Programa de Prevención y Tratamiento de las Glomerulopatías, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
Department of Nephrology, Hospital Evangélico, Montevideo, Uruguay.
Nephrol Dial Transplant. 2020 Apr 1;35(4):687-696. doi: 10.1093/ndt/gfz293.
Advances in life expectancy have led to an increase in the number of elderly people with end-stage renal disease (ESRD). Scarce information is available on the outcomes of kidney transplantation (KT) in extremely elderly patients based on an allocation policy prioritizing donor-recipient age matching.
We included recipients ≥75 years that underwent KT from similarly aged deceased donors at our institution between 2002 and 2015. Determinants of death-censored graft and patient survival were assessed by Cox regression.
We included 138 recipients with a median follow-up of 38.8 months. Median (interquartile range) age of recipients and donors was 77.5 (76.3-79.7) and 77.0 years (74.7-79.0), with 22.5% of donors ≥80 years. Primary graft non-function occurred in 8.0% (11/138) of patients. Cumulative incidence rates for post-transplant infection and biopsy-proven acute rejection (BPAR) were 70.3% (97/138) and 15.2% (21/138), respectively. One- and 5-year patient survival were 82.1 and 60.1%, respectively, whereas the corresponding rates for death-censored graft survival were 95.6 and 93.1%. Infection was the leading cause of death (46.0% of fatal cases). The occurrence of BPAR was associated with lower 1-year patient survival [hazard ratio (HR) = 4.21, 95% confidence interval (CI) 1.64-10.82; P = 0.003]. Diabetic nephropathy was the only factor predicting 5-year death-censored graft survival (HR = 4.82, 95% CI 1.08-21.56; P = 0.040).
ESRD patients ≥75 years can access KT and remain dialysis free for their remaining lifespan by using grafts from extremely aged deceased donors, yielding encouraging results in terms of recipient and graft survival.
预期寿命的提高导致终末期肾病（ESRD）老年患者人数增加。根据优先考虑供受者年龄匹配的分配政策，关于极其高龄患者肾移植（KT）结局的信息很少。
我们纳入了 2002 年至 2015 年在我们机构接受来自同龄已故供者的 KT 的年龄≥75 岁的受者。通过 Cox 回归评估死亡风险调整移植物和患者存活率的决定因素。
我们纳入了 138 例中位随访 38.8 个月的受者。受者和供者的中位（四分位间距）年龄为 77.5（76.3-79.7）和 77.0 岁（74.7-79.0），22.5%的供者≥80 岁。8.0%（11/138）的患者发生原发性移植物无功能。移植后感染和经活检证实的急性排斥反应（BPAR）的累积发生率分别为 70.3%（97/138）和 15.2%（21/138）。1 年和 5 年的患者存活率分别为 82.1%和 60.1%，而相应的死亡风险调整移植物存活率分别为 95.6%和 93.1%。感染是死亡的主要原因（46.0%的死亡病例）。BPAR 的发生与 1 年患者存活率降低相关[风险比（HR）=4.21，95%置信区间（CI）1.64-10.82；P=0.003]。糖尿病肾病是预测 5 年死亡风险调整移植物存活率的唯一因素（HR=4.82，95%CI 1.08-21.56；P=0.040）。
年龄≥75 岁的 ESRD 患者可以通过使用来自极其高龄已故供者的移植物进行 KT，并在其剩余的寿命内保持无透析状态，从而在受者和移植物存活率方面获得令人鼓舞的结果。
