Immunosuppression of the elderly kidney transplant recipient.

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

Transplantation

journal_title

Transplantation

authors

Danovitch GM,Gill J,Bunnapradist S

doi

10.1097/01.tp.0000275423.69689.dc

subject

Has Abstract

pub_date

2007-08-15 00:00:00

pages

285-91

issue

3

eissn

0041-1337

issn

1534-6080

pii

00007890-200708150-00001

journal_volume

84

pub_type

杂志文章,评审
  • Capacity of "transplanted" lymphocytes to traverse the intestinal epithelium of adult rats.

    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

    authors: Seelig LL Jr,Billingham RE

    更新日期:1981-10-01 00:00:00

  • Blocking the CD28-B7 T-cell costimulatory pathway abrogates the development of obliterative bronchiolitis in a murine heterotopic airway model.

    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

    authors: Yamada A,Konishi K,Cruz GL,Takehara M,Morikawa M,Nakagawa I,Murakami M,Abe T,Todo S,Uede T

    更新日期:2000-03-15 00:00:00

  • Subclinical Antibody-mediated Rejection After Kidney Transplantation: Treatment Outcomes.

    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

    authors: Parajuli S,Joachim E,Alagusundaramoorthy S,Blazel J,Aziz F,Garg N,Muth B,Mohamed M,Mandelbrot D,Zhong W,Djamali A

    更新日期:2019-08-01 00:00:00

  • The vanishing importance of age in renal transplantation.

    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

    authors: Roodnat JI,Zietse R,Mulder PG,Rischen-Vos J,van Gelder T,IJzermans JN,Weimar W

    更新日期:1999-02-27 00:00:00

  • Community preferences for the allocation of solid organs for transplantation: a systematic review.

    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

    authors: Tong A,Howard K,Jan S,Cass A,Rose J,Chadban S,Allen RD,Craig JC

    更新日期:2010-04-15 00:00:00

  • Utilization of Donor Kidneys With Acute Kidney Injury in Pediatric Kidney Transplant Recipients.

    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

    authors: Solomon S,Hayde N

    更新日期:2020-03-01 00:00:00

  • The Outcomes of Portal Vein Reconstruction With Vein Graft Interposition in Pediatric Liver Transplantation for Small Children With Biliary Atresia.

    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

    authors: Sakamoto S,Uchida H,Kitajima T,Shimizu S,Yoshimura S,Takeda M,Hirata Y,Fukuda A,Kasahara M

    更新日期:2020-01-01 00:00:00

  • Controlled Oxygenated Rewarming of Cold Stored Livers Prior to Transplantation: First Clinical Application of a New Concept.

    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

    authors: Hoyer DP,Mathé Z,Gallinat A,Canbay AC,Treckmann JW,Rauen U,Paul A,Minor T

    更新日期:2016-01-01 00:00:00

  • Membrane-associated lymphotoxin on natural killer cells activates endothelial cells via an NF-kappaB-dependent pathway.

    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

    authors: von Albertini M,Ferran C,Brostjan C,Bach FH,Goodman DJ

    更新日期:1998-11-15 00:00:00

  • B cells in cluster or in a scattered pattern do not correlate with clinical outcome of renal allograft rejection.

    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

    authors: Scheepstra C,Bemelman FJ,van der Loos C,Rowshani AT,van Donselaar-Van der Pant KA,Idu MM,ten Berge IJ,Florquin S

    更新日期:2008-09-27 00:00:00

  • Immunologic diagnosis of kidney rejection using FACS analysis of graft-infiltrating functional and activated T and NK cell subsets.

    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

    authors: Tötterman TH,Hanås E,Bergström R,Larsson E,Tufveson G

    更新日期:1989-05-01 00:00:00

  • Results of conversion from cyclosporine to azathioprine in cadaveric renal transplantation.

    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

    authors: Gonwa TA,Nghiem DD,Schulak JA,Corry RJ

    更新日期:1987-02-01 00:00:00

  • Strategies to minimize immunological and nonimmunological risk factors in the renal transplant population.

    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

    authors: First MR

    更新日期:2001-09-27 00:00:00

  • Cyclosporine minimization and cost reduction in renal transplant recipients receiving a C2-monitored, cyclosporine-based quadruple immunosuppressive regimen.

    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

    authors: Hardinger KL,Schnitzler MA,Koch MJ,Enkvetchakul D,Desai N,Jendrisak M,Lowell JA,Miller B,Shenoy S,Brennan DC

    更新日期:2004-10-27 00:00:00

  • High Intrapatient Variability of Tacrolimus Exposure in the Early Period After Liver Transplantation Is Associated With Poorer Outcomes.

