全部 标题 作者
关键词 摘要


Renal Transplantation from Elderly Living Donors

DOI: 10.1155/2013/475964

Full-Text   Cite this paper   Add to My Lib

Abstract:

Acceptance of elderly living kidney donors remains controversial due to the higher incidence of comorbidity and greater risk of postoperative complications. This is a review of publications in the English language between 2000 and 2013 about renal transplantation from elderly living donors to determine trends and effects of donation, and the outcomes of such transplantation. The last decade witnessed a 50% increase in living kidney donor transplants, with a disproportionate increase in donors >60 years. There is no accelerated loss of kidney function following donation, and the incidence of established renal failure (ERF) and hypertension among donors is similar to that of the general population. The overall incidence of ERF in living donors is about 0.134 per 1000 years. Elderly donors require rigorous assessment and should have a predicted glomerular filtration rate of at least 37.5?mL/min/1.73?m2 at the age of 80. Though elderly donors had lower glomerular filtration rate before donation, proportionate decline after donation was similar in both young and elderly groups. The risks of delayed graft function, acute rejection, and graft failure in transplants from living donors >65 years are significantly higher than transplants from younger donors. A multicentred, long-term, and prospective database addressing the outcomes of kidneys from elderly living donors is recommended. 1. Introduction Kidney transplantation is the optimum replacement therapy for patients with established renal failure (ERF), as it offers better quality of life and improved survival [1]. The demand for renal transplantation has increased due to the growing prevalence of ERF and extension of the criteria for accepting patients onto the waiting list. In response to the increasing need for organs, deceased donor programs (donation after circulatory death (DCD) and donation after brain death (DBD)) are being optimized, and living kidney donation expanded in several countries to include both related and unrelated donation. Further developments include ABO (blood group) incompatible transplantation, legalised altruistic nondirected living donation, and adoption of paired or more complex exchange of living donor programs. In the last decade in the UK, there has been significant growth in living donor kidney transplantation with 485 transplants in 2005, increasing to 1,055 in 2012 [2]. All these have not succeeded in meeting the demand for renal transplantation, and efforts to provide more donors have included the use of marginal living donors, particularly elderly living donors. The use

References

[1]  M. Tonelli, N. Wiebe, G. Knoll et al., “Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes,” American Journal of Transplantation, vol. 11, no. 10, pp. 2093–2109, 2011.
[2]  NHS Blood and transplant, http://organdonation.nhs.uk/statistics/transplant_activity_report/current_activity_reports/ukt/activity_report_2011_12.pdf, 2013.
[3]  F. Moreso, D. Serón, S. Gil-Vernet et al., “Donor age and delayed graft function as predictors of renal allograft survival in rejection-free patients,” Nephrology Dialysis Transplantation, vol. 14, no. 4, pp. 930–935, 1999.
[4]  Y. M. Woo, J. S. Gill, N. Johnson, B. J. G. Pereira, and S. Hariharan, “The advanced age deceased kidney donor: current outcomes and future opportunities,” Kidney International, vol. 67, no. 6, pp. 2407–2414, 2005.
[5]  J. H. Hong, K. Shirani, and A. Arshad, “Influence of cadaver donor age on the success of kidney transplants,” Transplantation, vol. 32, no. 6, pp. 532–534, 1981.
[6]  S. R. Kerr, K. J. Gillingham, E. M. Johnson, and A. J. Matas, “Living donors years: to use or not to use?” Transplantation, vol. 67, no. 7, pp. 999–1004, 1999.
[7]  L. S. De La Vega, A. Torres, H. E. Bohorquez et al., “Patient and graft outcomes from older living kidney donors are similar to those from younger donors despite lower GFR,” Kidney International, vol. 66, no. 4, pp. 1654–1661, 2004.
[8]  J. Gill, S. Bunnapradist, G. M. Danovitch, D. Gjertson, J. S. Gill, and M. Cecka, “Outcomes of kidney transplantation from older living donors to older recipients,” American Journal of Kidney Diseases, vol. 52, no. 3, pp. 541–552, 2008.
