Heldal Kristian, Hartmann Anders, Leivestad Torbjørn, Svendsen Martin V, Foss Aksel, Lien Bjørn, Midtvedt Karsten
Clinic of Internal Medicine, Sykehuset Telemark HF, Skien, Norway.
Transplantation. 2009 Apr 15;87(7):1045-51. doi: 10.1097/TP.0b013e31819cdddd.
Deciding whether an elderly patient with end-stage renal disease is a candidate for kidney transplantation can be difficult. We aimed to evaluate pre- and early posttransplant risk factors that could predict outcome in elderly kidney recipients.
Data from all elderly (>or= 70 years, n=354), senior (60-69 years, n=577), and control (45-54 years, n=563) patients receiving their first kidney transplant at our center from 1990 to 2005 were retrieved. Patient and graft survival were analyzed in a Cox model addressing the common risk factors including Charlson comorbidity index (CCI), pretransplant dialysis time, and early acute rejection episodes.
Acute rejection in the first 90 days, Hazard ratio (HR) 1.74 (1.34-2.25); time on dialysis, HR 1.02 (1.01-1.03) per month; and donor age more than 60 years, HR 1.52 (1.14-2.01) predicted mortality in the elderly. CCI score did not predict mortality in the elderly, HR 1.05 (0.98-1.12); but did so both in senior, HR 1.17 (1.08-1.27) and control recipients, HR 1.33 (1.19-1.48). Delayed graft function, HR 3.69 (2.01-6.79); donor age more than 60 years, HR 2.42 (1.30-4.49); and presence of human leukocyte antigen antibodies, HR 3.96 (1.38-11.37) were independent predictors for death-censored graft loss in the elderly.
Adequate immunosuppression with low frequency of rejection episodes improves the outcome for elderly kidney recipients as does a reduction of time on dialysis. CCI score at transplantation does not seem helpful in the selection of elderly patients for kidney transplantation but plays a significant role in patients under 70 years of age.
判定一名终末期肾病老年患者是否适合接受肾移植可能具有挑战性。我们旨在评估移植前及移植后早期的风险因素，这些因素可预测老年肾移植受者的预后。
检索了1990年至2005年在我们中心接受首次肾移植的所有老年（≥70岁，n = 354）、年长（60 - 69岁，n = 577）及对照（45 - 54岁，n = 563）患者的数据。在Cox模型中分析患者和移植物的生存率，该模型考虑了包括Charlson合并症指数（CCI）、移植前透析时间及早期急性排斥反应发作等常见风险因素。
术后90天内发生急性排斥反应，风险比（HR）为1.74（1.34 - 2.25）；透析时间，每月HR为1.02（1.01 - 1.03）；供体年龄超过60岁，HR为1.52（1.14 - 2.01），这些因素可预测老年患者的死亡率。CCI评分不能预测老年患者的死亡率，HR为1.05（0.98 - 1.12）；但在年长受者中可预测，HR为1.17（1.08 - 1.27），在对照受者中也可预测，HR为1.33（1.19 - 1.48）。移植肾功能延迟，HR为3.69（2.01 - 6.79）；供体年龄超过60岁，HR为2.42（1.30 - 4.49）；存在人类白细胞抗原抗体，HR为3.96（1.38 - 11.37），这些是老年患者死亡删失的移植物丢失的独立预测因素。
充分的免疫抑制且排斥反应发作频率低可改善老年肾移植受者的预后，减少透析时间也有同样效果。移植时的CCI评分在选择老年肾移植患者时似乎并无帮助，但在70岁以下患者中起重要作用。
