Mehta Jaya, Ndubueze Okonkwo, Tatum Daniel, Jeon Hoonbae, Paramesh Anil, Killackey Mary, Vijay Adarsh
Transplant Surgery, Tulane University School of Medicine, New Orleans, USA.
Cureus. 2023 Jan 20;15(1):e34021. doi: 10.7759/cureus.34021. eCollection 2023 Jan.
Patients older than 70 years are the fastest-growing age group of patients requiring renal replacement therapy. This has resulted in a corresponding increase in the number of elderly transplant recipients. We hypothesized that graft survival in this population would be comparable to that seen in the literature on kidney transplant recipients under 70 years of age.
This was a retrospective, single-center review of outcomes of kidney transplant recipients aged ≥70 years. Patients were dichotomized based on whether their allograft originated from a living or deceased donor.
A total of 59 recipients aged ≥70 years underwent kidney transplantation. Of these, five (8.5%) were lost to follow-up within the first year post transplant and excluded from the analysis. History of cerebrovascular accident (p = 0.003), coronary artery disease (p = 0.03), postoperative return to the operating room (p = 0.03), and readmission within one year of transplant were predictive of graft loss (p = 0.003). Overall graft survival in our cohort declined from 92.6% at one year to 53.8% at five years. Death-censored graft survival was 100% at one year and decreased to 80.8% at five years. There were no differences seen in patient, graft, or death-censored graft survival based on donor type.
Kidney transplant patients over 70 years, as seen in our cohort, had good short-term outcomes. Graft survival is similar to rates seen in younger cohorts but the decline in this rate over time is steeper in the older age group, possibly due to decreased patient survival. These findings could be validated further in larger multi-center studies.
70岁以上的患者是需要肾脏替代治疗的患者中增长最快的年龄组。这导致老年移植受者的数量相应增加。我们假设该人群的移植物存活率与70岁以下肾移植受者的文献报道相当。
这是一项对年龄≥70岁的肾移植受者结局的回顾性单中心研究。根据同种异体移植物来自活体还是 deceased 供体将患者分为两组。
共有59名年龄≥70岁的受者接受了肾移植。其中，5名（8.5%）在移植后第一年内失访并被排除在分析之外。脑血管意外病史（p = 0.003）、冠状动脉疾病（p = 0.03）、术后返回手术室（p = 0.03）以及移植后一年内再次入院是移植物丢失的预测因素（p = 0.003）。我们队列中的总体移植物存活率从1年时的92.6%下降到5年时的53.8%。死亡校正后的移植物存活率在1年时为100%，在5年时降至80.8%。根据供体类型，患者、移植物或死亡校正后的移植物存活率没有差异。
如我们队列中所见，70岁以上的肾移植患者有良好的短期结局。移植物存活率与年轻队列相似，但随着时间的推移，该比率在老年组中的下降更为陡峭，可能是由于患者存活率降低。这些发现可在更大规模的多中心研究中进一步验证。