[9]  B. O'Brien, S. Mastoridis, A. Sabharwal, N. Hakim, D. Taube, and V. Papalois, “Expanding the donor pool: living donor nephrectomy in the elderly and the overweight,” Transplantation, vol. 93, no. 11, pp. 1158–1165, 2012.
[10]  J. S. Gill, M. Tonelli, N. Johnson, B. Kiberd, D. Landsberg, and B. J. G. Pereira, “The impact of waiting time and comorbid conditions on the survival benefit of kidney transplantation,” Kidney International, vol. 68, no. 5, pp. 2345–2351, 2005.
[11]  J. R. Nyengaard and T. F. Bendtsen, “Glomerular number and size in relation to age, kidney weight, and body surface in normal man,” Anatomical Record, vol. 232, no. 2, pp. 194–201, 1992.
[12]  B. Kappel and S. Olsen, “Cortical interstitial tissue and sclerosed glomeruli in the normal human kidney, related to age and sex. A quantitative study,” Virchows Archiv, vol. 387, no. 3, pp. 271–277, 1980.
[13]  G. Fuiano, S. Sund, G. Mazza et al., “Renal hemodynamic response to maximal vasodilating stimulus in healthy older subjects,” Kidney International, vol. 59, no. 3, pp. 1052–1058, 2001.
[14]  E. D. Poggio, W. E. Braun, and C. Davis, “The science of stewardship: due diligence for kidney donors and kidney function in living kidney donation-evaluation, determinants, and implications for outcomes,” Clinical Journal of the American Society of Nephrology, vol. 4, no. 10, pp. 1677–1684, 2009.
[15]  A. Kanematsu, K. Tanabe, N. Ishikawa et al., “Impact of donor age on long-term graft survival in living donor kidney transplantation,” Transplantation Proceedings, vol. 30, no. 7, pp. 3118–3119, 1998.
[16]  C. K. Oh, S. N. Yoon, B. M. Lee et al., “Beneficial effects on the renal function of both recipients and donors in living donor kidney transplantation,” Transplantation Proceedings, vol. 40, no. 7, pp. 2310–2312, 2008.
[17]  I. Fehrman-Ekholm, C. Blinder, M. Stenbeck, G. Tydén, and C. Groth, “Kidney donors live longer,” Transplantation, vol. 64, no. 7, pp. 976–978, 1997.
[18]  T. Ramcharan and A. J. Matas, “Long-term (20–37 years) follow-up of living kidney donors,” American Journal of Transplantation, vol. 2, no. 10, pp. 959–964, 2002.
[19]  A. Hartmann, P. Fauchald, L. Westlie, I. B. Brekke, and H. Holdaas, “The risk of living kidney donation,” Nephrology Dialysis Transplantation, vol. 18, no. 5, pp. 871–873, 2003.
[20]  R. Schmitt and L. G. Cantley, “The impact of aging on kidney repair,” American Journal of Physiology, vol. 294, no. 6, pp. F1265–F1272, 2008.
[21]  US Renal Data System (USRDS), http://www.usrds.org/reference.htm, USRDS Annual Data Report (ADR) Reference Tables 2007, 2013.
[22]  US Renal Data System (USRDS), http://www.usrds.org/reference.htm, USRDS Annual Data Report (ADR) Reference Tables 2007, 2012.
[23]  R. Sapir-Pichhadze, A. Young, and S. Joseph Kim, “Living donor age and kidney transplant outcomes: an assessment of risk across the age continuum,” Transplant International, vol. 26, no. 5, pp. 493–501, 2013.
[24]  J. W. de Fijter, “The impact of age on rejection in kidney transplantation,” Drugs and Aging, vol. 22, no. 5, pp. 433–449, 2005.
[25]  J. A. Akoh and S. Stacey, “Assessment of potential living kidney donors: options for increasing donation,” Dialysis and Transplantation, vol. 37, no. 9, pp. 352–359, 2008.
[26]  F. L. Delmonico and M. A. Dew, “Living donor kidney transplantation in a global environment,” Kidney International, vol. 71, no. 7, pp. 608–614, 2007.
