年轻的已故供体肾脏在 20-50 岁的移植受者中比年龄较大的供体肾脏具有生存优势：来自 ERA-EDTA 登记处的一项研究。

Young deceased donor kidneys show a survival benefit over older donor kidneys in transplant recipients aged 20-50 years: a study by the ERA-EDTA Registry.

机构信息

ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

Department of Transplantation Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway.

出版信息

Nephrol Dial Transplant. 2020 Mar 1;35(3):534-543. doi: 10.1093/ndt/gfy268.

DOI:10.1093/ndt/gfy268

PMID:30203080

Abstract

BACKGROUND

Updated survival outcomes of young recipients receiving young or old deceased donor kidneys are required when considering accepting a deceased donor kidney.

METHODS

We examined outcomes in 6448 European kidney allografts donated from younger (≥20-<50 years) and older (≥50-<70 years) deceased donors when transplanted into very young (≥20-<35 years) or young (≥35-<50 years) adult recipients. Outcomes of first kidney transplantations during 2000-13 and followed-up to 2015 were determined via competing risk, restricted mean survival and Cox regression methods.

RESULTS

The 10-year cumulative incidence of graft failure was lowest in very young {22.0% [95% confidence interval (95% CI) 19.1-24.9]} and young [15.3% (95% CI 13.7-16.9)] recipients of younger donor kidneys and highest in very young [36.7% (95% CI 31.9-41.5)] and young [29.2% (95% CI 25.1-33.2)] recipients of older donor kidneys. At the 10-year follow-up, younger donor kidneys had a 1 year (very young) or 9 months (young) longer mean graft survival time compared with older donor kidneys. Graft failure risk in younger donor kidneys was 45% [very young adjusted hazard ratio (aHR) 0.55 (95% CI 0.44-0.68)] and 40% [young aHR 0.60 (95% CI 0.53-0.67)] lower compared with older donor kidneys. A 1-year increase in donor age resulted in a 2% [very young aHR 1.02 (95% CI 1.00-1.04)] or 1% [young aHR 1.01 (95% CI 1.00-1.01)] increase in the 10-year risk of death.

CONCLUSIONS

Younger donor kidneys show survival benefits over older donor kidneys in adult recipients ages 20-50 years. Updated survival outcomes from older deceased donors are necessary due to advances in transplantation medicine and the increasing role these donors play in organ transplantation.

摘要

背景

在考虑接受已故供体的肾脏时，需要更新年轻受者接受年轻或年老已故供体肾脏的生存结果。

方法

我们研究了在 2000 年至 2013 年期间进行的首次肾脏移植中，当将年轻（≥20-<50 岁）和老年（≥50-<70 岁）已故供体的肾脏移植到非常年轻（≥20-<35 岁）或年轻（≥35-<50 岁）的成年受者中时，年轻和老年供体的结局。通过竞争风险、限制平均生存和 Cox 回归方法确定了 2015 年随访时的结果。

结果

年轻供体肾脏在非常年轻（22.0%[95%可信区间（95%CI）19.1-24.9]）和年轻（15.3%[95%CI 13.7-16.9]）受者中的 10 年累积移植物失败发生率最低，而在非常年轻（36.7%[95%CI 31.9-41.5]）和年轻（29.2%[95%CI 25.1-33.2]）受者中的老年供体肾脏中最高。在 10 年的随访中，年轻供体肾脏的平均移植物存活时间比老年供体肾脏长 1 年（非常年轻）或 9 个月（年轻）。年轻供体肾脏的移植物失败风险比老年供体肾脏低 45%（非常年轻的调整危险比[aHR]0.55[95%CI 0.44-0.68]）和 40%（年轻 aHR 0.60[95%CI 0.53-0.67]）。供体年龄每增加 1 岁，非常年轻的 10 年死亡风险增加 2%（aHR 1.02[95%CI 1.00-1.04]），年轻的 10 年死亡风险增加 1%（aHR 1.01[95%CI 1.00-1.01]）。