Gill Jagbir, Bunnapradist Suphamai, Danovitch Gabriel M, Gjertson David, Gill John S, Cecka Michael
Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Am J Kidney Dis. 2008 Sep;52(3):541-52. doi: 10.1053/j.ajkd.2008.05.017. Epub 2008 Jul 24.
More than half the newly wait-listed patients for kidney transplantation in 2005 were older than 50 years, and 13% were older than 65 years. As waiting times for a deceased donor kidney increase, these older candidates are disadvantaged by rapidly deteriorating health, often resulting in death or removal from the wait list before transplantation.
An observational cohort study was conducted using data from the Organ Procurement Transplant Network/United Network for Organ Sharing.
SETTING & PARTICIPANTS: All adult kidney-only transplantations performed in recipients 60 years and older from 1996 to 2005 were included.
The recipient cohort was stratified into 4 groups based on donor source: older living donor (OLD: living donor age > 55 years), younger living donor (YLD: living donor age </= 55 years), standard criteria deceased donor (SCD), and expanded criteria deceased donor (ECD).
OUTCOMES & MEASUREMENTS: Early posttransplantation outcomes, graft survival, patient survival, renal function 1 year posttransplantation, and relative risk of graft loss and patient death were compared.
Of 23,754 kidney transplantations performed in recipients 60 years and older, 7,006 were living donor transplantations (1,133 were > 55 years [OLD] and 5,873 were <or= 55 years [YLD]), 12,197 from SCDs, and 4,551 from ECDs. Early posttransplantation outcomes were best in YLD transplantations, followed by SCD and OLD transplantations. OLD transplantations were associated with inferior 3-year graft survival rates (85.7%), but similar 3-year patient survival rates (88.4%) compared with YLD (3-year graft survival, 83.4%; patient survival, 87.4%) and had superior graft survival compared with all deceased donor options. Compared with OLD transplantations, ECD transplantations were associated with a greater risk of graft loss (hazard ratio, 2.36; 95% confidence interval, 1.18 to 4.74).
Observational retrospective studies using registry data are subject to inherent limitations, including the possibility of selection bias.
With superior graft and patient survival in recipients of transplants from OLDs compared with SCDs and ECDs, OLDs may be an important option for elderly transplantation candidates and should be considered for older patients with a willing and suitable older donor.
2005年新加入肾脏移植等待名单的患者中，超过半数年龄超过50岁，13%年龄超过65岁。随着等待死亡供体肾脏的时间增加，这些老年候选者因健康状况迅速恶化而处于不利地位，这常常导致他们在移植前死亡或被从等待名单中除名。
利用器官获取与移植网络/器官共享联合网络的数据进行了一项观察性队列研究。
纳入了1996年至2005年期间在60岁及以上受者中进行的所有仅肾脏移植手术。
根据供体来源将受者队列分为4组：老年活体供体（OLD：活体供体年龄>55岁）、年轻活体供体（YLD：活体供体年龄≤55岁）、标准标准死亡供体（SCD）和扩展标准死亡供体（ECD）。
比较了移植后早期结果、移植物存活率、患者存活率、移植后1年的肾功能以及移植物丢失和患者死亡的相对风险。
在60岁及以上受者中进行的23754例肾脏移植手术中，7006例为活体供体移植（1133例年龄>55岁[OLD]，5873例年龄≤55岁[YLD]），12197例来自SCD，4551例来自ECD。移植后早期结果在YLD移植中最佳，其次是SCD和OLD移植。与YLD（3年移植物存活率83.4%；患者存活率87.4%）相比，OLD移植的3年移植物存活率较低（85.7%），但3年患者存活率相似（88.4%），并且与所有死亡供体选择相比，其移植物存活率更高。与OLD移植相比，ECD移植与移植物丢失风险更大相关（风险比，2.36；95%置信区间，1.18至4.74）。
使用登记数据的观察性回顾性研究存在固有局限性，包括选择偏倚的可能性。
与SCD和ECD相比，OLD移植受者的移植物和患者存活率更高，OLD可能是老年移植候选者的一个重要选择，对于有意愿且合适的老年供体的老年患者应予以考虑。
