Rose Caren, Schaeffner Elke, Frei Ulrich, Gill Jagbir, Gill John S
Division of Nephrology, University of British Columbia, Vancouver, Canada;
Division of Nephrology, Charité University Medicine, Berlin, Germany;
J Am Soc Nephrol. 2015 Oct;26(10):2483-93. doi: 10.1681/ASN.2014080771. Epub 2015 Mar 26.
Strategies to increase expanded criteria donor (ECD) transplantation are needed. We quantified the extent to which ECD kidneys provide recipients with a lifetime of allograft function by determining the difference between patient survival and death-censored allograft survival (graft survival). Initial analyses compared 5-year outcomes in the Eurotransplant Senior Program (European) and the United States Renal Data System. Among European recipients ≥65 years, patient survival exceeded graft survival, and ECD recipients returned to dialysis for an average of 5.2 months after transplant failure. Among United States recipients ≥60 years, graft survival exceeded patient survival. Although patient survival in elderly recipients in the United States was low (49% at 5 years), the average difference in patient survival at 10 years in elderly recipients in the United States with an ECD versus non-ECD transplant was only 7 months. The probability of patient survival with a functioning allograft at 5 years was higher with ECD transplantation within 1 year after activation to the waiting list than with delayed non-ECD transplantation ≥3 years after activation to the waiting list. Subsequent analyses demonstrated that ECD transplants do not provide a lifetime of allograft function in recipients <50 years in the United States. These findings should encourage ECD transplantation in patients ≥60 years, demonstrate that rapid ECD transplantation is superior to delayed non-ECD transplantation, and challenge the policy in the United States of allowing patients <50 years to receive an ECD transplant.
需要采取策略来增加扩大标准供体（ECD）移植。我们通过确定患者生存率与死亡截尾的同种异体移植物生存率（移植物生存率）之间的差异，来量化ECD肾脏为受者提供终生同种异体移植物功能的程度。初步分析比较了欧洲移植高级计划（欧洲）和美国肾脏数据系统中的5年结局。在欧洲≥65岁的受者中，患者生存率超过了移植物生存率，ECD受者在移植失败后平均需要5.2个月恢复透析。在美国≥60岁的受者中，移植物生存率超过了患者生存率。尽管美国老年受者的患者生存率较低（5年时为49%），但接受ECD移植与非ECD移植的美国老年受者在10年时患者生存率的平均差异仅为7个月。在列入等待名单激活后1年内进行ECD移植的患者，其5年时拥有功能正常同种异体移植物的患者生存率高于列入等待名单激活后≥3年进行延迟非ECD移植的患者。后续分析表明，在美国<50岁的受者中，ECD移植并不能提供终生的同种异体移植物功能。这些发现应鼓励≥60岁的患者进行ECD移植，表明快速ECD移植优于延迟非ECD移植，并对美国允许<50岁的患者接受ECD移植的政策提出挑战。
