Transplantation in the elderly: a review.
Transplantation in the elderly: a review.
复制标题
DOI：
10.1023/a:1008246129084
复制
发表时间：
1997-01-01
期刊：
影响因子：
--
通讯作者：
Cole, E
中科院分区：
文献类型：
--
作者：
Jassal, S V;Opelz, G;Cole, E
目的： 1. 回顾目前关于 60 岁或以上肾移植患者的患者和移植物存活率、并发症发生率、患者选择和管理方案的知识。 2. 回顾从老年捐献者身上获取尸体器官的优点和缺点。 数据来源：证据来自 1976 年至 1996 年使用 MEDLINE 搜索识别的已发表文章；专家意见和以前评论文章的引用。结果：生存率随着时间的推移而提高，目前患者 5 年生存率为 54% 至 75%，移植物 5 年生存率为 52% 至 74%。移植物丢失的最常见原因是患者死亡，因为急性和慢性排斥反应在老年患者中较少见。与年轻 ESRD 患者相比，老年患者的截尾移植物存活率（如果将功能性移植物死亡视为截尾数据）更高。根据管理数据库的队列数据，即使在匹配合并症后，接受移植的老年透析患者仍具有生存优势。移植后发病率主要归因于感染并发症和恶性肿瘤患病率的增加。关于最佳免疫抑制方案的数据不足，需要在这个方向进行进一步的研究。目前的证据支持使用老年捐献者的肾脏，因为年轻捐献者的尸体器官相对缺乏，尽管从长远来看，患者和移植结果会更差。没有足够的证据支持关于年龄匹配或针对特殊群体的老年器官的明确结论。
PURPOSE: 1. To review current knowledge about patient and graft survival, complication rates, patient selection and management protocols in patients aged 60 years or more with a renal transplant. 2. To review the advantages and disadvantages of cadaveric organ retrieval from older donors.DATA SOURCES: Evidence was obtained from published articles identified using a MEDLINE search from 1976 to 1996; expert opinion and citations from previous review articles.RESULTS: Survival rates have improved with time and now range from 54 to 75% 5-year patient survival and 52-74% 5-year graft survival. The most common reason for graft loss is patient death as both acute and chronic rejection is less commonly seen in older patients. Censored graft survival (if death with a functioning graft is treated as censored data) is higher in elderly patients compared to younger ESRD patients. Based on cohort data from an administrative database a survival advantage is seen in older dialysis patients accepted for transplantation even after matching for comorbidity. Post-transplant morbidity is mainly attributable to infectious complications and an increased prevalence of malignancy. There is insufficient data about the most optimal immunosuppression regime and further research is required in this direction. The evidence currently supports the use of kidneys from older donors because of a relative lack of cadaveric organs from younger donors although a worse patient and graft outcome is recognized in the long term. Insufficient evidence exists to support a firm conclusion regarding age matching or targeting of older organs to special groups.