How great is the survival advantage of transplantation over dialysis in elderly patients?
How great is the survival advantage of transplantation over dialysis in elderly patients?
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DOI：
10.1093/ndt/gfh022
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发表时间：
2004-04-01
影响因子：
6.1
通讯作者：
Forsythe, JLR
中科院分区：
文献类型：
--
作者：
Oniscu, GC;Brown, H;Forsythe, JLR
背景>60岁的患者占苏格兰开始肾脏替代治疗的所有新患者的66%。本研究的目的是调查移植是否为这组患者提供任何生存益处。对1989年1月1日至1999年12月31日期间在苏格兰登记的325例>60岁的移植患者进行了随访，直至2000年12月31日。从国家肾脏和移植数据库和病例记录审查中获得社会人口统计学、合并症、列表和移植数据。比较了接受移植的患者和那些在随访期结束时未接受移植的患者的生存率。在适当的情况下使用MannWhitney，chi（2），Fisher精确检验和对数秩检验。在列出的325例患者中，128例（39.4%）在研究期间接受了首次移植，其余197例（60.6%）继续接受透析。移植受者在登记时更年轻（P < 0.0001），居住地更靠近移植中心（P = 0.043），在活跃等待名单上花费的时间比仍在透析的患者更少（P < 0.0001）。缺血性心脏病（P = 0.024）、脑血管病（P = 0.03）和心律失常（P = 0.016）发生率较低。总死亡率为0.16每患者年透析和0.10移植。移植后死亡风险显著降低（RR = 0.35，95%CI 0.22-0.54; P < 0.0001，log-rank），预期寿命延长（8.17 vs 4.32年）。对于适合移植的终末期肾衰竭老年患者，肾移植比透析具有显著的生存优势。
Background. Patients >60 years old represent 66% of all new patients starting renal replacement therapy in Scotland. The aim of this study was to investigate whether or not transplantation provides any survival benefit in this group of patients.Methods. 325 patients >60 years old listed for transplantation in Scotland between 1 January 1989 and 31 December 1999 were followed up until 31 December 2000. Sociodemographic, comorbidity, listing and transplant data were obtained from the national renal and transplant databases and case-notes review. Survival was compared between those who received a transplant and those who were listed but did not receive a transplant by the end of the follow-up period. MannWhitney, chi(2), Fisher's exact and log-rank tests were used where appropriate.Results. Of the 325 patients listed, 128 (39.4%) received a first transplant within the study period and the remaining 197 (60.6%) continued to undergo dialysis. The transplant recipients were younger at listing (P < 0.0001), lived closer to the transplant centre (P = 0.043) and spent less time on the active waiting list (P < 0.0001) than patients who remained on dialysis. They had less ischaemic heart disease (P = 0.024), cerebrovascular disease (P = 0.03) and arrhythmias (P = 0.016). The overall mortality rate was 0.16 per patient-year for dialysis and 0.10 for transplantation. There was a significantly lower risk of death (RR = 0.35, 95% CI 0.22-0.54; P < 0.0001, log-rank) and a longer life expectancy after listing with a transplant (8.17 vs 4.32 years).Conclusions. Renal transplantation offers a significant survival advantage over dialysis in elderly patients with end-stage renal failure who are considered suitable for transplantation.