spent less time on the active waiting list (P<0.0001) than patients who remained on dialysis. They had less ischaemic heart disease (P = 0.024), cerebrovascular disease (P = 0.03) and arrhythmias (P = 0.016). The overall mortality rate was 0.16 per patient-year for dialysis and 0.10 for transplantation. There was a significantly lower risk of death (RR = 0.35, 95% CI 0.22--0.54; P<0.0001, log-rank) and a longer life expectancy after listing with a transplant (8.17 vs 4.32 years).
Renal transplantation offers a significant survival advantage over dialysis in elderly patients with end-stage renal failure who are considered suitable for transplantation.
在苏格兰，60岁以上的患者占开始接受肾脏替代治疗的所有新患者的66%。本研究的目的是调查移植是否能为这组患者带来任何生存益处。
对1989年1月1日至1999年12月31日期间在苏格兰登记等待移植的325名60岁以上患者进行随访，直至2000年12月31日。从国家肾脏和移植数据库以及病历审查中获取社会人口统计学、合并症、登记和移植数据。比较随访期末接受移植的患者和登记但未接受移植的患者的生存率。在适当情况下使用曼-惠特尼检验、卡方检验、费舍尔精确检验和对数秩检验。
在登记的325名患者中，128名（39.4%）在研究期间接受了首次移植，其余197名（60.6%）继续接受透析。与继续接受透析的患者相比，移植受者登记时年龄更小（P<0.0001），居住距离移植中心更近（P = 0.043），在活跃等待名单上花费的时间更少（P<0.0001）。他们患缺血性心脏病（P = 0.024）、脑血管疾病（P = 0.03）和心律失常（P = 0.016）的情况较少。透析患者的总死亡率为每人年0.16，移植患者为0.10。移植后死亡风险显著降低（RR = 0.35，95%CI 0.22 - 0.54；P<0.0001，对数秩检验），登记移植后的预期寿命更长（8.17年对4.32年）。
对于被认为适合移植的老年终末期肾衰竭患者，肾移植比透析具有显著的生存优势。
