Clinical transplantation · 2014
Influence of recipient age on deceased donor kidney transplant outcomes in the expanded criteria donor era.
Клиническое исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Al-Shraideh Yousef, Farooq Umar, Farney Alan C, Palanisamy Amudha, Rogers Jeffrey, Orlando Giuseppe, Buckley Michael R, Reeves-Daniel Amber, Doares William, Kaczmorski Scott, Gautreaux Michael D, Iskandar Samy S, Hairston Gloria, Brim Elizabeth, Mangus Margaret, Stratta Robert J
Аннотация
METHODS: We performed a retrospective single-center review of 884 deceased donor (DD) kidney transplants (KTs) in patients (pts) aged ≥40 yr.
RESULTS: One hundred and four (11.8%) pts were ≥70 (mean 74), 286 (32.3%) were 60-69 (mean 64), and 494 (55.9%) were 40-59 (mean 51) yr of age; the proportion receiving expanded criteria donor (ECD) kidneys were 66%, 49%, and 30%, respectively (p < 0.001). Mean waiting time (15 months) was shorter for pts ≥70 yr compared to the other two groups combined (23 months, p = 0.002). With mean follow-up ranging from 54 to 70 months, actual pt (81% vs. 72%, p = 0.002) and graft (66% vs. 58.5%, p = 0.03) survival rates were higher in the younger compared to the two older groups, whereas death-censored graft survival was similar (76% vs. 73%, p = NS). The incidence of death with a functioning graft correlated with older recipient age group, increasing from 13% to 18% to 23% (p = 0.01). The incidence of delayed graft function was similar (31.8% overall), and renal function, morbidity, and resource utilization were similar among groups.
CONCLUSIONS: By directing ECD kidneys to selected older pts, waiting times are reduced and censored survival outcomes are similar to middle-aged patients, suggesting that matching strategies for graft and patient lifespan are warranted.
RESULTS: One hundred and four (11.8%) pts were ≥70 (mean 74), 286 (32.3%) were 60-69 (mean 64), and 494 (55.9%) were 40-59 (mean 51) yr of age; the proportion receiving expanded criteria donor (ECD) kidneys were 66%, 49%, and 30%, respectively (p < 0.001). Mean waiting time (15 months) was shorter for pts ≥70 yr compared to the other two groups combined (23 months, p = 0.002). With mean follow-up ranging from 54 to 70 months, actual pt (81% vs. 72%, p = 0.002) and graft (66% vs. 58.5%, p = 0.03) survival rates were higher in the younger compared to the two older groups, whereas death-censored graft survival was similar (76% vs. 73%, p = NS). The incidence of death with a functioning graft correlated with older recipient age group, increasing from 13% to 18% to 23% (p = 0.01). The incidence of delayed graft function was similar (31.8% overall), and renal function, morbidity, and resource utilization were similar among groups.
CONCLUSIONS: By directing ECD kidneys to selected older pts, waiting times are reduced and censored survival outcomes are similar to middle-aged patients, suggesting that matching strategies for graft and patient lifespan are warranted.
Предметные рубрики MeSH
AdultAge FactorsAgedCadaverFemaleFollow-Up StudiesGlomerular Filtration RateGraft SurvivalHumansKidney DiseasesKidney Function TestsKidney TransplantationMaleMiddle AgedPatient SelectionPostoperative PeriodPrognosisRetrospective StudiesRisk FactorsSurvival RateTissue DonorsTissue and Organ ProcurementTransplant RecipientsYoung Adult