Al-Shraideh Yousef, Farooq Umar, Farney Alan C, Palanisamy Amudha, Rogers Jeffrey, Orlando Giuseppe, Buckley Michael R, Reeves-Daniel Amber, Doares William, Kaczmorski Scott, Gautreaux Michael D, Iskandar Samy S, Hairston Gloria, Brim Elizabeth, Mangus Margaret, Stratta Robert J
Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Clin Transplant. 2014 Dec;28(12):1372-82. doi: 10.1111/ctr.12463. Epub 2014 Oct 16.
We performed a retrospective single-center review of 884 deceased donor (DD) kidney transplants (KTs) in patients (pts) aged ≥40 yr.
One hundred and four (11.8%) pts were ≥70 (mean 74), 286 (32.3%) were 60-69 (mean 64), and 494 (55.9%) were 40-59 (mean 51) yr of age; the proportion receiving expanded criteria donor (ECD) kidneys were 66%, 49%, and 30%, respectively (p < 0.001). Mean waiting time (15 months) was shorter for pts ≥70 yr compared to the other two groups combined (23 months, p = 0.002). With mean follow-up ranging from 54 to 70 months, actual pt (81% vs. 72%, p = 0.002) and graft (66% vs. 58.5%, p = 0.03) survival rates were higher in the younger compared to the two older groups, whereas death-censored graft survival was similar (76% vs. 73%, p = NS). The incidence of death with a functioning graft correlated with older recipient age group, increasing from 13% to 18% to 23% (p = 0.01). The incidence of delayed graft function was similar (31.8% overall), and renal function, morbidity, and resource utilization were similar among groups.
By directing ECD kidneys to selected older pts, waiting times are reduced and censored survival outcomes are similar to middle-aged patients, suggesting that matching strategies for graft and patient lifespan are warranted.
我们对884例年龄≥40岁患者的已故供体（DD）肾移植（KT）进行了单中心回顾性研究。
104例（11.8%）患者年龄≥70岁（平均74岁），286例（32.3%）患者年龄在60 - 69岁（平均64岁），494例（55.9%）患者年龄在40 - 59岁（平均51岁）；接受扩大标准供体（ECD）肾脏的比例分别为66%、49%和30%（p < 0.001）。年龄≥70岁的患者平均等待时间（15个月）比其他两组患者的平均等待时间（23个月）短（p = 0.002）。平均随访时间为54至70个月，年轻组患者的实际生存率（81%对72%，p = 0.002）和移植物生存率（66%对58.5%，p = 0.03）高于两个老年组，而死亡截尾移植物生存率相似（76%对73%，p = 无显著性差异）。有功能移植物的死亡发生率与受者年龄较大组相关，从13%增至18%再增至23%（p = 0.01）。移植肾功能延迟的发生率相似（总体为31.8%）且各组间肾功能、发病率及资源利用情况相似。
通过将ECD肾脏分配给特定的老年患者，等待时间缩短且截尾生存结果与中年患者相似，这表明移植肾与患者寿命的匹配策略是有必要的。
