TY  - UNPB
N1  - Copyright © The Author 2024.   Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/).  Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms.  Access may initially be restricted at the author?s request.
Y1  - 2024/11/28/
AV  - public
SP  - 1
EP  - 1
TI  - An investigation of the predictors of rejection and infection in the elderly kidney transplant recipients
A1  - Alshaer, Inji  M
M1  - Doctoral
UR  - https://discovery.ucl.ac.uk/id/eprint/10199987/
PB  - UCL (University College London)
N2  - The incidence of end-stage renal disease (ESRD) increases with age.
Transplantation is the treatment of choice for most patients with ESRD and improves
both the survival and quality of life of the older transplant recipients when compared
with dialysis. However, it is also associated with morbidity consequent to the
necessary pharmacological manipulation of the immune system, including infection
and malignancy. There is little evidence to inform any particular immunosuppression
regimen in older kidney transplant recipients. A United States(US) cross-specialist
working group recommended that future research directions include investigation of
the critical immune mechanisms that change with age, the need for
immunosuppressive strategies to vary by age and be based on measures of immune
exhaustion, investigation of clinical or laboratory parameters that could guide IS in
older adults and potential development of novel measures of immune status that
could be more valuable or informative in older adults.
In this thesis, I describe the existing literature on infection and frailty in older kidney
transplant recipients and confirm the existing evidence that older transplant
recipients (> 60 years) are at significantly increased risk of viral infections,
particularly cytomegalovirus (CMV), post-transplantation. This can lead to increased
frequency of hospitalization, frailty, and increased mortality. I then identified clinical
parameters that could predict outcomes and demonstrated that frailty before
transplantation in this cohort (>60 years old at the time of transplantation) is
associated with an increased risk of infections, particularly CMV, infection-related
hospitalization, and graft failure. Finally, I looked at laboratory parameters, in
particular a ratio of Interleukin-10(IL-10+) and tumour necrosis factor-?(TNF-?+) cells
within transitional B cells, which have been shown to predict transplant outcomes
based on recent evidence. Transitional B cell IL-10/TNF-? ratio was not affected by
age in this small cohort; however, a larger cohort is needed to study the association
between frailty and infection with transitional B cell cytokines.
ID  - discovery10199987
ER  -