Department of Organ Transplant Center, Kyungpook National University Hospital, Daegu, South Korea.
Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
Transplant Proc. 2020 Dec;52(10):3074-3079. doi: 10.1016/j.transproceed.2020.02.163. Epub 2020 Jun 26.
Donor-recipient age difference (DRAD) is one of the reasons why patients on kidney waiting lists refuse to receive the offered organ. However, its impact on deceased donor kidney transplantation (DDKT) outcomes is still controversial.
One hundred fifty-three kidney transplant recipients (KTRs) who received their first-time DDKT were enrolled. The KTRs were divided into groups by DRAD: group 1 (n = 74) (DRAD < 0) and group 2 (n = 79) (DRAD ≥ 0). The KTRs in group 2 were divided into 3 subgroups: DRAD 0 to 10 (n = 35), 10 to 20 (n = 32), and ≥ 20 (n = 12). The outcome measures included estimated glomerular filtration rate (eGFR), delayed graft function (DGF), acute rejection (AR), and graft and patient survival.
There were no significant differences in clinical outcomes between group 1 and 2 except eGFR until 5 years after DDKT. Among the subgroups of group 2, DGF, AR, patient survival, and eGFR until 5 years showed no significant differences. However, graft survival was significantly different (P = .015); in addition, in the DRAD ≥ 20 subgroup, graft survival decreased compared with that in the DRAD 10 to 20 subgroup and DRAD 0 to 10 subgroup (P = .020, P = .012, respectively). In a multivariate Cox proportional hazards analysis, the DRAD ≥ 20 subgroup showed a higher risk for graft failure than the DRAD 0 to 10 subgroup.
Although donors were of the same age or older than recipients, DDKT showed acceptable graft outcomes. However, because donors over 20 years older than recipients showed a decreased graft survival, it might be important to consider this point in donor-recipient matching of DDKT.
供受者年龄差异（DRAD）是导致肾脏等待名单上的患者拒绝接受所提供器官的原因之一。然而，其对已故供者肾移植（DDKT）结果的影响仍存在争议。
共纳入 153 例首次接受 DDKT 的肾移植受者（KTR）。根据 DRAD 将 KTR 分为两组：组 1（n=74）（DRAD＜0）和组 2（n=79）（DRAD≥0）。组 2 再分为 3 个亚组：DRAD 0 至 10（n=35）、10 至 20（n=32）和≥20（n=12）。观察终点包括估算肾小球滤过率（eGFR）、延迟肾功能恢复（DGF）、急性排斥反应（AR）以及移植物和患者存活率。
除 DDKT 后 5 年时 eGFR 外，组 1 和 2 之间的临床结局无显著差异。在组 2 的亚组中，DGF、AR、患者存活率以及 DDKT 后 5 年时的 eGFR 无显著差异。然而，移植物存活率存在显著差异（P=0.015）；此外，在 DRAD≥20 亚组中，与 DRAD 10 至 20 亚组和 DRAD 0 至 10 亚组相比，移植物存活率降低（P=0.020、P=0.012）。在多变量 Cox 比例风险分析中，DRAD≥20 亚组的移植物失败风险高于 DRAD 0 至 10 亚组。
尽管供者与受者年龄相同或更大，但 DDKT 显示出可接受的移植物结局。然而，由于供者比受者大 20 岁以上时移植物存活率降低，因此在 DDKT 的供受者匹配中考虑这一点可能很重要。
