Busson M, Benoit G
INSERM U93, Hôpital Saint Louis, Paris, France.
Clin Transplant. 1997 Feb;11(1):15-8.
A total of 6889 cadaver kidney grafts carried out in the French transplant network from 1 January 1989 to 31 December 1992 were analyzed using single and multifactorial methods in order to evaluate the impact on graft survival of matching for sex and age between donors and recipients. The mean graft survival rate was 75% at 3 yr with donors between 10 and 50 yr of age compared to 65% for donors under 10 yr of age and 67% at 3 yr for donors over 50 yr of age (p < 0.000001). For child recipients there were no significant differences in graft survival whatever the difference in age with the donor (+/- 10 yr). For young adults (17-49 yr of age) the prognosis at 3 yr was the same (75%) whether the donor was in the same age category or older than the recipient. For older adults (> 50 yr of age) a poorer prognosis was obtained when the donor was 10 yr or more older than the recipient (61% at 1 yr, p = 10(-4)). The grafts performed with male donors had a better prognosis (76% at 3 yr) than those using female donors (71% at 3 yr, p < 0.0002). The poorest results were obtained with female donors when the recipient was male (70% at 3 yr). The results of the multivariate analysis of seven parameters involved in graft survival show that the main parameters significantly controlling graft survival are preimmunization before the graft (p = 10(-6)), HLA-DR incompatibility (p = 0.004), retransplantation (p = 0.008), donor sex (p = 0.003), and matching for age between donor and recipient (p = 0.1). These results suggest that age and sex should be considered as criteria in the choice of donors and recipients in organ allocation.
为了评估供体与受体之间的性别和年龄匹配对肾移植存活的影响，我们采用单因素和多因素方法分析了1989年1月1日至1992年12月31日在法国移植网络中进行的6889例尸体肾移植。10至50岁供体的肾移植3年平均存活率为75%，而10岁以下供体的肾移植3年存活率为65%，50岁以上供体的肾移植3年存活率为67%（p<0.000001）。对于儿童受体，无论与供体的年龄差异如何（±10岁），移植存活均无显著差异。对于年轻成年人（17至49岁），无论供体与受体年龄相同还是供体年龄大于受体，3年预后均相同（75%）。对于老年人（>50岁），当供体比受体大10岁或更多时，预后较差（1年时为61%，p=10⁻⁴）。男性供体的肾移植预后较好（3年时为76%），而女性供体的肾移植预后较差（3年时为71%，p<0.0002）。当受体为男性时，女性供体的肾移植结果最差（3年时为70%）。对移植存活涉及的七个参数进行多因素分析的结果表明，显著控制移植存活的主要参数是移植前的预免疫（p=10⁻⁶）、HLA-DR不相容性（p=0.004）、再次移植（p=0.008）、供体性别（p=0.003）以及供体与受体的年龄匹配（p=0.1）。这些结果表明，在器官分配中选择供体和受体时应考虑年龄和性别标准。
