Kute Vivek B, Trivedi Hargovind L, Vanikar Aruna V, Shah Pankaj R, Gumber Manoj R, Patel Himanshu V, Modi Pranjal R, Shah Veena R
Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India.
Int J Artif Organs. 2012 Sep;35(9):663-70. doi: 10.5301/ijao.5000113.
Use of kidneys from donors aged 70 years and older is controversial. Organ shortage has led many transplant centers to accept kidneys from old, suboptimal deceased donors and make increasing use of old-for-old allocation systems. We describe our institutional experience with outcomes from transplanting deceased-donor kidneys from older donors (=70 years).
20 deceased donor renal transplants (DDRTx) were performed at our center using grafts from deceased donors 70 years and older between June 2004 and September 2011. Kidneys were allocated to dual or single grafting according to pre-transplant biopsy. Mean age of recipients was 47.60 ± 11.38 years, 13 of whom were males. Mean donor age was 76.49 ± 4.9 years; 10 of whom were males. The most common cause of donor death was cerebrovascular/road traffic accidents. Mean dialysis duration pre-transplantation was 19.5 ± 6.5 months. Mean HLA (Human Leukocyte Antigens) match was 1 ± 0.8. Most common recipient diseases leading to ESRD were chronic glomerulonephritis (25%), diabetes (20%), and hypertension (20%). Post-transplant immunosuppression consisted of a calcineurin inhibitor-based regimen.
Over a mean follow-up of 2.8 ± 1.7 years, patient and graft survival rates were 75% (n = 15) and 80% ( n = 16), respectively, with a mean serum creatinine of 1.78 ± 0.56 mg/dl; 20% of the patients had biopsy-proven acute rejection episodes. A total of 25% (n = 5) patients died, mainly due to infections.
DDRTx from older donors achieves acceptable graft function with patient/graft survival, provided that organs are allocated to dual or single grafting according to pre-transplant biopsy. These findings encourage the use of this approach even in low-income countries.
使用70岁及以上捐赠者的肾脏存在争议。器官短缺促使许多移植中心接受老年、不太理想的已故捐赠者的肾脏，并越来越多地采用老年对老年的分配系统。我们描述了我们机构在移植70岁及以上已故捐赠者的肾脏后的结果方面的经验。
2004年6月至2011年9月期间，我们中心使用70岁及以上已故捐赠者的移植物进行了20例已故捐赠者肾移植（DDRTx）。根据移植前活检将肾脏分配用于双肾移植或单肾移植。受者的平均年龄为47.60±11.38岁，其中13例为男性。捐赠者的平均年龄为76.49±4.9岁；其中10例为男性。捐赠者死亡的最常见原因是脑血管疾病/交通事故。移植前的平均透析时间为19.5±6.5个月。平均人类白细胞抗原（HLA）配型为1±0.8。导致终末期肾病的最常见受者疾病是慢性肾小球肾炎（25%）、糖尿病（20%）和高血压（20%）。移植后免疫抑制采用基于钙调神经磷酸酶抑制剂的方案。
平均随访2.8±1.7年，患者和移植物存活率分别为75%（n = 15）和80%（n = 16），平均血清肌酐为1.78±0.56mg/dl；20%的患者发生了活检证实的急性排斥反应。共有25%（n = 5）的患者死亡，主要原因是感染。
如果根据移植前活检将器官分配用于双肾移植或单肾移植，那么来自老年捐赠者的DDRTx可实现可接受的移植物功能以及患者/移植物存活率。这些发现鼓励即使在低收入国家也采用这种方法。
