Recipient-related risk factors for graft failure and death in elderly kidney transplant recipients.
Recipient-related risk factors for graft failure and death in elderly kidney transplant recipients.
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老年肾移植受者移植失败和死亡的受者相关危险因素。
DOI：
10.1371/journal.pone.0112938
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Chen L
中科院分区：
文献类型：
--
作者：
Lai X;Chen G;Qiu J;Wang C;Chen L
近年来，老年终末期肾病患者已成为肾移植候选人中增长最快的人群。然而，与这些患者的长期结局相关的风险因素仍不清楚。我们回顾性分析了2002年至2013年期间在我们中心接受原发性死亡肾移植的166名年龄在60岁或以上的受者。主要结果包括1年、3年和5年患者生存率以及总体和死亡删失移植物生存率。采用考克斯回归分析影响移植物和患者存活的独立危险因素。1年、3年、5年死亡截尾移植物存活率分别为93.6%、89.4%和83.6%。基于考克斯多变量分析，群体反应性抗体（PRA）>5% [风险比（HR）4.295，95%置信区间（CI）1.321-13.97]，移植物功能延迟恢复（HR 4.744，95% CI 1.611-13.973）和急性排斥反应（HR 4.971，95% CI 1.516-16.301）是移植物衰竭的独立危险因素。1、3、5年生存率分别为84.8%、82.1%和77.1%。较长的透析时间（HR 1.011，1个月增加，95% CI 1.002-1.020），移植物丢失（HR 3.501，95% CI 1.559-7.865）和低剂量更昔洛韦预防（1.5 g/d，3个月）（HR 3.173，95% CI 1.063-9.473）是与患者死亡相关的风险因素。5年结果显示，年龄≥60岁的老年肾移植受者的移植物和患者存活率极佳。PRA> 5%、移植物功能延迟和急性排斥反应是移植物衰竭的危险因素，而透析时间较长、移植物丢失和低剂量更昔洛韦预防是老年受者死亡的危险因素。这些因素代表了旨在改善老年受者移植物和患者存活率的干预措施的潜在目标。
Elderly patients with end-stage renal disease have become the fastest growing population of kidney transplant candidates in recent years. However, the risk factors associated with long-term outcomes in these patients remain unclear. We retrospectively analyzed 166 recipients aged 60 years or older who underwent primary deceased kidney transplantation between 2002 and 2013 in our center. The main outcomes included 1-, 3- and 5-year patient survival as well as overall and death-censored graft survival. The independent risk factors affecting graft and patient survival were analyzed using Cox regression analysis. The 1-, 3-, 5-year death-censored graft survival rates were 93.6%, 89.4% and 83.6%, respectively. Based on the Cox multivariate analysis, panel reactive antibody (PRA)>5% [hazard ratio (HR) 4.295, 95% confidence interval (CI) 1.321–13.97], delayed graft function (HR 4.744, 95% CI 1.611–13.973) and acute rejection (HR 4.971, 95% CI 1.516–16.301) were independent risk factors for graft failure. The 1-, 3-, 5-year patient survival rates were 84.8%, 82.1% and 77.1%, respectively. Longer dialysis time (HR 1.011 for 1-month increase, 95% CI 1.002–1.020), graft loss (HR 3.501, 95% CI 1.559–7.865) and low-dose ganciclovir prophylaxis (1.5 g/d for 3 months) (HR 3.173, 95% CI 1.063–9.473) were risk factors associated with patient death. The five-year results show an excellent graft and patient survival in elderly kidney transplant recipients aged ≥60 years. PRA>5%, delayed graft function, and acute rejection are risk factors for graft failure, while longer duration of dialysis, graft loss and low-dose ganciclovir prophylaxis are risk factors for mortality in elderly recipients. These factors represent potential targets for interventions aimed at improving graft and patient survival in elderly recipients.
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影响因子：
13.2
作者：
De Keyzer, Kristel;Van Laecke, Steven;Vanholder, Raymond
通讯作者：
Vanholder, Raymond
影响因子：
13.6
作者：
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