title: Understanding alterations in drug handling with aging: a focus on the pharmacokinetics of maintenance immunosuppressants in the elderly.
abstract: OBJECTIVE
  This review presents current knowledge of the impact of age on the pharmacokinetics of maintenance immunosuppressants.
  
  
  RESULTS
  Over the past decade, there has been a steady increase in older patients on organ transplant waiting lists. As a result, the average age of transplant recipients has significantly increased. The survival and quality-of-life benefits of transplantation in the elderly population have been demonstrated. Advancing age is associated with changes in immune responses, as well as changes in drug handling. Immunosenescence is a physiological part of aging and is linked to reduced rejection rates, but also higher rates of diabetes, infections and malignancies. Physiologic changes associated with age can have a significant impact on the pharmacokinetics of the maintenance immunosuppressive agents. Taken together, these age-related changes impact older transplant candidates and may have significant implications for managing immunosuppression in the elderly.
  
  
  CONCLUSIONS
  Despite the lack of formal efficacy, safety and pharmacokinetic studies of individual immunosuppressants in the elderly transplant population, there are enough data available for practitioners to be able to adequately manage their older patients. A proficient understanding of the factors that impact the pharmacokinetics of the immunosuppressants in the elderly is essential to managing these patients successfully.
authors.affiliation: aDepartments of Transplant Surgery and Pharmacy Services, and the Renal Division, Brigham and Women's Hospital bHarvard Medical School cTransplant Surgery Research Laboratory and Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA dDepartment of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany.
authors.forename: Steven
authors.initials: S
authors.lastname: Gabardi
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Tullius
authors.forename: Felix
authors.initials: F
authors.lastname: Krenzien
mesh_terms: D000368:Aged; D000375:Aging; D065569:Gastrointestinal Absorption; D006801:Humans; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D016377:Organ Transplantation
chemical_list: D007166:Immunosuppressive Agents