Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Department of Transfusion Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
Nephrol Dial Transplant. 2016 Dec;31(12):2143-2149. doi: 10.1093/ndt/gfw248. Epub 2016 Jul 1.
The Eurotransplant Senior Program (ESP) neglects HLA matching for elderly (≥65 years) kidney transplant recipients (KTR). Few data regarding the influence of DR matching on clinical and immunologic outcome in elderly KTR exist.
This retrospective long-term observational study included 244 elderly out of n = 972 adult KTR between 2004 and 2014. Data analysis included patient and graft survival, biopsy-proven rejections [T-cell-mediated rejections (TCMR) and antibody-mediated rejections] and development of de novo donor-specific HLA antibodies (DSA). Outcome data were assessed over a maximum period of 10 years.
Due to the nature of the ESP, elderly KTR showed significantly more HLA mismatches, shorter time on dialysis and shorter cold ischaemia time. Elderly KTR had significantly worse graft and patient survival, and after 7 years, the rate of de novo DSA (33 versus 25%, P = 0.034) and TCMR (39 versus 27%, P < 0.001) was significantly higher compared with younger KTR. Multivariate analysis identified donor age, delayed graft function and HLA-DR mismatches as independent risk factors for TCMR. Within the group of elderly KTR, HLA-DR mismatches were associated with a significantly higher incidence of TCMR and development of de novo DSA. Occurrence of TCMR and de novo DSA in elderly KTR resulted in significantly worse graft survival.
In elderly KTR, HLA-DR mismatches are independent risk factors for TCMR and the development of all classes of de novo DSA, both of which significantly impair graft survival. Introduction of HLA-DR matching in elderly KTR might significantly improve immunologic and overall outcome.
欧洲器官移植协会老年人计划（ESP）忽视了老年（≥65 岁）肾移植受者（KTR）的 HLA 配型。关于 HLA-DR 配型对老年 KTR 的临床和免疫结果的影响的数据很少。
本回顾性长期观察性研究纳入了 2004 年至 2014 年间 972 例成人 KTR 中的 244 例老年患者。数据分析包括患者和移植物存活率、活检证实的排斥反应（T 细胞介导的排斥反应（TCMR）和抗体介导的排斥反应）以及新出现的供体特异性 HLA 抗体（DSA）的发展。在最长 10 年的时间内评估结果数据。
由于 ESP 的性质，老年 KTR 表现出明显更多的 HLA 错配、更短的透析时间和更短的冷缺血时间。老年 KTR 的移植物和患者存活率明显较差，并且在 7 年后，新出现的 DSA（33%比 25%，P = 0.034）和 TCMR（39%比 27%，P < 0.001）的发生率明显高于年轻 KTR。多变量分析确定供体年龄、延迟移植物功能和 HLA-DR 错配是 TCMR 的独立危险因素。在老年 KTR 组中，HLA-DR 错配与 TCMR 和新出现的 DSA 的发生率显著相关。老年 KTR 中 TCMR 和新出现的 DSA 的发生导致移植物存活率显著下降。
在老年 KTR 中，HLA-DR 错配是 TCMR 和所有新出现的 DSA 类别的独立危险因素，这两者都显著损害移植物存活率。在老年 KTR 中引入 HLA-DR 配型可能会显著改善免疫和整体结果。
