Abstract:
:The growing number of elderly patients with end-stage kidney disease awaiting transplantation has resulted in a corresponding rise in the number of elderly transplant recipients. In this paper, we review existing literature on age-related changes, transplant outcomes, and complications in the elderly in an attempt to propose a tailored approach to immunosuppression management in this group of patients. Despite the fact that the benefit of transplantation in the elderly is well established, clinical trials evaluating the safety and efficacy of immunosuppression regimens are lacking. Until such data exists, immunosuppression of the elderly transplant recipient should be based on the traditional principles which guide all transplant protocols and consideration of factors that are unique to the elderly. There are limited data regarding age-related changes in immune function and metabolism of immunosuppression agents in this population. Results of registry data analyses suggest that the risk of acute rejection decreases with age; however, the impact of acute rejection on long-term allograft function is greater in this population. There is also an increased risk of infection and adverse events posttransplantation among these patients. Elderly patients are more likely to receive organs from extended criteria donors and the impact of donor factors on transplant outcomes must therefore be considered. Taking these factors into consideration, we propose an approach to immunosuppression in the elderly based on individual risk stratification of treatment failure and the potential for adverse events.
journal_name
Transplantationjournal_title
Transplantationauthors
Danovitch GM,Gill J,Bunnapradist Sdoi
10.1097/01.tp.0000275423.69689.dcsubject
Has Abstractpub_date
2007-08-15 00:00:00pages
285-91issue
3eissn
0041-1337issn
1534-6080pii
00007890-200708150-00001journal_volume
84pub_type
杂志文章,评审相关文献
TRANSPLANTATION文献大全abstract::Suspensions of viable lymph node cells (LNCs), both unlabeled and 3H-uridine labeled, from adult Fischer (FI) rats were inoculated into the lumens of established, surgically isolated segments of ileum in adult (FI x DA)F1 hybrid hosts. Vascular, lymphatic, and nerve supplies of the isolated segment were preserved. It ...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-198110000-00010
更新日期:1981-10-01 00:00:00
abstract:BACKGROUND:CTLA4IgG that binds to B7 effectively inhibits the signaling of CD28/B7 pathway and induces antigen-specific T-cell unresponsiveness in vitro and in vivo. We examined whether the development of obliterative bronchiolitis in a murine heterotopic airway transplantation model is T cell dependent and whether CTL...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-200003150-00012
更新日期:2000-03-15 00:00:00
abstract:BACKGROUND:Antibody-mediated rejection (AMR) is a leading cause of morbidity and mortality after kidney transplantation. Early diagnosis and treatment of subclinical AMR based on the donor-specific antibody (DSA) testing may result in better outcomes. METHODS:We tested this hypothesis in 220 kidney transplant recipien...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/TP.0000000000002566
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:The growing number of patients awaiting a kidney transplant raises questions about allocation of kidneys to the elderly and about the use of elderly donors. In all reported studies analyzing the influence of age on the outcome after renal transplantation, age is investigated as a categorical variable. METHO...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-199902270-00015
更新日期:1999-02-27 00:00:00
abstract:BACKGROUND:Organs for transplantation are a scarce community resource but community preferences and how they are incorporated into allocation policies are unclear. This systematic review aimed to ascertain community preferences for organ allocation and the principles underpinning these preferences. METHODS:Medline, Em...
