Tasaki Masayuki, Saito Kazuhide, Nakagawa Yuki, Ikeda Masahiro, Imai Naofumi, Narita Ichiei, Takahashi Kota
Division of Urology, Department of Regenerative and Transplant Medicine, Niigata Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, Japan,
Int Urol Nephrol. 2014 Jul;46(7):1441-6. doi: 10.1007/s11255-014-0655-8. Epub 2014 Feb 13.
We aimed to examine the influence of donor age on living-donor kidney transplantation (KTx), particularly with regard to long-term graft survival in young recipients with aged kidney grafts.
Between 1988 and 2012, 287 living-donor KTxs were performed in our center. The recipients were divided into 3 groups according to age in years: under 30 (young), 30-49 (middle-aged), and over 50 (old). The data regarding the influence of kidneys from donors aged over 50 years were retrospectively analyzed.
Graft survival at 1, 5, 10, and 15 years was 94.7, 94.7, 90.2, and 75.2%, respectively, in young recipients who received grafts from donors aged under 50 years, and 96.4, 91.9, 65.4, and 41.4%, respectively, in young recipients who received grafts from donors aged over 50 years (P = 0.023). In contrast, there were no significant differences regarding graft survival and donor age in the middle-aged and old recipient groups. Multivariate analysis revealed that young recipient and rejection episode were significant predictors of graft loss in transplantation from older donors. Histological examination revealed significant age-related changes in the grafts before transplant and a significant higher rate of glomerular hypertrophy at the 1-month protocol biopsy in young recipients with aged kidney grafts.
Kidney grafts from older living donors affected long-term graft survival in young recipients. In addition to the damage from rejection, aged kidney grafts, which have less nephron mass, may have a limited capacity to appropriately respond to increases in physiological or metabolic demands of young recipients, leading to a greater reduction in renal function.
我们旨在研究供体年龄对活体供肾移植（KTx）的影响，特别是对于接受老年供肾的年轻受者的长期移植肾存活情况。
1988年至2012年间，我们中心进行了287例活体供肾移植手术。根据受者年龄（岁）将其分为3组：30岁以下（年轻组）、30 - 49岁（中年组）和50岁以上（老年组）。对来自50岁以上供体肾脏的影响数据进行回顾性分析。
接受50岁以下供体肾脏的年轻受者，其移植肾1年、5年、10年和15年的存活率分别为94.7%、94.7%、90.2%和75.2%；而接受50岁以上供体肾脏的年轻受者，相应存活率分别为96.4%、91.9%、65.4%和41.4%（P = 0.023）。相比之下，中年组和老年组受者的移植肾存活情况与供体年龄之间无显著差异。多因素分析显示，年轻受者和排斥反应是老年供体移植中移植肾丢失的重要预测因素。组织学检查显示，移植前移植肾存在明显的年龄相关变化，且接受老年供肾的年轻受者在术后1个月的方案活检中，肾小球肥大率显著更高。
老年活体供体的肾脏移植影响年轻受者的长期移植肾存活。除了排斥反应造成的损害外，肾单位数量较少的老年移植肾可能对年轻受者生理或代谢需求增加的适应性反应能力有限，导致肾功能下降幅度更大。
