Immunosenescence in renal transplantation

Abstract

Purpose of review With global demographic changes and an overall improved healthcare, more older end-stage-renal-disease (ESRD) patients receive kidney transplants. At the same time, organs from older donors are utilized more frequently. Those developments have and will continue to impact allocation, immunosuppression and efforts improving organ quality. Recent findings Findings mainly outside the field of transplantation have provided insights into mechanisms that drive immunosenescence and immunogenicity, thus providing a rationale for an age-adapted immunosuppression and relevant clinical trials in the elderly. With fewer rejections in the elderly, alloimmune responses appear to be characterized by a decline in effectiveness and an augmented unspecific immune response. Summary Immunosenescence displays broad and ambivalent effects in elderly transplant recipients. Those changes appear to compensate a decline in allospecific effectiveness by a shift towards an augmented unspecific immune response. Immunosuppression needs to target those age-specific changes to optimize outcomes in elderly transplant recipients,

Differences in Gene Expression in Older Compared With Younger Kidney Transplant Recipients

“…In addition, the persistence of significant age-associated differences despite receipt of identical immunosuppression regimens suggests that adjustment of immunosuppression intensity based on patient “biological age” might reduce overimmunosuppression in many older patients, reducing adverse clinical outcomes, including viral infection. 8,32 Future studies will evaluate changes in pretransplant compared with posttransplant cohorts of older patients compared with younger patients to determine if there is a differential impact of transplantation and initiation of immunosuppression in patients of different ages and with different levels of gene expression at baseline.…”

Remodeling of the Immune Response With Aging: Immunosenescence and Its Potential Impact on COVID-19 Immune Response

“…This finding might explain, at least in part, the occurrence of age-related autoimmune conditions. In addition, the imbalance between innate and adaptive immunity may disturb the fine regulation of the effector immune response, leading to a severe acute pro-inflammatory state that may lead to organ rejection in transplanted patients ( 61 , 62 ).…”

Transplantation of Marginal Organs: Immunological Aspects and Therapeutic Perspectives in Kidney Transplantation

“…Other immune cell compartments appear to be affected by aging (42). Impaired B-cells proliferation and antibodies production have been reported.…”