Kuo P C, Johnson L B, Schweitzer E J, Alfrey E J, Waskerwitz J, Bartlett S T
Department of Surgery, University of Maryland Medical Systems, Baltimore, USA.
Am J Surg. 1996 Nov;172(5):551-5; discussion 556-7. doi: 10.1016/S0002-9610(96)00233-4.
The persistent shortage of ideal donor organs has resulted in increased transplantation of kidneys from older donors (age > 60 years). The overall experience with this donor subgroup indicates decreased graft survival.
The records of 413 renal transplants performed between July 1991 and July 1995 were reviewed in a retrospective fashion to determine those patients who had received a cadaveric (CT > 60; n = 17) or living donor (LT > 60; n = 7) renal transplant from an older donor. Control groups consisted of randomly selected patients who received cadaveric (CT < 50; n = 20) or living related (LT < 50; n = 20) renal transplants from donors less than 50 years of age.
In the CT > 60 group, 1-year graft survival was 57.4%, significantly less than in those of the LT < 50 (100%), LT > 60 (100%), and CT < 50 (89%) groups. Mean recipient serum creatinine in the CT > 60 group was twofold greater than that of other groups at 1, 6, and 12 months following transplantation. Cold ischemia time and creatinine clearance correlated highly with graft survival. Stepwise regression analysis showed creatinine clearance to be the sole independent predictor of graft survival. A calculated donor creatinine clearance < 50 mL/minute was associated with ultimate graft loss.
Age alone should not be an exclusion criterion to renal organ donation. When considering the older renal donor, creatinine clearance should be included within the decision algorithm.
理想供体器官的持续短缺导致来自老年供体（年龄>60岁）的肾脏移植数量增加。对这一供体亚组的总体经验表明移植物存活率降低。
回顾性分析1991年7月至1995年7月期间进行的413例肾移植记录，以确定那些接受来自老年供体的尸体肾移植（CT>60；n=17）或活体供体肾移植（LT>60；n=7）的患者。对照组由随机选择的接受来自年龄小于50岁供体的尸体肾移植（CT<50；n=20）或亲属活体肾移植（LT<50；n=20）的患者组成。
在CT>60组中，1年移植物存活率为57.4%，显著低于LT<50组（100%）、LT>60组（100%）和CT<50组（89%）。CT>60组受者移植后1、6和12个月时的平均血清肌酐水平是其他组的两倍。冷缺血时间和肌酐清除率与移植物存活率高度相关。逐步回归分析显示肌酐清除率是移植物存活的唯一独立预测因素。计算得出的供体肌酐清除率<50 mL/分钟与最终移植物丢失相关。
不应仅以年龄作为肾脏器官捐赠的排除标准。在考虑老年肾脏供体时，肌酐清除率应纳入决策算法中。
