Stedman Margaret R, Ahearn Patrick C, Liu Christine K, Chertow Glenn M, Tan Jane C
Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Kidney360. 2025 Jan 22;6(7):1198-1206. doi: 10.34067/KID.0000000710.
Older kidney transplant candidates experience a gain in life years from transplantation. More updated models using a contemporary cohort are needed to guide current clinical practice for older adults. The magnitude of gain in life years from transplant has diminished in recent years, likely driven by candidate characteristics and policy changes.
Life Years from Transplant (LYFT) is a measure of the predicted difference between the expected lifespan with and without a kidney transplant. The metric was originally proposed in 1999; since then, demographics of the kidney transplant candidate population have materially changed.
Using contemporary Scientific Registry of Transplant Recipients data, we propose more sophisticated methods for estimating LYFT with a focus on older kidney transplant candidates, a growing sector of the current candidate pool. We examine trends in predicted LYFT from 1995 to 2020.
We show that among older patients on the deceased donor waitlist, transplant remains a better option compared with dialysis (overall LYFT=5 years). LYFT trends have diminished modestly (by <1 life year) over time, in part related to efforts to enhance access to transplantation through intercurrent policy changes.
Updated LYFT estimates remain informative clinical measures that can support patient-centered decision-making. However, less homogenous metrics with meaningful disaggregation are needed to inform institutional evaluation and policy change. Models should be repeatedly evaluated as demographics of the candidate pool evolve.
年龄较大的肾移植候选者通过移植可延长生命年限。需要使用当代队列的更更新模型来指导当前针对老年人的临床实践。近年来，移植带来的生命年限延长幅度有所减小，这可能是由候选者特征和政策变化所致。
移植生命年限（LYFT）是衡量肾移植与未进行肾移植预期寿命之间预测差异的指标。该指标最初于1999年提出；自那时以来，肾移植候选者群体的人口统计学特征已发生重大变化。
利用当代移植受者科学登记处的数据，我们提出了更复杂的方法来估计LYFT，重点关注年龄较大的肾移植候选者，这是当前候选者群体中不断增长的一部分。我们研究了1995年至2020年预测LYFT的趋势。
我们表明，在已故供体等待名单上的老年患者中，与透析相比，移植仍然是更好的选择（总体LYFT = 5年）。随着时间的推移，LYFT趋势略有下降（不到1个生命年），部分原因是通过临时政策变化努力增加移植机会。
更新后的LYFT估计仍然是有助于以患者为中心的决策的信息性临床指标。然而，需要更具同质性且能进行有意义分类的指标来为机构评估和政策变化提供信息。随着候选者群体人口统计学特征的演变，模型应反复进行评估。
