Gineste Alexandra, Malvezzi Paolo, Jouve Thomas, Millet Claire, Rostaing Lionel, Noble Johan
Nephrology, Hemodialysis Apheresis and Kidney Transplantation, Department, CHU Grenoble Alpes, Grenoble, France.
Univ. Grenoble Alpes, CNRS, Inserm, CHU Grenoble Alpes, IAB, Grenoble, France.
Clin Kidney J. 2024 Jun 18;17(8):sfae182. doi: 10.1093/ckj/sfae182. eCollection 2024 Aug.
The rising prevalence of end-stage renal failure in the elderly has led to an increased number of kidney transplantations in older individuals. While age does not solely determine transplant eligibility, frailty in elderly recipients significantly impacts post-transplant outcomes, particularly within the first year.
The RETRAITE (REnal TRAnsplantIon ouTcome in Elderly recipients) study, a single-center retrospective cohort study at Grenoble Alpes University Hospital (France), examined kidney transplant recipients aged 70 years and above transplanted between 2015 and 2020. The composite primary endpoint was defined as either of any hospital stay exceeding 40 days, death and/or return to dialysis within the first post-transplant year. The study explored risk factors for recipient and graft survival, rejection, hospitalizations over 40 days, and severe infections during the initial post-transplant year.
Over six years, 149 patients aged 70 years or older received transplants. Eleven patients died, and seven returned to dialysis within the first year, corresponding to a 1-year graft survival rate of 87.9%. At 1 year, 49 patients (33%) met the composite endpoint. There was a significant association between the composite endpoint and curative anticoagulation [odds ratio (OR) 5.20; < .001], peripheral arteriopathy (OR 3.14; < .001) and delayed graft function (OR 8.24; < .001). This cohort then was merged with a cohort of 150 younger kidney transplanted patients and we confirmed these results. Time on dialysis, prolonged cold ischemia and donor age contributed to higher morbidity and mortality. Conversely, preemptive and living donor transplants were associated with lower morbidity and mortality.
In this cohort aged over 70 years, age alone did not statistically correlate with increased morbidity and mortality. Variables related to grafts and donors, especially curative anticoagulation, were linked to poorer outcomes, emphasizing the favorable impact of preemptive and living donor transplants on morbidity and mortality in elderly patients.
老年终末期肾衰竭患病率的上升导致老年个体肾移植数量增加。虽然年龄并非决定移植资格的唯一因素，但老年受者的虚弱状态会显著影响移植后结局，尤其是在第一年。
RETRAITE（老年受者肾移植结局）研究是法国格勒诺布尔阿尔卑斯大学医院开展的一项单中心回顾性队列研究，研究对象为2015年至2020年间接受肾移植的70岁及以上患者。复合主要终点定义为移植后第一年内任何一次住院时间超过40天、死亡和/或恢复透析。该研究探讨了受者和移植物存活、排斥反应、40天以上住院以及移植后第一年严重感染的危险因素。
在六年时间里，149名70岁及以上患者接受了移植。11名患者死亡，7名患者在第一年内恢复透析，1年移植物存活率为87.9%。1年时，49名患者（33%）达到复合终点。复合终点与治疗性抗凝（比值比[OR]5.20；P<0.001）、外周动脉病变（OR 3.14；P<0.001）和移植肾功能延迟（OR 8.24；P<0.001）之间存在显著关联。然后将该队列与150名年轻肾移植患者的队列合并，我们证实了这些结果。透析时间、冷缺血时间延长和供体年龄导致更高的发病率和死亡率。相反，抢先移植和活体供体移植与较低的发病率和死亡率相关。
在这个70岁以上的队列中，仅年龄与发病率和死亡率增加在统计学上无相关性。与移植物和供体相关的变量，尤其是治疗性抗凝，与较差的结局相关，强调了抢先移植和活体供体移植对老年患者发病率和死亡率的有利影响。