[27]  M. Abecassis, M. Adams, P. Adams et al., “Live organ donor consensus group. Consensus statement on the live organ donor,” JAMA, vol. 284, no. 22, pp. 2919–2926, 2000.
[28]  “The consensus statement of the Amsterdam forum on the care of the live kidney donor,” Transplantation, vol. 76, no. 4, pp. 1257–1260, 2004.
[29]  “British Transplant Society: United Kingdom guidelines for living donor kidney transplantation,” http://www.bts.org.uk/Documents/Guidelines/Active/UK%20Guidelines%20for%20Living%20Donor%20Kidney%20July%202011.pdf, 2013.
[30]  F. L. Delmonico and O. S. Surman, “Is this live-organ donor your patient?” Transplantation, vol. 76, no. 8, pp. 1257–1260, 2003.
[31]  I. Fehrman-Ekholm, G. Nordén, A. Lennerling et al., “Incidence of end-stage renal disease among live kidney donors,” Transplantation, vol. 82, no. 12, pp. 1646–1648, 2006.
[32]  D. A. Mandelbrot, M. Pavlakis, G. M. Danovitch et al., “The medical evaluation of living kidney donors: a survey of US transplant centers,” American Journal of Transplantation, vol. 7, no. 10, pp. 2333–2343, 2007.
[33]  C. L. Davis and F. L. Delmonico, “Living-donor kidney transplantation: a review of the current practices for the live donor,” Journal of the American Society of Nephrology, vol. 16, no. 7, pp. 2098–2110, 2005.
[34]  F. L. Delmonico, “A report of the Amsterdam forum on the care of the live kidney donor: data and medical guidelines,” Transplantation, vol. 79, no. 6, pp. S53–S66, 2005.
[35]  M. J. Bia, E. L. Ramos, G. M. Danovitch et al., “Evaluation of living renal donors: the current practice of us transplant centers,” Transplantation, vol. 60, no. 4, pp. 322–327, 1995.
[36]  M. Gabolde, C. Hervé, and A. Moulin, “Evaluation, selection, and follow-up of live kidney donors: a review of current practice in French renal transplant centres,” Nephrology Dialysis Transplantation, vol. 16, no. 10, pp. 2048–2052, 2001.
[37]  A. D. Rule, H. M. Gussak, G. R. Pond et al., “Transplantation measured and estimated GFR in healthy potential kidney donors,” American Journal of Kidney Diseases, vol. 43, no. 1, pp. 112–119, 2004.
[38]  D. F. Davies and N. W. Shock, “Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males,” The Journal of Clinical Investigation, vol. 29, no. 5, pp. 496–507, 1950.
[39]  G. Nordén, A. Lennerling, and G. Nyberg, “Low absolute glomerular filtration rate in the living kidney donor: a risk factor for graft loss,” Transplantation, vol. 70, no. 9, pp. 1360–1362, 2000.
[40]  P. Brindel, O. Hanon, J. Dartigues et al., “Prevalence, awareness, treatment, and control of hypertension in the elderly: the Three City study,” Journal of Hypertension, vol. 24, no. 1, pp. 51–58, 2006.
[41]  K. L. Ong, B. M. Y. Cheung, Y. B. Man, C. P. Lau, and K. S. L. Lam, “Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004,” Hypertension, vol. 49, no. 1, pp. 69–75, 2007.
[42]  P. S. Vokonas, W. B. Kannel, and L. A. Cupples, “Epidemiology and risk of hypertension in the elderly: the Framingham study,” Journal of Hypertension, vol. 6, supplement 1, pp. S3–S9, 1988.
[43]  S. Textor and S. Taler, “Expanding criteria for living kidney donors: what are the limits?” Transplantation Reviews, vol. 22, no. 3, pp. 187–191, 2008.
[44]  C. B. Vigneault, W. S. Asch, N. K. Dahl, and M. J. Bia, “Should living kidney donor candidates with impaired fasting glucose donate?” Clinical Journal of the American Society of Nephrology, vol. 6, no. 8, pp. 2054–2059, 2011.
