Cofán Pujol F, Oppenheimer Salinas F, Talbot-Wright R, Carretero González P
Unidad de Transplante Renal, Universidad de Barcelona, España.
Arch Esp Urol. 1996 Dec;49(10):1013-20.
The insufficient number of kidney transplants has gradually raised the age limit to the cadaver kidney donor. The use of grafts harvested from older donors has been debated due to the existing structural and functional changes that might influence renal function and long-term graft survival. The foregoing aspects are discussed herein.
The anatomical, histological and functional changes in the kidney associated with ageing are analyzed. The clinical experience with renal grafts from older donors before and after cyclosporine became available are reviewed. The ethical issues on whether grafts from very old donors should be used and who should receive these grafts are discussed.
The use of grafts from donors over 60 years old had no significant short and medium term differences in comparison with younger donors in terms of graft survival, although a higher incidence of acute tubular necrosis and poor renal function have been observed. There are no conclusive studies on the long-term effects on graft survival when kidneys from donors aged over 65 are utilized. In our experience, the results achieved with grafts from donors over 70 has been unsatisfactory. The guidelines utilized in the selection of grafts derived from older donors are presented.
Grafts from donors aged 60 to 70 may be utilized in renal transplantation following precise selection criteria. Graft survival has been satisfactory, although a higher incidence of acute tubular necrosis and higher creatinine levels have been observed. We do not advocate the use of grafts from donors over 70, except in very exceptional cases. Long-term multicenter studies on grafts from very old donors and trials using alternative immunosuppressor modalities that might permit optimal use of these grafts are warranted.
肾移植数量不足已逐渐提高了尸体肾供体的年龄限制。由于存在可能影响肾功能和移植肾长期存活的结构和功能变化，使用来自老年供体的移植物一直存在争议。本文将讨论上述方面。
分析与衰老相关的肾脏解剖、组织学和功能变化。回顾环孢素问世前后老年供体肾移植的临床经验。讨论关于是否应使用来自高龄供体的移植物以及谁应接受这些移植物的伦理问题。
与年轻供体相比，使用60岁以上供体的移植物在移植肾存活方面没有显著的短期和中期差异，尽管观察到急性肾小管坏死的发生率较高且肾功能较差。对于使用65岁以上供体的肾脏对移植肾存活的长期影响，尚无定论性研究。根据我们的经验，使用70岁以上供体的移植物所取得的结果并不理想。介绍了选择老年供体来源移植物时所采用的指导原则。
60至70岁供体的移植物在遵循精确选择标准的情况下可用于肾移植。移植肾存活率令人满意，尽管观察到急性肾小管坏死的发生率较高且肌酐水平较高。除了非常特殊的情况外，我们不主张使用70岁以上供体的移植物。有必要对高龄供体的移植物进行长期多中心研究，并开展使用可能允许最佳利用这些移植物的替代免疫抑制方式的试验。
