70岁及以上脑死亡供体肾移植后的长期预后
Long-term Outcomes After Kidney Transplantation From DBD Donors Aged 70 y and Older.
作者信息
Lindahl Jørn Petter, Åsberg Anders, Heldal Kristian, Jenssen Trond, Dörje Christina, Skauby Morten, Midtvedt Karsten
机构信息
Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Department of Pharmacy, University of Oslo, Oslo, Norway.
出版信息
Transplant Direct. 2024 Jun 20;10(7):e1660. doi: 10.1097/TXD.0000000000001660. eCollection 2024 Jul.
BACKGROUND
Transplantation of kidneys from elderly donations after brain death (DBD) donors has increased owing to organ shortages. We aimed to assess the impact on long-term kidney transplant outcomes from DBD donors aged 70 y and older compared with kidneys from younger donors.
METHODS
From 2007 to 2022, 2274 first single kidney transplantations from DBD donors were performed at our center. Data from 1417 kidney transplant recipients receiving a DBD organ were included and categorized into 3 groups according to donor age: 70 y and older (n = 444, median age 74 y), 60-69 y (n = 527, median age 64 y), and a reference group consisting of donors aged 45-54 y (n = 446, median age 50 y). Kaplan-Meier plots and multivariate Cox regression with correction for recipient, donor, and transplant characteristics were used to investigate patient and kidney graft survival outcomes.
RESULTS
The median patient follow-up time was 9.3 y (interquartile range, 5.3-13.1). The adjusted hazard ratios for patient death in recipients of kidneys from DBD donors aged 70 y and older compared with 60-69 y and 45-54 y were 1.12 (95% confidence interval [CI], 0.92-1.36; 0.26) and 1.62 (95% CI, 1.26-2.07; 0.001), respectively. Compared with recipients of donors aged 60-69 y and 45-54 y, the adjusted hazard ratios for kidney graft loss in recipients of donors aged 70 y and older were 1.23 (95% CI, 1.02-1.48; 0.029) and 1.94 (95% CI, 1.54-2.45; 0.001), respectively.
CONCLUSIONS
Transplantation of kidneys from DBD donors aged 70 y and older resulted in acceptable long-term outcomes and is encouraging.
背景
由于器官短缺，脑死亡（DBD）供体中老年人捐献肾脏的移植数量有所增加。我们旨在评估与年轻供体的肾脏相比，70岁及以上DBD供体的肾脏对长期肾移植结果的影响。
方法
2007年至2022年期间，我们中心进行了2274例首次单肾移植手术，供体为DBD供体。纳入了1417例接受DBD器官的肾移植受者的数据，并根据供体年龄分为3组：70岁及以上（n = 444，中位年龄74岁）、60 - 69岁（n = 527，中位年龄64岁），以及一个由45 - 54岁供体组成的参照组（n = 446，中位年龄50岁）。采用Kaplan - Meier曲线和多变量Cox回归分析，并对受者、供体和移植特征进行校正，以研究患者和肾移植的存活结果。
结果
患者的中位随访时间为9.3年（四分位间距为5.3 - 13.1年）。与60 - 69岁和45 - 54岁供体的肾脏受者相比，70岁及以上DBD供体的肾脏受者的患者死亡校正风险比分别为1.12（95%置信区间[CI]，0.92 - 1.36；P = 0.26）和1.62（95% CI，1.26 - 2.07；P = 0.001）。与60 - 69岁和45 - 54岁供体的受者相比，70岁及以上供体的受者的肾移植丢失校正风险比分别为1.23（95% CI，1.02 - 1.48；P = 0.029）和1.94（95% CI，1.54 - 2.45；P = 0.001）。
结论
70岁及以上DBD供体的肾脏移植产生了可接受的长期结果，令人鼓舞。
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