老年肾移植的临床进展
摘要
<正>与维持透析相比,肾移植能够延长老年终末期肾病(ESRD)患者的生存时间,改善其生存质量[1]。肾移植等候名单中的老年ESRD患者数量呈逐年增加趋势,但由于老年ESRD患者普遍存在一般状态较差、伴随疾病较多、虚弱、认知障碍等健康问题直接影响肾移植术后恢复,因此老年患者获得手术机会较少,等候肾移植时间较长。国外数个指南支持老年ESRD患者进行肾移植[2,3],认为年龄通常并不是肾移植的禁忌证,而年龄相关疾病却是肾移植的
引文
1 Singh P,Ng YH,Unruh M.Kidney transplantation among the elderly:challenges and opportunities to improve outcomes[J].Adv Chronic Kidney Dis,2016;23(1):44-50.
2 Knoll G,Cockfield S,Blydt-Hansen T,et al.Canadian society of transplantation:consensus guidelines on eligibility for kidney transplantation[J].CMAJ,2005;173(10):S1-25.
3 Kasiske BL,Cangro CB,Hariharan S,et al.The evaluation of renal transplantation candidates:clinical practice guidelines[J].Am JTransplant,2001;1(Suppl 2):3-95.
4 Kolko A,Dueymes JM,Couchoud C,et al.Baseline characteristics and indicators of support for new dialysis patients in 2011[J].Nephrol T-her,2013;9(Suppl 1):S65-94.
5 Abramowicz D,Cochat P,Claas FH,et al.European renal best practice guideline on kidney donor and recipient evaluation and perioperative care[J].Nephrol Dial Transplant,2015;30(11):1790-7.
6 Concepcion BP,Forbes RC,Schaefer HM.Older candidates for kidney transplantation:who to refer and what to expect[J]?World J Transplant,2016;6(4):650-7.
7 Hart A,Weir MR,Kasiske BL.Cardiovascular risk assessment in kidney transplantation[J].Kidney Int,2015;87(3):527-34.
8 Lentine KL,Hurst FP,Jindal RM,et al.Cardiovascular risk assessment among potential kidney transplant candidates:approaches and controversies[J].Am J Kidney Dis,2010;55(1):152-67.
9 Wang LW,Fahim MA,Hayen A,et al.Cardiac testing for coronary artery disease in potential kidney transplant recipients:a systematic review of test accuracy studies[J].Am J Kidney Dis,2011;57(3):476-87.
10 Wu C,Evans I,Joseph R,et al.Comorbid conditions in kidney transplantation:association with graft and patient survival[J].J Am Soc Nephrol,2005;16(11):3437-44.
11 Heldal K,Hartmann A,Leivestad T,et al.Clinical outcomes in elderly kidney transplant recipients are related to acute rejection episodes rather than pretransplant comorbidity[J].Transplantation,2009;87(7):1045-51.
12 Laging M,Kal-van Gestel JA,van de Wetering J,et al.A high comorbidity score should not be a contraindication for kidney transplantation[J].Transplantation,2016;100(2):400-6.
13 Mc Adams-DeMarco MA,Law A,Salter ML,et al.Frailty and early hospital readmission after kidney transplantation[J].Am J Transplant,2013;13(8):2091-5.
14 de Vries NM,Staal JB,van Ravensberg CD,et al.Outcome instruments to measure frailty:a systematic review[J].Ageing Res Rev,2011;10(1):104-14.
15段子才,徐琪.老年人虚弱的测评和干预研究进展[J].中国康复理论与实践,2015;21(11):1282-6.
16 Reese PP,Bloom RD,Shults J,et al.Functional status and survival after kidney transplantation[J].Transplantation,2014;97(2):189-95.
17 Reese PP,Shults J,Bloom RD,et al.Functional status,time to transplantation,and survival benefit of kidney transplantation among waitlisted candidates[J].Am J Kidney Dis,2015;66(5):837-45.
18 Chen LX,Josephson MA,Hedeker D,et al.A clinical prediction score to guide referral of elderly dialysis patients for kidney transplant evaluation[J].Kidney Int Rep,2017;2(4):645-53.
