Department of Organ Transplant Medicine, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
Department of Nephrology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
Clin Exp Nephrol. 2024 Sep;28(9):932-942. doi: 10.1007/s10157-024-02488-5. Epub 2024 Apr 14.
The number of marginal living kidney donors has increased. Medically complex donors who have hypertension, older age, or low estimated glomerular filtration rate (eGFR) have been more likely to be used.
We conducted a retrospective cohort study of living kidney donors at a single center. We analyzed 309 living donors and divided them into three groups: group with older donors (aged ≥70 years) (n = 41), middle-aged (aged 46-69 years) (n = 239), and young donors (aged <46 years) (N = 29). Donor factors associated with chronic kidney disease (CKD) stage 3b or worse within 5 years post-donation were investigated.
Of the 309 live donors, 86 (27.8%) developed CKD stage3b or worse within 5 years post-donation. The incidence of CKD stage3b or worse within 5 years post-donation was significantly higher in older donor (p < 0.01). Cox regression models revealed that older donor ages and lower eGFR were significantly related to the development of CKD stage3b or worse, independent of comorbidities such as obesity and hypertension [hazard ratio (95% CI); 4.59 (1.02-20.6), p = 047, 0.95 (0.94-0.96), p ≤ 0.01, respectively]. However, recovery of eGFR 4-5 years after donation was noted in the middle-aged and older donor groups, whereas the level of eGFR remained unchanged in the young group.
Older donors tend to develop CKD stage3b within 5 years post-donation but with the potential of recovery. Healthy older people (aged ≥70 years) could be candidates for living donors under careful monitoring of kidney function after donation.
边缘供体的数量有所增加。具有高血压、年龄较大或估算肾小球滤过率（eGFR）较低等医学复杂性的供体更有可能被使用。
我们对单中心的活体肾脏捐献者进行了回顾性队列研究。我们分析了 309 名活体供体，并将他们分为三组：老年供体组（年龄≥70 岁）（n=41）、中年供体组（年龄 46-69 岁）（n=239）和年轻供体组（年龄<46 岁）（n=29）。研究了与捐赠后 5 年内发生慢性肾脏病（CKD）3b 期或更差阶段相关的供体因素。
在 309 名活体供体中，有 86 名（27.8%）在捐赠后 5 年内发展为 CKD 3b 期或更差。老年供体组在捐赠后 5 年内发生 CKD 3b 期或更差的发生率明显较高（p<0.01）。Cox 回归模型显示，老年供体年龄和较低的 eGFR 与 CKD 3b 期或更差的发生显著相关，独立于肥胖和高血压等合并症[风险比（95%可信区间）；4.59（1.02-20.6），p=0.047，0.95（0.94-0.96），p≤0.01]。然而，中年和老年供体组在捐赠后 4-5 年内 eGFR 恢复，而年轻供体组的 eGFR 水平保持不变。
老年供体在捐赠后 5 年内往往会发展为 CKD 3b 期，但有恢复的可能。健康的老年人（年龄≥70 岁）可以在仔细监测捐赠后肾功能的情况下成为活体供体的候选者。
