Iwai Tomoaki, Uchida Junji, Kuwabara Nobuyuki, Kabei Kazuya, Yukimatsu Nao, Okamura Motohiro, Yamasaki Takeshi, Naganuma Toshihide, Kumada Norihiko, Nakatani Tatsuya
Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Urol Int. 2015;95(1):99-105. doi: 10.1159/000368324. Epub 2015 Jan 27.
Patients aged 60 years and older stand for the fastest growing group of patients with end-stage renal disease worldwide, and the need for kidney transplants among this population is rising. In Japan, living donor kidney transplantation is mainly performed to deal with the severe shortage of deceased donors, and the number of spousal transplants is currently increasing.
A total of 164 patients with ESRD underwent living donor kidney transplantation at our institution, of whom 21 patients aged 60 years and older had spousal kidney transplantation. ABO-incompatible kidney transplantation was performed in 5 of the 21 cases. We analyzed these recipients.
Patient and graft survival rates were 100%. The incidence of acute rejection was 23.8%. Eight patients experienced cytomegalovirus viremia, two patients experienced Pneumocystis jiroveci infection, and one experienced bacterial pneumonia. Two patients developed cancers and underwent curative operation after transplantation.
Elderly kidney transplantation from spousal donors is associated with age-related immune dysfunction, which may develop infections and malignancies and could be immunologically high risk due to the high rate of ABO-incompatibility and poor histocompatibility. An effort to minimize the adverse effect of immunosuppression and to reduce the risk of acute rejection may be needed for an excellent long-term outcome.
60岁及以上的患者是全球终末期肾病患者中增长最快的群体，该人群对肾移植的需求正在上升。在日本，为应对已故供体的严重短缺，主要开展活体供肾移植，目前配偶间肾移植的数量正在增加。
共有164例终末期肾病患者在我院接受了活体供肾移植，其中21例60岁及以上的患者接受了配偶间肾移植。21例中有5例进行了ABO血型不相容肾移植。我们对这些受者进行了分析。
患者和移植物存活率均为100%。急性排斥反应发生率为23.8%。8例患者发生巨细胞病毒血症，2例患者发生耶氏肺孢子菌感染，1例发生细菌性肺炎。2例患者移植后发生癌症并接受了根治性手术。
配偶供体的老年肾移植与年龄相关的免疫功能障碍有关，这可能会引发感染和恶性肿瘤，并可能因ABO血型不相容率高和组织相容性差而在免疫方面具有高风险。为获得良好的长期预后，可能需要努力将免疫抑制的不良影响降至最低，并降低急性排斥反应的风险。
