Lankarani Maryam Moghani, Assari Shervin, Nourbala Mohammad Hossein
Medicine and Health Promotion Institute, Tehran, Iran.
Ann Transplant. 2009 Oct-Dec;14(4):20-5.
To investigate the effects of age and gender matching on patient and graft survival in living unrelated kidney transplantation.
MATERIAL/METHODS: All 2649 first-time kidney transplanted cases who had received their graft from a living unrelated donor in Baqiyatallah Hospital (Tehran, Iran) were enrolled (1992-2005). Based on the age and gender matching state of the donors (D) and recipients (R), the recipients were divided into four age-match (A) and four gender-match (G) groups. Age-match groups included A(1) (R< or =40, D< or =40, n=1483), A(2) (R>40, D< or =40, n=1044), A(3) (R< or =40, D>40, n=82) and A(4) (R>40, D>40, n=40). Gender-match groups comprised G(1) (R: female, D: female, n=209), G(2) (R: male, D: male, n=1428), G(3) (R: female, D: male, n=768) and G(4) (R: male, D: female, n=244). Using Kaplan-Meier method, 6-month, to 5-year graft/patient survival rates were determined for different patient groups. Survival curves were compared using log rank test after stratification.
Male recipients living with a female donor's kidney had a shorter survival compared to both the males having received a male kidney and the females having received a female kidney. Graft survival also showed a marginally significant difference and was shorter among the males with a female kidney graft compared to the males living with a male kidney graft. In contrast, donor's sex caused no difference in patient or graft survival among female recipients. When survival curves of age-match groups were compared, both graft and patient survival times were significantly shorter among the younger patients having a kidney graft received from an older donor. Patient survival was also shorter among old recipients having received an old kidney compared with old patients having a kidney graft from a young donor. Though graft survival among the old patients with old grafts was also shorter than in those with young grafts, the difference was not significant. When the subjects were stratified by donors' age, the results showed that old patients with young kidneys survived shorter than young patients with young kidneys.
Better living unrelated renal transplantation outcome is expected with younger kidney grafts (i.e. donor < or =40 yr) and avoiding grafting female kidneys into male recipients.
研究年龄和性别匹配对非亲属活体肾移植患者及移植物存活的影响。
材料/方法：纳入在伊朗德黑兰巴奇亚塔拉医院接受非亲属活体供肾的2649例首次肾移植患者（1992 - 2005年）。根据供者（D）和受者（R）的年龄和性别匹配情况，将受者分为四个年龄匹配组（A）和四个性别匹配组（G）。年龄匹配组包括A(1)（R≤40岁，D≤40岁，n = 1483）、A(2)（R > 40岁，D≤40岁，n = 1044）、A(3)（R≤40岁，D > 40岁，n = 82）和A(4)（R > 40岁，D > 40岁，n = 40）。性别匹配组包括G(1)（R：女性，D：女性，n = 209）、G(2)（R：男性，D：男性，n = 1428）、G(3)（R：女性，D：男性，n = 768）和G(4)（R：男性，D：女性，n = 244）。采用Kaplan - Meier法确定不同患者组6个月至5年的移植物/患者存活率。分层后使用对数秩检验比较生存曲线。
接受女性供肾的男性受者的存活时间短于接受男性供肾的男性受者和接受女性供肾的女性受者。移植物存活也显示出微小的显著差异，接受女性供肾的男性受者的移植物存活时间短于接受男性供肾的男性受者。相比之下，供者性别对女性受者的患者或移植物存活无差异。比较年龄匹配组的生存曲线时，接受老年供者肾脏移植的年轻患者的移植物和患者存活时间均显著缩短。接受老年供肾的老年受者的患者存活时间也短于接受年轻供者肾脏移植的老年患者。虽然接受老年供肾的老年患者的移植物存活时间也短于接受年轻供肾的患者，但差异不显著。当按供者年龄分层时，结果显示接受年轻供肾的老年患者的存活时间短于接受年轻供肾的年轻患者。
使用较年轻的肾脏移植物（即供者≤40岁）并避免将女性供肾移植给男性受者，有望获得更好的非亲属活体肾移植结果。
