Age and Immune Response in Organ Transplantation

Martins, Paulo Ney Aguiar; Pratschke, Johann; Pascher, Andreas; Fritsche, Lutz; Frei, Ulrich; Neuhaus, P.; Tullius, Stefan G.

doi:10.1097/01.tp.0000146258.79425.04

Cited by 119 publications

(74 citation statements)

References 61 publications

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“…Immunosuppressive management in the elderly transplant recipient is increasingly complex, with higher risks of infection posttransplantation (4 -6) and decreased immunogenicity (4,7,8) with increasing age. It is further complicated by the preferential allocation of higher risk donor organs to the elderly (9), modifying the baseline risks for posttransplant outcomes in this group of patients.…”

Section: Introductionmentioning

confidence: 99%

Induction Immunosuppressive Therapy in the Elderly Kidney Transplant Recipient in the United States

Gill¹,

Sampaio²,

Gill³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The choice of induction agent in the elderly kidney transplant recipient is unclear. Results In high-risk recipients with high-risk donors there was a higher risk of rejection and functional graft loss with IL2RA versus rATG. Among low-risk recipients with low-risk donors there was no difference in outcomes between IL2RA and rATG. In the two groups in which donor or recipient was high risk, there was a higher risk of rejection but not functional graft loss with IL2RA. Among low-risk recipients with high-risk donors, there was a trend toward a higher risk of death with IL2RA.Conclusions rATG may be preferable in high-risk recipients with high-risk donors and possibly low-risk recipients with high-risk donors. In the remaining groups, although rATG is associated with a lower risk of acute rejection, long-term outcomes do not appear to differ. Prospective comparison of these agents in an elderly cohort is warranted to compare the efficacy and adverse consequences of these agents to refine the use of induction immunosuppressive therapy in the elderly population.

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Section: Introductionmentioning

confidence: 99%

Induction Immunosuppressive Therapy in the Elderly Kidney Transplant Recipient in the United States

Gill¹,

Sampaio²,

Gill³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Finally, the independent effect of age at time of delivery on the RhD immunisation risk is difficult to explain. It is known that elderly people have diminished immune responses to vaccines and to solid organ transplantations, 34,35 but an effect of age in this healthy young group of women leading to an increased immunisation risk, is poorly understood. Theoretically, the effect could be caused by indirect factors, not covered by our study, that are related to maternal age and immunisation risk.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for RhD Immunisation Despite Antenatal and Postnatal Anti-D Prophylaxis

Koelewijn

Haas

Vrijkotte

et al. 2010

Obstetrical &Amp; Gynecological Survey

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Objective To identify risk factors for Rhesus D (RhD) immunisation in pregnancy, despite adequate antenatal and postnatal anti-D prophylaxis in the previous pregnancy. To generate evidence for improved primary prevention by extra administration of anti-D Ig in the presence of a risk factor.Design Case-control study.Setting Nation-wide evaluation of the Dutch antenatal anti-D-prophylaxis programme.Population Cases: 42 RhD-immunised parae-1, recognised by first-trimester routine red cell antibody screening in their current pregnancy, who received antenatal and postnatal anti-D Ig prophylaxis (gifts of 1000 iu) in their first pregnancy. Controls: 339 parae-1 without red cell antibodies.Methods Data were collected via obstetric care workers and/or personal interviews with women.Main outcome measure Significant risk factors for RhD immunisation in multivariate analysis.Results Independent risk factors were non-spontaneous delivery (assisted vaginal delivery or caesarean section) (OR 2.23; 95% CI:1.04-4.74), postmaturity ( ‡42 weeks of completed gestation: OR 3.07; 95% CI:1.02-9.02), pregnancy-related red blood cell transfusion (OR 3.51; 95% CI:0.97-12.7 and age (OR 0.89/year; 95% CI:0.80-0.98). In 43% of cases, none of the categorical risk factors was present.Conclusions In at least half of the failures of anti-D Ig prophylaxis, a condition related to increased fetomaternal haemorrhage (FMH) and/or insufficient anti-D Ig levels was observed. Hence, RhD immunisation may be further reduced by strict compliance to guidelines concerning determination of FMH and accordingly adjusted anti-D Ig prophylaxis, or by routine administration of extra anti-D Ig after a non-spontaneous delivery and/or a complicated or prolonged third stage of labour.

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“…Comorbid conditions such as diverticular disease, diabetes, vascular insufficiency, and urinary tract abnormalities can also lead to a higher risk of post-transplant infections [1]. An increase in incidence of infections with aging has been described [67][68][69], which in turn can be responsible of a higher post-transplant mortality [69].…”

Section: The Older Recipientmentioning

confidence: 99%

Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients

Rosa

Muscogiuri

Sarno

2013

ISRN Transplantation

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Kidney transplantation (KT) is the therapy of choice for end-stage renal disease (ESRD). The ESRD population is aging and so are patients waiting for KT. New strategies have been made for increasing the donor and recipient pools, and as a consequence kidneys from older donors or donors with significant comorbidities, the so-called "expanded criteria donor" (ECD) kidneys, are used for transplantation. Although good outcomes have been achieved from ECD, several issues are still waiting for clarification and need to be discussed. The concept of age matching is accepted as a method to ameliorate utilization of these allografts, but an optimal and widely accepted strategy is still not defined. The development of machine perfusion and the dual kidney transplantation are techniques which further improve the outcome of transplants from ECD, but the described experiences are scarce or coming from small single institutional reports. Also due to age-related immune dysfunction and associated comorbidities, the elderly recipients are more susceptible to immunosuppression related complications (e.g., infections and malignancy), although a widely accepted and validated immunosuppressive regimen is still lacking. In this paper, we review the issues related to KT employing allografts from marginal donors with a particular interest for the elderly patients.

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Age and Immune Response in Organ Transplantation

Cited by 119 publications

References 61 publications

Induction Immunosuppressive Therapy in the Elderly Kidney Transplant Recipient in the United States

Induction Immunosuppressive Therapy in the Elderly Kidney Transplant Recipient in the United States

Risk Factors for RhD Immunisation Despite Antenatal and Postnatal Anti-D Prophylaxis

Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients

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