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Nierenspende und Nierentransplantation im Alter

Kidney donors and kidney transplantation in the elderly

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Zusammenfassung

Mit zunehmendem Alter steigt für den terminal niereninsuffizienten Patienten das Risiko, an der Dialyse zu sterben. Im Rahmen des Eurotransplant-Senior-Programm (ESP) werden Nieren alter Spender (>64 Jahre) an alte Empfänger (>64 Jahre) transplantiert. Regionale Allokation, unabhängig vom Grad der Gewebeübereinstimmung („HLA matching“) zwischen Spender und Empfänger und dadurch kurze Transportzeit minimieren die nichtimmunologische Schädigung der empfindlichen alten Nieren und garantieren eine gute Transplantatfunktion. Die ersten 5 Jahre zeigen, dass dieses Programm erfolgreich ist. Alte Spender werden vermehrt utilisiert und damit die alten Patienten auf der Warteliste vermehrt transplantiert. Diese guten Ergebnisse sind nur durch eine engmaschige Evaluation und Nachsorge erreichbar. Ist dies gewährleistet, so ist die Nierentransplantation im erhöhten Lebensalter—auch mit alten Spenderorganen—besser als die Langzeitdialyse. Die HLA-Übereinstimmung sollte jedoch bei der Allokation im ESP in Zukunft stärker berücksichtigt werden, um die Zahl an Abstoßungsreaktionen zu vermindern.

Abstract

The likelihood of terminal renal insufficiency escalates with age, increasing the risk of dying as a patient requiring dialysis. In 1999, Eurotransplant initiated the Eurotransplant Senior Programm (ESP), in which the kidneys of old donors (>64 years) are allocated to recipients 64 years and older. Allocation does not take HLA-matching into account and is performed regionally only according to blood-group-compatibility to keep the storage time short. As a consequence of the short ischemic time, and thus reduced non-immunological damage to the anyways susceptible old kidney, graft-function and graft-survival in the ESP are very good. The results of the initial 5 years of this program show that it successfully utilizes more kidneys from old donors and that more old recipients are being transplanted, with a satisfactory graft-function. Increased donor- and/or recipient age require a thorough evaluation to exclude malignant and other diseases. Furthermore, short term controls on the waiting list and following kidney transplantation are prerequisites for successful transplantation in the aged recipient. If this is guaranteed, kidney transplantation in the old recipient—even with old donor organs—is a good alternative to the morbidity of a prolonged dialysis. Nevertheless, the role of HLA-matching should be reconsidered to reduce rejections.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie—Campus Mitte (CCM), Charité-Universitätsmedizin Berlin

    M. Giessing, B. Schönberger & S. A. Loening

  2. Klinik für Urologie, Evangelisches Diakoniewerk Friederikenstift, Hannover

    S. Conrad

  3. Klinik und Poliklinik für Urologie, Universitätsklinik Hamburg-Eppendorf

    S. Conrad & H. Huland

  4. Klinik für Nephrologie—Campus Mitte (CCM), Charité-Universitätsmedizin Berlin

    K. Budde & H.-H. Neumayer

  5. Charité-Universitätsmedizin Berlin, Klinik und Poliklinik für Urologie—Campus Mitte (CCM), Schumannstraße 20–21, 10098, Berlin

    M. Giessing

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  1. M. Giessing
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Correspondence to M. Giessing.

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Giessing, M., Conrad, S., Schönberger, B. et al. Nierenspende und Nierentransplantation im Alter. Urologe [A] 43, 947–954 (2004). https://doi.org/10.1007/s00120-004-0641-3

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