Sex difference and immunosenescence affect transplantation outcomes

Abstract

Kidney transplantation is a well-established alternative to renal replacement therapy. Although the number of patients with end-stage renal disease (ESRD) is increasing, the availability of kidney for transplantation is still insufficient to meet the needs. As age increases, the prevalence of ESRD increases; thus, the population of aged donors and recipients occupies large proportion. Accumulated senescent cells secrete pro-inflammatory factors and induce senescence. Additionally, it is gradually becoming clear that biological sex differences can influence aging and cause differences in senescence. Here, we review whether age-related sex differences affect organ transplant outcomes and what should be done in the future.

Keywords: aging; end-stage renal disease; kidney transplantation; senescence; sex difference.

Figure 1

Mechanism of sex and aging affecting transplantation. Graft size mismatch is considered as nephron counts mismatch in males and females. For female recipients, Y chromosome is minor histo-incompatible antigen but also inactivation of X chromosome may lead to higher expression of several genes related to immunity, such as TLR7. Aging can affect the sex hormone balance and accumulation of senescence cells, resulting in alloimmune response changes.