Nunes P, Mota A, Parada B, Figueiredo A, Rolo F, Bastos C, Macário F
Department of Urology and Renal Transplantation, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
Transplant Proc. 2005 Jul-Aug;37(6):2737-42. doi: 10.1016/j.transproceed.2005.05.037.
Compare renal transplant long-term outcomes among recipients aged 60 years or older with those in younger patients.
We analyzed 103 transplants in recipients above 60 years of age for the influence of key factors related to the graft and patient. The results were compared with 1060 transplant recipients aged 18 to 59 years.
The mean ages were 62.93 and 40.35 years for the older and younger group. The older group showed a higher prevalence of obesity and unknown etiologies for the end-stage renal disease. Important comorbidity was significantly more frequent among recipients aged more than 60 years, mainly of a cardiovascular nature (56% vs 18.5%). Donor age (39.75 vs 31.59 years), cold ischemia time (22.43 vs 20.49 hours) and human leukocyte antigen compatibilities (2.59 vs 2.36) were significantly greater in the older subset. After a mean follow-up of 4.72 and 6.07 years for the older versus younger group, we found no differences in initial graft function, acute rejection rate, and serum creatinine/clearance. Patient and graft survivals at 1, 5, and 10 years were lower among the 60+ group. There were no differences in graft survival censored for death with a functioning graft, namely, 95.1%, 89.4%, and 81.2% for the 60+ cohort. The main cause of graft loss in the older group was death with a functioning graft.
Renal transplantation should be considered for selected patients older than 60 years. Despite a shorter life expectancy, they benefit from it similar to younger recipients.
比较60岁及以上肾移植受者与年轻患者的长期肾移植结局。
我们分析了103例60岁以上受者的肾移植情况，以探讨与移植物和患者相关的关键因素的影响。将结果与1060例18至59岁的肾移植受者进行比较。
老年组和年轻组的平均年龄分别为62.93岁和40.35岁。老年组肥胖症患病率较高，且终末期肾病的病因不明。60岁以上受者中重要合并症的发生率明显更高，主要是心血管方面的合并症（56%对18.5%）。老年亚组的供体年龄（39.75岁对31.59岁）、冷缺血时间（22.43小时对20.49小时）和人类白细胞抗原相容性（2.59对2.36）显著更高。老年组和年轻组的平均随访时间分别为4.72年和6.07年，我们发现初始移植物功能、急性排斥反应率和血清肌酐/清除率没有差异。60岁及以上组在1年、5年和10年时的患者和移植物存活率较低。对于有功能移植物的死亡进行审查后的移植物存活率没有差异，即60岁及以上队列分别为95.1%、89.4%和81.2%。老年组移植物丢失的主要原因是有功能移植物的死亡。
对于60岁以上的特定患者应考虑进行肾移植。尽管预期寿命较短，但他们与年轻受者一样能从中受益。
