Department of Clinical Epidemiology and Evaluation, Nancy University, Vandoeuvre-lès-Nancy, France.
Nephrol Dial Transplant. 2010 Jan;25(1):292-300. doi: 10.1093/ndt/gfp469. Epub 2009 Sep 11.
Impact of kidney transplantation on survival of French end-stage renal disease (ESRD) patients is unknown.
A total of 1495 adults living in the Lorraine region and starting renal replacement therapy from 1997 to 2003 were included. A propensity score (PS) of registration on the renal transplant waiting list was estimated. Patient survival was studied using a time-dependent Cox multivariate regression and a Cox model stratified by PS tertiles. Survival of older patients (> or =60 years) was detailed.
Survival was associated with age, medical factors and transplantation. The hazard ratio (HR) of death for patients on dialysis compared to transplant recipients was 4.6 (95% CI: 2.9-7.2). The survival analysis stratified by PS was similar to the multivariate Cox model. The survival benefit of transplantation over dialysis persisted among elderly patients [HR: 4.6 (95% CI: 2.2-9.7)].
In a French community-based network, after taking into account comorbidities, transplantation was associated with longer survival even among elderly patients. Age per se should not therefore be considered as a contraindication to renal transplantation. However, elderly patients should be evaluated carefully before registration on the list. Medical guidelines should put forward a standard set of criteria for access to renal transplantation.
肾移植对法国终末期肾病（ESRD）患者生存的影响尚不清楚。
共纳入 1997 年至 2003 年居住在洛林地区并开始接受肾脏替代治疗的 1495 名成年人。估计了在肾移植等候名单上登记的倾向评分（PS）。使用时间依赖性 Cox 多变量回归和按 PS 三分位数分层的 Cox 模型研究了患者的生存情况。详细研究了老年患者（≥60 岁）的生存情况。
生存与年龄、医疗因素和移植有关。与移植受者相比，透析患者的死亡风险比（HR）为 4.6（95%CI：2.9-7.2）。按 PS 分层的生存分析与多变量 Cox 模型相似。在老年患者中，移植相对于透析的生存获益仍然存在[HR：4.6（95%CI：2.2-9.7）]。
在法国基于社区的网络中，在考虑合并症后，移植与更长的生存时间相关，即使在老年患者中也是如此。因此，年龄本身不应被视为肾移植的禁忌症。然而，在登记名单之前，应仔细评估老年患者。医学指南应提出一套标准的肾移植准入标准。
