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.
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.
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.
aDivision of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
bInstitute of Transplant Immunology, Hannover Medical School, Hannover
cDepartment of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
dDepartment of Urology, Osaka Medical College, Osaka, Japan
eDivision of Transplant Surgery, Department of Surgery, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
Correspondence to Stefan G. Tullius, MD, PhD, Division of Transplant Surgery & Transplant Surgery Research Laboratory, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. E-mail: firstname.lastname@example.org