Jay Colleen L, Washburn Kenneth, Dean Patrick G, Helmick Ryan A, Pugh Jacqueline A, Stegall Mark D
1 Transplant Center, University of Texas Health Science Center, San Antonio, TX. 2 Division of Transplant Surgery, Mayo Clinic, Rochester, MN. 3 Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, TN. 4 South Texas Veterans Health Care System, San Antonio, TX. 5 Division of Hospital Medicine, University of Texas Health Science Center, San Antonio, TX.
Transplantation. 2017 Apr;101(4):867-872. doi: 10.1097/TP.0000000000001405.
Given high dialysis mortality rates for patients older than 60 years, accepting a kidney with a high Kidney Donor Profile Index (KDPI) score could enable earlier and potentially preemptive transplantation (preKT). However, evidence regarding the risks of high KDPI allografts in older patients is limited. Our objective was to determine the relative benefit for older patients of KDPI greater than 85% transplant either preemptively or not compared with remaining on the waitlist.
United Network of Organ Sharing data from 2003 to 2012 for adult deceased donor kidney transplant candidates was analyzed to evaluate patient survival in patients older than 60 years for preKT and non-preKT KDPI greater than 85% transplants compared with candidates remaining on the waitlist including patients who received KDPI 0% to 85% transplants according to multivariate Cox regression models.
In the first year posttransplant for KDPI greater than 85% of transplants in recipients older than 60 years, preKT had a reduced mortality hazard (hazards ratio [HR], 0.61; 95% confidence interval [95% CI], 0.41-0.90) and non-preKT an increased mortality hazard (HR, 1.15; 95% CI, 1.03-1.27) compared with the waitlist including KDPI 0% to 85% transplant recipients. At 1 to 2 years and after 2 years, both KDPI greater than 85% groups had significant reductions in mortality (1-2 years: preKT HR, 0.38; 95% CI, [0.23-0.60] and non-preKT HR, 0.52; 95% CI, 0.45-0.61; and 2+ years: preKT HR, 0.50; 95% CI, 0.38-0.66 and non-preKT HR, 0.64; 95% CI, 0.58-0.70, respectively).
PreKT and non-preKT KDPI greater than 85% transplant was associated with lower mortality hazard after the first year compared with the waitlist including KDPI 0% to 85% transplants in patients older than 60 years. Further consideration should be given to increased utilization of high KDPI grafts in older patients with the goal of avoiding or limiting time on dialysis.
鉴于60岁以上患者的透析死亡率较高，接受肾脏捐赠者风险指数（KDPI）评分较高的肾脏可实现更早且可能是抢先性的移植（preKT）。然而，关于老年患者中高KDPI同种异体移植物风险的证据有限。我们的目标是确定与继续留在等待名单上相比，KDPI大于85%的移植对老年患者进行抢先或非抢先移植的相对益处。
分析器官共享联合网络2003年至2012年成人已故捐赠者肾脏移植候选者的数据，以评估60岁以上患者中，与继续留在等待名单上的候选者（包括接受KDPI 0%至85%移植的患者）相比，preKT和非preKT的KDPI大于85%移植患者的生存情况，采用多变量Cox回归模型。
在60岁以上接受者中，KDPI大于85%的移植术后第一年，与包括KDPI 0%至85%移植受者的等待名单相比，preKT的死亡风险降低（风险比[HR]，0.61；95%置信区间[95%CI]，0.41 - 0.90），非preKT的死亡风险增加（HR，1.15；95%CI，1.03 - 1.27）。在1至2年以及2年后，KDPI大于85%的两组患者死亡率均显著降低（1 - 2年：preKT HR，0.38；95%CI，[0.23 - 0.60]，非preKT HR，0.52；95%CI，0.45 - 0.61；2年以上：preKT HR，0.50；95%CI，0.38 - 0.66，非preKT HR，0.64；95%CI，0.58 - 0.70）。
与包括KDPI 0%至85%移植的等待名单相比，60岁以上患者中，KDPI大于85%的preKT和非preKT移植在术后第一年与较低的死亡风险相关。应进一步考虑增加老年患者中高KDPI移植物的利用率，以避免或减少透析时间。