journal_title:Transplantation
pub_type: 杂志文章,评审
doi:10.1097/TP.0b013e3181cf1ee1
更新日期:2010-04-15 00:00:00
abstract:BACKGROUND:An elevated terminal creatinine is frequently used as a reason for organ refusal in pediatric kidney transplantation. There is increasing evidence that adults who receive kidneys from donors with moderate to severe acute kidney injury (AKI) have similar outcomes to recipients who receive kidneys from donors ...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/TP.0000000000002827
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:Several technical modifications in portal vein (PV) reconstruction have shown excellent outcomes in pediatric liver transplantation (LT); however, which procedure is the best for PV reconstruction of the hypoplastic PV in pediatric LT remains unclear. METHODS:One hundred sixteen pediatric patients aged 1 or...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/TP.0000000000002793
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Abrupt temperature shift from hypothermia to normothermia incurred on reperfusion of organ grafts has been delineated as a genuine factor contributing to reperfusion injury and graft dysfunction after transplantation. METHODS:In a first clinical series of 6 patients, cold-stored livers, all allocated by the...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/TP.0000000000000915
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Inhibition of complement in small animal models of xenotransplantation has demonstrated graft infiltration with natural killer (NK) cells and monocytes associated with endothelial cell (EC) activation. We have previously demonstrated that human NK cells activate porcine EC in vitro, which results in adhesion...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-199811150-00017
更新日期:1998-11-15 00:00:00
abstract:BACKGROUND:The role of CD20+ B cells in renal allograft rejection has been reappreciated. Importantly, recent studies suggest a relation between CD20+ B cell aggregates and poorer clinical outcome. In the present study, we attempted to confirm these early reports in a tightly controlled patient population and to differ...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/TP.0b013e3181860a74
更新日期:2008-09-27 00:00:00
abstract::In human organ transplantation, the correct diagnosis of rejection may be difficult using clinical and/or histopathologic criteria, and immunologic assays should therefore be considered. We have applied monoclonal antibodies in 2-color flow cytometric (FACS) analysis to study phenotypic patterns of kidney-infiltrating...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-198905000-00014
更新日期:1989-05-01 00:00:00
abstract::Between December 1983 and August 1985, 110 cadaver transplants were performed at our institution. All were started on cyclosporine (CsA) and prednisone (P) for immunosuppressive therapy. Of the 110 patients, 46 were converted from CsA to azathioprine (AZA) for a variety of reasons (cost, toxicity, patient preference, ...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-198702000-00012
更新日期:1987-02-01 00:00:00
abstract::To improve long-term outcome after renal transplantation, attention should be placed on the tailored use of immunosuppressive regimens that have a more favorable impact on the immunological and nonimmunological risk profiles of an individual recipient. Tacrolimus is widely used for maintenance and rejection immunosupp...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-200109271-00007
更新日期:2001-09-27 00:00:00
abstract:BACKGROUND:Targeting 2-hr postdose cyclosporine (C2) levels to 1,000 to 1,700 mg/dL during the first 6 months after renal transplantation is recommended for triple immunosuppressive regimens. This trial determines whether lower C2 levels could be targeted safely in de novo kidney transplant recipients under a quadruple...
journal_title:Transplantation
pub_type: 临床试验,杂志文章
doi:10.1097/01.tp.0000137423.01887.7d
更新日期:2004-10-27 00:00:00
abstract:BACKGROUND:Tacrolimus (TAC) is the cornerstone of immunosuppressive regimen in liver transplantation (LT). Its pharmacokinetics is characterized by a high interpatient and intrapatient variability (IPV) leading to an unpredictable dose-response relationship. The aim of our study was to evaluate the impact of TAC IPV (I...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/TP.0000000000002052
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:Information on the risk factors, particularly kidney function, and impact of long-term cardiovascular events (CVE) after liver transplantation (LT) remains scarce. METHODS:This is a retrospective, single-center study that included consecutive LT recipients between 2007 and 2017. The incidence of CVE, their ...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/TP.0000000000002852
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Renal dysfunction early after kidney transplantation has multiple causes including ischemia-reperfusion (I/R) injury and drug-induced nephrotoxicity. This study assesses the acute nephrotoxicity of tacrolimus (Tac) and sirolimus (Sir) in a rat renal isograft model. METHODS:Lewis renal isografts and uninephr...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/01.tp.0000128837.07640.ae
更新日期:2004-08-15 00:00:00
