Department of Medicine, Stanford University, Palo Alto, CA 94304, USA.
Am J Nephrol. 2013;38(3):204-11. doi: 10.1159/000354483. Epub 2013 Aug 27.
BACKGROUND/AIMS: The elderly are the fastest growing subpopulation with end-stage renal disease. The goal of our study was to define characteristics of elderly patients who were considered ineligible for transplantation compared to those who were listed.
984 patients were referred for evaluation during a 2-year period. Records of patients ≥65 years of age (n = 123) were reviewed. Patients who were listed versus not listed were characterized. Factors associated with waitlisting were determined using standard statistical tools.
Half of elderly transplant candidates were accepted for listing compared to 75.4% of those aged <65 years. In multivariable logistic regression, older age (OR 1.29 per year ≥65, 95% CI 1.14-1.45), coronary artery disease (OR 8.57, 95% CI 2.41-30.53), and poor mobility (OR 13.97, 95% CI 4.76-41.00) were independently associated with denial of listing. The receiver operating characteristic curve showed good discrimination for denial of listing (area under the receiver operating characteristic curve of 0.88).
Elderly candidates carry a heavy burden of comorbidities and over half of those evaluated are deemed unsuitable for waitlisting. Better delineation of characteristics associated with suitability for transplant candidacy in the elderly is warranted to facilitate appropriate referrals by physicians and management of expectations in potential candidates.
背景/目的：老年人是终末期肾病患者中增长最快的亚群。我们的研究目的是确定与被列入名单的患者相比，不适合接受移植的老年患者的特征。
在两年期间，有 984 名患者被转介进行评估。回顾了年龄≥65 岁的患者（n=123）的记录。对列入名单和未列入名单的患者进行了特征描述。使用标准统计工具确定与列入名单相关的因素。
与<65 岁的患者相比，一半的老年移植候选者被接受列入名单，而 75.4%的患者被接受列入名单。在多变量逻辑回归中，年龄较大（≥65 岁每年的 OR 为 1.29，95%CI 为 1.14-1.45）、冠状动脉疾病（OR 为 8.57，95%CI 为 2.41-30.53）和行动不便（OR 为 13.97，95%CI 为 4.76-41.00）与列入名单的拒绝独立相关。接受者操作特征曲线显示，拒绝列入名单的区分度良好（接受者操作特征曲线下面积为 0.88）。
老年患者伴有多种合并症，评估的患者中有一半以上被认为不适合列入等候名单。需要更好地确定与老年患者适合移植候选资格相关的特征，以便医生进行适当的转介，并管理潜在候选人的期望。
