Age, functional status, and survival benefit from kidney transplantation

描述（由申请人提供）：肾移植是终末期肾病（ESRD）的最佳治疗方法，包括老年ESRD患者，但捐赠肾脏的稀缺性使人们关注如何将移植分配给最受益的个体。肾移植需求的增长和未满足是由美国ESRD患病率的上升所驱动的。从1995年到2005年，ESRD患病率增加了70%，65岁以上患者的患病率上升幅度更大。透析治疗的ESRD患者死亡率明显升高。例如，65 - 69岁的透析患者的寿命仅为一般人群中相同年龄个体的25%。与透析相比，肾移植在所有年龄段的生存和生活质量方面都有显著改善。然而，与年轻受者相比，老年受者从肾脏移植中获得的寿命更短。因此，器官共享联合网络（United Network for Organ Sharing）制定了先进的政策应用程序，随着患者年龄的增长，将减少肾移植的机会。总之，这些事实表明，决策者和临床医生迫切需要更准确的肾移植候选人和受者死亡率预测指标，以优化器官的公平和有效使用。这项拨款的中心前提是功能状态将作为肾移植生存获益的一种新颖而准确的预测指标。最近来自老年医学的见解揭示了更好的功能状态和更长的生存期之间的密切关系。功能状态可以捕获合并症如糖尿病和血管疾病的累积影响。肾移植候选者在接受多年透析的同时，往往会经历很高的发病率，导致移植后暂时停用名单、永久移除、死亡或生存率低。因此，我们将研究功能状态是否可以用于预测等待移植的ESRD患者之间健康状况的重要差异。因为即使在健康人群中，功能状态也会随着年龄的增长而下降，所以我们还将研究功能状态的预测价值在不同年龄层之间是否存在差异。我们建议对肾移植候选者和受者进行回顾性队列研究，使用一个新的数据集，该数据集将来自器官共享联合网络和一家大型透析提供商的注册数据联系起来。该研究将有以下具体目的：1)确定功能状态是否预测肾移植候选人和受者的生存；2)评估年龄如何影响肾移植候选者和受者的功能状态与生存的关系；3)确定功能状态是否预示着肾移植等待名单上的切除或失活。本研究的结果有可能为有关分配移植肾脏稀缺资源的政策制定提供信息，并帮助ESRD患者及其医生了解肾移植对所有年龄个体的相对风险和益处。

DESCRIPTION (provided by applicant): Kidney transplantation is the optimal treatment for end-stage renal disease (ESRD), including for older patients with ESRD, but the scarcity of donated kidneys has focused interest on allocating transplants to the individuals who benefit the most. The growing and unmet need for kidney transplants is driven by the rising prevalence of ESRD in the United States. ESRD prevalence increased 70% from 1995 - 2005, with an even greater rate of rise among patients over 65 years old. Mortality for ESRD patients on dialysis is markedly elevated. For example, dialysis patients 65 - 69 years old live only 25% as long as individuals of the same age in the general population. Compared to dialysis, kidney transplantation leads to substantial improvements in survival and quality of life at all ages. However, older recipients gain fewer years of life from a kidney transplant compared to younger recipients. As a result, the United Network for Organ Sharing has advanced policy applications that would decrease access to kidney transplantation as patients get older. Collectively, these facts indicate that policy-makers and clinicians urgently need more accurate predictors of mortality among kidney transplant candidates and recipients to optimize the fair and efficient use of organs. The central premise of this grant is that functional status would act as a novel and accurate predictor of survival benefit from kidney transplantation. Recent insights from geriatric medicine reveal a strong relationship between better functional status and longer survival. Functional status can capture the cumulative impact of co-morbidities such as diabetes and vascular disease. Kidney transplant candidates often experience a high rate of morbidities while receiving years of dialysis, leading to temporary de-activation on the list, permanent removal, death, or poor survival after transplantation. Therefore, we will study whether functional status can be used to predict important differences in health between individuals with ESRD awaiting a transplant. Because functional status declines with aging even in healthy populations, we will also examine whether the predictive value of functional status differs between age strata. We propose a retrospective cohort study of kidney transplant candidates and recipients using a novel dataset that links registry data from the United Network for Organ Sharing and a large dialysis provider. The study will have the following specific aims: 1) To determine if functional status predicts survival among kidney transplant candidates and recipients; 2) To assess how age affects the relationship of functional status to survival among kidney transplant candidates and recipients; and 3) To determine if functional status predicts removal or inactivation on the waiting list for a kidney transplant. The results of this study have the potential to inform policy development related to allocating the scarce resource of transplanted kidneys, and to help patients with ESRD and their physicians understand the relative risks and benefits of kidney transplantation for individuals of all ages.