Early mortality rates in older kidney recipients with comorbid risk factors
Early mortality rates in older kidney recipients with comorbid risk factors
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DOI：
10.1097/01.tp.0000251780.01031.81
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发表时间：
2007-02-27
期刊：
影响因子：
6.2
通讯作者：
Wynn, James J.
中科院分区：
文献类型：
--
作者：
Kauffman, H. Myron;McBride, Maureen A.;Wynn, James J.
背景目前，有超过60，000名候选人在已故肾脏捐赠者的等待名单上，50岁以上的候选人的比例每年都在继续增长。国家数据以前没有被用于评估老年患者的合并症与死亡率的关系。一项对30,262名年龄在18-59岁之间的死亡供体和8,895名年龄≥ 60岁的死亡供体进行的多变量分析评估了6种受体合并症与90天和365天患者死亡率的相关性。扩大标准供体（ECD）和移植肾功能延迟恢复（DGF）的额外影响也被评估。年龄≥ 60岁的受体的365天死亡率（10.5%）是18-59岁受体（4.4%）的两倍多，合并症显著增加死亡率甚至更高（10.6-21.4%）。年龄60岁接受ECD肾移植的受者的365天死亡率为14.4%，发生DGF的受者为15.9%，而有合并症但无DGF和无ECD的受者的死亡率范围为16.0%至42.3%。年龄≥ 60岁合并症的受者的365天移植死亡率高于相同合并症患者的365天等待名单死亡率，表明移植缺乏生存获益。年龄≥ 60岁合并症患者的死亡率高于无合并症患者，显著高于年轻患者，也高于等待患者。因此，将肾脏分配给患有合并症的老年患者的效用可能很差，并且可能需要讨论排除列表标准。
Background. There are over 60,000 candidates on the deceased donor kidney wait-list and the percentage of candidates over age 50 years continues to grow each year. National data have not previously been used to evaluate the association of comorbidities with mortality in older patients.Methods. A multivariate analysis of 30,262 deceased donor primary kidney recipients aged 18-59 years and 8,895 aged >= 60 years evaluated the association of six recipient comorbidities on 90- and 365-day patient mortality rates. The additional effects of expanded criteria donors (ECD) and development of delayed graft function (DGF) were also evaluated.Results. The 365-day mortality rate for recipients aged >= 60 years (10.5%) was more than twice that of recipients aged 18-59 years (4.4%) and comorbidities significantly increased mortality rates even higher (10.6-21.4%). The 365-day mortality rate for recipients aged 60 years who received an ECD kidney was 14.4% and who developed DGF was 15.9% while recipients with comorbidities but no DGF and no ECD ranged from 16.0 to 42.3%. The 365-day transplant mortality rate of recipients aged >= 60 years with comorbidities is higher than the 365-day wait-list mortality for patients with the same comorbidities, suggesting a lack of survival benefit from transplantation.Conclusions. Mortality rates for patients aged >= 60 years with comorbidities are higher than for those without comorbidities, significantly higher than for younger patients, and higher than for wait-listed patients. Thus, utility may be poorly served by allocating kidneys to older patients with comorbidities, and perhaps discussion of exclusionary listing criteria is warranted.