A Rationale for Age-Adapted Immunosuppression in Organ Transplantation.
A Rationale for Age-Adapted Immunosuppression in Organ Transplantation.
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DOI：
10.1097/tp.0000000000000842
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发表时间：
2015-11
期刊：
影响因子：
6.2
通讯作者：
Tullius SG
中科院分区：
文献类型：
--
作者：
Krenzien F;ElKhal A;Quante M;Rodriguez Cetina Biefer H;Hirofumi U;Gabardi S;Tullius SG
人口结构的变化与需要移植的终末期器官衰竭老年患者的稳步增加有关。因此，目前大多数移植受者的年龄都超过 50 岁，来自老年捐献者的器官得到更频繁的利用。然而，老年患者移植的益处已得到广泛认可，而老年接受者最常见的死亡原因可能与其免疫抑制剂的副作用有关。免疫衰老是衰老的一个生理部分，与糖尿病、细菌感染和恶性肿瘤的高发病率有关，这些是老年患者死亡的主要原因。这些与年龄相关的变化会影响老年移植候选者，并可能对年龄适应的免疫抑制产生重大影响。例如，免疫衰老与老年受者的急性排斥率较低有关，而老年器官的移植与较高的排斥率有关。此外，移植后新发糖尿病在老年人中更为常见，可能与皮质类固醇、钙调神经磷酸酶抑制剂和 mTOR 抑制剂有关。这篇综述介绍了基于移植内外的实验和临床研究的年龄适应免疫抑制的最新知识。维持和诱导治疗的建议可能有助于改善移植物功能并设计未来的老年人临床试验。
Demographic changes are associated with a steady increase of older patients with end-stage organ failure in need for transplantation. As a result, the majority of transplant recipients are currently older >50 years and organs from elderly donors are more frequently utilized. Nevertheless, the benefit of transplantation in older patients is well recognized whereas the most frequent causes of death among older recipients are potentially linked to side effects of their immunosuppressants. Immunosenescence is a physiological part of aging linked to higher rates of diabetes, bacterial infections and malignancies representing the major causes of death in older patients. These age-related changes impact older transplant candidates and may have significant implications for an age-adapted immunosuppression. For instance, immunosenescence is linked to lower rates of acute rejections in older recipients while the engraftment of older organs has been associated with higher rejection rates. Moreover, new-onset diabetes mellitus following transplantation is more frequent in the elderly, potentially related to corticosteroids, calcineurin inhibitors and mTOR inhibitors. This review presents current knowledge for an age-adapted immunosuppression based on both, experimental and clinical studies in and beyond transplantation. Recommendations of maintenance and induction therapy may help to improve graft function and to design future clinical trials in the elderly.