Division of Nephrology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.
Clin J Am Soc Nephrol. 2010 Nov;5(11):2109-14. doi: 10.2215/CJN.03490410. Epub 2010 Oct 28.
Few elderly ESRD patients are ever wait-listed for deceased-donor transplantation (DDTX), and waiting list outcomes may not reflect access to transplantation in this group. Our objective was to determine longitudinal changes in access to transplantation among all elderly patients with ESRD, not just those wait-listed for DDTX.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using data from the US Renal Data System, we determined changes in the adjusted likelihood of transplantation from any donor source as an indicator of access to transplantation among all incident ESRD patients aged 60 to 75 years between 1995 and 2006.
Access to transplantation doubled between 1995 and 2006 despite an apparent decrease in the likelihood of DDTX after wait-listing. A threefold increase in the likelihood of living-donor transplantation, including a 1.5-fold increase in living-donor transplantation after wait-listing, was a key factor that led to increased access to transplantation. When a lead-time bias related to the increased practice of placing patients on the waiting list before dialysis initiation in more recent years was accounted for, there was no decrease in the likelihood of DDTX after wait-listing. The likelihood of receiving a DDTX after placement on the waiting list was maintained by a threefold increase in expanded-criteria-donor transplantation and a 26% reduction in the risk for death on the waiting list.
Although transplantation remains infrequent, elderly patients were twice as likely to undergo transplantation in 2006 versus 1995. Elderly patients with ESRD should not be dissuaded from pursuing transplantation.
接受已故供者肾移植（DDTX）的老年终末期肾病（ESRD）患者很少，等待名单结果可能无法反映该人群获得移植的情况。我们的目的是确定所有老年 ESRD 患者获得移植的机会是否随时间发生变化，而不仅是等待 DDTX 的患者。
设计、地点、参与者和测量方法：利用美国肾脏数据系统的数据，我们根据任何供者来源的移植调整后可能性的变化来确定 1995 年至 2006 年间所有 60 至 75 岁的新诊断 ESRD 患者获得移植的机会，作为一个指标。
尽管等待名单后 DDTX 的可能性似乎降低，但 2006 年获得移植的机会是 1995 年的两倍。活体供者移植可能性增加了两倍，包括等待名单后活体供者移植的可能性增加了 1.5 倍，这是导致获得移植机会增加的关键因素。当考虑到最近几年由于在开始透析前增加将患者列入等待名单的做法而导致的领先时间偏倚时，等待名单后 DDTX 的可能性并没有降低。等待名单后接受 DDTX 的可能性是通过扩大标准供者移植的可能性增加三倍和等待名单上死亡风险降低 26%来维持的。
尽管移植仍然很少见，但与 1995 年相比，2006 年老年 ESRD 患者接受移植的可能性增加了一倍。老年 ESRD 患者不应被劝阻进行移植。
