2010 年改变分配标准后 Eurotransplant 高级项目中肾移植存活率的比较：单中心经验。

Comparison of kidney allograft survival in the Eurotransplant senior program after changing the allocation criteria in 2010-A single center experience.

机构信息

Department of General, Visceral and Transplant Surgery, Münster University Hospital, Münster, Germany.

Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, Münster University Hospital, Münster, Germany.

出版信息

PLoS One. 2020 Jul 23;15(7):e0235680. doi: 10.1371/journal.pone.0235680. eCollection 2020.

DOI:10.1371/journal.pone.0235680

PMID:32702005

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7377418/

Abstract

AIMS

The European Senior Program (ESP) aims to avoid waiting list competition between younger and elderly patients applying for renal transplantation. By listing patients ≥65 years on a separate waiting list and locally allocating of grafts ≥65 years exclusively to this cohort, waiting and cold ischemia times are predicted to be shortened, potentially resulting in improved kidney transplantation outcomes. This study compared a historic cohort of renal transplant recipients being simultaneously listed on the general and the ESP waiting lists with a collective exclusively listed on the ESP list in terms of surrogates of the transplantation outcome.

METHODS

Total 151 eligible patients ≥ 65 years from Münster transplant Center, Germany, between 1999 and 2014 were included. Graft function, graft and patient survival were compared using surrogate markers of short- and long-term graft function. Patients were grouped according to their time of transplantation.

RESULTS

Recipients and donors in the newESP (nESP) cohort were significantly older (69.6 ± 3.5 years vs 67.1 ± 2 years, p<0.05; 72.0 ± 5.0 years vs 70.3 ± 5.0 years, p = 0.039), had significantly shorter dialysis vintage (19.6 ± 21.7 months vs 60.2 ± 28.1 months, p<0.001) and suffered from significantly more comorbidities (2.2 ± 0.9 vs 1.8 ± 0.8, p = 0.009) than the historic cohort (HC). Five-year death-censored graft survival was better than in the HC, but 5-year graft and patient survival were better in the ESP cohort. After 2005, cold ischemia time between groups was comparable. nESP grafts showed more primary function and significantly better long-term graft function 18 months after transplantation and onwards.

CONCLUSION

nESP recipients received significantly older grafts, but experienced significantly shorter time on dialysis. Cold ischemia times were comparable, but graft function in the nESP cohort was significantly better in the long term.

摘要

目的

欧洲老年人计划（ESP）旨在避免年轻患者和老年患者在申请肾移植时的等待名单竞争。通过将≥65 岁的患者列入单独的等待名单，并将≥65 岁的移植物在当地专门分配给该队列，预计等待时间和冷缺血时间将缩短，从而潜在地改善肾移植结果。本研究比较了同时在一般等待名单和 ESP 等待名单上登记的一组肾移植受者与专门在 ESP 名单上登记的一组受者在移植结果的替代指标方面的情况。

方法

共纳入德国明斯特移植中心 1999 年至 2014 年间的 151 名符合条件的≥65 岁患者。使用短期和长期移植物功能的替代标志物比较移植物功能、移植物和患者存活率。根据移植时间对患者进行分组。

结果

新 ESP（nESP）队列的受者和供者年龄明显较大（69.6±3.5 岁比 67.1±2 岁，p<0.05；72.0±5.0 岁比 70.3±5.0 岁，p=0.039），透析时间明显较短（19.6±21.7 个月比 60.2±28.1 个月，p<0.001），合并症明显更多（2.2±0.9 比 1.8±0.8，p=0.009），比历史队列（HC）。5 年死亡无移植失败生存率优于 HC，但 5 年移植和患者生存率优于 ESP 队列。2005 年后，两组之间的冷缺血时间相当。nESP 移植物在移植后 18 个月及以后具有更高的初始功能，且长期移植物功能明显更好。