Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France.
Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Transpl Int. 2024 Aug 29;37:13208. doi: 10.3389/ti.2024.13208. eCollection 2024.
Living donation (LD) transplantation is the preferred treatment for kidney failure as compared to donation after brain death (DBD), but age may play a role. We compared the 1-year estimated glomerular filtration rate (eGFR) after kidney transplantation for recipients of LD and DBD stratified by recipient and donor age between 2015 and 2018 in a matched cohort. The strength of the association between donation type and 1-year eGFR differed by recipient age ( < 0.0001). For LD recipients aged 40-54 years versus same-aged DBD recipients, the adjusted odds ratio (aOR) for eGFR ≥60 mL/min/1.73 m was 1.48 (95% CI: 1.16-1.90). For DBD recipients aged ≥ 60 years, the aOR was 0.18 (95% CI: 0.12-0.29) versus DBD recipients aged 40-54 years but was 0.91 (95% CI: 0.67-1.24) versus LD recipients aged ≥60 years. In the matched cohort, 4-year graft and patient survival differed by donor age and type. As compared with DBD grafts, LD grafts increased the proportion of recipients with 1-year eGFR ≥60 mL/min/1.73 m. Recipients aged ≥60 years benefited most from LD transplantation, even if the donor was aged ≥60 years. For younger recipients, large age differences between donor and recipient could also be addressed with a paired exchange program.
活体捐赠 (LD) 移植是治疗肾衰竭的首选方法，优于脑死亡后捐赠 (DBD)，但年龄可能起作用。我们比较了 2015 年至 2018 年间，在匹配队列中按受体和供体年龄分层的 LD 和 DBD 受体 1 年后估计肾小球滤过率 (eGFR)。捐赠类型与 1 年后 eGFR 之间的关联强度因受体年龄而异 ( < 0.0001)。对于 40-54 岁的 LD 受体与同龄的 DBD 受体相比，eGFR ≥60 mL/min/1.73 m 的调整后优势比 (aOR) 为 1.48 (95%CI: 1.16-1.90)。对于年龄≥60 岁的 DBD 受体，aOR 为 0.18 (95%CI: 0.12-0.29)，而年龄为 40-54 岁的 DBD 受体，而年龄≥60 岁的 LD 受体为 0.91 (95%CI: 0.67-1.24)。在匹配队列中，供体年龄和类型对 4 年移植物和患者存活率有影响。与 DBD 移植物相比，LD 移植物增加了 1 年后 eGFR ≥60 mL/min/1.73 m 的受体比例。年龄≥60 岁的受体从 LD 移植中获益最大，即使供体年龄≥60 岁。对于年龄较小的受体，供体和受体之间的年龄差异较大，也可以通过配对交换计划来解决。
