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A importância da alocação preferencial de órgãos no transplante renal
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Resumo(s)
Introdução: A transplantação renal é a terapêutica substitutiva renal que garante maior sobrevida e melhor qualidade de vida, no entanto, o número de dadores disponíveis é bastante inferior ao de potenciais recetores, como tal, torna-se fundamental otimizar os recursos disponíveis.
Objetivos: Demonstrar que, para recetores de idade avançada, não existem diferenças na sobrevida global e de enxerto, quando recebem um órgão de dadores mais jovens
´em comparação a dadores de idade mais avançada
Metodologia: Estudo retrospetivo e unicêntrico em recetores de idade avançada, seguidos na unidade de Transplantação Renal da Unidade Local de Saúde de Santa Maria, entre janeiro de 1999 e março de 2019. Os outcomes primários avaliados foram a sobrevida de enxerto e a sobrevida global aos 1º, 2º, 3º e 5º ano pós-transplante.
Resultados: Analisados 144 doentes submetidos a transplante renal, sendo que 68 (47.2%) tinham sido transplantados com rins provenientes de dadores com idade ≤60 anos e 76 (52.8%) com idade >60 anos. Eram maioritariamente do género masculino (56,3%; n=81) e com uma média de idades de 64,5 ± 3,1 anos. Não houve diferenças significativas nas características das populações analisadas, além da idade do dador. Relativamente aos resultados, observou-se uma menor função de enxerto ao 1º ano (p=0.000) e maior taxa de função tardia de enxerto (p=0.026) no grupo de recetores de dador com idade > 60 anos. A taxa de rejeição de enxerto ao 1º ano foi superior nos doentes que receberam órgãos de dadores com idade mais avançada (p=0.010). Não se verificaram diferenças significativas tanto na sobrevida de enxerto (76.5% vs 63.2%, p=0.083), como na mortalidade aos 5 anos (22.1% vs 25.0%, p=0.552) dos dadores mais jovens quando comparados com os de idade mais avançada.
Conclusões: Os resultados reforçam a alocação preferencial de enxertos de dadores mais velhos a recetores de idade mais avançada
Introduction: Kidney transplantation is the renal replacement therapy that ensures the greatest survival and quality of life. However, the number of available donors is significantly lower than the number of potential recipients, making it essential to optimize the available resources Objective: To demonstrate that, for elderly recipients, there are no differences in overall and graft survival when receiving an organ from younger donors compared to older donors. Methods: This was a retrospective, single-center study involving elderly recipients followed at the Renal Transplantation Unit of the Local Health Unit of Santa Maria, between January 1999 and March 2019. Demographic, anthropometric, clinical, and laboratory data of recipients and donors were analyzed. The primary outcomes evaluated were graft survival and overall survival at 1, 2, 3, and 5 years post-transplant. Results:A total of 144 patients who underwent kidney transplantation were analyzed, of which 68 (47.2%) had received kidneys from donors aged ≤60 years and 76 (52.8%) from donors aged >60 years. The majority were male (56.3%; n=81) with an average age of 64.5 ± 3.1 years. There were no significant differences in the characteristics of the analyzed populations except for the age of the donor. Regarding the results, there was lower graft function at 1 year (p=0.000) and a higher rate of delayed graft function (p=0.026) in the group of recipients with donors aged >60 years. The graft rejection rate at 1 year was higher in patients who received organs from older donors (p=0.010). There were no significant differences in graft survival (76.5% vs 63.2%, p=0.083) or mortality at 5 years (22.1% vs 25.0%, p=0.552) between younger and older donor groups. Conclusions: The results support the preferential allocation of grafts from older donors to elderly recipients, ensuring better quality organs for younger patients who will derive greater benefit.
Introduction: Kidney transplantation is the renal replacement therapy that ensures the greatest survival and quality of life. However, the number of available donors is significantly lower than the number of potential recipients, making it essential to optimize the available resources Objective: To demonstrate that, for elderly recipients, there are no differences in overall and graft survival when receiving an organ from younger donors compared to older donors. Methods: This was a retrospective, single-center study involving elderly recipients followed at the Renal Transplantation Unit of the Local Health Unit of Santa Maria, between January 1999 and March 2019. Demographic, anthropometric, clinical, and laboratory data of recipients and donors were analyzed. The primary outcomes evaluated were graft survival and overall survival at 1, 2, 3, and 5 years post-transplant. Results:A total of 144 patients who underwent kidney transplantation were analyzed, of which 68 (47.2%) had received kidneys from donors aged ≤60 years and 76 (52.8%) from donors aged >60 years. The majority were male (56.3%; n=81) with an average age of 64.5 ± 3.1 years. There were no significant differences in the characteristics of the analyzed populations except for the age of the donor. Regarding the results, there was lower graft function at 1 year (p=0.000) and a higher rate of delayed graft function (p=0.026) in the group of recipients with donors aged >60 years. The graft rejection rate at 1 year was higher in patients who received organs from older donors (p=0.010). There were no significant differences in graft survival (76.5% vs 63.2%, p=0.083) or mortality at 5 years (22.1% vs 25.0%, p=0.552) between younger and older donor groups. Conclusions: The results support the preferential allocation of grafts from older donors to elderly recipients, ensuring better quality organs for younger patients who will derive greater benefit.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Transplante renal Alocação preferencial Nefrologia