Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.
HLA-Diagnostic and lmmunogenetics, Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland.
Swiss Med Wkly. 2023 Aug 9;153:40098. doi: 10.57187/smw.2023.40098.
Addressing the current demographic development, the efficacy and safety of kidney transplantations from very senior donors needs to be carefully evaluated. The aim of this study was to analyse patient and graft outcomes of kidney allograft recipients stratified by donor age.
We retrospectively investigated n = 491 patients from a prospective, observational renal transplant cohort. Patients with kidneys from very old donors (n = 75, aged >70 years), elderly donors (n = 158, between 60-70 years), and regular donors (n = 258, aged <60 years) were investigated. The primary outcome was death-censored graft survival within the predefined donor age groups.
Overall, n = 57 death-censored graft losses occurred. Graft loss was proportionally highest in the very old donor group (n = 11/75), but this did not reach statistical significance when compared to the elderly (14/158) and regular donor groups (32/258); (p = 0.37). Kaplan-Meier analysis demonstrated that 3-year/5-year death-censored graft survival in the very old donor group was 96%/86% and did not differ from the other age groups (p = 0.44). Median estimated glomerular filtration rate (eGFR), calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula (in ml/min/1.73 m2 of body surface) 12 months post-transplant did not differ between the elderly donor and very old donor groups (p = 0.53). However, patients who received regular donor kidneys had higher median eGFR compared to recipients in both the elderly and very old donor groups (p <0.0001). During follow-up, 31% of patients developed at least one acute rejection episode. Time-to-event analysis demonstrated no difference in occurrence of any acute rejection event across all three groups (p = 0.11).
This study demonstrates that kidney transplantation from carefully selected very old donors seems a valid option with reasonable short- and mid-term outcomes.
为应对当前的人口发展趋势，需要仔细评估来自非常高龄供体的肾脏移植的疗效和安全性。本研究旨在分析按供体年龄分层的肾移植受者的患者和移植物结局。
我们回顾性调查了来自前瞻性观察性肾移植队列的 n = 491 名患者。研究对象包括来自非常高龄供体（n = 75，年龄>70 岁）、老年供体（n = 158，年龄 60-70 岁）和常规供体（n = 258，年龄<60 岁）的患者。主要结局是在预先定义的供体年龄组内死亡风险校正的移植物存活率。
总体而言，n = 57 例死亡风险校正的移植物丢失。非常高龄供体组（n = 11/75）的移植物丢失比例最高，但与老年（n = 14/158）和常规供体组（n = 32/258）相比，差异无统计学意义（p = 0.37）。Kaplan-Meier 分析表明，非常高龄供体组的 3 年/5 年死亡风险校正移植物存活率分别为 96%/86%，与其他年龄组无差异（p = 0.44）。根据慢性肾脏病流行病学合作组（CKD-EPI）公式（以 ml/min/1.73 m2 体表面积计算）计算的 12 个月后估算肾小球滤过率（eGFR）中位数在老年供体组和非常高龄供体组之间无差异（p = 0.53）。然而，与老年供体和非常高龄供体组的受者相比，接受常规供体肾脏的患者的中位 eGFR 更高（p<0.0001）。在随访期间，31%的患者至少发生了一次急性排斥反应。时间事件分析表明，三组之间急性排斥事件的发生无差异（p = 0.11）。
本研究表明，从精心挑选的非常高龄供体中进行肾脏移植似乎是一种可行的选择，具有合理的短期和中期结局。
