Laging Mirjam, Kal-van Gestel Judith A, Weimar Willem, Roodnat Joke I
Department of Internal Medicine, Section of Nephrology and Transplantation, Rotterdam Transplant Group, Erasmus MC, Rotterdam, the Netherlands.
Transplant Direct. 2019 Sep 27;5(10):e496. doi: 10.1097/TXD.0000000000000940. eCollection 2019 Oct.
Age criteria for kidney transplantation have been liberalized over the years resulting in more waitlisted elderly patients. What are the prospects of elderly patients on the waiting list?
Between 2000 and 2013, 2622 patients had been waitlisted. Waiting time was defined as the period between dialysis onset and being delisted. Patients were categorized according to age upon listing: <25; 25-44; 45-54; 55-64; and >64 years. Furthermore, the influence of ABO blood type and panel reactive antibodies on outflow patterns was studied.
At the end of observation (November 2017), 1957 (75%) patients had been transplanted, 333 (13%) had been delisted without a transplantation, 271 (10%) had died, and 61 (2%) were still waiting. When comparing the age categories, outflow patterns were completely different. The percentage of patients transplanted decreased with increasing age, while the percentage of patients that had been delisted or had died increased with increasing age, especially in the population without living donor. Within 6 years, 93% of the population <25 years had received a (primarily living) donor kidney. In the populations >55 years, 39% received a living donor kidney, while >50% of patients without a living donor had been delisted/died. Multivariable analysis showed that the influence of age, ABO blood type, and panel reactive antibodies on outflow patterns was significant, but the magnitude of the influence of the latter 2 was only modest compared with that of age.
"Elderly" (not only >64 y but even 55-64 y) received a living donor kidney transplantation less often. Moreover, they cannot bear the waiting time for a deceased donor kidney, resulting in delisting without a transplant in more than half the population of patients without a living donor. Promoting living donor kidney transplantation is the only modification that improves transplantation and decreases delisting/death on the waiting list in this population.
多年来，肾移植的年龄标准已经放宽，导致等待名单上的老年患者增多。等待名单上的老年患者前景如何？
2000年至2013年期间，有2622名患者被列入等待名单。等待时间定义为透析开始至被移除等待名单的时间段。患者根据列入等待名单时的年龄进行分类：<25岁；25 - 44岁；45 - 54岁；55 - 64岁；>64岁。此外，研究了ABO血型和群体反应性抗体对转出模式的影响。
在观察结束时（2017年11月），1957名（75%）患者接受了移植，333名（13%）未接受移植就被移除等待名单，271名（10%）死亡，61名（2%）仍在等待。比较不同年龄组时，转出模式完全不同。接受移植的患者百分比随年龄增长而下降，而被移除等待名单或死亡的患者百分比随年龄增长而增加，尤其是在没有活体供体的人群中。6年内，<25岁人群中93%接受了（主要是活体）供体肾移植。在>55岁的人群中，39%接受了活体供体肾移植，而超过50%没有活体供体的患者被移除等待名单/死亡。多变量分析表明，年龄、ABO血型和群体反应性抗体对转出模式有显著影响，但与年龄相比，后两者的影响程度较小。
“老年”患者（不仅>64岁，甚至55 - 64岁）接受活体供体肾移植的频率较低。此外，他们无法承受等待 deceased 供体肾的时间，导致超过一半没有活体供体的患者未接受移植就被移除等待名单。促进活体供体肾移植是改善该人群移植情况并减少等待名单上被移除/死亡情况的唯一改进措施。
