So Sarah, Au Eric H K, Lim Wai H, Lee Vincent W S, Wong Germaine
Department of Renal Medicine, Westmead Hospital, Sydney, Australia.
School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Kidney Int Rep. 2020 Dec 13;6(3):727-736. doi: 10.1016/j.ekir.2020.11.035. eCollection 2021 Mar.
Individuals aged ≥65 years are increasingly prevalent on the waitlist for kidney transplantation, yet evidence on recipient and donor factors that define optimal outcomes in elderly patients after kidney transplantation is scarce.
We used multivariable Cox regression modeling to determine the factors associated with all-cause death, death with a functioning graft, and overall and death-censored graft survival, using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry.
A total of 802 kidney transplant recipients aged ≥65 years underwent their first transplantation between June 2006 and December 2016. Median age at transplantation was 68 years (interquartile range = 66-69 years). The 1-year and 5-year overall patient and graft survivals (95% confidence interval [CI]) were 95.1 (93.5-96.7) and 79.0 (75.1-82.9), and 92.9 (91.1-94.7) and 75.4 (71.3-79.5), respectively. Factors associated with higher risks of all-cause death included prevalent coronary artery disease (adjusted hazard ratio [95% confidence interval] = 1.47 [1.03-2.11]), cerebrovascular disease (1.99 [1.26-3.16]), increasing graft ischemic time (1.06 per hour [1.03-1.09]), donor age (1.02 per year [1.01-1.03]), delayed graft function (1.64 [1.13-2.39]), and peritoneal dialysis pretransplantation (1.71 [1.17-2.51]).
Prevalent vascular disease and peritoneal dialysis as a pretransplantation dialysis modality are risk factors associated with poorer outcomes in transplant recipients aged ≥65 years. Careful selection and evaluation of potential candidates may improve graft and patient outcomes in older patients.
65岁及以上的个体在肾脏移植等待名单上的比例越来越高，但关于确定老年患者肾移植后最佳结局的受者和供者因素的证据却很少。
我们使用多变量Cox回归模型，利用澳大利亚和新西兰透析与移植（ANZDATA）登记处的数据，确定与全因死亡、移植肾功能存活时死亡以及总体和死亡删失的移植物存活相关的因素。
2006年6月至2016年12月期间，共有802名65岁及以上的肾移植受者接受了首次移植。移植时的中位年龄为68岁（四分位间距=66 - 69岁）。1年和5年的总体患者及移植物存活率（95%置信区间[CI]）分别为95.1（93.5 - 96.7）和79.0（75.1 - 82.9），以及92.9（91.1 - 94.7）和75.4（71.3 - 79.5）。与全因死亡风险较高相关的因素包括冠心病（校正风险比[95%置信区间]=1.47[1.03 - 2.11]）、脑血管疾病（1.99[1.26 - 3.16]）、移植物缺血时间增加（每小时1.06[1.03 - 1.09]）、供者年龄（每年1.02[1.01 - 1.03]）、移植肾功能延迟（1.64[1.
