Collins Michael G, Chang Sean H, Russ Graeme R, McDonald Stephen P
Nephrology and Transplantation Services, Queen Elizabeth Hospital, Adelaide, Australia.
Transplantation. 2009 Apr 27;87(8):1201-9. doi: 10.1097/TP.0b013e31819ec3a6.
Kidneys from expanded criteria donors (ECD) are reported to have inferior transplant outcomes.
Using the Australia and New Zealand Dialysis and Transplant Registry, we reviewed deceased donor kidneys transplanted from 1991 to 2005 in Australia and New Zealand, followed until December 2006. ECD was defined using United Network for Organ Sharing criteria. Graft and patient outcomes, estimated glomerular filtration rates (eGFR), acute rejection, and delayed graft function were analyzed by donor-age and ECD status, with adjustment for important covariates.
There were 3248 recipients of non-ECD kidneys and 781 recipients of ECD kidneys. Compared with donors aged less than 50 years, adjusted hazard ratios for graft failure (GF) at 0 to 1 and 1 to 5 years for ECD kidneys from donors aged 60 years or above were 1.92 (1.48-2.49; P<0.001) and 2.52 (1.97-3.23; P<0.001). The hazard ratios for GF were 1.87 (1.31-2.70; P<0.05) for ECD kidneys from donors aged 50 to 59 years in the first year but were not increased subsequently. Mean eGFR at 1 year decreased with increasing donor age and ECD status (56.4 [53.8-58.9] mL/min for kidneys from donors aged <50, 46.6 [45.0-48.3] and 43.5 [41.1-45.9] for non-ECD and ECD donors aged 50 to 59 years, respectively, and 38.6 [36.9-40.4] for donors > or =60; P<0.001) but subsequent eGFR loss was similar except for donors aged 60 years or above (P=0.021). Acute rejection and delayed graft function were more frequent in ECD kidney recipients, but the associations between GF and donor age/ECD status were independent of these factors.
For recipients of ECD kidneys, donor age 60 years or above is the most significant determinant of poor outcome; donor age 50 to 59 years represents a category of intermediate risk.
据报道，扩大标准供体（ECD）的肾脏移植效果较差。
利用澳大利亚和新西兰透析与移植登记处的数据，我们回顾了1991年至2005年在澳大利亚和新西兰接受移植的已故供体肾脏，随访至2006年12月。ECD根据器官共享联合网络的标准定义。通过供体年龄和ECD状态分析移植肾和患者的结局、估计肾小球滤过率（eGFR）、急性排斥反应和移植肾功能延迟恢复情况，并对重要的协变量进行调整。
非ECD肾脏受者有3248例，ECD肾脏受者有781例。与年龄小于50岁的供体相比，60岁及以上供体的ECD肾脏在0至1年和1至5年时移植肾失功（GF）的校正风险比分别为1.92（1.48 - 2.49；P<0.001）和2.52（1.97 - 3.23；P<0.001）。50至59岁供体的ECD肾脏在第一年的GF风险比为1.87（1.31 - 2.70；P<0.05），但随后未增加。1年时的平均eGFR随着供体年龄和ECD状态的增加而降低（年龄<50岁供体的肾脏为56.4[53.8 - 58.9]mL/min，50至59岁非ECD和ECD供体的肾脏分别为46.6[45.0 - 48.3]和43.5[41.1 - 45.9]，年龄≥60岁供体的肾脏为38.6[36.9 - 40.4]；P<0.001），但除60岁及以上供体外，随后的eGFR下降相似（P = 0.021）。急性排斥反应和移植肾功能延迟恢复在ECD肾脏受者中更常见，但GF与供体年龄/ECD状态之间的关联独立于这些因素。
对于ECD肾脏受者，60岁及以上供体是预后不良的最主要决定因素；50至59岁供体代表中等风险类别。