19 Grams ME,Kucirka LM,Hanrahan CF,et al.Candidacy for kidney transplantation of older adults[J].J Am Geriatr Soc,2012;60(1):1-7.
20 Dusseux E,Albano L,Fafin C,et al.A simple clinical tool to inform the decision-making process to refer elderly incident dialysis patients for kidney transplant evaluation[J].Kidney Int,2015;88(1):121-9.
21 Gill JS,Schaeffner E,Chadban S,et al.Quantification of the early risk of death in elderly kidney transplant recipients[J].Am J Transplant,2013;13(2):427-32.
22 Knoll GA.Kidney transplantation in the older adult[J].Am J Kidney Dis,2013;61(5):790-7.
23 Englum BR,Schechter MA,Irish WD,et al.Outcomes in kidney transplant recipients from older living donors[J].Transplantation,2015;99(2):309-15.
24 Iwai T,Uchida J,Kuwabara N,et al.Clinical outcome of elderly kidney transplant recipients from spousal donors[J].Urol Int,2015;95(1):99-105.
25 Uchida J,Iwai T,Machida Y,et al.ABO-incompatible kidney transplantation in elderly patients over 60 years of age[J].Int Urol Nephrol,2012;44(5):1563-70.
26 Peters-Sengers H,Berger SP,Heemskerk MB,et al.Stretching the limits of renal transplantation in elderly recipients of grafts from elderly deceased donors[J].J Am Soc Nephrol,2017;28(2):621-31.
27 Morales M,Gutiérrez E,Hernández A,et al.Preemptive kidney transplantation in elderly recipients with kidneys discarded of very old donors:a good alternative[J].Nefrologia,2015;35(3):246-55.
28 Mc Adams-DeMarco M,James N,Salter M,et al.Trends in kidney transplant outcomes in older adults[J].J Am Geriatr Soc,2014;62(12):2235-42.
29 Hod T,Goldfarb-Rumyantzev AS.Clinical issues in renal transplantation in the elderly[J].Clin Transplant,2015;29(2):167-75.
30 Kasiske B,Chakkera H,Louis T,et al.A meta-analysis of immunosuppression withdrawal trials in renal tansplantation[J].J Am Soc Nephrol,2000;11(10):1910-7.
31 Pascher A,Reutzel-Selke A,Jurisch A,et al.Alterations of the immune response with increasing recipient age are associated with reduced long term organ graft function of rat kidney allografts[J].Transplantation,2003;76(11):1560-8.
32 Martin PN,Pratshke J,Pascher A,et al.Age and the immune response in organ transplantation[J].Transplantation,2005;79(2):127-32.
33 Shaw A,Joshi S,Greenwood H,et al.Aging of the innate immune system[J].Curr Opin Immunol,2010;22(4):507-13.
34 Jacobson P,Schladt D,Oetting W,et al.Lower calcineurin inhibitor doses in older compared to younger kidney transplant recipients yield similar troughs[J].Am J Transplant,2012;12(12):3326-36.
35 Danovitch G,Gill J,Bunnapradist S.Immunosuppression of the elderly kidney transplant recipient[J].Transplantation,2007;84(3):285-91.
36 Gill J,Sampaio M,Gill J,et al.Induction immunosuppressive therapy in the elderly kidney transplant recipient in the United States[J].Clin J Am Soc Nephrol,2011;6(5):1168-78.
37 Palanisamy A,Al Manasra A,Pilch N,et al.Induction therapy:clinical and quality of life outcomes in aged renal transplant recipients[J].Clin Transplant,2015;29(3):222-6.
38 Bottomley MJ,Harden PN.Update on the long-term complications of renal transplantation[J].Br Med Bull,2013;106:117-34.
39 Kessler M,Jay N,Molle R,et al.Excess risk of cancer in renal transplant patients[J].Transpl Int,2006;19(11):908-14.
40曹有军,胡小鹏,尹航,等.肾移植术后恶性肿瘤发生率分析[J].国际移植与血液净化杂志,2014;12(1):12-5.
