El-Agroudy Amgad E, Al-Arrayed Sameer M, Al-Arrayed Ahmed S, Al-Ghareeb Sumaya M, Farid Eman, Zabor Kazem, Abd Alla Sadiq
Nephrology and Transplant Center, Salmaniya Medical Complex, Manama, Bahrain.
Ann Transplant. 2009 Oct-Dec;14(4):26-32.
We retrospectively reviewed the results of renal transplantation in patients over 60 years of age at our center.
MATERIAL/METHODS: A retrospective study was conducted of 212 Bahraini patients receiving renal transplants from January 1979 to December 2007. All medical records were reviewed for demographic data, graft function and survival. Patient and graft survival was compared for patients above and below the age of 60.
Seventeen patients >60 years with a mean age of 64.1+/-3.6 years at the time of transplantation. Diabetic nephropathy (52%) was the most common causes of end-stage renal disease. Mean donor age was 26+/-6 years and most of them were unrelated (82%). Of the elderly patients, 4 died: 3 with a functioning graft, 1 within one year of transplantation. Cardiovascular causes (3 patients, 75%) were the most common cause of death. Causes of graft loss were death with a functioning graft (4) and chronic rejection (1). Cox's proportional-hazards regression analysis showed on univariate analysis that pre-transplant hypertension, diabetes mellitus and vascular surgery (CABG) before transplant significantly affected the dependent variable of graft loss. Multivariate analysis did not show these variables to be significant. Kaplan Meier patient survival curves showed statistically significant differences between study (>60 years) and control (18-59 years) patients (p=0.04) at 10 year.
We conclude that Patients older than 60 yr of age can be transplanted safely and successfully, especially when they are properly screened for the presence of significant risk factors such as severe cardiovascular disease and diabetes.
我们回顾性分析了我院60岁以上患者肾移植的结果。
材料/方法：对1979年1月至2007年12月在我院接受肾移植的212例巴林患者进行回顾性研究。查阅所有病历以获取人口统计学数据、移植物功能及存活情况。比较60岁及以上和60岁以下患者的患者及移植物存活率。
17例年龄>60岁的患者，移植时平均年龄为64.1±3.6岁。糖尿病肾病（52%）是终末期肾病最常见的病因。供者平均年龄为26±6岁，大多数为非亲属供者（82%）。老年患者中，4例死亡：3例移植物功能良好，1例在移植后1年内死亡。心血管原因（3例，75%）是最常见的死亡原因。移植物丢失的原因包括移植物功能良好时死亡（4例）和慢性排斥反应（1例）。Cox比例风险回归分析单因素分析显示，移植前高血压、糖尿病及移植前血管手术（冠状动脉旁路移植术）显著影响移植物丢失这一因变量。多因素分析未显示这些变量具有显著性。Kaplan-Meier患者生存曲线显示，研究组（>60岁）和对照组（18 - 59岁）患者在10年时存在统计学显著差异（p = 0.04）。
我们得出结论，60岁以上的患者能够安全、成功地进行移植，尤其是在对严重心血管疾病和糖尿病等重大危险因素进行适当筛查时。
