老年人群肾移植结果：系统评价与荟萃分析
Kidney Transplant Outcomes in Elderly Population: A Systematic Review and Meta-analysis.
作者信息
Artiles Alberto, Domínguez Ana, Subiela José Daniel, Boissier Romain, Campi Riccardo, Prudhomme Thommas, Pecoraro Alessio, Breda Alberto, Burgos Francisco Javier, Territo Angelo, Hevia Vital
机构信息
Urology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid, Spain.
Aix-Marseille University, Marseille, France.
出版信息
Eur Urol Open Sci. 2023 Mar 22;51:13-25. doi: 10.1016/j.euros.2023.02.011. eCollection 2023 May.
CONTEXT
Owing to population ageing, a growing number of kidney transplants (KTs) in elderly population are being performed. KT is the best treatment for patients with end-stage renal disease (ESRD). However, in older patients, the decision between dialysis and KT can be difficult due to potential inferior outcomes. Few studies have been published addressing this issue, and literature outcomes are controversial.
OBJECTIVE
To conduct a systematic review and meta-analysis to appraise the evidence about outcomes of KT in elderly patients (>70 yr).
EVIDENCE ACQUISITION
A systematic review and meta-analysis (PROSPERO registration: CRD42022337038) was performed. Search was conducted on PubMed and LILACS databases. Comparative and noncomparative studies addressing outcomes (overall survival [OS], graft survival [GS], complications, delayed graft function [DGF], primary nonfunction, graft loss, estimated glomerular filtrate rate, or acute rejection) of KT in people older than 70 yr were included.
EVIDENCE SYNTHESIS
Of the 10 357 yielded articles, 19 met the inclusion criteria (18 observational studies, one prospective multicentre study, and no randomised controlled trials), enrolling a total of 293 501 KT patients. Comparative studies reporting enough quantitative data for target outcomes were combined. There were significant inferior 5-yr OS (relative risk [RR], 1.66; 95% confidence interval [CI], 1.18-2.35) and 5-yr GS in the elderly group (RR, 1.37; 95% CI, 1.14-1.65) to those in the <70-yr group. Short-term GS at 1 and 3 yr was similar between groups, and similar findings occurred with DGF, graft loss, and acute rejection rates. Few data about postoperative complications were reported.
CONCLUSIONS
Elderly recipients have worse OS at all time points and long-term GS compared with younger recipients (<70 yr). Postoperative complications were under-reported and could not be assessed. The DGF, acute rejection, death with functioning graft, and graft loss were not inferior in elderly recipients. Geriatric assessment in this setting might be useful for selecting better elderly candidates for KT.
PATIENT SUMMARY
Compared with younger population, kidney transplant in elderly patients has inferior patient and graft survival outcomes in the long term.
背景
由于人口老龄化，老年人群中进行的肾移植（KT）数量日益增加。肾移植是终末期肾病（ESRD）患者的最佳治疗方法。然而，对于老年患者，由于可能出现较差的预后，在透析和肾移植之间做出决定可能很困难。针对这一问题发表的研究很少，且文献结果存在争议。
目的
进行系统评价和荟萃分析，以评估老年患者（>70岁）肾移植预后的证据。
证据获取
进行了系统评价和荟萃分析（PROSPERO注册号：CRD42022337038）。在PubMed和LILACS数据库上进行了检索。纳入了关于70岁以上人群肾移植预后（总生存[OS]、移植物生存[GS]、并发症、移植肾功能延迟恢复[DGF]、原发性无功能、移植物丢失、估计肾小球滤过率或急性排斥反应）的比较性和非比较性研究。
证据综合
在检索出的10357篇文章中，19篇符合纳入标准（18项观察性研究、1项前瞻性多中心研究，无随机对照试验），共纳入293501例肾移植患者。对报告了足够目标预后定量数据的比较性研究进行了合并。老年组的5年总生存率（相对危险度[RR]，1.66；95%置信区间[CI]，1.18 - 2.35）和5年移植物生存率（RR，1.37；95%CI，1.14 - 1.65）显著低于70岁以下组。两组1年和3年的短期移植物生存率相似，移植肾功能延迟恢复、移植物丢失和急性排斥反应率也有类似结果。关于术后并发症的报道数据很少。
结论
与年轻受者（<70岁）相比，老年受者在所有时间点点点的总生存率和长期移植物生存率较差。术后并发症报告不足，无法进行评估。老年受者的移植肾功能延迟恢复、急性排斥反应、有功能移植物情况下的死亡和移植物丢失并不差。在这种情况下，老年评估可能有助于为肾移植选择更好的老年候选者。
患者总结
与年轻人群相比，老年患者肾移植的患者和移植物长期生存结果较差。
Zotero 插件