    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

    authors: Rayar M,Tron C,Jézéquel C,Beaurepaire JM,Petitcollin A,Houssel-Debry P,Camus C,Verdier MC,Dehlawi A,Lakéhal M,Desfourneaux V,Meunier B,Sulpice L,Bellissant E,Boudjema K,Lemaitre F

    更新日期:2018-03-01 00:00:00

  • Incidence, Predictors, and Impact on Survival of Long-term Cardiovascular Events After Liver Transplantation.

    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

    authors: Sastre L,García R,Gándara JG,Ruiz P,Lombardo J,Colmenero J,Navasa M,Crespo G

    更新日期:2020-02-01 00:00:00

  • Acute nephrotoxicity of tacrolimus and sirolimus in renal isografts: differential intragraft expression of transforming growth factor-beta1 and alpha-smooth muscle actin.

    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

    authors: Ninova D,Covarrubias M,Rea DJ,Park WD,Grande JP,Stegall MD

    更新日期:2004-08-15 00:00:00

  • Terminal sialic acid residues on human glycophorin A are recognized by porcine kupffer cells.

    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

    authors: Burlak C,Twining LM,Rees MA

    更新日期:2005-08-15 00:00:00

  • The effect of two new immunosuppressive agents, FK506 and didemnin B, in murine pregnancy.

    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

    authors: Farley DE,Shelby J,Alexander D,Scott JR

    更新日期:1991-07-01 00:00:00

  • Non-major histocompatibility system immunogenetic influences in rat renal allograft survival.

    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

    authors: Paris AM,Bishop C,Festenstein H,Gunther E

    更新日期:1978-05-01 00:00:00

  • The effects of inhaled nitric oxide, gabexate mesilate, and retrograde flush in the lung graft from non-heart beating minipig donors.

    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

    authors: Luh SP,Tsai CC,Shau WY,Chen JS,Kuo SH,Lin-Shiau SY,Lee YC

    更新日期:2000-05-27 00:00:00

  • Immunoprotection and Functional Improvement of Allogeneic Islets in Diabetic Mice, Using a Stable Indoleamine 2,3-Dioxygenase Producing Scaffold.

    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

    authors: Hosseini-Tabatabaei A,Jalili RB,Khosravi-Maharlooei M,Hartwell R,Kilani RT,Zhang Y,Ghahary A

    更新日期:2015-07-01 00:00:00

  • Screening for de novo anti-human leukocyte antigen antibodies in nonsensitized kidney transplant recipients does not predict acute rejection.

    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

    authors: Gill JS,Landsberg D,Johnston O,Shapiro RJ,Magil AB,Wu V,Tinckam K,Keown P

    更新日期:2010-01-27 00:00:00

  • Selective deletion of antigen-specific, activated T cells by a humanized MAB to CD2 (MEDI-507) is mediated by NK cells.

    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

    authors: Branco L,Barren P,Mao SY,Pfarr D,Kaplan R,Postema C,Langermann S,Koenig S,Johnson S

    更新日期:1999-11-27 00:00:00

  • Vanishing bile-duct syndrome following liver transplantation--is it reversible?

    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

    authors: Hubscher SG,Buckels JA,Elias E,McMaster P,Neuberger J

    更新日期:1991-05-01 00:00:00

  • Inhibitory effect of Multiglycosidorum tripterygii on coronary arteriosclerosis after heart transplantation.

    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

    authors: Hachida M,Zhang XL,Lu H,Hoshi H,Koyanagi H

    更新日期:1998-06-15 00:00:00

  • The hemodynamic effects of intraoperative injection of muromonab CD3.

    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

    authors: Robinson ST,Barry JM,Norman DJ

    更新日期:1993-08-01 00:00:00

  • Clinical benefit of neoral dose monitoring with cyclosporine 2-hr post-dose levels compared with trough levels in stable heart transplant patients.

    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

    authors: Cantarovich M,Elstein E,de Varennes B,Barkun JS

    更新日期:1999-12-27 00:00:00

  • Access to kidney transplantation in France of non-French patients and French patients living in overseas territories.

    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

    authors: Cantrelle C,Laurens C,Luciolli E,Loty B,Tuppin P

    更新日期:2006-04-27 00:00:00

  • Transgenic Expression of Human CD46 on Porcine Endothelium: Effect on Coagulation and Fibrinolytic Cascades During Ex Vivo Human-to-Pig Limb Xenoperfusions.

    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

    authors: Bongoni AK,Kiermeir D,Schnider J,Jenni H,Garimella P,Bähr A,Klymiuk N,Wolf E,Ayares D,Voegelin E,Constantinescu MA,Seebach JD,Rieben R

    更新日期:2015-10-01 00:00:00