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Aging, Immunosenescence, and Transplantation Tolerance

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Handbook of Immunosenescence

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Abstract

The immune system response to organ transplantation is a complex interplay of effector functions and regulatory controls. Just as aging dramatically impacts the body’s response to pathogens, the immunological impact of aging on the success or failure of organ transplantation is multilayered and defined by how the immune system loses its effector functions and regulation. Among these, the most important, and best understood, are the changes to T cell functioning and how anergy, replicative senescence, and immune exhaustion decrease the allo-response to transplanted organs. The decreased effector functions of T cells can allow for the development of organ tolerance and allow for the decreased reliance on immunosuppressive medications.

Additionally, the impact of aging is broader than the immunosenescent impact on T cells. Changes to the innate immune system, antigen presentation, memory responses, B cells, and regulatory cells can all impact the body’s response to organ transplantation. These changes impact decisions regarding immunosuppression medications in the elderly, whether tolerance induction is a potential therapy, and even how organs are allocated for elderly patients.

Ultimately, by carefully understanding immunosenescence and the changes that the immune system undergoes during aging, the field of transplant immunology can greatly enhance how it addresses the needs of an aging transplantation patient population. Furthermore, an exciting area of research centers on how the understanding of immunosenescence can guide future research to develop novel treatments – more effective immunosuppression, induced allograft tolerance, and xenotransplantation.

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Authors and Affiliations

  1. Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Charles G. Rickert & James F. Markmann

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  1. Charles G. Rickert
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  2. James F. Markmann
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Correspondence to James F. Markmann .

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Editors and Affiliations

  1. Division of Geriatrics Research Center on Aging, University of Sherbrooke Dept. of Medicine, Sherbrooke, Québec, Canada

    Tamas Fulop

  2. Dept of Experimental Pathology, University of Bologna, Bologna, Italy

    Claudio Franceschi

  3. Institute for Health and Life Sciences, Tokyo, Japan

    Katsuiku Hirokawa

  4. Center for Medical Research, University of Tübingen, Tübingen, Germany

    Graham Pawelec

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Rickert, C.G., Markmann, J.F. (2018). Aging, Immunosenescence, and Transplantation Tolerance. In: Fulop, T., Franceschi, C., Hirokawa, K., Pawelec, G. (eds) Handbook of Immunosenescence. Springer, Cham. https://doi.org/10.1007/978-3-319-64597-1_138-1

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