Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA.
Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, Washington, USA.
Clin Transplant. 2024 Jan;38(1):e15170. doi: 10.1111/ctr.15170. Epub 2023 Nov 9.
An increasing number of older patients are undergoing kidney transplant. Because of a finite longevity, more patients will be faced with failing allografts. At present there is a limited understanding of the benefits and risks associated with kidney retransplantation in this challenging population.
We performed a retrospective analysis of the Organ Procurement and Transplantation Network database of all adults ≥70 undergoing kidney retransplant from January 1, 2014 to December 31, 2022. We examined patient and graft survival of retransplanted patients compared to first time transplants. We also analyzed the risk factors that impacted the survival.
During the study period there has been a significant rise in the number of retransplants performed, with 631 patients undergoing the procedure. Although clinically insignificant, overall graft, and patient survival rates were slightly lower in the retransplant group compared to the primary transplant group. With retransplant, patient survival was 91.3%, 75.6%, and 56.9% compared to 93.4%, 81.4%, and 64.4% with primary transplant at 1, 3, and 5 years, respectively. With retransplant, graft survival was 89.5%, 73.5%, 57.4% compared to 91.5%, 79.0%, and 63.6% in a primary transplant group at 1, 3, and 5 years, respectively. Multivariable analysis showed that factors predicting poor survival included longer time on dialysis before retransplantation and decreased functional capacity. No survival difference was noted between recipients of deceased versus living donor kidneys. Patients who underwent retransplantation before initiating dialysis had better patient and graft survival.
Patients aged ≥70 achieve satisfactory outcomes following kidney retransplantation, highlighting that chronologic age should not preclude this medically complex population from this life-saving procedure. Improvement in functional status and timely retransplantation are the key factors to successful outcome.
越来越多的老年患者接受了肾脏移植。由于寿命有限，更多的患者将面临移植失败。目前，对于这一具有挑战性的人群，人们对肾移植再移植的获益和风险的了解有限。
我们对 2014 年 1 月 1 日至 2022 年 12 月 31 日期间，在器官获取与移植网络数据库中所有年龄≥70 岁的接受肾移植再移植的成年人进行了回顾性分析。我们比较了再移植患者与首次移植患者的患者和移植物存活率。我们还分析了影响存活率的危险因素。
在研究期间，接受再移植的患者数量显著增加，共有 631 例患者接受了该手术。尽管差异无统计学意义，但与初次移植组相比，再移植组的总体移植物和患者存活率略低。再移植患者的 1、3 和 5 年的患者存活率分别为 91.3%、75.6%和 56.9%，而初次移植患者的 1、3 和 5 年的患者存活率分别为 93.4%、81.4%和 64.4%。再移植患者的 1、3 和 5 年的移植物存活率分别为 89.5%、73.5%和 57.4%，而初次移植患者的 1、3 和 5 年的移植物存活率分别为 91.5%、79.0%和 63.6%。多变量分析表明，预测存活率差的因素包括再移植前透析时间延长和功能能力下降。在接受死亡供体和活体供体肾脏的患者之间，没有观察到存活率差异。在开始透析前接受再移植的患者有更好的患者和移植物存活率。
年龄≥70 岁的患者接受肾移植再移植后可获得满意的结果，这表明，生理年龄不应使这一具有复杂医学问题的人群被排除在这种救命手术之外。功能状态的改善和及时的再移植是获得成功结果的关键因素。