[45]  H. N. Ibrahim, A. Kukla, G. Cordner, R. Bailey, K. Gillingham, and A. J. Matas, “Diabetes after kidney donation,” American Journal of Transplantation, vol. 10, no. 2, pp. 331–337, 2010.
[46]  G. Knoll, “Trends in kidney transplantation over the past decade,” Drugs, vol. 68, supplement 1, pp. 3–10, 2008.
[47]  L. D. Horvat, S. Z. Shariff, and A. X. Garg, “Global trends in the rates of living kidney donation,” Kidney International, vol. 75, no. 10, pp. 1088–1098, 2009.
[48]  Organ Procurement and Transplantation Network (OPTN), “OPTN & SRTR Annual report,” http://srtr.transplant.hrsa.gov/annual_reports/2011/flash/01_kidney/index.html#/8/zoomed, 2012.
[49]  K. Noppakun, F. G. Cosio, P. G. Dean, S. J. Taler, R. Wauters, and J. P. Grande, “Living donor age and kidney transplant outcomes,” American Journal of Transplantation, vol. 11, no. 6, pp. 1279–1286, 2011.
[50]  A. L. Friedman, K. Cheung, S. A. Roman, and J. A. Sosa, “Early clinical and economic outcomes of patients undergoing living donor nephrectomy in the United States,” Archives of Surgery, vol. 145, no. 4, pp. 356–362, 2010.
[51]  S.-F. Tsai, K.-H. Shu, H.-C. Ho et al., “Long-term outcomes of living kidney donors over the past 28 years in a single center in Taiwan,” Transplantation Proceedings, vol. 44, no. 1, pp. 39–42, 2012.
[52]  R. Kido, Y. Shibagaki, K. Iwadoh et al., “How do living kidney donors develop end-stage renal disease?” American Journal of Transplantation, vol. 9, no. 11, pp. 2514–2519, 2009.
[53]  K. H. Choi, S. C. Yang, D. J. Joo et al., “Clinical assessment of renal function stabilization after living donor nephrectomy,” Transplantation Proceedings, vol. 44, no. 10, pp. 2906–2909, 2012.
[54]  J. A. Velosa, K. P. Offord, and D. R. Schroeder, “Effect of age, sex, and glomerular filtration rate on renal function outcome of living kidney donors,” Transplantation, vol. 60, no. 12, pp. 1618–1621, 1995.
[55]  H. A. Bock, M. Bachofen, J. Landmann, and G. Thiel, “Glomerular hyperfiltration after unilateral nephrectomy in living kidney donors,” Transplant International, vol. 5, pp. S156–159, 1992.
[56]  G. Boner, W. D. Shelp, M. Newton, and R. E. Rieselbach, “Factors influencing the increase in glomerular filtration rate in the remaining kidney of transplant donors,” American Journal of Medicine, vol. 55, no. 2, pp. 169–174, 1973.
[57]  A. B. Saxena, B. D. Myers, G. Derby et al., “Adaptive hyperfiltration in the aging kidney after contralateral nephrectomy,” American Journal of Physiology, vol. 291, no. 3, pp. F629–F634, 2006.
[58]  L. F. C. Dols, N. F. M. Kok, J. I. Roodnat et al., “Living kidney donors: impact of age on long-term safety,” American Journal of Transplantation, vol. 11, no. 4, pp. 737–742, 2011.
[59]  L. Berardinelli, E. Pozzoli, C. Beretta et al., “Long-term outcome of living donors older than 60 years,” Transplantation Proceedings, vol. 42, no. 4, pp. 1111–1113, 2010.
[60]  A. Young, S. J. Kim, M. R. Speechley et al., “Accepting kidneys from older living donors: impact on transplant recipient outcomes,” American Journal of Transplantation, vol. 11, no. 4, pp. 743–750, 2011.
[61]  E. D. Poggio, A. D. Rule, R. Tanchanco et al., “Demographic and clinical characteristics associated with glomerular filtration rates in living kidney donors,” Kidney International, vol. 75, no. 10, pp. 1079–1087, 2009.
