移植技術と研究

Old-for-Old Age Matching in Living Donor Kidney Transplantation: A Single-Center Experience

Abstract

Takuzo Fujiwara, Shinichiro Tanaka, Kei Namba, Haruchika Yamamoto, Shoma Teruta, Nozomi Morikawa, Shimpei Tsudaka and Hiroaki Matsuda

The impact of donor age, especially from older donors (≥ 60 years), on recipient outcomes in living donor kidney transplantation were retrospectively evaluated in 181 consecutive primary kidney transplant recipients. Patients were categorized according to donor age: age ≤ 39 (n=15), 40‒49 (n=28), 50‒59 (n=71), and ≥ 60 years (n=67). Cox proportional hazard multivariate analysis was used to calculate the relative risk of patient and graft survival. Cox analysis showed that donor age, as a continuous variable, was not a risk factor for patient or graft survival. Deathuncensored (65.4%) and censored (73.1%) graft survival rates in the oldest donor group were lowest, although the differences did not reach statistical significance (p=0.086 and 0.127, respectively). Mean estimated glomerular filtration rates one year after transplantation in these 4 groups were 63.1 ± 13.9, 60.4 ± 18.5, 49.2 ± 15.4 and 42.6 ± 11.4 ml/ min/1.73 m2, respectively (p < 0.001). Subdivision by age of recipients of kidney donors ≥ 60 years into those aged, ≤ 39, (n=31), 40-59, (n=25) and ≥ 60 (n=11) years, showed optimal results in old for old combination transplants. The death-uncensored graft survival rates in the 3 subgroups were 64.5%, 76.0% and 90.9%, respectively (p=0.869), whereas their mean estimated glomerular filtration rates 1 year after transplantation were 40.7 ± 7.4, 41.0 ± 10.7 and 51.4 ± 14.3 ml/min/1.73 m2, respectively (p=0.025). Age-matching may be beneficial when performing living donor kidney transplantation from older donors.