Alexander J W, Vaughn W K
Transplantation Division, University of Cincinnati Medical Center, Ohio.
Transplantation. 1991 Jan;51(1):135-41. doi: 10.1097/00007890-199101000-00021.
The influence of donor age on outcome was studied in the recipients of 12,131 cadaveric renal allografts, 3026 heart allografts, and 2913 liver allografts with followup information in the UNOS data base for transplants performed between 10/1/87 and 12/31/89. For recipients of kidney transplants, donors of ages 6-15 had significantly better 1-year graft survival than donors of ages 56-65, but the difference was only 7.0%. Donors of age greater than 65 actually did better than donors ages 56-65, but donors less than or equal to 5 were less satisfactory. Kidneys from older donors survived as well as kidneys from younger donors in patients with repeat transplants, diabetes, black race, age over 45, O HLA or 5 and 6 HLA matches, delayed graft function, shared kidneys and PRA greater than 50. For kidney recipients, multifactorial analysis by Cox regression showed that donor age was less important than the use of ALG, donor race, diabetes or peak PRA in ages 16-45, delayed function, repeat transplant, and HLA match. Recipients of heart transplants from donors ages 45-55 had 1-year graft survival that was 8.4% less than recipients of hearts from donors age 16-45. However, 32.7% of heart patients died during the first 12 months after listing without benefit of a transplant. Liver transplant recipients of donor ages 16-45 had 10.8% better 1-year graft survival than recipients of donors greater than 45, but a greater percentage of older donors were transplanted to high risk and older recipients. Tragically, 24.3% of patients listed for liver transplantation died within 12 months without a transplant. This analysis shows that satisfactory graft survival can be achieved using older donors and that age in itself should not be a barrier to organ donation, providing that organ function is normal and that specific disease of the organ is absent.
在1987年10月1日至1989年12月31日期间进行移植且有随访信息的12131例尸体肾移植受者、3026例心脏移植受者和2913例肝脏移植受者中，研究了供体年龄对移植结果的影响。对于肾移植受者，6至15岁供体的1年移植肾存活率显著高于56至65岁供体，但差异仅为7.0%。65岁以上供体的实际表现优于56至65岁供体，但5岁及以下供体的情况不太理想。在再次移植、糖尿病、黑人种族、45岁以上、O HLA或5和6 HLA配型、移植肾功能延迟、共享肾以及PRA大于50的患者中，老年供体的肾与年轻供体的肾存活情况相同。对于肾移植受者，通过Cox回归进行的多因素分析表明，在16至45岁的受者中，供体年龄不如使用抗淋巴细胞球蛋白、供体种族、糖尿病或峰值PRA、移植肾功能延迟、再次移植以及HLA配型重要。45至55岁供体心脏的移植受者，其1年移植心脏存活率比16至45岁供体心脏的移植受者低8.4%。然而，32.7%的心脏移植患者在列入名单后的前12个月内未接受移植就死亡了。16至45岁供体肝脏的移植受者，其1年移植肝存活率比45岁以上供体肝脏的移植受者高10.8%，但更大比例的老年供体被移植给了高风险和老年受者。不幸的是，24.3%列入肝移植名单的患者在12个月内未接受移植就死亡了。该分析表明，使用老年供体也可实现令人满意的移植肾存活率，而且只要器官功能正常且无特定器官疾病，年龄本身不应成为器官捐赠的障碍。