[62]  Y. M. Barri, T. Parker, Y. Daoud, and R. J. Glassock, “Definition of chronic kidney disease after uninephrectomy in living donors: what are the implications?” Transplantation, vol. 90, no. 5, pp. 575–580, 2010.
[63]  U. Frei, J. Noeldeke, V. Machold-Fabrizii et al., “Prospective age-matching in elderly kidney transplant recipients-a 5-year analysis of the eurotransplant senior program,” American Journal of Transplantation, vol. 8, no. 1, pp. 50–57, 2008.
[64]  M. D. Ellison, M. A. McBride, S. E. Taranto, F. L. Delmonico, and H. M. Kauffman, “Living kidney donors in need of kidney transplants: a report from the organ procurement and transplantation network,” Transplantation, vol. 74, no. 9, pp. 1349–1351, 2002.
[65]  W. S. Cherikh, C. J. Young, B. F. Kramer, S. E. Taranto, H. B. Randall, and P.-Y. Fan, “Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation,” American Journal of Transplantation, vol. 11, no. 8, pp. 1650–1655, 2011.
[66]  E. M. Gibney, A. L. King, D. G. Maluf, A. X. Garg, and C. R. Parikh, “Living kidney donors requiring transplantation: focus on African Americans,” Transplantation, vol. 84, no. 5, pp. 647–649, 2007.
[67]  B. R. Morgan and H. N. Ibrahim, “Long-term outcomes of kidney donors,” Current Opinion in Nephrology and Hypertension, vol. 20, no. 6, pp. 605–609, 2011.
[68]  A. E. El-Agroudy, E. W. Wafa, A. A. Sabry et al., “The health of elderly living kidney donors after donation,” Annals of Transplantation, vol. 14, no. 2, pp. 13–19, 2009.
[69]  I. Fehrman-Ekholm, F. Dunér, B. Brink, G. Tydén, and C. Elinder, “No evidence of accelerated loss of kidney function in living kidney donors: results from a cross-sectional follow-up,” Transplantation, vol. 72, no. 3, pp. 444–449, 2001.
[70]  G. Mjoen, K. Midtvedt, I. Holme et al., “One- and five-year follow-ups on blood pressure and renal function in kidney donors,” Transplant International, vol. 24, no. 1, pp. 73–77, 2011.
[71]  N. Boudville, G. V. R. Prasad, G. Knoll et al., “Meta-analysis: risk for hypertension in living kidney donors,” Annals of Internal Medicine, vol. 145, no. 3, pp. 185–196, 2006.
[72]  M. L. Nicholson, R. Elwell, M. Kaushik, A. Bagul, and S. A. Hosgood, “Health-related quality of life after living donor nephrectomy: a randomized controlled trial of laparoscopic versus open nephrectomy,” Transplantation, vol. 91, no. 4, pp. 457–461, 2011.
[73]  N. F. Kok, M. Y. Lind, B. M. E. Hansson et al., “Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial,” British Medical Journal, vol. 333, no. 7561, pp. 221–224, 2006.
[74]  R. C. Minnee, W. A. Bemelman, S. W. Polle et al., “Older living kidney donors: surgical outcome and quality of life,” Transplantation, vol. 86, no. 2, pp. 251–256, 2008.
[75]  C. Chien, H. Wang, Y. Chiang, S. Chu, H. Liu, and K. Liu, “Quality of life after laparoscopic donor nephrectomy,” Transplantation proceedings, vol. 42, no. 3, pp. 696–698, 2010.
[76]  A. Shrestha, A. Shrestha, C. Vallance, W. S. McKane, B. M. Shrestha, and A. T. Raftery, “Quality of life of living kidney donors: a single-center experience,” Transplantation Proceedings, vol. 40, no. 5, pp. 1375–1377, 2008.
[77]  R. Naumovic, L. Djukanovic, J. Marinkovic, and V. Lezaic, “Effect of donor age on the outcome of living-related kidney transplantation,” Transplant International, vol. 18, no. 11, pp. 1266–1274, 2005.
