Vrochides D, Hassanain M, Metrakos P, Tchervenkov J, Chaudhury P, Chan G, Paraskevas S
Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada.
Hippokratia. 2011 Apr;15(2):167-9.
Most deceased donor kidney allocation protocols are based on waiting time and do not take into account either recipient's life expectancy. This study investigates whether graft survival is affected by patient life expectancy.
A total of 640 adult kidney transplants were performed. Recipients were divided in group A (patients ≤ 50 years) and group B (patients > 50 years). The status of graft+recipient combination was characterized as: a) deceased recipient with functional graft, b) alive recipient with functional graft and c) deceased or alive recipient with nonfunctional graft.
Mean kidney recipient survival was 15.15 (95% CI: 14.54, 15.77) and 12.40 (95% CI: 11.47, 13.33) years for groups A and B respectively (p < 0.0001). Mean graft survival was 13.62 (95% CI: 12.81, 14.43) and 12.42 (95% CI: 11.59, 13.25) years for groups A and B respectively (p=0.6516). Non-functional grafts were identified in 18.4% (n=57) and 16.4% (n=54) of group A and B respectively.
Allocation of renal grafts to older patients does not result in significant loss of graft-years. Recipients' life expectancy has a small impact on graft survival. We should not deviate from the basic principles of equality, when kidney allocation systems are designed.
大多数已故供体肾分配方案基于等待时间，未考虑受者的预期寿命。本研究调查移植肾存活是否受患者预期寿命影响。
共进行了640例成人肾移植。受者分为A组（年龄≤50岁患者）和B组（年龄>50岁患者）。移植肾与受者组合的状态分为：a）有功能移植肾的已故受者，b）有功能移植肾的存活受者，c）无功能移植肾的已故或存活受者。
A组和B组肾移植受者平均存活时间分别为15.15年（95%可信区间：14.54，15.77）和12.40年（95%可信区间：11.47，13.33）（p<0.0001）。A组和B组移植肾平均存活时间分别为13.62年（95%可信区间：12.81，14.43）和12.42年（95%可信区间：11.59，13.25）（p=0.6516）。A组和B组分别有18.4%（n=57）和16.4%（n=54）的移植肾无功能。
将肾移植分配给老年患者不会导致移植肾年数的显著损失。受者的预期寿命对移植肾存活影响较小。在设计肾脏分配系统时，我们不应偏离平等的基本原则。
