Renal Transplant Center "A. Vercellone," Nephrology, Dialysis and Renal Transplant Division, "Città della Salute e della Scienza di Torino" University Hospital, Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy; and.
Immunogenetics and Transplant Biology Service, "Città della Salute e della Scienza di Torino," Department of Medical Sciences, University of Turin, Turin, Italy.
Clin J Am Soc Nephrol. 2017 Feb 7;12(2):323-331. doi: 10.2215/CJN.06550616. Epub 2016 Dec 15.
Extended criteria donors represent nowadays a main resource for kidney transplantation, and recovery criteria are becoming increasingly inclusive. However, the limits of this approach are not clear as well as the effects of extreme donor ages on long-term kidney transplantation outcomes. To address these issues, we performed a retrospective study on extended criteria donor kidney transplantation.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 647 consecutive extended criteria donor kidney transplantations performed over 11 years (2003-2013) were included. Donor, recipient, and procedural variables were classified according to donor age decades (group A, 50-59 years old [n=91]; group B, 60-69 years old [n=264]; group C, 70-79 years old [n=265]; and group D, ≥80 years old [n=27]). Organs were allocated in single- or dual-kidney transplantation after a multistep evaluation including clinical and histologic criteria. Long-term outcomes and main adverse events were analyzed among age groups and in either single- or dual-kidney transplantation. Kidney discard rate incidence and causes were evaluated.
Median follow-up was 4.9 years (25th; 75th percentiles: 2.7; 7.6 years); patient and graft survival were comparable among age groups (5-year patient survival: group A, 87.8%; group B, 88.1%; group C, 88.0%; and group D, 90.1%; P=0.77; graft survival: group A, 74.0%; group B, 74.2%; group C, 75.2%; and group D, 65.9%; P=0.62) and between dual-kidney transplantation and single-kidney transplantation except for group D, with a better survival for dual-kidney transplantation (P=0.04). No difference was found analyzing complications incidence or graft function over time. Kidney discard rate was similar in groups A, B, and C (15.4%, 17.7%, and 20.1%, respectively) and increased in group D (48.2%; odds ratio, 5.1 with A as the reference group; 95% confidence interval, 2.96 to 8.79).
Discard rate and long-term outcomes are similar among extended criteria donor kidney transplantation from donors ages 50-79 years old. Conversely, discard rate was strikingly higher among kidneys from octogenarian donors, but appropriate selection provides comparable long-term outcomes, with better graft survival for dual-kidney transplantation.
扩展标准供体目前是肾移植的主要来源，而恢复标准也变得越来越具包容性。然而，这种方法的局限性尚不清楚，极端供体年龄对长期肾移植结果的影响也不清楚。为了解决这些问题，我们对扩展标准供体肾移植进行了回顾性研究。
设计、设置、参与者和测量：共纳入 647 例连续接受扩展标准供体肾移植的患者，时间跨度为 11 年（2003-2013 年）。根据供体年龄（A 组：50-59 岁[91 例]；B 组：60-69 岁[264 例]；C 组：70-79 岁[265 例]；D 组：≥80 岁[27 例]）对供体、受者和手术变量进行分类。在多步评估后，器官被分配用于单器官或双器官移植，包括临床和组织学标准。在年龄组和单器官或双器官移植中分析了长期结果和主要不良事件。评估了器官废弃率的发生率和原因。
中位随访时间为 4.9 年（25 分位；75 分位：2.7；7.6 年）；各年龄组患者和移植物存活率相当（5 年患者存活率：A 组 87.8%；B 组 88.1%；C 组 88.0%；D 组 90.1%；P=0.77；移植物存活率：A 组 74.0%；B 组 74.2%；C 组 75.2%；D 组 65.9%；P=0.62），且双器官移植和单器官移植之间除 D 组外无差异，双器官移植的存活率更高（P=0.04）。分析并发症发生率或随时间推移的移植物功能时未发现差异。A、B 和 C 组的器官废弃率相似（分别为 15.4%、17.7%和 20.1%），而 D 组增加至 48.2%（与 A 组相比，优势比为 5.1；95%置信区间为 2.96 至 8.79）。
50-79 岁扩展标准供体肾移植的废弃率和长期结果相似。相反，来自 80 岁以上供体的器官废弃率明显更高，但适当的选择可提供可比的长期结果，双器官移植的移植物存活率更高。
