Lai Q, Nudo F, Levi Sandri G B, Melandro F, Ferretti S, Grieco M, Garofalo M, Poli L, Pretagostini R, Berloco P B
Department of General Surgery and Organ Transplantation, Sapienza University, Umberto I Hospital, Rome, Italy.
Transplant Proc. 2011 May;43(4):1030-2. doi: 10.1016/j.transproceed.2011.01.137.
Use of expanded-criteria donors (ECDs) for kidney transplantation has progressively increased in the past years with the intent to improve the number of available grafts. However, it is still uncertain if ECD kidneys have worse survivals than standard-criteria ones. The aim of this study was to retrospectively analyze a cohort of ECD patients comparing the 2 subgroups of 50-59- and >60-year-old donors in terms of donor, recipient, and transplant features and survival rates.
Ninety-one cases were analyzed. The cohort was stratified into 2 subgroups according to donor age: group 1, age 50-59 years (n=26); and group 2, age ≥60 years (n=67).
Group 2 represented older donors and a higher percentage of donors with a previous history of hypertension. In Group 1, preharvest creatinine values showed higher results. No difference was detected regarding patient and graft survivals, with 5-year survival rates of 92.3% versus 86.7%, and 70.8% versus 69.8%, respectively. The best way to select the donors is still under debate. In our experience, a biopsy-driven selection was performed exclusively for group 2 ECDs. Considering the similar survivals obtained, we speculated that an accurate biopsy-based selection of older grafts allows one to avoid "bad" donors from the allocation system, thereby obtaining improved survival results.
Biopsy-driven pretransplantation selection appears to be the main system to optimize results, to achieve outcomes similar to nonbiopsied younger donors. Routine biopsies also in the younger subgroup of ECD may achieve a further improvement in survival.
在过去几年中，扩大标准供体（ECD）用于肾移植的情况逐渐增多，目的是增加可用移植物的数量。然而，ECD肾的存活率是否低于标准标准供体的肾仍不确定。本研究的目的是回顾性分析一组ECD患者，比较50 - 59岁和>60岁供体的两个亚组在供体、受体和移植特征及存活率方面的情况。
分析了91例病例。根据供体年龄将队列分为两个亚组：第1组，年龄50 - 59岁（n = 26）；第2组，年龄≥60岁（n = 67）。
第2组代表年龄较大的供体，且有高血压病史的供体比例更高。在第1组中，收获前肌酐值结果更高。在患者和移植物存活率方面未检测到差异，5年存活率分别为92.3%对86.7%，以及70.8%对69.8%。选择供体的最佳方法仍在争论中。根据我们的经验，仅对第2组ECD进行了活检驱动的选择。考虑到获得的存活率相似，我们推测基于活检对较老移植物进行准确选择可以避免分配系统中的“不良”供体，从而获得更好的存活结果。
活检驱动的移植前选择似乎是优化结果的主要系统，以实现与未活检的年轻供体相似的结局。在ECD的年轻亚组中进行常规活检也可能进一步提高存活率。
