Winkler Susanne, Kim Min-Jeong, Fisler Andrea, Farese Stefan, Burkhalter Felix, von Moos Seraina, Forster Christian, Wehmeier Caroline, Dickenmann Michael, Schaub Stefan
Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.
Department of Nephrology, Kantonsspital Aarau, Aarau, Switzerland.
Transpl Int. 2025 May 2;38:14544. doi: 10.3389/ti.2025.14544. eCollection 2025.
The interplay of recipient age and graft loss causes is underexplored, despite its relevance for patient management and endpoint definition in clinical trials. This study aimed to investigate the impact of recipient age on graft loss causes. In this retrospective single-center cohort study with 1743 kidney transplantations between 1995 and 2022, graft losses were assigned to either death with graft function (DwGF) or graft failure (GF). Additionally, causes of death and GF were determined by reviewing all available clinical/histological information. Data were analyzed across recipient age groups (≤40, 41-60 and >60 years) and across three time periods (1995-2004, 2005-2014, 2015-2022). Among 816 graft losses, 56% were attributed to DwGF and 44% to GF. The proportion of DwGF increased stepwise with age (21% in young vs. 52% in middle-aged vs. 76% in elderly patients; p < 0.0001), with similar proportions across the three time periods. Rejection alone or in combination with other events caused GF in 76% of young, 51% of middle-aged, and 34% of elderly patients (p < 0.0001). Main death-causes were cardiovascular events (23%), infections (23%) and malignancies (23%). Graft loss causes are strongly age-related. This might have significant implications for clinical study design and patient management.
尽管受者年龄与移植物丢失原因之间的相互作用对患者管理和临床试验终点定义具有相关性，但目前对此研究不足。本研究旨在调查受者年龄对移植物丢失原因的影响。在这项回顾性单中心队列研究中，纳入了1995年至2022年间的1743例肾移植病例，移植物丢失被分为带移植物功能死亡（DwGF）或移植物失败（GF）。此外，通过回顾所有可用的临床/组织学信息来确定死亡和GF的原因。数据按受者年龄组（≤40岁、41 - 60岁和>60岁）以及三个时间段（1995 - 2004年、2005 - 2014年、2015 - 2022年）进行分析。在816例移植物丢失中，56%归因于DwGF，44%归因于GF。DwGF的比例随年龄逐步增加（年轻患者中为21%，中年患者中为52%，老年患者中为76%；p < 0.0001），在三个时间段中比例相似。单独排斥或与其他事件共同导致GF的情况在年轻患者中占76%，中年患者中占51%，老年患者中占34%（p < 0.0001）。主要死亡原因是心血管事件（23%）、感染（23%）和恶性肿瘤（23%）。移植物丢失原因与年龄密切相关。这可能对临床研究设计和患者管理具有重要意义。
