Rao K V, Kasiske B L, Odlund M D, Ney A L, Andersen R C
Department of Medicine, University of Minnesota Medical School, Minneapolis.
Transplantation. 1990 Jan;49(1):91-5. doi: 10.1097/00007890-199001000-00020.
To assess the impact of cadaver donor age on posttransplant renal function and graft survival, we analyzed our clinical results in 17 recipients of younger donor kidneys (less than 10 years) and 48 recipients of older donor kidneys (greater than 50 years) and compared them with a control group of 598 patients who received kidneys from donors between 11 and 50 years of age. The 3 groups were comparable with respect to recipient age, duration of dialysis, prior transfusions, previous transplants, cold ischemia time, HLA AB mismatches, cytotoxic antibody profile, posttransplant ATN, and prophylactic ALG treatment. The cumulative patient survival at 1, 2, and 3 years was not significantly different among the 3 groups, but the graft survival in recipients of older donor kidneys was significantly lower than the control (71% vs. 62% at 2 years, P = .09 and 66% vs. 55% at 3 years, P = .0003. The short-term renal function assessed at 1 month posttransplant was significantly lower in the older donor group compared with the control (creatinine clearance 45 mL/min vs. 59 mL/min, P = .0003). Likewise, the long-term renal function assessed at the last follow-up was also lower in the older donor group than the control (creatinine clearance 40 mL/min vs. 49 mL/min, P = .07). There were no significant differences in graft survival or short- or long-term renal function between the younger donor group and the control group. These observations suggest that transplantation of a kidney from an older cadaver donor is associated with an inferior posttransplant outcome. The practical decision whether or not to use an older donor kidney should be individualized taking this as well as other factors into account.
为评估尸体供者年龄对移植后肾功能及移植物存活的影响，我们分析了17例接受年轻供者肾脏（小于10岁）受者和48例接受年长供者肾脏（大于50岁）受者的临床结果，并将其与598例接受11至50岁供者肾脏的患者组成的对照组进行比较。三组在受者年龄、透析时间、既往输血史、既往移植史、冷缺血时间、HLA AB错配、细胞毒性抗体谱、移植后急性肾小管坏死及预防性抗淋巴细胞球蛋白治疗方面具有可比性。三组在1年、2年和3年时的累积患者生存率无显著差异，但年长供者肾脏受者的移植物存活率显著低于对照组（2年时分别为71%对62%，P = 0.09；3年时分别为66%对55%，P = 0.0003）。移植后1个月评估的短期肾功能，年长供者组显著低于对照组（肌酐清除率45 mL/分钟对59 mL/分钟，P = 0.0003）。同样，在最后一次随访时评估的长期肾功能，年长供者组也低于对照组（肌酐清除率40 mL/分钟对49 mL/分钟，P = 0.07）。年轻供者组与对照组在移植物存活或短期及长期肾功能方面无显著差异。这些观察结果表明，使用年长尸体供者的肾脏进行移植与较差的移植后结局相关。在决定是否使用年长供者的肾脏时，应综合考虑这一因素及其他因素，进行个体化决策。
