Benefits of Living Over Deceased Donor Kidney Transplantation in Elderly Recipients. A Propensity Score Matched Analysis of a Large European Registry Cohort.

IF 2.7 3区医学 Q1 SURGERY

Transplant International Pub Date : 2024-08-23 DOI:10.3389/ti.2024.13452

Néstor Toapanta,Jordi Comas,Ignacio Revuelta,Anna Manonelles,Carme Facundo,María José Pérez-Saez,Anna Vila,Emma Arcos,Jaume Tort,Magali Giral,Maarten Naesens,Dirk Kuypers,Anders Asberg,Francesc Moreso,Oriol Bestard,

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引用次数: 0

Abstract

Although kidney transplantation from living donors (LD) offers better long-term results than from deceased donors (DD), elderly recipients are less likely to receive LD transplants than younger ones. We analyzed renal transplant outcomes from LD versus DD in elderly recipients with a propensity-matched score. This retrospective, observational study included the first single kidney transplants in recipients aged ≥65 years from two European registry cohorts (2013-2020, n = 4,257). Recipients of LD (n = 408), brain death donors (BDD, n = 3,072), and controlled cardiocirculatory death donors (cDCD, n = 777) were matched for donor and recipient age, sex, dialysis time and recipient diabetes. Major graft and patient outcomes were investigated. Unmatched analyses showed that LD recipients were more likely to be transplanted preemptively and had shorter dialysis times than any DD type. The propensity score matched Cox's regression analysis between LD and BDD (387-pairs) and LD and cDCD (259-pairs) revealing a higher hazard ratio for graft failure with BDD (2.19 [95% CI: 1.16-4.15], p = 0.016) and cDCD (3.38 [95% CI: 1.79-6.39], p < 0.001). One-year eGFR was higher in LD transplants than in BDD and cDCD recipients. In elderly recipients, LD transplantation offers superior graft survival and renal function compared to BDD or cDCD. This strategy should be further promoted to improve transplant outcomes.

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老年受者接受活体肾移植比接受死体肾移植的益处。对欧洲大型登记队列的倾向得分匹配分析。

虽然活体捐献者（LD）肾移植的长期效果优于已故捐献者（DD），但老年受者接受 LD 移植的可能性低于年轻受者。我们分析了老年受者接受 LD 与 DD 肾移植的结果，并进行了倾向匹配评分。这项回顾性观察研究纳入了两个欧洲登记队列（2013-2020 年，n = 4,257 例）中年龄≥65 岁受者的首例单肾移植。LD（n = 408）、脑死亡捐献者（BDD，n = 3,072）和受控心循环死亡捐献者（cDCD，n = 777）的受者与捐献者和受者的年龄、性别、透析时间和受者糖尿病情况相匹配。对主要移植物和患者的预后进行了调查。非配对分析表明，与任何 DD 类型相比，LD 受体更有可能接受先期移植，且透析时间更短。LD 和 BDD（387 对）以及 LD 和 cDCD（259 对）之间的倾向得分匹配 Cox 回归分析显示，BDD（2.19 [95% CI: 1.16-4.15]，p = 0.016）和 cDCD（3.38 [95% CI: 1.79-6.39]，p < 0.001）的移植失败危险比更高。LD移植者的一年eGFR高于BDD和cDCD受者。在老年受者中，LD移植比BDD或cDCD移植具有更高的移植存活率和肾功能。应进一步推广这一策略，以改善移植结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant International 医学-外科

CiteScore

4.70

自引率

6.50%

发文量

211

审稿时长

3-8 weeks

期刊介绍： The aim of the journal is to serve as a forum for the exchange of scientific information in the form of original and high quality papers in the field of transplantation. Clinical and experimental studies, as well as editorials, letters to the editors, and, occasionally, reviews on the biology, physiology, and immunology of transplantation of tissues and organs, are published. Publishing time for the latter is approximately six months, provided major revisions are not needed. The journal is published in yearly volumes, each volume containing twelve issues. Papers submitted to the journal are subject to peer review.