Department of Pediatrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
University of Oslo, Oslo, Norway.
Pediatr Transplant. 2020 Sep;24(6):e13751. doi: 10.1111/petr.13751. Epub 2020 Jun 2.
Living donors (LDs) are preferred over DDs for renal transplantation in children due to superior GS. Oslo University Hospital has never restricted living donation by upper age. The aim of this study was to investigate long-term outcomes using grandparents (GPLD) compared to PLD. Retrospective nationwide review in the period 1970-2017. First renal graft recipients using a GPLD were compared to PLD kidney recipients for long-term renal function and GS. 278 children (≤18 years) received a first renal transplant: 27/251 recipients with a GPLD/PLD. GPLD (median 59 (42-74) years) were significantly older than PLD (median 41 (23-65) years, (P < .001). Median DRAD was 52 (38-70) vs 28 (17-48) years, respectively. GS from GPLD and PLD had a 1-, 5-, and 10-year survival of 100%, 100%, and 90% vs 93%, 82%, and 72%, respectively (P = .6). In a multivariate Cox regression analysis adjusted for gender, donor age, recipient age, and year of transplant, this finding was similar (HR 0.98; 95% CI 0.34-2.84, P = .97). Five-year eGFR was 47.3 and 59.5 mL/min/1.73 m in the GPLD and PLD groups (P = .028), respectively. In this nationwide retrospective analysis, GS for pediatric renal recipients using GPLD was comparable to PLD. Renal function assessed as eGFR was lower in the GPLD group. The GPLD group was significantly older than the PLD group, but overall this did not impact transplant outcome. Based on these findings, older age alone should not exclude grandparent donations.
在儿童肾移植中，由于更好的 GS，活体供者（LDs）优于尸体供者（DDs）。奥斯陆大学医院从未对活体捐赠的年龄上限进行限制。本研究的目的是比较使用（外）祖父母（GPLD）与 PLD 的长期结果。在 1970 年至 2017 年期间，进行了一项全国性的回顾性研究。将使用 GPLD 的首例肾移植受者与 PLD 肾移植受者进行比较，以评估长期肾功能和 GS。278 名（≤18 岁）儿童接受了首次肾移植：27/251 名受者接受了 GPLD/PLD 肾移植。GPLD（中位数 59（42-74）岁）明显比 PLD（中位数 41（23-65）岁）年长（P<.001）。GPLD 和 PLD 的平均 DRAD 分别为 52（38-70）和 28（17-48）年。GPLD 和 PLD 的 1、5 和 10 年生存率分别为 100%、100%和 90%和 93%、82%和 72%（P=.6）。在调整性别、供者年龄、受者年龄和移植年份的多变量 Cox 回归分析中，这一发现相似（HR 0.98；95%CI 0.34-2.84，P=.97）。GPLD 和 PLD 组的 5 年 eGFR 分别为 47.3 和 59.5 mL/min/1.73 m（P=.028）。在这项全国性的回顾性分析中，使用 GPLD 的儿科肾移植受者的 GS 与 PLD 相当。eGFR 评估的肾功能在 GPLD 组较低。GPLD 组比 PLD 组明显年长，但总体而言，这并未影响移植结果。基于这些发现，仅年龄较大不应排除（外）祖父母的捐赠。
