老年人肾移植后的结果：一项回顾性队列研究。
Outcomes following renal transplantation in older people: a retrospective cohort study.
机构信息
Department of Renal Surgery and Transplantation, Western Infirmary, Glasgow G11 6NY, UK.
出版信息
BMC Geriatr. 2013 Jul 24;13:79. doi: 10.1186/1471-2318-13-79.
BACKGROUND
The mean age of renal transplant recipients is rising, with age no longer considered a contraindication. Outcomes in older patients have not, however, been fully defined. The aim of our study is to evaluate outcomes in older people following renal transplantation at a Scottish regional transplant unit.
METHODS
All renal transplants from January 2001 to December 2010 were analysed (n = 762). Outcomes following renal transplantation in people over 65 years old were compared to those in younger patients. Outcome measures were: delayed graft function (DGF), primary non-function (PNF), biopsy proven acute rejection (BPAR), serum creatinine at 1 year and graft and recipient survival. Lengths of initial hospital stay and re-admission rates were also assessed. Student's T-Test was used to analyse continuous variables, Pearson's Chi-Squared test for categorical variables and the Kaplan-Meier estimator for survival analysis.
RESULTS
Older recipients received proportionately more kidneys from older donors (27.1% vs. 6.3%; p < 0.001). Such kidneys were more likely to have DGF (40.7% vs. 16.9%; p < 0.001). Graft loss at 1 year was higher in kidneys from older donors (15.3% vs. 7.6%; p = 0.04). There was no significant difference in patient survival at 1 year based on the age of the donor kidney. Recipient age did not affect DGF (16.9% vs. 18.5%; p = 0.77) or graft loss at 1 year (11.9% vs. 7.8%; p = 0.28). Older recipients were, however, more likely to die in the first year post transplant (6.8% vs. 2.1%; p = 0.03). BPAR was less common in older patients (6.8% vs. 22%; p < 0.01). Older recipients were more likely to be readmitted to hospital (31.8% vs. 10.9%; p < 0.001).
CONCLUSIONS
Older patients experience good outcomes following renal transplantation and donor or recipient age alone should not preclude this treatment. An awareness of this in clinicians managing older patients is important since the prevalence of End Stage Renal Disease is increasing in this age group.
背景
接受肾移植患者的平均年龄不断上升，年龄不再被视为禁忌。然而，老年患者的预后尚未完全明确。本研究的目的是评估苏格兰某地区移植中心老年患者接受肾移植后的结局。
方法
分析 2001 年 1 月至 2010 年 12 月所有的肾移植病例（n = 762）。将年龄大于 65 岁的患者与年龄小于 65 岁的患者的肾移植后结局进行比较。观察指标包括：延迟性肾功能恢复（DGF）、无功能移植物（PNF）、经活检证实的急性排斥反应（BPAR）、术后 1 年血清肌酐、移植物和受者存活率。同时评估患者的初始住院时间和再入院率。采用 Student's T 检验分析连续变量，采用 Pearson's Chi-Squared 检验分析分类变量，采用 Kaplan-Meier 估计器分析生存情况。
结果
老年受者接受来自老年供者的肾脏比例较高（27.1%比 6.3%；p < 0.001），这些肾脏发生 DGF 的比例更高（40.7%比 16.9%；p < 0.001）。1 年时老年供者来源的移植物丢失率更高（15.3%比 7.6%；p = 0.04）。但根据供肾的年龄，1 年时患者的存活率无显著差异。受者年龄并不影响 DGF（16.9%比 18.5%；p = 0.77）或 1 年时的移植物丢失率（11.9%比 7.8%；p = 0.28）。然而，老年受者在移植后 1 年内死亡的风险更高（6.8%比 2.1%；p = 0.03）。老年患者发生 BPAR 的比例较低（6.8%比 22%；p < 0.01）。老年受者再入院的比例更高（31.8%比 10.9%；p < 0.001）。
结论
老年患者接受肾移植后结局良好，因此，不应仅仅因为供者或受者年龄而排除这种治疗方法。临床医生在管理老年患者时应意识到这一点，因为该年龄段的终末期肾病发病率正在上升。
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