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Review
. 2013 Jul;27(3):65-75.
doi: 10.1016/j.trre.2013.03.001. Epub 2013 Apr 30.

Immunosenescence and organ transplantation

Timm Heinbokel  1 , Abdallah Elkhal, Guangxiang Liu, Karoline Edtinger, Stefan G Tullius
Affiliations
Review

Immunosenescence and organ transplantation

Timm Heinbokel et al. Transplant Rev (Orlando). 2013 Jul.

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.

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Figures

Figure 1
Figure 1. Clinical implications of immunosenescence for the elderly transplant recipient
Modified immune responses subsequent to immunosenescence are clinically characterized by higher rates of chronic allograft failure and less frequent, however more detrimental acute rejections, implicating age-adapted immunosuppression and organ allocation. AR, acute rejection.
Figure 2
Figure 2. Cellular substrates of the aging immune system
Immunosenescence impacts innate and adaptive immune responses on all levels. HSC, hematopoietic stem cell; CLP, common lymphoid progenitor; ADCC, antibody-dependent cell-mediated cytotoxicity; GC, germinal center; AB, antibody; FDC, follicular dendritic cell; GMP, granulocyte-macrophage progenitor; ROS, reactive oxygen species; PGE2, Prostaglandin E2; VEGF, vascular endothelial growth factor.
Figure 3
Figure 3. Increasing donor age as a risk factor for inferior transplant outcome
Intrinsic functional impairments, susceptibility to IRI and DGF, enhanced direct allorecognition, and a more pro-inflammatory state of organs from old donors contribute to a cycle of damage, modified immune recognition and compromised repair that ultimately translates into increased risk of transplant failure and inferior transplant outcome. AR, acute rejection.
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