Трансплантационные технологии и исследования

Single Center Experience with Deceased Donor Kidney Transplantation in Patients Aged 70 and Older: A Matched-Pair Cohort Study

Abstract

Umar Farooq, Yousef Al-Shraideh, Ravi Katari, BS, Alan C. Farney, Jeffrey Rogers, Giuseppe Orlando, Michael D. Gautreaux, Gloria Hairston, Margaret Mangus, Elizabeth Brim1, Robert J. Stratta, Amudha Palanisamy, Amber Reeves-Daniel, William Doares, Scott Kaczmorski and Samy S. Iskandar

The purpose of this study was to compare mate deceased donor (DD) kidney transplant (KT) outcomes in patients ≥70 versus <70 years of age in a matched-pair analysis.

Methods: Single center retrospective review of adult KT cases.

Results: From 5/03 to 3/12, we identified 33 DD kidney pairs that met the above criteria. Mean donor age and BMI were 52 years and 27.4 kg/m2, respectively, including 19 (58%) expanded criteria donors. Mean recipient ages were 73.6 and 55.3 years in the 2 groups (p<0.01). No significant differences were noted in multiple recipient and transplant characteristics in the older and younger groups. With a mean follow-up of 58 months, actual patient (79% older versus 94% younger, p=0.15) and kidney graft survival ([KGS] 64% older versus 67% younger) rates were comparable. Two-year patient (97% older versus 94% younger) and KGS (91% older versus 82% younger) rates revealed few early deaths or graft losses in the older group. Death-censored KGS (81% older versus 69% younger) rates demonstrated that the older group had more deaths with functioning grafts (DWFG, 21% versus 3%, p=0.05). Mean length of initial hospital stay, renal function, and rates of delayed graft function, acute rejection, major infection, re-operations and readmissions were comparable. In 13 patients aged 75 years and older, the incidence of DWFG was 31% in patients compared to 15% in patients aged 70-74 (p=0.33 compared to those >75), and 3% in all 33 younger patients (p=0.02 compared to those >75). The timing of DWFG was at a mean of 40.5 months in patients aged 75 and older compared to 72 months for those aged 70-74 years.  

Conclusions: When controlling for donor factors in a paired kidney analysis, medium-term outcomes are largely influenced by a higher incidence of DWFGs in the elderly, particularly in patients aged 75 and older.