41位海建,宋志宇,周洪澜,等.肾移植患者术后并发原肾透明细胞癌2例报告及文献复习[J].中国实验诊断学,2016;20(7):1180-1.
42杨典东,高振利,林春华,等.腹腔镜手术治疗肾移植后自体上尿路上皮癌九例[J].中华器官移植杂志,2012;33(1):25-7.
43张杰,杨锦建,蔡宪安.肾移植后自体双侧上尿路同时并发尿路上皮癌四例[J].中华器官移植杂志,2011;32(12):760-1.
44 Zilinska Z,Sersenova M,Chrastina M,et al.Occurrence of malignancies after kidney transplantation in adults:Slovak multicenter experience[J].Neoplasma,2017;2(64):311-7.
45 Imko-Walczuk B,Kielbowicz M,Malyszko J,et al.Kaposi sarcoma in the genital area in a kidney transplant patient:a case report and literature review[J].Transplant Proc,2016;48(5):1843-8.
46 Lunardi F,Calabrese F,Furian L,et al.Epstein-Barr virus-associated gastric carcinoma 33 years after kidney transplantation[J].NDTPlus,2011;4(1):49-52.
47 Kato T,Kakuta Y,Abe T,et al.The benefits of cancer screening in kidney transplant recipients:a single-center experience[J].Cancer Med,2016;5(2):153-8.
48 Gallagher MP,Kelly PJ,Jardine M,et al.Long-term cancer risk of immunosuppressive regimens after kidney transplantation[J].J Am Soc Nephrol,2010;21(5):852-8.
49 Clayton PA,Mc Donald SP,Chapman JR,et al.Mycophenolate versus azathioprine for kidney transplantation:a 15-year follow-up of a randomized trial[J].Transplantation,2012;94(2):152-8.
50 Mc Geown MG,Douglas JF,Middleton D.One thousand renal transplants at Belfast City Hospital:post-graft neoplasia 1968-1999,comparing azathioprine only with cyclosporin-based regimes in a single centre[J].Clin Transpl,2000;14:193-202.
51 Giese T,Sommerer C,Zeier M,et al.Monitoring immunosuppression with measures of NFAT decreases cancer incidence[J].Clin Immunol,2009;132(3):305-11.
52 Hope CM,Coates PTH,Carroll RP.Immune profiling and cancer post transplantation[J].World J Nephrol,2015;4(1):41-56.
53 Dantal J,Hourmant M,Cantarovich D,et al.Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence:randomised comparison of two cyclosporin regimens[J].Lancet,1998;351(9103):623-8.
54 Hoogendijk-van den Akker JM,Harden PN,Hoitsma AJ,et al.Twoyear randomized controlled prospective trial converting treatment of stable renal transplant recipients with cutaneous invasive squamous cell carcinomas to sirolimus[J].J Clin Oncol,2013;31(10):1317-23.
55 Carroll RP,Hester J,Wood KJ,et al.Conversion to sirolimus in kidney transplant recipients with squamous cell cancer and changes in immune phenotype[J].Nephrol Dial Transplant,2013;28(2):462-5.
56 Chakera A,Bennett S,Lawrence S,et al.Antigen-specific T cell responses to BK polyomavirus antigens identify functional anti-viral immunity and may help to guide immunosuppression following renal transplantation[J].Clin Exp Immunol,2011;165(3):401-9.
57 Binggeli S,Egli A,Schaub S,et al.Polyomavirus BK-specific cellular immune response to VP1 and large T-antigen in kidney transplant recipients[J].Am J Transplant,2007;7(5):1131-9.
58 Santangelo ML,Criscitiello C,Renda A,et al.Immunosuppression and multiple primary malignancies in kidney-transplanted patients:a single-institute study[J].Bio Med Res Int,2015;2015:183523.
59 Sarno G,Nappi R,Altieri B,et al.Current evidence on vitamin D deficiency and kidney transplant:What's new[J]?Rev Endocr Metab Disord,2017;18(3):323-34.
60 Obi Y,Ichimaru N,Hamano T,et al.Orally active vitamin D for potential chemoprevention of posttransplant malignancy[J].Cancer Prev Res,2012;5(10):1229-35.
