The vanishing importance of age in renal transplantation.
The vanishing importance of age in renal transplantation.
复制标题
年龄在肾移植中的重要性逐渐消失。
作者：
J. Roodnat;R. Zietse;P. Mulder;J. Rischen‐Vos;T. Gelder;J. Ijzermans;W. Weimar
背景
越来越多的病人等待肾脏移植提出了有关肾脏分配给老年人和老年人捐赠者的问题。在所有分析年龄对肾移植后结局影响的研究中，年龄均作为分类变量进行研究。
方法
我们对1983年7月至1997年7月间接受移植的509例接受环孢素治疗的初次尸体肾移植受者的年龄进行了分类（Kaplan-Meier）和连续（考克斯）变量研究。对于Kaplan-Meier分析，将人群分为3个大规模年龄组：17-43岁（n=171）、44-55岁（n=169）和56-75岁（n=169）。
结果
在年轻患者中，患者存活率更好，移植物存活率因死亡而被删失更差。总的移植物存活率（终点是死亡或移植物衰竭）不受年龄的显著影响。在考克斯比例风险分析中，移植年份是影响所有终点的重要自变量。由于这种影响不是线性的，因此定义了三个相对风险保持稳定的时期：1983-1990年，1991-1993年和1994-1997年。在第二阶段，移植失败或死亡的相对风险是第一阶段的49%。在第三阶段，相对风险已降至第一阶段的22%。年龄和供体年龄是总体移植失败的重要预测因素。这些变量与移植年份之间没有相互作用。在每个移植期内，受体年龄增加1岁，总体移植失败的相对风险仅增加1.44%。供者年龄的影响呈J型曲线，30岁时最小。随着时间的推移，结果的改善抵消了受体或供体年龄增加的影响。
结论
考虑到随着时间的推移，结果不断改善，目前没有理由对肾移植受者或捐赠者进行年龄限制。
BACKGROUND
The growing number of patients awaiting a kidney transplant raises questions about allocation of kidneys to the elderly and about the use of elderly donors. In all reported studies analyzing the influence of age on the outcome after renal transplantation, age is investigated as a categorical variable.
METHODS
We studied age both as a categorical (Kaplan-Meier) and as a continuous (Cox) variable in a total of 509 cyclosporine-treated recipients of a primary cadaveric kidney graft who underwent transplantation between July 1983 and July 1997. For the Kaplan-Meier analysis, the population was divided into three comparably sized age groups: 17-43 years (n=171), 44-55 years (n=169), and 56-75 years (n=169).
RESULTS
Patient survival was better and graft survival censored for death was worse in the younger patients. Overall graft survival (end point was death or graft failure) was not significantly influenced by age. In the Cox proportional hazards analysis, transplantation year turned out to be an important, independent variable influencing all end points. Because the influence was not linear, three periods were defined in which the relative risk remained stable: 1983-1990, 1991-1993, and 1994-1997. In the second period, the relative risk for transplant failure or death was 49% of that in the first period. In the third period, the relative risk had decreased to 22% of that in the first period. Recipient age and donor age were significant predictors of overall transplant failure. There was no interaction between these variables and transplantation year. Within each transplantation period, an increase in recipient age by 1 year increased the relative risk for overall graft failure by only 1.44%. The influence of donor age followed a J-shaped curve with a minimum at 30 years. The influence of increasing either recipient or donor age was counteracted by the improving results over time.
CONCLUSION
Considering the improving results over time, there are, at this moment, no arguments for an age restriction for kidney transplant recipients or donors.
随着年龄的增长，有丝分裂原诱导的淋巴细胞增殖减少。
影响因子：
4.6
作者：
Murasko,DM;Weiner,P;Kaye,D
通讯作者：
Kaye,D