Transplantation Unit, Renal Division, Department of Medicine, CHUQ L'Hôtel-Dieu de Québec, Faculty of Medicine, Université Laval, Québec, QC, Canada.
Transpl Int. 2013 Feb;26(2):162-9. doi: 10.1111/tri.12016. Epub 2012 Dec 1.
Delayed graft function (DGF) has a negative impact on graft survival in donation after brain death (DBD) but not for donation after cardiac death (DCD) kidneys. However, older donor age is associated with graft loss in DCD transplants. We sought to examine the interaction between donor age and DGF in DBD kidneys. This is a single-center, retrospective review of 657 consecutive DBD recipients transplanted between 1990 and 2005. We stratified the cohort by decades of donor age and studied the association between DGF and graft failure using Cox models. The risk of graft loss associated with DGF was not significantly increased for donor age below 60 years (adjusted hazard ratio [aHR] 1.12, 1.51, and 0.90, respectively, for age <40, 41-50 and 51-60 years) but significantly increased after 60 years (aHR 2.67; P = 0.019). Analysis of death-censored graft failure yielded similar results for donor age below 60 years and showed a substantially increased risk with donors above 60 years (aHR 6.98, P = 0.002). This analysis reveals an unexpectedly high impact of older donor age on the association between DGF and renal transplant outcomes. Further research is needed to determine the best use of kidneys from donors above 60 years old, where DGF is expected.
延迟移植物功能（DGF）对脑死亡后供体（DBD）的移植物存活有负面影响，但对心脏死亡后供体（DCD）的肾脏没有影响。然而，供体年龄较大与 DCD 移植中的移植物丢失有关。我们试图研究 DBD 供体中供体年龄和 DGF 之间的相互作用。这是一项对 1990 年至 2005 年间连续 657 例 DBD 受者进行的单中心回顾性研究。我们根据供体年龄的十年进行分层，并使用 Cox 模型研究 DGF 与移植物衰竭之间的关系。对于年龄低于 60 岁的供体（年龄<40、41-50 和 51-60 岁的调整危险比[aHR]分别为 1.12、1.51 和 0.90），DGF 相关的移植物丢失风险没有显著增加，但在 60 岁以上时显著增加（aHR 2.67；P=0.019）。对于年龄低于 60 岁的供体，对死亡校正移植物衰竭的分析也得出了类似的结果，并且显示出供体年龄超过 60 岁时风险大大增加（aHR 6.98，P=0.002）。这项分析揭示了供体年龄较大对 DGF 和肾移植结果之间关系的意外高影响。需要进一步研究以确定如何最好地利用预期有 DGF 的 60 岁以上供体的肾脏。