61 Courbebaisse M,Alberti C,Colas S,et al.Vitamin D supplementation in renaL transplant recipients(VITALE):a prospective,multicentre,double-blind,randomized trial of vitamin D estimating the benefit and safety of vitamin D3 treatment at a dose of 100,000 UI compared with a dose of 12,000 UI in renal transplant recipients:study protocol for a double-blind,randomized,controlled trial[J].Trials,2014;15(1):430.
2 Knoll G,Cockfield S,Blydt-Hansen T,et al.Canadian society of transplantation:consensus guidelines on eligibility for kidney transplantation[J].CMAJ,2005;173(10):S1-25.
3 Kasiske BL,Cangro CB,Hariharan S,et al.The evaluation of renal transplantation candidates:clinical practice guidelines[J].Am JTransplant,2001;1(Suppl 2):3-95.
4 Kolko A,Dueymes JM,Couchoud C,et al.Baseline characteristics and indicators of support for new dialysis patients in 2011[J].Nephrol T-her,2013;9(Suppl 1):S65-94.
5 Abramowicz D,Cochat P,Claas FH,et al.European renal best practice guideline on kidney donor and recipient evaluation and perioperative care[J].Nephrol Dial Transplant,2015;30(11):1790-7.
6 Concepcion BP,Forbes RC,Schaefer HM.Older candidates for kidney transplantation:who to refer and what to expect[J]?World J Transplant,2016;6(4):650-7.
7 Hart A,Weir MR,Kasiske BL.Cardiovascular risk assessment in kidney transplantation[J].Kidney Int,2015;87(3):527-34.
8 Lentine KL,Hurst FP,Jindal RM,et al.Cardiovascular risk assessment among potential kidney transplant candidates:approaches and controversies[J].Am J Kidney Dis,2010;55(1):152-67.
9 Wang LW,Fahim MA,Hayen A,et al.Cardiac testing for coronary artery disease in potential kidney transplant recipients:a systematic review of test accuracy studies[J].Am J Kidney Dis,2011;57(3):476-87.
10 Wu C,Evans I,Joseph R,et al.Comorbid conditions in kidney transplantation:association with graft and patient survival[J].J Am Soc Nephrol,2005;16(11):3437-44.
11 Heldal K,Hartmann A,Leivestad T,et al.Clinical outcomes in elderly kidney transplant recipients are related to acute rejection episodes rather than pretransplant comorbidity[J].Transplantation,2009;87(7):1045-51.
12 Laging M,Kal-van Gestel JA,van de Wetering J,et al.A high comorbidity score should not be a contraindication for kidney transplantation[J].Transplantation,2016;100(2):400-6.
13 Mc Adams-DeMarco MA,Law A,Salter ML,et al.Frailty and early hospital readmission after kidney transplantation[J].Am J Transplant,2013;13(8):2091-5.
14 de Vries NM,Staal JB,van Ravensberg CD,et al.Outcome instruments to measure frailty:a systematic review[J].Ageing Res Rev,2011;10(1):104-14.
15段子才,徐琪.老年人虚弱的测评和干预研究进展[J].中国康复理论与实践,2015;21(11):1282-6.
16 Reese PP,Bloom RD,Shults J,et al.Functional status and survival after kidney transplantation[J].Transplantation,2014;97(2):189-95.
17 Reese PP,Shults J,Bloom RD,et al.Functional status,time to transplantation,and survival benefit of kidney transplantation among waitlisted candidates[J].Am J Kidney Dis,2015;66(5):837-45.
18 Chen LX,Josephson MA,Hedeker D,et al.A clinical prediction score to guide referral of elderly dialysis patients for kidney transplant evaluation[J].Kidney Int Rep,2017;2(4):645-53.
19 Grams ME,Kucirka LM,Hanrahan CF,et al.Candidacy for kidney transplantation of older adults[J].J Am Geriatr Soc,2012;60(1):1-7.
20 Dusseux E,Albano L,Fafin C,et al.A simple clinical tool to inform the decision-making process to refer elderly incident dialysis patients for kidney transplant evaluation[J].Kidney Int,2015;88(1):121-9.
