Impedovo S V, Ditonno P, Ricapito V, Bettocchi C, Gesualdo L, Grandaliano G, Selvaggi F P, Battaglia M
Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Transplant Proc. 2013 Sep;45(7):2650-3. doi: 10.1016/j.transproceed.2013.08.003.
Renal transplantation in patients older than 60 years has long been regarded with skepticism owing to the increased risk of complications although, as compared with dialysis treatment, a graft seems to improve not only the quality of life but also long-term patient survival. This study sought to analyze the impact of recipient age older than 60 years on patient and graft outcomes.
We retrospectively investigated the outcomes of 761 kidney transplant recipients from cadaveric donors performed between February 1998 and July 2011. While 69 subjects were at least 60 years of age (group A), 692 were younger than 60 years (group B) at the time of transplantation.
Mean follow-up was 60.1 ± 38.5 months. Delayed graft function (DGF) requiring dialysis was observed in 36 group A (52.1%) and 205 group B (29.6%) subjects (P = .001). However, there were also significant differences between group A and group B in terms of mean donor age (60.3 vs 44.6 years; P < .001) and mean donor estimated creatinine clearance (57.8 vs 83.4 mL/min; P < .001). There were no significant differences in death-censored graft survival between the two groups, but elderly patients experienced worse survival (P = .0005). The most common causes of patient death were myocardial infarction, other cardiovascular complications, and tumors.
Kidney transplantation is a good option for elderly recipients with end-stage renal disease, providing long graft survival and a good quality of life, although these patients are more likely to develop cancer or cardiovascular disease. Our findings suggested that older patients should not be excluded a priori from transplantation, but meticulous screening for cancer and heart disease should be always be performed to improve outcomes.
60岁以上患者的肾移植长期以来一直受到质疑，因为并发症风险增加，尽管与透析治疗相比，移植肾似乎不仅能改善生活质量，还能提高患者的长期生存率。本研究旨在分析60岁以上受者年龄对患者和移植肾结局的影响。
我们回顾性研究了1998年2月至2011年7月间761例尸体供肾肾移植受者的结局。移植时，69例受试者至少60岁（A组），692例年龄小于60岁（B组）。
平均随访时间为60.1±38.5个月。A组36例（52.1%）和B组205例（29.6%）受试者出现需要透析的移植肾功能延迟恢复（DGF）（P = .001）。然而，A组和B组在平均供者年龄（60.3岁对44.6岁；P < .001）和平均供者估计肌酐清除率（57.8对83.4 mL/分钟；P < .001）方面也存在显著差异。两组间死亡删失移植肾生存率无显著差异，但老年患者生存率较差（P = .000５）。患者死亡的最常见原因是心肌梗死、其他心血管并发症和肿瘤。
肾移植对于老年终末期肾病受者是一个不错的选择，可提供较长的移植肾存活时间和良好的生活质量，尽管这些患者更易患癌症或心血管疾病。我们的研究结果表明，不应先验地将老年患者排除在移植之外，但应始终对癌症和心脏病进行细致筛查以改善结局。
