Vistoli F, Boggi U, Vanadia Bartolo T, Del Chiaro M, Croce C, Gremmo F, Coletti L, Tregnaghi C, Paleologo G, Barsotti M, Rizzo G, Mosca F
Divisione di Chirurgia Generale e Trapianti, Università di Pisa, Pisa, Italy.
Transplant Proc. 2004 Apr;36(3):481-4. doi: 10.1016/j.transproceed.2004.02.007.
There are no agreed criteria to predict the outcome of elderly donor kidneys or to decide between single (SKG) or dual (DKG) kidney graft transplantation.
Between January 1999 and January 2003, 46 SKG and 14 DKG were performed from elderly donors (mean donor age 71.6 years; range: 66 to 87). Kidney biopsies were scored according to Karpinski. A calculated admission creatinine clearance <50 mL/min and/or a biopsy score of 5 or 6 were used to select kidneys for DKG. Grafts with better function or lower biopsy scores were employed for SKG.
Mean cold ischemia time (CIT) was 16.8 hours (range 8.1 to 28.6) in SKG, and 16.3 hours (range 4.6 to 24.3) for the first kidney and 17.4 hours (range 5.1 to 25.9) for the second graft in DKG. Delayed graft function (DGF) occurred in 34.1% SKG and in 28.5% DKG. Acute rejection rates were 9.1% for SKG and 0% for DKG. Three-year actuarial patient survival rates were 97.7% for SKG and 92.9% for DKG; for kidneys, 95.4% and 92.9%. One-year mean serum creatinine levels were 1.8 mg/dL (range 1.1 to 4.0) for SKG and 1.2 mg/dL (range 1.0 to 1.8) for DKG (P =.01). CIT longer than 16 hours was related to increased rates of DGF for both SKG (45.4% vs 22.7%) or DKG (42.9% vs 14.3%) and reduced 3-year graft survival rates (SKG: 90.9% vs 100%; DKG: 85.7% vs 100%).
With stringent selection criteria and short CIT (<16 hours), elderly donor kidneys may show good results, thus meaningfully expanding the donor pool.
目前尚无公认的标准来预测老年供肾的预后，也无法决定进行单肾移植（SKG）还是双肾移植（DKG）。
1999年1月至2003年1月期间，对老年供者（供者平均年龄71.6岁；范围：66至87岁）进行了46例SKG和14例DKG。根据卡尔平斯基标准对肾活检进行评分。计算得出的入院时肌酐清除率<50 mL/分钟和/或活检评分为5或6用于选择进行DKG的肾脏。功能较好或活检评分较低的移植物用于SKG。
SKG的平均冷缺血时间（CIT）为16.8小时（范围8.1至28.6），DKG中第一个肾脏的平均冷缺血时间为16.3小时（范围4.6至24.3），第二个移植物为17.4小时（范围5.1至25.9）。延迟性移植物功能恢复（DGF）在SKG中发生率为34.1%，在DKG中为28.5%。急性排斥反应率在SKG中为9.1%，在DKG中为0%。SKG的三年患者精算生存率为97.7%，DKG为92.9%；肾脏的三年精算生存率分别为95.4%和92.9%。SKG的一年平均血清肌酐水平为1.8 mg/dL（范围1.1至4.0），DKG为1.2 mg/dL（范围1.0至1.8）（P = 0.01）。CIT超过16小时与SKG（45.4%对22.7%）或DKG（42.9%对14.3%）的DGF发生率增加以及三年移植物生存率降低相关（SKG：90.9%对100%；DKG：85.7%对100%）。
通过严格的选择标准和较短的CIT（<16小时），老年供肾可能会取得良好的效果，从而有意义地扩大供肾池。
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