Schaubel D, Desmeules M, Mao Y, Jeffery J, Fenton S
Bureau of Chronic Disease Epidemiology, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario, Canada.
Transplantation. 1995 Dec 27;60(12):1389-94. doi: 10.1097/00007890-199560120-00003.
Renal transplantation is a relatively recent treatment option among the elderly with end-stage renal disease (ESRD). Since little is known regarding the clinical benefits of transplantation relative to dialysis in this age group, this study compares transplantation and dialysis among the elderly with respect to patient survival. Data utilized in this investigation were obtained from the Canadian Organ Replacement Register (CORR). The study population consisted of the 6400 patients aged 60 and over at registration, diagnosed between 1987 and 1993, for whom data on comorbid conditions were available. Survival probability, death rates, age-standardized mortality ratios (SMRs) and Cox regression analysis were employed to evaluate the survival experience among the transplant and dialysis groups. Transplant recipients were matched (by age, underlying diagnosis leading to ESRD, and number of comorbid conditions) to 2 randomly selected patients who did not undergo transplantation. Using Cox regression, the time-dependent hazard ratio for transplantation versus dialysis patients was estimated at 0.47 (P < 0.0001), indicating that even after adjusting for other known prognostic factors, elderly patients who received a transplant experienced significantly greater survival probability than those who remained on dialysis. When transplant patients were matched to randomly selected dialysis patients with the constraint that the corresponding dialysis patient have at least as much follow-up time as the transplant patient had waiting time, five-year survival rates were 81% and 51% for the transplant and dialysis groups, respectively (P < 0.0001). These results support the potential advantage of transplantation among the elderly, and may have important implications for renal care in this age group.
肾移植是终末期肾病（ESRD）老年患者中相对较新的一种治疗选择。由于对于该年龄组中肾移植相对于透析的临床益处了解甚少，本研究比较了老年患者肾移植和透析后的患者生存率。本调查所使用的数据来自加拿大器官替代登记处（CORR）。研究人群包括在1987年至1993年期间登记时年龄在60岁及以上、被诊断患有ESRD且有合并症数据的6400名患者。采用生存概率、死亡率、年龄标准化死亡率（SMR）和Cox回归分析来评估移植组和透析组的生存情况。将移植受者（按年龄、导致ESRD的潜在诊断以及合并症数量）与2名随机选择的未接受移植的患者进行匹配。使用Cox回归分析，估计移植患者与透析患者的时间依赖性风险比为0.47（P < 0.0001），这表明即使在调整了其他已知的预后因素后，接受移植的老年患者的生存概率仍显著高于继续接受透析的患者。当移植患者与随机选择的透析患者进行匹配，且规定相应的透析患者的随访时间至少与移植患者的等待时间一样长时，移植组和透析组的五年生存率分别为81%和51%（P < 0.0001）。这些结果支持了肾移植对老年患者的潜在优势，并且可能对该年龄组的肾脏护理具有重要意义。
