Aging and the immune response to organ transplantation

Colvin, Monica; Smith, Candice A.; Tullius, Stefan G.; Goldstein, Daniel R.

doi:10.1172/jci90601

Cited by 50 publications

(48 citation statements)

References 96 publications

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“…The aging recipient is subject to the interaction between a senescent immune system, immunosuppression, and comorbid conditions. Conversely, aging hearts exhibit more pronounced immunogenicity 26,27 and are less tolerant to ischemia‐reperfusion injury 18,22 . This study supports these findings, showing that several post‐HTx complications are linked to the interaction between donor and recipient ages.…”

Section: Discussionsupporting

confidence: 82%

Donor‐recipient age interaction and the impact on clinical results after heart transplantation

Lechiancole

Vendramin

Sponga

et al. 2020

Clinical Transplantation

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To evaluate the impact of donor‐recipient age matching on clinical outcomes after heart transplantation, a total of 509 patients (January 1990‐December 2018, mean follow‐up 111 ± 80 months) were stratified into 4 groups (young‐R/young‐D, young‐R/old‐D, old‐R/young‐D, old‐R/old‐D) according to the recipient (young‐R < 60, old‐R ≥ 60 years) and the donor (young‐D < 50, old‐D ≥ 50 years) age. No difference was found among 30‐day mortality (P = .11) and postoperative complications between groups. Both unadjusted and adjusted survival was significantly higher for group young‐R/young‐D than that of other groups, in which survival was similar [adjusted HR for mortality of 2.0(1.2‐3.4), 2.1(1.4‐3.8) and 2.5(1.6‐4.1) for groups old‐R/young‐D, young‐R/old‐D, old‐R/old‐D, respectively]. Compared to other groups, the incidence of grade ≥ 2 CAV was significantly lower in old‐R/young‐D group [adjusted HR 0.4(0.2‐0.7)]. Among young recipients, the rate of acute grade ≥ 2 rejection episodes was higher in those receiving an old donor graft (P = .04). Old recipient groups were more affected by neoplasms and severe renal failure than young recipient groups (P < .01). Employment of hearts from donors ≥50 years of age adversely affects survival in recipients <60 years of age but does not influence outcomes in older recipients. Also, donor and recipient ages seem to have opposite effects on incidence of rejections and CAV of high grade.

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Section: Discussionsupporting

confidence: 82%

Donor‐recipient age interaction and the impact on clinical results after heart transplantation

Lechiancole

Vendramin

Sponga

et al. 2020

Clinical Transplantation

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“…There are a number of possible mediators of the relationship between increasing recipient age and post‐transplant mortality proposed in the literature. Several studies have suggested that older recipients are subject to an age‐related depletion in innate, humoral, and cell‐mediated immune response via functional alterations in B‐ and T‐cell populations, which may account for the higher incidence of acute rejection among younger recipients . The resulting immunosenescence may also contribute to higher rates of infection and malignancy as recipient cause of death among older patients .…”

Section: Discussionmentioning

confidence: 99%

Donor and recipient age matching in heart transplantation: analysis of theUNOSRegistry

et al. 2019

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Summary The association of donor and recipient age with survival following adult heart transplantation has not been well characterized. The purpose of this study was to examine the impact of the relationship between donor and recipient age on post‐transplant survival. We retrospectively reviewed the 2005–2018 UNOS heart transplant database for all adult recipients undergoing first‐time isolated heart transplantation. The impact of donor and recipient age on survival was analyzed with Cox proportional hazards modeling using restricted cubic splines. A total of 25 480 heart transplant donor and recipient pairs met inclusion criteria. Unadjusted and adjusted Cox proportional hazards modeling demonstrated a near‐linear association between increasing donor age and decreased survival; in addition, older and younger recipient age was associated with decreased survival. After adjustment, there was no significant interaction between donor and recipient age. Older donors decreased survival similarly in both older and younger recipients. Increasing donor age and both younger and older recipient age are independently associated with worsened post‐heart transplant survival. The relationship between donor and recipient age does not significantly affect survival following heart transplant.

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“…First, immunological incompatibility is known to contribute to transplant failure . Studies show aging transplant recipients are subject to the complex interaction of the senescent immune system, immunosuppression, and comorbid conditions . We report the average HLA mismatch level and DR locus mismatch level in Table , however, the immunological information necessary to determine the specific cause of transplant failure for each patient is not available from the UNOS database alone.…”

Section: Discussionmentioning

confidence: 99%

Description and analysis of patients and outcomes following third‐time heart transplantation: An analysis of the United Network for Organ Sharing database from 1985 to 2017

Bhalla

Bano

Basu

et al. 2019

Clinical Transplantation

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Background: Following second heart transplantation (HTx), some patients experience graft failure and require third-time heart transplantation. Little data exist to guide decision-making with regard to repeat retransplantation in older patients. Methods:We performed a retrospective cohort analysis of patients receiving a third HTx, as identified in the United Network for Organ Sharing (UNOS) database from 1985 to 2017. Results:The study cohort consisted of N = 60 patients, with an average age of 29 with a standard deviation of ±18 years. Overall survival for the cohort at 1, 5, and 10 years is 83%, 64%, and 44%, respectively. The rate of third-time HTxs has steadily increased in all age groups. Patients older than 50 years now account for 18.3% of all third-time HTxs. Although this group demonstrated longer average previous graft survival, after third HTx they demonstrate significantly poorer survival outcomes compared to third-time HTx recipients younger than 21 (P = 0.05). Age over 50, BMI over 30, and diabetes were all found to be independent risk factors for decreased survival following third HTx. Conclusions:We describe trends in patients undergoing third HTx. We highlight subsets of such recipients who exhibit decreased survival.

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Aging and the immune response to organ transplantation

Cited by 50 publications

References 96 publications

Donor‐recipient age interaction and the impact on clinical results after heart transplantation

Donor‐recipient age interaction and the impact on clinical results after heart transplantation

Donor and recipient age matching in heart transplantation: analysis of theUNOSRegistry

Description and analysis of patients and outcomes following third‐time heart transplantation: An analysis of the United Network for Organ Sharing database from 1985 to 2017

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