21 Gill JS,Schaeffner E,Chadban S,et al.Quantification of the early risk of death in elderly kidney transplant recipients[J].Am J Transplant,2013;13(2):427-32.
22 Knoll GA.Kidney transplantation in the older adult[J].Am J Kidney Dis,2013;61(5):790-7.
23 Englum BR,Schechter MA,Irish WD,et al.Outcomes in kidney transplant recipients from older living donors[J].Transplantation,2015;99(2):309-15.
24 Iwai T,Uchida J,Kuwabara N,et al.Clinical outcome of elderly kidney transplant recipients from spousal donors[J].Urol Int,2015;95(1):99-105.
25 Uchida J,Iwai T,Machida Y,et al.ABO-incompatible kidney transplantation in elderly patients over 60 years of age[J].Int Urol Nephrol,2012;44(5):1563-70.
26 Peters-Sengers H,Berger SP,Heemskerk MB,et al.Stretching the limits of renal transplantation in elderly recipients of grafts from elderly deceased donors[J].J Am Soc Nephrol,2017;28(2):621-31.
27 Morales M,Gutiérrez E,Hernández A,et al.Preemptive kidney transplantation in elderly recipients with kidneys discarded of very old donors:a good alternative[J].Nefrologia,2015;35(3):246-55.
28 Mc Adams-DeMarco M,James N,Salter M,et al.Trends in kidney transplant outcomes in older adults[J].J Am Geriatr Soc,2014;62(12):2235-42.
29 Hod T,Goldfarb-Rumyantzev AS.Clinical issues in renal transplantation in the elderly[J].Clin Transplant,2015;29(2):167-75.
30 Kasiske B,Chakkera H,Louis T,et al.A meta-analysis of immunosuppression withdrawal trials in renal tansplantation[J].J Am Soc Nephrol,2000;11(10):1910-7.
31 Pascher A,Reutzel-Selke A,Jurisch A,et al.Alterations of the immune response with increasing recipient age are associated with reduced long term organ graft function of rat kidney allografts[J].Transplantation,2003;76(11):1560-8.
32 Martin PN,Pratshke J,Pascher A,et al.Age and the immune response in organ transplantation[J].Transplantation,2005;79(2):127-32.
33 Shaw A,Joshi S,Greenwood H,et al.Aging of the innate immune system[J].Curr Opin Immunol,2010;22(4):507-13.
34 Jacobson P,Schladt D,Oetting W,et al.Lower calcineurin inhibitor doses in older compared to younger kidney transplant recipients yield similar troughs[J].Am J Transplant,2012;12(12):3326-36.
35 Danovitch G,Gill J,Bunnapradist S.Immunosuppression of the elderly kidney transplant recipient[J].Transplantation,2007;84(3):285-91.
36 Gill J,Sampaio M,Gill J,et al.Induction immunosuppressive therapy in the elderly kidney transplant recipient in the United States[J].Clin J Am Soc Nephrol,2011;6(5):1168-78.
37 Palanisamy A,Al Manasra A,Pilch N,et al.Induction therapy:clinical and quality of life outcomes in aged renal transplant recipients[J].Clin Transplant,2015;29(3):222-6.
38 Bottomley MJ,Harden PN.Update on the long-term complications of renal transplantation[J].Br Med Bull,2013;106:117-34.
39 Kessler M,Jay N,Molle R,et al.Excess risk of cancer in renal transplant patients[J].Transpl Int,2006;19(11):908-14.
40曹有军,胡小鹏,尹航,等.肾移植术后恶性肿瘤发生率分析[J].国际移植与血液净化杂志,2014;12(1):12-5.
41位海建,宋志宇,周洪澜,等.肾移植患者术后并发原肾透明细胞癌2例报告及文献复习[J].中国实验诊断学,2016;20(7):1180-1.
42杨典东,高振利,林春华,等.腹腔镜手术治疗肾移植后自体上尿路上皮癌九例[J].中华器官移植杂志,2012;33(1):25-7.
43张杰,杨锦建,蔡宪安.肾移植后自体双侧上尿路同时并发尿路上皮癌四例[J].中华器官移植杂志,2011;32(12):760-1.
