Division of Nephrology, Department of Pediatrics, McGill University Faculty of Medicine, Montreal, QC, Canada.
Transplantation. 2011 Dec 15;92(11):1237-43. doi: 10.1097/TP.0b013e31823411d7.
Age at transplant and graft failure risk are associated in young kidney transplant recipients. The risk of graft failure may also vary by current age, irrespective of age at transplant. We sought to estimate age-specific graft failure rates in young kidney transplant recipients and to estimate the relative hazards of graft failure at different ages, compared with at the age of 25 to 29 years.
We evaluated 90,689 patients recorded in the United States Renal Data System database who received a first transplant when younger than 40 years (1988-2009); 18,310 were younger than 21 years at transplant. Time-dependent Cox models with time-varying covariates were used to estimate the association between age (time-dependent) and death-censored graft failure risk, adjusted for time since transplant and other potential confounders.
There were 31,857 graft failures over a median follow-up of 5.9 years (interquartile range, 2.5-10.5 years; maximum, 21.8 years). Crude age-specific graft failure rates were highest in 19 year olds (6.6 per 100 person-years). Compared with individuals with the same time since transplant observed at 25 to 29 years of age, death-censored graft failure rates were highest in 17 to 24 year olds (hazard ratio, 1.20; [95% confidence interval 1.13, 1.27] for 17-20 year olds and 1.20 [1.13, 1.26] for 21-24 year olds; both P<0.0001) and lowest in 5 to 12 year olds (hazard ratio, 0.60; [0.53, 0.68] for 5-9 year olds and 0.56 [0.49, 0.64] for 10-12 year olds; both P<0.0001).
Among first kidney transplant recipients younger than 40 years, older adolescents and young adults (17-24 years) have the highest risk of graft failure, irrespective of age at transplant.
在年轻的肾移植受者中，移植时的年龄和移植物失败的风险相关。移植物失败的风险也可能因当前年龄而异，而与移植时的年龄无关。我们试图估计年轻肾移植受者的特定年龄移植物失败率，并估计与 25 至 29 岁相比，不同年龄的移植物失败的相对危险。
我们评估了美国肾脏数据系统数据库中记录的 90689 名在 40 岁以下（1988-2009 年）接受首次移植的患者；18310 名患者在移植时年龄小于 21 岁。使用具有时变协变量的时间依赖性 Cox 模型来估计年龄（时间依赖性）与死亡校正移植物失败风险之间的关联，同时调整了移植后时间和其他潜在混杂因素的影响。
中位随访 5.9 年（四分位距 2.5-10.5 年；最长 21.8 年）期间，发生了 31857 例移植物失败。19 岁患者的年龄特异性移植物失败率最高（6.6/100 人年）。与在 25 至 29 岁时具有相同移植后时间的患者相比，17 至 24 岁患者的死亡校正移植物失败率最高（危险比 1.20[95%置信区间 1.13，1.27]；17-20 岁和 1.20[1.13，1.26]；均 P<0.0001），5 至 12 岁患者的移植物失败率最低（危险比 0.60[0.53，0.68]；5-9 岁和 0.56[0.49，0.64]；均 P<0.0001）。
在年龄小于 40 岁的首次肾移植受者中，年龄较大的青少年和年轻人（17-24 岁）的移植物失败风险最高，而与移植时的年龄无关。
