Division of Transplant Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA.
Transplantation. 2012 Sep 15;94(5):499-505. doi: 10.1097/TP.0b013e31825c5940.
Despite the increasing use of older living donors in kidney transplantation, intermediate-term donor and recipient outcomes are poorly characterized.
We retrospectively compared 143 recipients from donors older than 50 years (older) to 319 recipients from donors 50 years or younger (younger).
Mean older donor age (years) was 58; younger age was 37 (P<0.001). One-year, three-year, and five-year patient survival was 99.3%, 94.1%, and 91.3% in recipients of older donors and 99.7%, 98.7%, and 95.4% in recipients of younger donors respectively (P=not significant). One-year, three-year, and five-year death-censored graft survival was 99.2%, 95.0%, and 93.7% in older recipients and 99.7%, 96.7%, and 95.4% in younger recipients respectively (P=not significant). Older and younger recipients demonstrated equivalent rates of vascular complications (2.7% vs. 1.2%, P=not significant) and acute rejection (7.7% vs. 9%, P=not significant). Recipients from donors aged 51 to 59 (n=95), 60 to 69 (n=42), and older than 70 years (n=6) had diminished graft function (eGFR=46±13, 44.9±16, 32.2±18.6 mL/min/1.73m(2) at 5 years respectively) compared with younger donor recipients (58.4±20.0 mL/min/1.73m(2), P<0.001). Older donors had decreased baseline renal function compared with younger donors (eGFR of 82.5±35.12 and 105.3±46.7 mL/min/1.73m(2), respectively). No progressive decline in renal function was observed in older donors (3 years after donation).
Older living donor kidneys can be transplanted with low perioperative risk without compromising recipient 5-year patient or graft survival or donor renal function. Younger donor kidneys have superior graft function 5 years after transplantation, highlighting the need for appropriate donor/recipient matching.
尽管越来越多的老年活体供者用于肾脏移植，但中期供者和受者的结局仍描述不佳。
我们回顾性比较了 143 例年龄大于 50 岁的供者（老年）和 319 例年龄为 50 岁或更年轻的供者（年轻）的受者。
老年供者的平均年龄（岁）为 58 岁，年轻供者为 37 岁（P<0.001）。老年供者组受者的 1 年、3 年和 5 年患者生存率分别为 99.3%、94.1%和 91.3%，年轻供者组受者分别为 99.7%、98.7%和 95.4%（P=无显著性差异）。老年受者组的 1 年、3 年和 5 年无死亡censored 移植物生存率分别为 99.2%、95.0%和 93.7%，年轻受者组分别为 99.7%、96.7%和 95.4%（P=无显著性差异）。老年和年轻受者的血管并发症发生率（2.7% vs. 1.2%，P=无显著性差异）和急性排斥反应发生率（7.7% vs. 9%，P=无显著性差异）相似。年龄在 51 至 59 岁（n=95）、60 至 69 岁（n=42）和大于 70 岁（n=6）的供者的移植物功能下降（5 年时 eGFR 分别为 46±13、44.9±16 和 32.2±18.6 mL/min/1.73m2），低于年轻供者受者（58.4±20.0 mL/min/1.73m2，P<0.001）。与年轻供者相比，老年供者的基线肾功能下降（eGFR 分别为 82.5±35.12 和 105.3±46.7 mL/min/1.73m2）。在老年供者中，未观察到肾功能进行性下降（供肾 3 年后）。
老年活体供者肾脏移植的围手术期风险较低，不影响受者 5 年的患者或移植物生存率或供者的肾功能。年轻供者的移植物功能在移植后 5 年更好，这突出了适当的供者/受者匹配的必要性。
