Jacobi Johannes, Beckmann Sophie, Heller Katharina, Hilgers Karl F, Apel Hendrik, Spriewald Bernd, Eckardt Kai-Uwe, Amann Kerstin U
Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Department of Urology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Ann Transplant. 2016 Feb 11;21:94-104. doi: 10.12659/aot.895731.
The aim of this study was to evaluate the outcome after transplantation of deceased allografts in donor/recipient pairs aged ≥65 years enrolled in the Eurotransplant Senior Program (ESP).
In this retrospective cohort study we evaluated data from 89 patients transplanted under the ESP protocol from 2008 to 2013. Outcome parameters included graft and patient survival, rate of biopsy-proven acute rejections (BPAR), peri- and post-operative complications, tumor development, development of donor-specific antibodies (DSA), and the prognostic role of preimplantation biopsies.
One-year patient and allograft survival rates were 92.1% and 84.3%, respectively. During follow-up, 23 (26%) patients died; the major cause of death was sepsis, followed by cardiovascular events and malignancies. BPAR episodes were frequent within the first year (~33%) and overall were less common in patients treated with tacrolimus. Post-transplant malignancies were seen in 15 (17%) patients. During follow-up, 16 (18%) patients developed DSA; patients with delayed graft function (DGF) were more likely to develop DSA (p=0.029). A higher preimplantation biopsy score was associated with DGF but did not predict later graft outcome.
The results highlight increased risks in ESP transplant candidates and the importance of careful surveillance of this patient group.
本研究旨在评估纳入欧洲移植老年项目（ESP）的65岁及以上供体/受体对中， deceased同种异体移植物移植后的结果。
在这项回顾性队列研究中，我们评估了2008年至2013年根据ESP方案进行移植的89例患者的数据。结果参数包括移植物和患者生存率、活检证实的急性排斥反应（BPAR）发生率、围手术期和术后并发症、肿瘤发生、供体特异性抗体（DSA）的产生以及植入前活检的预后作用。
1年患者和移植物生存率分别为92.1%和84.3%。在随访期间，23例（26%）患者死亡；主要死亡原因是败血症, 其次是心血管事件和恶性肿瘤。BPAR事件在第一年较为频繁（约33%），总体上在接受他克莫司治疗的患者中较少见。15例（17%）患者出现移植后恶性肿瘤。在随访期间，16例（18%）患者产生了DSA；移植肾功能延迟（DGF）的患者更有可能产生DSA（p=0.029）。植入前活检评分较高与DGF相关，但不能预测后期移植物结果。
结果突出了ESP移植候选者中增加的风险以及对该患者群体进行仔细监测的重要性。
