Remuzzi Giuseppe, Cravedi Paolo, Perna Annalisa, Dimitrov Borislav D, Turturro Marta, Locatelli Giuseppe, Rigotti Paolo, Baldan Nicola, Beatini Marco, Valente Umberto, Scalamogna Mario, Ruggenenti Piero
Azienda Ospedaliera, Ospedali Riuniti di Bergamo, Bergamo, Italy.
N Engl J Med. 2006 Jan 26;354(4):343-52. doi: 10.1056/NEJMoa052891.
Long-term survival of kidney grafts from older donors is inferior to that of grafts from younger donors. We sought to determine whether selecting older kidneys according to their histologic characteristics before implantation would positively influence long-term outcome.
In a prospective cohort study, we assessed outcomes among 62 patients who received one or two histologically evaluated kidneys from donors older than 60 years of age. These outcomes were compared with outcomes among 248 matched recipients of single kidney grafts that had not been histologically evaluated and were either from donors 60 years of age or younger (124 positive-reference recipients who, according to available data, were expected to have an optimal outcome) or from those older than 60 years (124 negative-reference recipients, expected to have a worse outcome). The primary end point was graft survival.
During a median period of 23 months, 4 recipients (6 percent) of histologically evaluated kidneys progressed to dialysis, as compared with 7 positive-reference recipients (6 percent) and 29 negative-reference recipients (23 percent). Graft survival in recipients of histologically evaluated kidneys did not differ significantly from that of grafts in positive-reference recipients but was superior to that of grafts in negative-reference recipients (hazard ratio for graft failure in the negative-reference recipients relative to the recipients of histologically evaluated kidneys, 3.68; 95 percent confidence interval, 1.29 to 10.52; P=0.02). The performance of preimplantation histologic evaluation predicted better survival both in the whole study group (P=0.02) and among recipients of kidneys from older donors (P=0.01).
The long-term survival of single or dual kidney grafts from donors older than 60 years of age is excellent, provided that the grafts are evaluated histologically before implantation. This approach may help to expand the donor-organ pool for kidney transplantation.
来自老年供者的肾移植长期存活率低于年轻供者的肾移植。我们试图确定在植入前根据老年肾脏的组织学特征进行选择是否会对长期结果产生积极影响。
在一项前瞻性队列研究中，我们评估了62例接受一或两枚来自60岁以上供者且经过组织学评估肾脏的患者的结局。将这些结局与248例匹配的接受单肾移植患者的结局进行比较，这些患者的移植肾未经过组织学评估，供者年龄为60岁及以下（124例阳性对照受者，根据现有数据预计有最佳结局）或60岁以上（124例阴性对照受者，预计结局较差）。主要终点是移植肾存活。
在中位23个月的时间里，4例接受组织学评估肾脏的受者（6%）进展至透析，相比之下，7例阳性对照受者（6%）和29例阴性对照受者（23%）进展至透析。接受组织学评估肾脏受者的移植肾存活与阳性对照受者的移植肾存活无显著差异，但优于阴性对照受者的移植肾存活（阴性对照受者相对于接受组织学评估肾脏受者的移植肾失败风险比为3.68；95%置信区间为1.29至10.52；P = 0.02）。植入前组织学评估的表现预测了整个研究组（P = 0.02）以及老年供者肾脏受者（P = 0.01）更好的存活率。
如果在植入前对60岁以上供者的单肾或双肾移植进行组织学评估，其长期存活率良好。这种方法可能有助于扩大肾移植的供体库。
