供体年龄对活体肾移植预后的影响

Effect of donor age on prognosis of riving donor kidney transplantation

目的探讨供体年龄对活体肾移植预后的影响。方法回顾性分析2004年至2011年间在我院实施的活体亲属肾移植217例，按供体年龄或供受体年龄差异分组，随访并比较各组受者的血肌酐水平和术后并发症情况。结果随着供体年龄的增长，受体移植术后血肌酐水平呈上升趋势。与供受体年龄差〈-5岁组比较，供体年龄差〉5岁组的Ser水平在1个月[（143．5±42．1）μmol／L比（114．4±30．4）μmol／L]、3个月[（139．9±36．6）μmol／L比（110．6±33．3）μmol／L1、1年1（132．1±22．1）μmol／L比（105．5±35．9）μmol／L1及2年（132．0±45．4）μmol／L比（97．2±17．5）μmol／L]均增高，差异有统计学意义（均P〈0．05）。与年轻供肾组（〈50岁）相比，老年供肾组（〉50岁）的急性排斥反应发生率（19．4％比9．7％）和慢性排斥反应发生率（9．7％比1．4％）也显著增高（均P〈0．05）。术后人及肾的存活率比较差异无统计学意义。供受体年龄差异是术后2年Scr水平异常的独立危险因素（OR=5．010，P〈0．05）。结论供体年龄是肾移植预后的重要影响因素，老年供肾的疗效较差。

Objective To assess the impact of donor age on the outcome of living donor kidney transplantation. Methods A total of 217 patients undergoing living donor kidney transplantation during 2004 to 2011 were enrolled in our retrospective study. The recipients were divided into different groups according to their donors＇ age or the age gaps between donors and recipients. A follow-up survey was conducted to evaluate the serum creatinine level and the incidence of comphcations after transplantation. Results As the donors age grew, the recipients＇ serum creatinine increased. The serum creatinine levels of patients with older donors（age gap〉5 years） at 1 month[（143.5±42.1） μmol/L vs （114.4±30.4） μmol/L], 3 months （139.9±36.6） μmol/L vs （110.6±33.3） μmol/L], 1 year [（132.1±22.1）μmol/L vs （105.5±35.9） Ixmol/L] and 2 years （132.0±45.4） μmol/L vs （97.2±17.5） μmol/L] after operation were significantly higher than those with younger donors（age gap〈-5）（P〈0.05）. The incidence of acute rejection （19.4% vs 9.7%, P〈0105） and chronic rejection （9.7% vs 1.4%, P〈0.05） was significantly higher in the group with donors older than 50 years old than those with donors younger than 50 years old. But no significant difference was observed in the survival of the grafts or the recipients. Age gap between the donor and recipient was an independent risk factor for abnormal serum creatinine level at 2 years after transplantation （OR=5.010, P〈0.05）. Conclusions Donor age is an important impact factor on the outcome of living donor kidney transplantation. Recipients of older living donation have poorer prognosis.