Hernandez Roland A, Malek Sayeed K, Milford Edgar L, Finlayson Samuel R G, Tullius Stefan G
1 Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA. 2 Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 3 Division of Transplant Surgery, Brigham and Women's Hospital, Boston, MA. 4 Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA. 5 Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT. 6 Address correspondence to: Stefan G. Tullius, M.D., Ph.D., Division of Transplant Surgery, Brigham and Women's Hospital, 75 Francis Street, PBB215, Boston, MA 02140.
Transplantation. 2014 Nov 27;98(10):1069-76. doi: 10.1097/TP.0000000000000181.
The Kidney Donor Profile Index (KDPI) is a more precise donor organ quality metric replacing age-based characterization of donor risk. Little prior attention has been paid on the outcomes of lower-quality kidneys transplanted into elderly recipients. Although we have previously shown that immunological risks associated with older organs are attenuated by advanced recipient age, it remains unknown whether risks associated with lower-quality KDPI organs are similarly reduced in older recipients.
Donor organ quality as measured by the KDPI was divided into quintiles (very high, high, medium, low, and very low quality), and Cox proportional hazards was used to assess graft and recipient survival in first-time adult deceased donor transplant recipients by recipient age.
In uncensored graft survival analysis, recipients older than 69 years had demonstrated comparable outcomes if they received low-quality kidneys compared to medium-quality kidneys. Death-censored analysis demonstrated no increased relative risk when low-quality kidneys were transplanted into recipients aged 70 to 79 years (hazard ratio [HR], 1.11; P=0.19) or older than 79 years (HR, 1.08; P=0.59). In overall survival analysis, elderly recipients gained no relative benefit from medium-quality kidneys over low-quality kidneys (70-79 years: HR, 1.03, P=0.51; >79 years: HR, 1.08; P=0.32).
Our analysis demonstrates that transplanting medium-quality kidneys into elderly recipients does not provide significant advantage over low-quality kidneys.
肾脏供体特征指数（KDPI）是一种更精确的供体器官质量指标，用以取代基于年龄的供体风险特征描述。此前很少有人关注低质量肾脏移植给老年受者的结局。尽管我们之前已经表明，老年受者可减轻与老年器官相关的免疫风险，但尚不清楚与低质量KDPI器官相关的风险在老年受者中是否同样降低。
将通过KDPI测量的供体器官质量分为五等份（非常高、高、中、低和非常低质量），并使用Cox比例风险模型按受者年龄评估首次接受成年死亡供体移植受者的移植物和受者存活率。
在未删失的移植物存活分析中，69岁以上的受者如果接受低质量肾脏，其结局与接受中等质量肾脏的受者相当。死亡删失分析表明，将低质量肾脏移植给70至79岁（风险比[HR]，1.11；P=0.19）或79岁以上（HR，1.08；P=0.59）的受者时，相对风险没有增加。在总生存分析中，老年受者接受中等质量肾脏相对于低质量肾脏没有获得相对益处（70-79岁：HR，1.03，P=0.51；>79岁：HR，1.08；P=0.32）。
我们的分析表明，将中等质量肾脏移植给老年受者相比低质量肾脏并没有显著优势。
