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<https://discovery.ucl.ac.uk/id/eprint/10199987> <http://purl.org/ontology/bibo/abstract> "The incidence of end-stage renal disease (ESRD) increases with age.\r\nTransplantation is the treatment of choice for most patients with ESRD and improves\r\nboth the survival and quality of life of the older transplant recipients when compared\r\nwith dialysis. However, it is also associated with morbidity consequent to the\r\nnecessary pharmacological manipulation of the immune system, including infection\r\nand malignancy. There is little evidence to inform any particular immunosuppression\r\nregimen in older kidney transplant recipients. A United States(US) cross-specialist\r\nworking group recommended that future research directions include investigation of\r\nthe critical immune mechanisms that change with age, the need for\r\nimmunosuppressive strategies to vary by age and be based on measures of immune\r\nexhaustion, investigation of clinical or laboratory parameters that could guide IS in\r\nolder adults and potential development of novel measures of immune status that\r\ncould be more valuable or informative in older adults.\r\nIn this thesis, I describe the existing literature on infection and frailty in older kidney\r\ntransplant recipients and confirm the existing evidence that older transplant\r\nrecipients (> 60 years) are at significantly increased risk of viral infections,\r\nparticularly cytomegalovirus (CMV), post-transplantation. This can lead to increased\r\nfrequency of hospitalization, frailty, and increased mortality. I then identified clinical\r\nparameters that could predict outcomes and demonstrated that frailty before\r\ntransplantation in this cohort (>60 years old at the time of transplantation) is\r\nassociated with an increased risk of infections, particularly CMV, infection-related\r\nhospitalization, and graft failure. Finally, I looked at laboratory parameters, in\r\nparticular a ratio of Interleukin-10(IL-10+) and tumour necrosis factor-α(TNF-α+) cells\r\nwithin transitional B cells, which have been shown to predict transplant outcomes\r\nbased on recent evidence. Transitional B cell IL-10/TNF-α ratio was not affected by\r\nage in this small cohort; however, a larger cohort is needed to study the association\r\nbetween frailty and infection with transitional B cell cytokines."^^<http://www.w3.org/2001/XMLSchema#string> .
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