60 岁以上合并症较高的患者的肾脏移植。是否有生存获益？阿根廷的一项多中心研究。

Renal Transplantation in Patients Older Than 60 Years With High Comorbidity. Is There a Survival Benefit? A Multicenter Study in Argentina.

机构信息

Nefrología y Trasplante renal, Hospital Universitario Austral, Buenos Aires, Argentina.

Sección Nefrología, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno", Buenos Aires, Argentina.

出版信息

Transplantation. 2020 Aug;104(8):1746-1751. doi: 10.1097/TP.0000000000003070.

DOI:10.1097/TP.0000000000003070

PMID:32732855

Abstract

BACKGROUND

The impact of renal transplantation (RT) in the elderly with many comorbid conditions is a matter of concern. The aim of our study was to assess the impact of RT on the survival of patients older than 60 years compared with those remaining on the waiting list (WL) according to their comorbidities.

METHODS

In this multicentric observational retrospective cohort study, we included all patients older than 60 years old admitted on the WL from 01 January 2006 to 31 December 2016. The Charlson comorbidity index (CCI) score was calculated for each patient at inclusion on the WL. Kidney donor risk index was used to assess donor characteristics.

RESULTS

One thousand and thirty-six patients were included on the WL of which 371 (36%) received an RT during a median follow-up period of 2.5 (1.4-4.1) years. Patient survival was higher after RT compared to patients remaining on the WL, 87%, 80%, and 72% versus 87%, 55%, and 30% at 1, 3, and 5 years, respectively. After RT survival at 5 years was 37% higher for patients with CCI ≥ 3, and 46% higher in those with CCI < 3, compared with patients remaining on the WL. On univariate and multivariate analysis, patient survival was independently associated with a CCI of ≥3 (hazard ratio 1.62; confidence interval 1.09-2.41; P < 0.02) and the use of calcineurin-based therapy maintenance therapy (hazard ratio 0.53; confidence interval 0.34-0.82; P < 0.004).

CONCLUSIONS

Our study showed that RT improved survival in patients older than 60 years even those with high comorbidities. The survival after transplantation was also affected by comorbidities.

摘要

背景

在患有多种合并症的老年患者中进行肾移植（RT）的影响是一个值得关注的问题。我们的研究目的是评估根据合并症，与继续留在等待名单（WL）上的患者相比，RT 对 60 岁以上患者的生存影响。

方法

在这项多中心观察性回顾性队列研究中，我们纳入了所有在 2006 年 1 月 1 日至 2016 年 12 月 31 日期间列入 WL 的 60 岁以上患者。在列入 WL 时，每位患者的 Charlson 合并症指数（CCI）评分均进行了计算。使用供体风险指数评估供体特征。

结果

1036 名患者列入 WL，其中 371 名（36%）在中位随访 2.5（1.4-4.1）年后接受了 RT。与继续留在 WL 的患者相比，接受 RT 的患者的生存率更高，分别为 87%、80%和 72%，1、3 和 5 年时分别为 87%、55%和 30%。在 RT 后，CCI≥3 的患者 5 年生存率提高了 37%，CCI<3 的患者提高了 46%，而继续留在 WL 的患者生存率则分别为 55%和 30%。在单因素和多因素分析中，患者的生存率与 CCI≥3（危险比 1.62；95%置信区间 1.09-2.41；P<0.02）和使用钙调神经磷酸酶抑制剂维持治疗（危险比 0.53；95%置信区间 0.34-0.82；P<0.004）独立相关。