211 replies to this topic

[John Schloendorn]

When you transplant an organ from an elderly donor to a young recipient, do you get special rejection issues as a direct result of the age difference? E.g. some special molecule that exists only in aged tissues gets recognized as foreign and rejected? Does such a thing exist?

[Athanasios]

When you transplant an organ from an elderly donor to a young recipient, do you get special rejection issues as a direct result of the age difference?

I can't find unique rejection issues but there is a definite increase in chance of rejection at a certain age of the donor.

It looks like the age cut-offs, upper and lower bound are different for different tissues and are also sensitive to if the organ is from a living donor or not. I am not sure if reduced graft survival is due to a similar mechanism across the board.

For example, here is info on upper-bound limits and the kidney:

Drugs Aging. 2005;22(5):433-49.
The impact of age on rejection in kidney transplantation.
de Fijter JW.

...Two issues have been identified with the use of old (>50 years of age) donor kidneys. First, compared with kidneys from younger donors, they have an increased incidence of acute interstitial rejection. Secondly, once a rejection episode occurs, the ability to mount a tissue repair process seems impaired. An explanation for the increased loss of grafts from old donors that have experienced acute rejection episodes is that such kidneys have fewer nephrons that function adequately and that the cumulated effect of damage results in an earlier demise of the graft compared with younger donor kidneys. Alternatively, graft parenchymal cells may undergo premature senescence or aging as a result of multiple injuries and repair. If progressive loss of renal mass or senescence is the mechanism responsible for increased graft loss, then it is expected that grafts from older donors will show a progressive decrease in function over time and that the rate of decline of function will correlate with donor age. We have suggested that increased graft loss of older donor kidneys results from increased incidence of acute rejection episodes in the early post-transplantation months together with a partly impaired ability to repair the tissue. Drug pharmacokinetic parameters are generally little influenced by age. However, the degree to which drugs suppress the immune system, and the extent to which kidneys from older donors are susceptible to the nephrotoxic effects of certain drugs, are unpredictable. There appears to be a more delicate balance between adequate immunosuppression and excess nonimmune toxicity in patients receiving older kidneys...

PMID: 15903355 [PubMed - indexed for MEDLINE]

and children receiving an adult kidney will have issues:

Superior long-term graft function and better growth of grafts in children receiving kidneys from paediatric compared with adult donors.
Pape L, Hoppe J, Becker T, Ehrich JH, Neipp M, Ahlenstiel T, Offner G.

Department of Pediatric Nephrology, Visceral and Transplant Surgery, Medical School of Hannover, Germany. larspape@t-online.de
BACKGROUND: Organs from paediatric donors are often not accepted for paediatric recipients because previous reports suggested inferior graft function for small kidneys transplanted in children. On the other hand, studies have shown that kidneys of adult donors transplanted into children down-regulate filtration after transplantation and may not increase their function to the need of the growing child. METHODS: We assessed 64 male and 35 female (total n = 99) white children aged <10 years (male: mean 5.1 years, SD 2.8; female: mean 5.8 years, SD 3.4) who had received cadaveric kidney transplants at our centre between 1990 and 2005. Mean observation time was 5.9 years, SD 4.0. The children were divided into two groups depending on the kidney donor age: 63 children (mean age 5.0 years, SD 2.9) received an organ of an adult, and 39 (mean age 6.4 years, SD 3.4) of a paediatric donor. Immunosuppression was performed with prednisolone, cyclosporin A microemulsion+/-mycophenolate mofetil. RESULTS: Three to five years after transplantation the calculated glomerular filtration rate corrected to body surface was significantly higher in recipients of paediatric organs. The size of paediatric grafts doubled in the first years after transplantation while adult grafts had a stable size. Graft survival was comparable in both groups during observation time. CONCLUSIONS: We conclude that paediatric donor kidneys should be given preferentially to paediatric recipients due to better long-term function.

PMID: 16861725 [PubMed - indexed for MEDLINE]

I hope that helps.