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Review
. 2024 Jan 9:2:1325232.
doi: 10.3389/frtra.2023.1325232. eCollection 2023.

The combinatorial effect of age and biological sex on alloimmunity and transplantation outcome

Friederike Martin  1   2 , Yao Xiao  1 , Vanessa Welten  3 , Keita Nakamori  1   4 , Merih Gizlenci  1 , Hao Zhou  1 , Stefan G Tullius  1
Affiliations
Review

The combinatorial effect of age and biological sex on alloimmunity and transplantation outcome

Friederike Martin et al. Front Transplant. .

Abstract

Both age and biological sex affect transplantation outcomes. We have recently shown in a large volume clinical analysis utilizing the SRTR data that graft survival is inferior in young female kidney transplant recipients. In this multi-factorial analysis, older female recipients presented with a trend towards improved transplant outcomes compared to both young female recipients and male recipients of any age. Those data supported by reports of those of others suggest that sex and age impact alloimmune responses both, individually and synergistically. Biological sex and hormone levels change throughout a lifetime with recognized effects on longevity in addition to an impact on the development and course of several disease preconditions. Detailed mechanisms of those sex and age-specific aspects have thus far been studied outside of transplantation. Effects on alloimmunity are largely unknown. Moreover, the combinatorial impact that both, biological sex and age have on transplant outcomes is not understood. Here, we summarize available data that analyze how age in combination with biological sex may shape alloimmune responses and affect transplant outcomes.

Keywords: age; alloimmunity and transplantation; immunosenescence; sex; sex hormones.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Recipient age affects the relevance of donor-recipient sex mismatches for transplantation outcome in kidney, liver, heart, and lung transplantation. Potential mismatches are represented by the symbols for female and female donors, and old and young male and female recipients in the first column. ↑, favorable outcomes; ↓, unfavorable outcomes; red minus sign, worst combination in comparison with any other age- and sex-group. Of note, data on lung transplantation apply exclusively to patients with idiopathic pulmonary fibrosis (3, 5, 8, 9, 32). Created with BioRender.com.
Figure 2
Figure 2
Changing sex hormone levels in females and males over lifetime and its potential clinical relevance for transplantation outcome and clinical decision making. IRI, ischemia reperfusion injury. Created with BioRender.com.
See this image and copyright information in PMC

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