70岁以上患者的移植后生存率与正在进行透析相比:匹配对分析
Bree Shi1, Tracey Ying2, Steven J Chadban2
1Kidney Node, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia; Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, South Australia, Australia.
概括
移植为70岁以上的老年患者提供了生存益处,尽管最初的死亡率风险更高. 九个月后,移植接受者 (KTRs) 与透析患者相比,死亡率明显降低.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 移植免疫学 移植免疫学
- 老年医学 老年医学
背景情况:
- 移植通常可以改善存活率和生活质量.
- 对老年患者 (70岁以上) 进行移植的益处尚未得到充分证实.
- 透析是这个年龄组末期病 (ESKD) 的首要替代方案.
研究的目的:
- 为了评估与等待清单中的透析患者相比,老年移植患者的生存结果.
- 确定与老年人移植相关的长期益处和风险.
主要方法:
- 使用澳大利亚和新西兰透析和移植注册 (2009-2019) 的队列研究.
- 老年移植接受者 (KTRs,n=465) 与基于年龄,ESKD原因和透析持续时间的等待列表透析患者相匹配.
- 使用分层的考克斯回归进行了生存分析,在移植时审查透析患者.
主要成果:
- 在KTR患者中,初始移植后的死亡率超过了透析患者的死亡率,主要是由于感染 (每100个患者年1.9对0.3 ,P=.03).
- 在9个月之后,KTRs表现出生存优势,在中位数1.7年的随访期间,KTRs的死亡率降低了38% (P=.02).
- 在KTR患者中,五年生存率为80%,在透析患者中为53% (P<.001). 生活标准和标准标准供体接受者获得了即时的好处,而扩展标准供体接受者早期风险更高.
结论:
- 接受移植的老年人面临着更高的早期死亡风险,但与继续接受透析相比,他们的生存率逐渐更高.
- 移植可以成为选择ESKD老年患者的有益治疗选择,提供长期生存优势.
- 仔细的供体选择,特别是关于扩展标准的供体,对于优化老年移植受体的结果至关重要.
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