Immunosenescence and organ transplantation

Abstract

Increasing numbers of elderly transplant recipients and a growing demand for organs from older donors impose pressing challenges on transplantation medicine. Continuous and complex modifications of the immune system in parallel to aging have a major impact on transplant outcome and organ quality. Both, altered alloimmune responses and increased immunogenicity of organs present risk factors for inferior patient and graft survival. Moreover, a growing body of knowledge on age-dependent modifications of allorecognition and alloimmune responses may require age-adapted immunosuppression and organ allocation. Here, we summarize relevant aspects of immunosenescence and their possible clinical impact on organ transplantation.

Report from the American Society of Transplantation on frailty in solid organ transplantation

“…Pathophysiological mechanisms of frailty and aging somewhat overlap. [3][4][5] Sarcopenia (loss of skeletal muscle mass) may be a precursor to the development of frailty and its adverse health outcomes. Genetic susceptibility, comorbidities, physiological aging, and environmental factors, also play a role in the pathophysiology of frailty.…”

Aging of Stem and Progenitor Cells: Mechanisms, Impact on Therapeutic Potential, and Rejuvenation

“…This concept of "immunosenescence", can modify overall immunity. Accordingly, the effect of immunosenescence on stem cells, progenitor cells, and especially primary mesenchymal stem cells (MSCs) may alter their proliferation, differentiation and therapeutic potential, and, as many of their intrinsic beneficial functions deteriorate with age, and other misbalanced regulatory events lead to alterations in their immunoregulatory potential [51]. Aging influences the secretion of numerous paracrine signals, thus disturbing the endogenous regeneration of solid organs [52], it would therefore application stem cells together with some factors, such as cytokines, biomatrices or mural cells could transiently create a healthy paracrine environment, enhance engraftment and differentiation of transplanted cells [53].…”

Infections after kidney transplantation. Does age matter?

“…To date, no change in immunosuppressive or prophylactic therapy is recommended based on the age of an adult KT recipient. The concept of individualized maintenance immunosuppression has been explored in KT recipients but has yet to be implemented in every center …”