Kauffman H Myron, McBride Maureen A, Cors Cynthia S, Roza Allan M, Wynn James J
Research Department, United Network for Organ Sharing, Richmond, VA, USA.
Transplantation. 2007 Feb 27;83(4):404-10. doi: 10.1097/01.tp.0000251780.01031.81.
There are over 60,000 candidates on the deceased donor kidney wait-list and the percentage of candidates over age 50 years continues to grow each year. National data have not previously been used to evaluate the association of comorbidities with mortality in older patients.
A multivariate analysis of 30,262 deceased donor primary kidney recipients aged 18-59 years and 8,895 aged >or=60 years evaluated the association of six recipient comorbidities on 90- and 365-day patient mortality rates. The additional effects of expanded criteria donors (ECD) and development of delayed graft function (DGF) were also evaluated.
The 365-day mortality rate for recipients aged >or=60 years (10.5%) was more than twice that of recipients aged 18-59 years (4.4%) and comorbidities significantly increased mortality rates even higher (10.6-21.4%). The 365-day mortality rate for recipients aged >or=60 years who received an ECD kidney was 14.4% and who developed DGF was 15.9% while recipients with comorbidities but no DGF and no ECD ranged from 16.0 to 42.3%. The 365-day transplant mortality rate of recipients aged >or=60 years with comorbidities is higher than the 365-day wait-list mortality for patients with the same comorbidities, suggesting a lack of survival benefit from transplantation.
Mortality rates for patients aged >or=60 years with comorbidities are higher than for those without comorbidities, significantly higher than for younger patients, and higher than for wait-listed patients. Thus, utility may be poorly served by allocating kidneys to older patients with comorbidities, and perhaps discussion of exclusionary listing criteria is warranted.
在已故捐赠者肾脏等待名单上有超过60000名候选人，且年龄超过50岁的候选人比例每年都在持续增长。此前尚未使用全国性数据来评估老年患者合并症与死亡率之间的关联。
对30262名年龄在18至59岁的已故捐赠者原发性肾脏接受者和8895名年龄≥60岁的接受者进行多变量分析，以评估六种接受者合并症与90天和365天患者死亡率之间的关联。还评估了扩展标准供体（ECD）和移植肾功能延迟恢复（DGF）的额外影响。
年龄≥60岁的接受者的365天死亡率（10.5%）是年龄在18至59岁的接受者（4.4%）的两倍多，合并症显著提高了死亡率，甚至更高（10.6%至21.4%）。接受ECD肾脏的年龄≥60岁的接受者的365天死亡率为14.4%，发生DGF的为15.9%，而有合并症但无DGF且无ECD的接受者的死亡率在16.0%至42.3%之间。年龄≥60岁且有合并症的接受者的365天移植死亡率高于具有相同合并症的患者的365天等待名单死亡率，这表明移植并未带来生存益处。
有合并症的年龄≥60岁的患者的死亡率高于无合并症的患者，显著高于年轻患者，且高于等待名单上的患者。因此，将肾脏分配给有合并症的老年患者可能无法很好地实现效用，或许有必要讨论排除性列入标准。
