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Immunosenescence and Immunosuppressive Drugs in the Elderly

  • Living reference work entry
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Handbook of Immunosenescence

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Abstract

The majority of patients awaiting or receiving solid organ transplantation are older than 50 years. The implications of immunosenescence are broad since the elderly transplant recipient is characterized by higher rates of diabetes, infections, and malignancies, which represent major causes of death. Indeed, those changes are linked to the applied immunosuppressive drugs and may indicate an age-adapted immunosuppression. For instance, corticosteroids, calcineurin inhibitors, and mToR inhibitors are related to new-onset diabetes. On the other hand, acute rejection rates are less frequent in older recipients, whereas the engraftment of older organs is linked to higher rejection rates. Another complicating factor is age-related physiologic changes resulting in altered pharmacokinetics of the immunosuppressive agents. Therefore, age-adapted induction and maintenance therapies must address the impact of immunosenescence and altered pharmacokinetic profiles when appropriately managing elderly transplant recipients. A selective application of immunosuppressive protocols, in addition to proper dose adjustments, may allow a more tailored treatment of older organ transplant recipients.

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Authors and Affiliations

  1. Department of Surgery, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Felix Krenzien

  2. Department of Pharmacy Services, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sandra El Hajj

  3. Department of Transplant Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Stefan G. Tullius

  4. Departments of Transplant Surgery and Pharmacy Services/Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Steven Gabardi

  5. Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Steven Gabardi

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  1. Felix Krenzien
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  2. Sandra El Hajj
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  3. Stefan G. Tullius
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  4. Steven Gabardi
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Correspondence to Felix Krenzien .

Editor information

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

Section Editor information

  1. Research Center on Aging, Department of Medicine, Immunology Graduate Programme, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada

    Tamas Fulop

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Krenzien, F., El Hajj, S., Tullius, S.G., Gabardi, S. (2018). Immunosenescence and Immunosuppressive Drugs in the Elderly. 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_137-1

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