Syed S. Mujtahedi, Colleen L. Jay, Natalia Sakhovskaya, Amber Reeves-Daniel, Alejandra Mena-Gutierrez, Christopher J. Webb, Emily K. E. McCracken, Alan C. Farney, Giuseppe Orlando, Jigish Vyas, Arianna Cabrales, Robert J. Stratta
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Mean donor age was lower in the ReKT group (44 ± 17 ReKT vs. 54 ± 13 years PrKT), as was KDPI (58 ± 24 vs. 74 ± 21% PrKT, both <i>p</i> < 0.05). A total of 44% of ReKT patients had a cPRA level above 50% compared to 10.3% PrKT (<i>p</i> < 0.0001). Rates were comparable between groups for primary nonfunction (2.6% ReKT vs. 3.7% PrKT) and delayed graft function (23% ReKT vs. 32% PrKT, <i>p</i> = 0.29). Five-year patient (55.2% ReKT vs. 74.3% PrKT, <i>p</i> = 0.03) and graft survival rates (GSRs, 55.2% ReKT vs. 64.7% PrKT, <i>p</i> = 0.32) were higher in the PrKT group. Death with functioning graft (DWFG) occurred in 59% of ReKT versus 37.4% of PrKT patients (<i>p</i> = 0.01) and accounted for 79.3% ReKT and 65.3% PrKT graft losses. 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引用次数: 0
摘要
越来越多的老年患者正在接受原发性肾移植（PrKT）或再移植（ReKT）。方法对所有老年患者（年龄≥65岁）的已故供体KTs （DDKTs）进行单中心回顾性队列研究。从2004年12月到2022年8月，我们在老年患者中进行了668例DDKTs，包括39例ReKTs和629例PrKTs。ReKT组的平均供者年龄较低（44±17 ReKT比54±13 PrKT）， KDPI(58±24比74±21% PrKT，均p <；0.05)。共有44%的ReKT患者的cPRA水平高于50%，而PrKT的这一比例为10.3% (p <；0.0001)。原发性无功能（ReKT 2.6% vs. PrKT 3.7%）和延迟移植物功能（ReKT 23% vs. PrKT 32%, p = 0.29）组间的发生率具有可比性。PrKT组5年患者（55.2% ReKT vs. 74.3% PrKT, p = 0.03）和移植物存活率（GSRs, 55.2% ReKT vs. 64.7% PrKT, p = 0.32）更高。59%的ReKT患者和37.4%的PrKT患者发生功能性移植物死亡（DWFG） （p = 0.01），占ReKT和PrKT移植物损失的79.3%和65.3%。死亡审查后的GSRs没有差异（ReKT为62.5%，PrKT为68.3%,p = 0.6）。结论：接受已故供体rekt的老年受者发生DWFG的风险较高，但死亡审查结果与年龄匹配的PrKT受者相当。
Kidney Retransplantation in the Elderly: Are the Benefits Worth the Risks?
Introduction
An increasing number of elderly patients are undergoing either primary kidney transplantation (PrKT) or retransplantation (ReKT).
Methods
Single-center retrospective cohort study of all deceased donor KTs (DDKTs) performed in elderly patients (age ≥65 years).
Results
From December 2004 through August 2022, we performed 668 DDKTs in elderly patients including 39 ReKTs and 629 PrKTs. Mean donor age was lower in the ReKT group (44 ± 17 ReKT vs. 54 ± 13 years PrKT), as was KDPI (58 ± 24 vs. 74 ± 21% PrKT, both p < 0.05). A total of 44% of ReKT patients had a cPRA level above 50% compared to 10.3% PrKT (p < 0.0001). Rates were comparable between groups for primary nonfunction (2.6% ReKT vs. 3.7% PrKT) and delayed graft function (23% ReKT vs. 32% PrKT, p = 0.29). Five-year patient (55.2% ReKT vs. 74.3% PrKT, p = 0.03) and graft survival rates (GSRs, 55.2% ReKT vs. 64.7% PrKT, p = 0.32) were higher in the PrKT group. Death with functioning graft (DWFG) occurred in 59% of ReKT versus 37.4% of PrKT patients (p = 0.01) and accounted for 79.3% ReKT and 65.3% PrKT graft losses. Death-censored GSRs were not different (62.5% ReKT vs. 68.3% PrKT, p = 0.6).
Conclusions
Elderly recipients of deceased donor ReKTs have a higher risk of DWFG, but death-censored outcomes are comparable to age-matched PrKT recipients.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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