Potent early immune response after kidney transplantation in patients of the European senior transplant program.
BACKGROUND
The increasing age of organ donors and the transplantation of older recipients have become clinical practice. Age-adapted immunosuppressive protocols considering these changes are currently not established. This study analyzed the age-dependent immune response after human kidney transplantation.


METHODS
One hundred renal allograft recipients were prospectively evaluated from 2004 to 2005. Patients older than 65 years of the European Senior Program receiving kidneys from donors older than 65 years were compared with recipients younger than 65 years receiving kidneys from donors younger than 65 years. Age-dependent modifications of the immune response were evaluated before transplantation and 7 days and 6 months after grafting by flow cytometry analysis of lymphocyte surface markers in peripheral blood. The cytokine pattern was determined by Cytometric Bead Array, T-cell alloreactivity by enzyme-linked immunospot analysis.


RESULTS
There were no differences between the groups regarding patient survival, graft survival, and function at 6 months after transplantation. Before transplantation, 7 days and 6 months thereafter recipients older than 65 years demonstrated significantly elevated numbers of memory T-cells while counts for naive T-cells were significantly reduced. Numbers of activated cytotoxic cells were elevated with increasing age before and 7 days after transplantation. T-cell alloreactivity was more pronounced in older recipients at all time points. Seven days after transplantation tumor necrosis factor-alpha (TNF-alpha) levels were significantly higher, whereas TNF-alpha and interleukin-10 (IL-10) concentrations were significantly reduced after 6 months in older recipients.


CONCLUSIONS
Our data demonstrate an initially pronounced immune response in elderly recipients receiving grafts from elderly donors. This observation supports the concept of a donor and recipient age-adapted immunosuppression.
Department of General, Visceral, and Transplantation Surgery, Charité-Virchow Clinic, Universitätsmedizin Berlin, Germany. johann.pratschke@charite.de
Johann
J
Pratschke
Vera
V
Merk
Anja
A
Reutzel-Selke
Andreas
A
Pascher
Christian
C
Denecke
Andreas
A
Lun
Ali
A
Said
Constanze
C
Schönemann
Frank
F
Ulrich
Petra
P
Reinke
Ulrich
U
Frei
Peter
P
Neuhaus
Stefan G
SG
Tullius
D000328:Adult; D000367:Age Factors; D000368:Aged; D001604:Berlin; D005260:Female; D005434:Flow Cytometry; D005858:Germany; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007371:Interferon-gamma / Q000097:blood; D007378:Interleukins / Q000097:blood; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D014019:Tissue Donors; D014181:Transplantation Immunology; D014184:Transplantation, Homologous; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma; D008775:Methylprednisolone