Living Kidney Donors Ages 70 and Older: Recipient and Donor Outcomes
Living Kidney Donors Ages 70 and Older: Recipient and Donor Outcomes
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DOI：
10.2215/cjn.04160511
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发表时间：
2011-12-01
影响因子：
9.8
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
--
作者：
Berger, Jonathan C.;Muzaale, Abimereki D.;Segev, Dorry L.
背景和目的严重的器官短缺导致等待肾移植的患者等待时间延长，死亡率增加。因此，患者正在转向老年活体捐赠者。目前还不清楚是否应该存在捐献的年龄上限，无论是在受体和供体的outcome.Design，设置，参与者和测量在美国，219名年龄>= 70的健康成年人在279个移植中心中的80个捐献肾脏。竞争风险模型与匹配的对照被用来研究年龄较大的供体和同种异体移植物存活之间的独立关联，解释受体死亡率的竞争风险以及其他移植因素。结果在年龄较大的活体同种异体移植物的受体中，移植物丢失显著高于匹配的50- 59岁的活体同种异体移植物（亚危险比[SHR] 1.62，95%置信区间[CI] 1.16至2.28，P = 0.005），但与匹配的非扩展标准50至59岁死亡供体同种异体移植物相似（SHR 1.19，95% CI 0.87至1.63，P = 0.3）。年龄≥ 70岁的活体供肾者的死亡率并不高于来自NHANES-III队列的健康匹配对照组;事实上，死亡率更低，可能反映了年龄较大的活体供肾者的选择性高于国家健康和营养检查调查III（NHANES-III; HR 0.37，95%CI 0.21 ~ 0.65，P < 0.001）。结论这些研究结果支持老年人活体捐献，但强调了寻找年轻供体的优势，特别是对于年轻受者。Clin J Am Soc Nephrol 6：2887-2893，2011. doi：10.2215/CJN.04160511
Background and objectives The profound organ shortage has resulted in longer waiting times and increased mortality for those awaiting kidney transplantation. Consequently, patients are turning to older living donors. It is unclear if an upper age limit for donation should exist, both in terms of recipient and donor outcomes.Design, setting, participants, & measurements In the United States, 219 healthy adults aged >= 70 have donated kidneys at 80 of 279 transplant centers. Competing risks models with matched controls were used to study the independent association between older donor age and allograft survival, accounting for the competing risk of recipient mortality as well as other transplant factors.Results Among recipients of older live donor allografts, graft loss was significantly higher than matched 50-to 59-year-old live donor allografts (subhazard ratio [SHR] 1.62, 95% confidence interval [CI] 1.16 to 2.28, P = 0.005) but similar to matched nonextended criteria 50-to 59-year-old deceased donor allografts (SHR 1.19, 95% CI 0.87 to 1.63, P = 0.3). Mortality among living kidney donors aged >= 70 was no higher than healthy matched controls drawn from the NHANES-III cohort; in fact, mortality was lower, probably reflecting higher selectivity among older live donors than could be captured in National Health and Nutrition Examination Survey III (NHANES-III; HR 0.37, 95% CI 0.21 to 0.65, P < 0.001).Conclusions These findings support living donation among older adults but highlight the advantages of finding a younger donor, particularly for younger recipients. Clin J Am Soc Nephrol 6: 2887-2893, 2011. doi: 10.2215/CJN.04160511