Rotterdam Transplantation Institute, Department of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, Netherlands.
Transpl Int. 2023 Dec 22;36:11751. doi: 10.3389/ti.2023.11751. eCollection 2023.
It is not known whether antibody-mediated rejection (ABMR) is age-related, whether it plateaus late after transplantation, and to what extent it contributes to graft loss in older recipients. Patients transplanted between 2010 and 2015 ( = 1,054) in a single center had regular follow-up until January 2023. Recipients were divided into age groups at transplantation: 18-39 years ("young"), 40-55 years ("middle age"), and >55 years ("elderly"). Ten years after transplantation the cumulative % of recipients with ABMR was 17% in young, 15% in middle age, and 12% in elderly recipients ( < 0.001). The cumulative incidence of ABMR increased over time and plateaued 8-10 years after transplantation. In the elderly, with a median follow-up of 7.5 years, on average 30% of the recipients with ABMR died with a functional graft and ABMR contributed only 4% to overall graft loss in this group. These results were cross-validated in a cohort of recipients with >15 years follow-up. Multivariate cox-regression analysis showed that increasing recipient age was independently associated with decreasing risk for ABMR. In conclusion, the cumulative risk for ABMR is age-dependent, plateaus late after transplantation, and contributes little to overall graft loss in older recipients.
目前尚不清楚抗体介导的排斥反应（ABMR）是否与年龄有关，它是否在移植后晚期趋于稳定，以及在多大程度上导致老年受者的移植物丢失。在一个中心，2010 年至 2015 年间接受移植的患者（=1054 例）接受了定期随访，直至 2023 年 1 月。受者在移植时分为年龄组：18-39 岁（“年轻”）、40-55 岁（“中年”）和>55 岁（“老年”）。移植后 10 年，年轻、中年和老年受者中 ABMR 的累积发生率分别为 17%、15%和 12%（<0.001）。ABMR 的累积发生率随时间增加，并在移植后 8-10 年趋于稳定。在中位随访时间为 7.5 年的老年患者中，ABMR 患者中有 30%平均死于功能移植物，ABMR 仅导致该组患者整体移植物丢失的 4%。这些结果在具有 >15 年随访的受者队列中得到了交叉验证。多变量 Cox 回归分析显示，受者年龄的增加与 ABMR 风险的降低独立相关。总之，ABMR 的累积风险与年龄有关，在移植后晚期趋于稳定，并且在老年受者中对整体移植物丢失的贡献很小。
