Pérez-Sáez María José, Montero Núria, Redondo-Pachón Dolores, Crespo Marta, Pascual Julio
1 Department of Nephrology, Hospital del Mar, Barcelona, Spain. 2 Department of Nephrology, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain.
Transplantation. 2017 Apr;101(4):727-745. doi: 10.1097/TP.0000000000001635.
The old-for-old allocation policy used for kidney transplantation (KT) has confirmed the survival benefit compared to remaining listed on dialysis. Shortage of standard donors has stimulated the development of strategies aimed to expand acceptance criteria, particularly of kidneys from elderly donors. We have systematically reviewed the literature on those different strategies. In addition to the review of outcomes of expanded criteria donor or advanced age kidneys, we assessed the value of the Kidney Donor Profile Index policy, preimplantation biopsy, dual KT, machine perfusion and special immunosuppressive protocols. Survival and functional outcomes achieved with expanded criteria donor, high Kidney Donor Profile Index or advanced age kidneys are poorer than those with standard ones. Outcomes using advanced age brain-dead or cardiac-dead donor kidneys are similar. Preimplantation biopsies and related scores have been useful to predict function, but their applicability to transplant or refuse a kidney graft has probably been overestimated. Machine perfusion techniques have decreased delayed graft function and could improve graft survival. Investing 2 kidneys in 1 recipient does not make sense when a single KT would be enough, particularly in elderly recipients. Tailored immunosuppression when transplanting an old kidney may be useful, but no formal trials are available.Old donors constitute an enormous source of useful kidneys, but their retrieval in many countries is infrequent. The assumption of limited but precious functional expectancy for an old kidney and substantial reduction of discard rates should be generalized to mitigate these limitations.
肾移植（KT）采用的老年供肾分配政策已证实与继续接受透析相比具有生存获益。标准供体的短缺促使了旨在扩大接受标准的策略的发展，尤其是针对老年供肾。我们系统回顾了有关这些不同策略的文献。除了对扩大标准供体或高龄供肾的结果进行综述外，我们还评估了肾脏供体特征指数政策、植入前活检、双肾移植、机器灌注和特殊免疫抑制方案的价值。扩大标准供体、高肾脏供体特征指数或高龄供肾所获得的生存和功能结果比标准供肾的结果更差。使用高龄脑死亡或心脏死亡供肾的结果相似。植入前活检及相关评分有助于预测功能，但它们在移植或拒绝肾移植方面的适用性可能被高估了。机器灌注技术降低了移植肾功能延迟，并可能改善移植肾存活。当单肾移植就足够时，尤其是在老年受者中，给一名受者植入两个肾脏是没有意义的。移植老年供肾时采用个体化免疫抑制可能有用，但尚无正式试验。老年供体是有用肾脏的巨大来源，但在许多国家，获取老年供肾的情况并不常见。应普遍接受老年供肾功能预期有限但宝贵的观点，并大幅降低丢弃率，以减轻这些限制。
