Department of Urology, Nara Medical University, Kashihara, Nara, Japan.
Department of Urology, Nara Medical University, Kashihara, Nara, Japan; Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Nara, Japan.
Transplant Proc. 2024 Oct;56(8):1721-1731. doi: 10.1016/j.transproceed.2024.08.029. Epub 2024 Sep 3.
Controversial issues in registering candidates for deceased-donor kidney transplantation (DDKT) comprise various factors, including age, life expectancy, and dialysis duration. We investigated patient characteristics on the waiting list and discussed suitable criteria in Japan, which has a long waiting period.
This study included 592 patients on the waiting list for DDKT at our institute between 1982 and 2023. We retrospectively reviewed patients' medical charts and obtained their clinical information. Patient characteristics according to outcomes and eligibility criteria for applying for or renewing registration were investigated. No prisoners were used in the study, and the participants were neither coerced nor paid.
Approximately 70%, 45%, and 14.5% of the registered patients were aged >60, >70, and 80 years, respectively. The number of patients aged ≥70 years gradually decreased over time. The median waiting periods of patients who underwent and interrupted DDKT were 13 and 7 years, respectively. Patients in their 70s with a >15-year dialysis period tended to have opportunities for DDKT. Living-donor kidney transplantation was performed in patients aged <60 years. Waiting patients were significantly younger and had a shorter dialysis duration. Advanced age at registration was associated with a significantly high risk of interruption.
Advanced age and longer dialysis periods were considered at registration because patients with these factors tended to experience interruptions despite the long waiting period and high cost. Although older patients can undergo DDKT, factors including surgical cost and risks are considered. Eligibility/ineligibility criteria should be established for DDKT waiting lists in Japan.
争议性问题在注册候选人死亡供体肾移植（DDKT）包括各种因素，如年龄、预期寿命和透析时间。我们调查了等待名单上的患者特征，并讨论了在日本合适的标准，日本有一个很长的等待期。
本研究包括 1982 年至 2023 年期间在我们研究所等待 DDKT 的 592 名患者。我们回顾性地审查了患者的病历，并获得了他们的临床信息。根据结果和申请或更新登记的资格标准，调查了患者的特征。研究中未使用囚犯，参与者既不受胁迫也没有报酬。
大约 70%、45%和 14.5%的注册患者年龄分别大于 60、70 和 80 岁。年龄大于 70 岁的患者人数随着时间的推移逐渐减少。接受和中断 DDKT 的患者的中位等待时间分别为 13 年和 7 年。透析时间>15 年的 70 多岁患者有机会接受 DDKT。<60 岁的患者进行活体供肾移植。等待的患者明显更年轻，透析时间更短。登记时年龄较大与中断的风险显著增加相关。
在登记时考虑了年龄较大和透析时间较长，因为尽管等待时间长且成本高，这些因素的患者往往会中断。尽管老年患者可以接受 DDKT，但会考虑手术成本和风险等因素。日本应该为 DDKT 等待名单制定资格/不合格标准。
