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Aging and the immune response to organ transplantation
Monica M. Colvin, … , Stefan G. Tullius, Daniel R. Goldstein
Monica M. Colvin, … , Stefan G. Tullius, Daniel R. Goldstein
Published May 15, 2017
Citation Information: J Clin Invest. 2017;127(7):2523-2529. https://doi.org/10.1172/JCI90601.
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Review Series

Aging and the immune response to organ transplantation

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Abstract

An increasing number of older people receive organ transplants for various end-stage conditions. Although organ transplantation is an effective therapy for older patients (i.e., older than 65 years of age), such as in end-stage renal disease, this therapy has not been optimized for older patients because of our lack of understanding of the effect of aging and the immune response to organ transplantation. Here, we provide an overview of the impact of aging on both the allograft and the recipient and its effect on the immune response to organ transplantation. We describe what has been determined to date, discuss existing gaps in our knowledge, and make suggestions on necessary future studies to optimize organ transplantation for older people.

Authors

Monica M. Colvin, Candice A. Smith, Stefan G. Tullius, Daniel R. Goldstein

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Figure 1

Impact of aging on donor organ and recipient immune system during organ transplantation.

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Impact of aging on donor organ and recipient immune system during organ ...
Aging increases the immunogenicity of the donor allograft, in part owing to passenger DCs. With aging, the donor graft has less tolerance in response to ischemia/reperfusion injury and likely has a reduced capacity to repair after implantation. Old grafts lead to increased transplant vasculopathy through unknown mechanisms. After transplantation, aging impairs CD8+ T cell responses to reject organ transplants, although CD8+ T cells may also impair immune modulation. CD4+ Th1 T cell responses are reduced but IL-17 production is increased with aging. Decreased Treg output from the thymus may impair transplantation tolerance in aged recipients. The aged B cell pool may enhance T cell alloreactive priming and may pose a barrier to immune modulation.
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