老年活体供者提供优质肾脏：单中心经验（老年活体供者）
Older living donors provide excellent quality kidneys: a single center experience (older living donors).
作者信息
Johnson Scott R, Khwaja Khalid, Pavlakis Martha, Monaco Anthony P, Hanto Douglas W
机构信息
Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
出版信息
Clin Transplant. 2005 Oct;19(5):600-6. doi: 10.1111/j.1399-0012.2004.00328.x.
BACKGROUND
The role of advanced age live donors remains controversial because of decline in glomerular filtration rate and perceived increased risks of perioperative complications.
METHODS
A retrospective review of all live donor transplants performed from January 2000 to December 2003.
RESULTS
Seventy-eight live donor transplants were performed during the period of review, 47 (60.3%) female and 31 (39.7%) male. Twenty-two (28.2%) of the donors were >50 yr old, 15 (68%) female and seven (32%) male. Living related donation was performed in 56 (74.4%) and unrelated in 20 (35.6%). Laparoscopic nephrectomy was performed in 29 (37.2%) and open nephrectomy in 49 (62.8%). More donors >50 underwent laparoscopic nephrectomy, 13 of 22 (59.1%) vs. 16 of 56 (28.6%). Overall patient and graft survival at 1 yr are 97 and 97%. One-year patient and graft survival is 100% vs. 96% and 100% vs. 96% in the older vs. young donors. Rejection occurred in nine of 78 (11.5%), but was not different between groups. Older donors had a reduced creatinine clearance 107.5 +/- 3.4 vs. 124.2 +/- 3.1 mL/min (p = 0.002) and a reduced clearance normalized for body surface area 60.6 +/- 3.6 mL/(min m2) vs. 70.2 +/- 2.6 mL/(min m2) (p = 0.045). Recipient serum creatinine was higher on postoperative day 1 in the older donor group 5.4 mg/dL vs. 4.4 mg/dL (p = 0.009). There was no difference in recipient serum creatinine at postoperative day 7, 30, 90, 180, 365 and 730. Donor serum creatinine was not different between groups on postoperative days 1, 7 and 30 but was higher in group 1 vs. group 2 on postoperative day 365, 1.26 +/- 0.26 mg/dL vs. 1.01 +/- 0.18 mg/dL (p = 0.020).
CONCLUSIONS
Despite a reduced initial creatinine clearance, renal function is comparable in recipients of both young and old donor kidneys. Older donors had a slightly reduced serum creatinine 1 yr post-donation that warrants additional follow-up to determine if the observations continue. The introduction of laparoscopic nephrectomy may provide additional incentive for older donors to present for live donor nephrectomy.
背景
由于肾小球滤过率下降以及围手术期并发症风险增加，高龄活体供者的作用仍存在争议。
方法
对2000年1月至2003年12月期间进行的所有活体供者移植手术进行回顾性分析。
结果
在回顾期间共进行了78例活体供者移植手术，其中女性47例（60.3%），男性31例（39.7%）。22例（28.2%）供者年龄>50岁，其中女性15例（68%），男性7例（32%）。亲属活体供肾56例（74.4%），非亲属活体供肾20例（35.6%）。29例（37.2%）采用腹腔镜肾切除术，49例（62.8%）采用开放肾切除术。年龄>50岁的供者中更多采用腹腔镜肾切除术，22例中有13例（59.1%），而56例中16例（28.6%）。1年时总体患者和移植肾存活率分别为97%和97%。老年供者与年轻供者相比，1年时患者和移植肾存活率分别为100%对96%以及100%对96%。78例中有9例（11.5%）发生排斥反应，但两组之间无差异。老年供者肌酐清除率降低，分别为107.5±3.4 vs. 124.2±3.1 mL/min（p = 0.002），按体表面积标准化后的清除率也降低，分别为60.6±3.6 mL/(min·m2) vs. 70.2±2.6 mL/(min·m2)（p = 0.045）。老年供者组术后第1天受者血清肌酐较高，为5.4 mg/dL对4.4 mg/dL（p = 0.009）。术后第7、30、90、180、365和730天受者血清肌酐无差异。供者术后第1、7和30天血清肌酐两组间无差异，但术后第365天第1组高于第2组，分别为1.26±0.26 mg/dL对1.01±0.18 mg/dL（p = 0.020）。
结论
尽管初始肌酐清除率降低，但年轻和老年供肾受者的肾功能相当。老年供者捐献后1年血清肌酐略有降低，这值得进一步随访以确定这种情况是否持续。腹腔镜肾切除术的应用可能会促使更多老年供者前来进行活体供肾切除术。
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