44 Zilinska Z,Sersenova M,Chrastina M,et al.Occurrence of malignancies after kidney transplantation in adults:Slovak multicenter experience[J].Neoplasma,2017;2(64):311-7.
45 Imko-Walczuk B,Kielbowicz M,Malyszko J,et al.Kaposi sarcoma in the genital area in a kidney transplant patient:a case report and literature review[J].Transplant Proc,2016;48(5):1843-8.
46 Lunardi F,Calabrese F,Furian L,et al.Epstein-Barr virus-associated gastric carcinoma 33 years after kidney transplantation[J].NDTPlus,2011;4(1):49-52.
47 Kato T,Kakuta Y,Abe T,et al.The benefits of cancer screening in kidney transplant recipients:a single-center experience[J].Cancer Med,2016;5(2):153-8.
48 Gallagher MP,Kelly PJ,Jardine M,et al.Long-term cancer risk of immunosuppressive regimens after kidney transplantation[J].J Am Soc Nephrol,2010;21(5):852-8.
49 Clayton PA,Mc Donald SP,Chapman JR,et al.Mycophenolate versus azathioprine for kidney transplantation:a 15-year follow-up of a randomized trial[J].Transplantation,2012;94(2):152-8.
50 Mc Geown MG,Douglas JF,Middleton D.One thousand renal transplants at Belfast City Hospital:post-graft neoplasia 1968-1999,comparing azathioprine only with cyclosporin-based regimes in a single centre[J].Clin Transpl,2000;14:193-202.
51 Giese T,Sommerer C,Zeier M,et al.Monitoring immunosuppression with measures of NFAT decreases cancer incidence[J].Clin Immunol,2009;132(3):305-11.
52 Hope CM,Coates PTH,Carroll RP.Immune profiling and cancer post transplantation[J].World J Nephrol,2015;4(1):41-56.
53 Dantal J,Hourmant M,Cantarovich D,et al.Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence:randomised comparison of two cyclosporin regimens[J].Lancet,1998;351(9103):623-8.
54 Hoogendijk-van den Akker JM,Harden PN,Hoitsma AJ,et al.Twoyear randomized controlled prospective trial converting treatment of stable renal transplant recipients with cutaneous invasive squamous cell carcinomas to sirolimus[J].J Clin Oncol,2013;31(10):1317-23.
55 Carroll RP,Hester J,Wood KJ,et al.Conversion to sirolimus in kidney transplant recipients with squamous cell cancer and changes in immune phenotype[J].Nephrol Dial Transplant,2013;28(2):462-5.
56 Chakera A,Bennett S,Lawrence S,et al.Antigen-specific T cell responses to BK polyomavirus antigens identify functional anti-viral immunity and may help to guide immunosuppression following renal transplantation[J].Clin Exp Immunol,2011;165(3):401-9.
57 Binggeli S,Egli A,Schaub S,et al.Polyomavirus BK-specific cellular immune response to VP1 and large T-antigen in kidney transplant recipients[J].Am J Transplant,2007;7(5):1131-9.
58 Santangelo ML,Criscitiello C,Renda A,et al.Immunosuppression and multiple primary malignancies in kidney-transplanted patients:a single-institute study[J].Bio Med Res Int,2015;2015:183523.
59 Sarno G,Nappi R,Altieri B,et al.Current evidence on vitamin D deficiency and kidney transplant:What's new[J]?Rev Endocr Metab Disord,2017;18(3):323-34.
60 Obi Y,Ichimaru N,Hamano T,et al.Orally active vitamin D for potential chemoprevention of posttransplant malignancy[J].Cancer Prev Res,2012;5(10):1229-35.
61 Courbebaisse M,Alberti C,Colas S,et al.Vitamin D supplementation in renaL transplant recipients(VITALE):a prospective,multicentre,double-blind,randomized trial of vitamin D estimating the benefit and safety of vitamin D3 treatment at a dose of 100,000 UI compared with a dose of 12,000 UI in renal transplant recipients:study protocol for a double-blind,randomized,controlled trial[J].Trials,2014;15(1):430.