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An investigation of the predictors of rejection and infection in the elderly kidney transplant recipients

Alshaer, Inji M; (2024) An investigation of the predictors of rejection and infection in the elderly kidney transplant recipients. Doctoral thesis (M.D(Res)), UCL (University College London). Green open access

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Abstract

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-α(TNF-α+) cells within transitional B cells, which have been shown to predict transplant outcomes based on recent evidence. Transitional B cell IL-10/TNF-α 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.

Type: Thesis (Doctoral)
Qualification: M.D(Res)
Title: An investigation of the predictors of rejection and infection in the elderly kidney transplant recipients
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: 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.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10199987
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