[78]  P. Ferrari, W. Lim, H. Dent, and S. P. McDonald, “Effect of donor-recipient age difference on graft function and survival in live-donor kidney transplantation,” Nephrology Dialysis Transplantation, vol. 26, no. 2, pp. 702–708, 2011.
[79]  J. A. Akoh and T. Rana, “Impact of donor age on outcome of kidney transplantation from controlled donation after cardiac death,” Saudi Journal of Kidney Disease and Transplantation, vol. 24, no. 4, pp. 673–681, 2013.
[80]  S. Baid-Agrawal and U. A. Frei, “Living donor renal transplantation: recent developments and perspectives,” Nature Clinical Practice Nephrology, vol. 3, no. 1, pp. 31–41, 2007.
[81]  S. R. Johnson, K. Khwaja, M. Pavlakis, A. P. Monaco, and D. W. Hanto, “Older living donors provide excellent quality kidneys: a single center experience (older living donors),” Clinical Transplantation, vol. 19, no. 5, pp. 600–606, 2005.
[82]  N. Simforoosh, A. Basiri, M. R. Fattahi et al., “Living unrelated versus living related kidney transplantation: 20 Years' experience with 2155 cases,” Transplantation Proceedings, vol. 38, no. 2, pp. 422–425, 2006.
[83]  A. Voiculescu, K. Ivens, G. R. Hetzel et al., “Kidney transplantation from related and unrelated living donors in a single German centre,” Nephrology Dialysis Transplantation, vol. 18, no. 2, pp. 418–425, 2003.
[84]  Y. Iordanous, N. Seymour, A. Young et al., “Recipient outcomes for expanded criteria living kidney donors: the disconnect between current evidence and practice,” American Journal of Transplantation, vol. 9, no. 7, pp. 1558–1573, 2009.
[85]  J. C. Jeong, M.-G. Kim, H. Ro et al., “Kidney transplantation using expanded criteria donors in Korea,” Transplantation Proceedings, vol. 44, no. 1, pp. 54–56, 2012.
[86]  P. Chang, J. Gill, J. Dong et al., “Living donor age and kidney allograft half-life: implications for living donor paired exchange programs,” Clinical Journal of the American Society of Nephrology, vol. 7, no. 5, pp. 835–841, 2012.
[87]  J. S. Gill, J. Gill, C. Rose, N. Zalunardo, and D. Landsberg, “The older living kidney donor: part of the solution to the organ shortage,” Transplantation, vol. 82, no. 12, pp. 1662–1666, 2006.
[88]  J. C. Berger, A. D. Muzaale, N. James et al., “Living kidney donors ages 70 and older: recipient and donor outcomes,” Clinical Journal of the American Society of Nephrology, vol. 6, no. 12, pp. 2887–2893, 2011.
[89]  A. J. Matas, W. D. Payne, D. E. R. Sutherland et al., “2,500 Living donor kidney transplants: a single-center experience,” Annals of Surgery, vol. 234, no. 2, pp. 149–164, 2001.
[90]  M. D. Rizzari, T. M. Suszynski, K. J. Gillingham, and A. J. Matas, “Consideration of donor age and human leukocyte antigen matching in the setting of multiple potential living kidney donors,” Transplantation, vol. 92, no. 1, pp. 70–75, 2011.
[91]  S. V. Fuggle, J. E. Allen, R. J. Johnson et al., “Factors affecting graft and patient survival after live donor kidney transplantation in the UK,” Transplantation, vol. 89, no. 6, pp. 694–701, 2010.
[92]  C. M. ?ien, A. V. Reis?ter, T. Leivestad, F. W. Dekker, P. D. Line, and I. Os, “Living donor kidney transplantation: the effects of donor age and gender on short- and long-term outcomes,” Transplantation, vol. 83, no. 5, pp. 600–606, 2007.
[93]  R. A. Metzger, F. L. Delmonico, S. Feng, F. K. Port, J. J. Wynn, and R. M. Merion, “Expanded criteria donors for kidney transplantation,” American Journal of Transplantation, vol. 3, supplement 4, pp. 114–125, 2003.

Full-Text

comments powered by Disqus