abstract:BACKGROUND:We have previously shown that recognition of human erythrocytes by porcine Kupffer cells is mediated by a carbohydrate-dependent mechanism. The present study explores the possible ligands existing on human glycophorin A and tests their ability to inhibit erythrocyte rosette formation. METHODS:Human erythroc...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/01.tp.0000162974.94890.9f
更新日期:2005-08-15 00:00:00
abstract::The purpose of this study was to investigate two promising immunosuppressive agents, didemnin B (DB) and FK506 (FK), during pregnancy to assess potential adverse maternal or fetal effects. Pregnant C3H mice were randomized into control and high- and low-dose treatment groups for each drug. Animals received daily injec...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-199107000-00022
更新日期:1991-07-01 00:00:00
abstract::H-1-incompatible rat renal allograft survival rates are strongly influenced by the non-major histocompatibility system (MHS) genes. The same H-1 (MHS) incompatibility tested on four different non-MHS backgrounds gave widely differing results ranging from 11 to 60% fractional survival between the best and the poorest (...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-197805000-00006
更新日期:1978-05-01 00:00:00
abstract:BACKGROUND:The use of lung grafts from non-heart-beating donors (NHBD) is one way of solving the donor organ shortage problem. In this experiment, we studied the effect of retrograde flush (RF) from the left atrium before harvest, inhaled nitric oxide (NO), and gabexate mesilate (FOY), a protease inhibitor, in the lung...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-200005270-00008
更新日期:2000-05-27 00:00:00
abstract:BACKGROUND:We have previously shown that an immunomodulatory enzyme, indoleamine 2,3-dioxygenase (IDO) in dermal fibroblasts generates a tryptophan-deficient environment that selectively inhibits proliferation and induces apoptosis of bystander CD4+ and CD8+ T cells, but not pancreatic islets. Because these immune cell...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/TP.0000000000000661
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to determine whether screening for anti-human leukocyte antigen (HLA) antibodies (Abs) could predict development of acute rejection (AR) before clinical evidence of kidney allograft dysfunction in nonsensitized recipients. METHODS:Eighty-four non-HLA identical kidney transplant...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/TP.0b013e3181c3503e
更新日期:2010-01-27 00:00:00
abstract::CD2 is a 50-kDa transmembrane glycoprotein that plays an important role in T and natural killer (NT) lymphocyte functions. CD2 serves as both an adhesion molecule and as a costimulatory molecule through interactions with its ligand, CD58, on antigen presenting or target cells. Consistent with earlier studies using a r...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-199911270-00026
更新日期:1999-11-27 00:00:00
abstract::Loss of bile ducts is a characteristic feature of chronic rejection in the liver allograft (also known as irreversible rejection and vanishing bile-duct syndrome). Typically, this occurs as a progressive lesion resulting in irreversible damage and graft failure requiring retransplantation. In this study, we describe 6...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-199105000-00014
更新日期:1991-05-01 00:00:00
abstract:BACKGROUND:Graft coronary arteriosclerosis (GCA) is the major limiting factor for long-term survival after heart transplantation. In this study, we investigated the effect of Multiglycosidorum tripterygii (MT) on GCA and platelet-derived growth factor A (PDGF-A) mRNA expression of transplanted hearts. METHODS:Two grou...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-199806150-00006
更新日期:1998-06-15 00:00:00
abstract::During anesthesia 5 mg of muromonab CD3 (OKT3), an anti-CD3 monoclonal antibody, was administered prophylactically to twelve patients undergoing cadaveric renal transplantation. Preoperatively, all patients were at or near their dry body weights. Methylprednisolone 500 mg on call to or in the operating room, azathiopr...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-199308000-00020
更新日期:1993-08-01 00:00:00
abstract:BACKGROUND:Based on the excellent correlation between cyclosporine A 2-hr postdose blood levels (C2) and the area under the concentration versus time curve, we evaluated the clinical benefit of Neoral dose monitoring with C2 compared trough levels (C0) in stable heart transplant patients. METHODS:We studied 114 stable...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/00007890-199912270-00003
更新日期:1999-12-27 00:00:00
abstract:BACKGROUND:In France, foreign patients, whether resident or not in France, can register on the national waiting list under certain conditions. We compared waiting time to kidney transplantation, the level of HLA matching and graft cold ischemia time between foreign patients and French patients living in mainland France...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/01.tp.0000205182.96861.3a
更新日期:2006-04-27 00:00:00
abstract:BACKGROUND:Dysregulation of the coagulation system due to inflammatory responses and cross-species molecular incompatibilities represents a major obstacle to successful xenotransplantation. We hypothesized that complement inhibition mediated by transgenic expression of human CD46 in pigs might also regulate the coagula...
journal_title:Transplantation
pub_type: 杂志文章
doi:10.1097/TP.0000000000000746
更新日期:2015-10-01 00:00:00