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  • Review Article
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Kidney transplantation and the ageing immune system

Nature Reviews Nephrology volume 8, pages 700–708 (2012)Cite this article

Abstract

The world population is rapidly growing and ageing at a pace that is projected to continue for at least three decades. This shift towards an older populace has invariably increased the number of individuals with diseases related to ageing, such as chronic kidney disease. The increase in chronic kidney disease is associated with a growing number of elderly patients receiving kidney transplants. Understanding how the immune system changes with increasing age will help to define the risks of rejection and infection in the elderly population and will focus attention on the need for individualized immunosuppression for patients in this age group. This Review addresses what is currently known about ageing and the immune system, highlighting age-related changes that affect the outcome of transplantation in elderly individuals. The need for new strategies to improve outcomes in this growing population of elderly renal transplant recipients is also emphasized.

Key Points

  • In the USA, the incident rate of end-stage renal disease is highest in patients aged >65 years and the ageing population is likely to result in more elderly renal transplant recipients

  • Although elderly renal transplant recipients are at increased risk of late mortality owing to comorbidities associated with ageing, early patient and graft survival are comparable to those of younger patients

  • Understanding how the immune system changes with increasing age might help clinicians to consider a more individualized immunosuppressive approach to the elderly transplant recipient to avoid inappropriate immunosuppression

  • Ageing causes thymic involution, narrowing of the T-cell repertoire, cellular senescence and reduced costimulatory signals, resulting in defects in T-cell-mediated immunity, which has an important role in allograft rejection

  • Advanced age is associated with alterations in the differentiation and function of haematopoietic stem cells, which has implications for the upper age limit of bone marrow transplant donors

  • Prospective studies of immunological function in elderly transplant recipients are needed before we can advise with certainty on the best therapeutic approach to immunosuppression in these patients

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Figure 1: An increasing number of patients aged ≥65 years were listed for deceased donor kidney transplantation in the USA between 1992 and 2011.
Figure 2: Ageing has negative effects on the development and maintenance of the adaptive immune system.
Figure 3: Innate immunity is altered with ageing.

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Acknowledgements

The authors' work is supported by National Institutes of Health grant DK080048 (J. Jameson), DK075718 (D. McKay), DK091136 (D. McKay), CIRM RM1-01709 (D. McKay), and Price Charities Foundation/Scripps Clinic and Green Hospital (D. McKay)

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology-Hypertension, University of California San Diego, 3350 La Jolla Village Drive, San Diego, 92161, CA, USA

    Dianne McKay

  2. Department of Biology, California State University San Marcos, 333 S. Twin Oaks Valley Road, San Marcos, 92096, CA, USA

    Julie Jameson

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  1. Dianne McKay
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  2. Julie Jameson
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Both authors researched the data for the article, provided a substantial contribution to discussions of the content, wrote the article and reviewed and/or edited the manuscript before submission.

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Correspondence to Julie Jameson.

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Competing interests

D. McKay and J. Jameson have received research funding from Novartis.

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McKay, D., Jameson, J. Kidney transplantation and the ageing immune system. Nat Rev Nephrol 8, 700–708 (2012). https://doi.org/10.1038/nrneph.2012.242

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