Yoo K D, An J N, Kim C T, Cho J H, Kim C D, Park S K, Chae D W, Oh Y K, Lim C S, Kim Y S, Kim Y H, Lee J P
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
Transplant Proc. 2015 Apr;47(3):600-7. doi: 10.1016/j.transproceed.2015.01.021.
The kidney transplantation rate in elderly patients is increasing rapidly. However, the clinical outcomes of kidney transplantation in elderly patients have not yet been thoroughly evaluated.
This multicenter cohort study included adult kidney transplant recipients (KTRs) admitted to five major tertiary hospitals in Korea between 1997 and 2012. A total of 3,565 adult participants were enrolled. Patient survival, allograft survival, and biopsy-proven acute rejection (BPAR) of 242 elderly recipients (≥ 60 years) were assessed and compared with those of a younger population.
Patients were divided into five groups according to age at time of transplantation. The proportion of elderly patients was 6.7 % (mean age, 63.1 ± 2.7 years; n = 242). The numbers of male patients (69.4%), those with diabetes mellitus history (36.3%), and those with pretransplantation ischemic heart disease history (17.7%) were significantly higher in the elderly group than in the younger age groups. Elderly patients were more likely to receive a cadaveric kidney, and overall mortality rates were significantly higher in the elderly patients (1-year survival 93.3%, 5-year survival 91.3%). However, death-censored allograft survival rate and BPAR were not affected by patient age (P = .104 and .501, respectively). Among the elderly, BPAR and female donors were independent risk factors for allograft loss.
The overall survival rate of the elderly KTRs was significantly lower than that of younger KTRs. However, the death-censored allograft survival rate did not differ between groups. Kidney transplantation should not be stagnated especially in elderly patients with end-stage renal disease.
老年患者的肾移植率正在迅速上升。然而，老年患者肾移植的临床结果尚未得到充分评估。
这项多中心队列研究纳入了1997年至2012年间入住韩国五家主要三级医院的成年肾移植受者（KTR）。共招募了3565名成年参与者。评估了242名老年受者（≥60岁）的患者生存率、移植肾生存率和活检证实的急性排斥反应（BPAR），并与年轻人群进行了比较。
根据移植时的年龄将患者分为五组。老年患者的比例为6.7%（平均年龄，63.1±2.7岁；n = 242）。老年组男性患者（69.4%）、有糖尿病病史的患者（36.3%）和移植前有缺血性心脏病病史的患者（17.7%）的数量明显高于年轻组。老年患者更有可能接受尸体肾，老年患者的总体死亡率明显更高（1年生存率93.3%，5年生存率91.3%）。然而，死亡校正后的移植肾生存率和BPAR不受患者年龄的影响（分别为P = 0.104和0.501）。在老年人中，BPAR和女性供体是移植肾丢失的独立危险因素。
老年KTR的总体生存率明显低于年轻KTR。然而，死亡校正后的移植肾生存率在各组之间没有差异。肾移植不应停滞不前，特别是对于患有终末期肾病的老年患者。
