Purpose of review With global demographic changes and an overall improved healthcare, more older end-stage renal disease (ESRD) patients receive kidney transplants. At the same time, organs from older donors are utilized more frequently. Those developments have and will continue to impact allocation, immunosuppression and efforts improving organ quality. Recent findings Findings mainly outside the field of transplantation have provided insights into mechanisms that drive immunosenescence and immunogenicity, thus providing a rationale for an age-adapted immunosuppression and relevant clinical trials in the elderly. With fewer rejections in the elderly, alloimmune responses appear to be characterized by a decline in effectiveness and an augmented unspecific immune response. Summary Immunosenescence displays broad and ambivalent effects in elderly transplant recipients. Those changes appear to compensate a decline in allospecific effectiveness by a shift towards an augmented unspecific immune response. Immunosuppression needs to target those age-specific changes to optimize outcomes in elderly transplant recipients.

Ageing, immunosenescence, kidney transplantation, rejection, tolerance
dx.doi.org/10.1097/MOT.0000000000000210, hdl.handle.net/1765/90856
Current Opinion in Organ Transplantation
Department of Surgery

Seyda, M, Quante, R, Uehara, H, Slegtenhorst, B.R, Elkhal, A, & Tullius, S.G. (2015). Immunosenescence in renal transplantation: A changing balance of innate and adaptive immunity. Current Opinion in Organ Transplantation (Vol. 20, pp. 417–423). doi:10.1097/MOT.0000000000000210