Mesnard Benoit, Territo Angelo, Campi Riccardo, Hevia Vital, Andras Iulia, Piana Alberto, Pecoraro Alessio, Boissier Romain, Prudhomme Thomas
Department of Urology, Nantes Université, CHU Nantes, Nantes, France.
Uro-Oncology and Kidney Transplant Unit, Department of Urology at "Fundació Puigvert" Hospital, Autonoma University of Barcelona, Barcelona, Spain.
World J Urol. 2023 Mar;41(3):695-707. doi: 10.1007/s00345-023-04311-4. Epub 2023 Mar 13.
The incidence of kidney transplants from elderly donors over 70 years of age has increased significantly over the past 10 years to reach 20% of available kidney graft in some European countries. However, there is little data available on the outcomes of transplants from these donors. We performed a systematic review to evaluate the outcomes of transplantation from donors over 70 years of age.
A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline, Embase, and Cochrane databases were searched to identify all studies reporting outcomes on kidney transplants from donors over 70 years. Due to the heterogeneity of the studies, a meta-analysis could not be performed.
A total of 29,765 patients in 27 studies were included. The mean donors age was 74.79 years, and proportion of kidney graft from women was 53.54%. The estimated 1- and 5-year kidney death-censored graft survivals from donors > 70 years old were, respectively, 85.95 and 80.27%, and the patient survivals were 90.88 and 71.29%. The occurrence of delayed graft function was 41.75%, and primary non-function was 4.67%. Estimated graft function at 1 and 5 years was 36 and 38 mL/min/1.73 m. Paucity data were available on post-operative complications.
Elderly donors appear to be a reliable source of grafts. However, these transplants are associated with a high rate of delayed graft function without repercussion on long-term graft survival. Allocation strategy to elderly recipients is the main factor of decreased recipient survival.
在过去10年中，70岁以上老年供者的肾移植发生率显著增加，在一些欧洲国家已达到可用肾移植的20%。然而，关于这些供者肾移植结果的数据很少。我们进行了一项系统评价，以评估70岁以上供者的移植结果。
根据系统评价和Meta分析的首选报告项目进行系统评价。检索Medline、Embase和Cochrane数据库，以识别所有报告70岁以上供者肾移植结果的研究。由于研究的异质性，无法进行Meta分析。
共纳入27项研究中的29765例患者。供者平均年龄为74.79岁，女性肾移植比例为53.54%。70岁以上供者的1年和5年肾脏死亡截尾移植存活率分别为85.95%和80.27%，患者存活率分别为90.88%和71.29%。移植肾功能延迟发生率为41.75%，原发性无功能发生率为4.67%。1年和5年时的估计移植肾功能分别为36和38 mL/min/1.73m²。关于术后并发症的数据很少。
老年供者似乎是可靠的移植物来源。然而，这些移植与移植肾功能延迟的高发生率相关，对长期移植存活没有影响。分配给老年受者的策略是受者存活率降低的主要因素。
