Department of Hepatobiliary and Transplant Surgery, St Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
Department of Biology, Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Kildare, Ireland.
Transpl Immunol. 2023 Aug;79:101851. doi: 10.1016/j.trim.2023.101851. Epub 2023 May 12.
Biological aging is the accumulation of cellular and molecular damage within an individual over time. The biological age of a donor organ is known to influence clinical outcomes of solid organ transplantation, including delayed graft function and frequency of rejection episodes. While much research has focused on the biological age of donor organs, the recipient's biological age may also influence transplantation outcomes. The aim of this scoping review was to identify and provide an overview of the existing evidence regarding biological aging in solid organ transplant recipients and the impact on patient outcomes post-transplant.
Literature searches were carried out on PubMed, Web of Science, Google Scholar, Embase and TRIP using the phrases 'solid organ transplant', 'cell senescence', 'cell aging' and 'outcomes', using boolean 'and/or' phrases and MeSH terms. Duplicates were removed and abstracts were reviewed by two independent reviewers. Full papers were then screened for inclusion by two reviewers. Data extraction was carried out using a standardised proforma agreed on prior to starting.
32 studies, including data on a total of 7760 patients, were identified for inclusion in this review; 23 relating to kidney transplant recipients, three to liver transplant, five to lung transplant and one to heart transplantation. A wide range of biomarkers of biological aging have been assessed in kidney transplant recipients, whereas studies of liver, lung and heart transplant have predominantly assessed recipient telomere length. The most robust associations with clinical outcomes are observed in kidney transplant recipients, possibly influenced by the larger number of studies and the use of a wider range of biomarkers of biological aging. In kidney transplant recipients reduced thymic function and accumulation of terminally differentiated T cell populations was associated with reduced risk of acute rejection but increased risk of infection and mortality.
Studies to date on biological aging in transplant recipients have been heavily biased to kidney transplant recipients. The results from these studies suggest recipient biological age can influence clinical outcomes and future research is needed to prioritise robust biomarkers of biological aging in transplant recipients.
生物衰老指的是个体随着时间的推移，细胞和分子损伤的积累。供体器官的生物年龄已知会影响实体器官移植的临床结果，包括移植物功能延迟和排斥反应发作的频率。虽然许多研究都集中在供体器官的生物年龄上，但受体的生物年龄也可能影响移植结果。本范围综述的目的是确定并概述有关实体器官移植受者生物衰老以及对移植后患者结局的影响的现有证据。
在 PubMed、Web of Science、Google Scholar、Embase 和 TRIP 上使用“实体器官移植”、“细胞衰老”、“细胞老化”和“结果”等短语，使用布尔“和/或”短语和 MeSH 术语进行文献检索。去除重复项，由两名独立审查员审查摘要。然后，由两名审查员筛选全文是否符合纳入标准。使用事先商定的标准化表格进行数据提取。
共确定了 32 项研究，包括总共 7760 名患者的数据，这些研究被纳入本综述；其中 23 项涉及肾移植受者，3 项涉及肝移植受者，5 项涉及肺移植受者，1 项涉及心脏移植受者。在肾移植受者中评估了广泛的生物衰老生物标志物，而肝、肺和心脏移植的研究主要评估了受体端粒长度。与临床结局最密切相关的是肾移植受者，这可能是由于研究数量较多，以及使用了更广泛的生物衰老生物标志物。在肾移植受者中，胸腺功能降低和终末分化 T 细胞群的积累与急性排斥反应风险降低但感染和死亡率增加有关。
迄今为止，关于移植受者生物衰老的研究严重偏向于肾移植受者。这些研究的结果表明，受体的生物年龄会影响临床结局，未来的研究需要优先确定移植受者中稳健的生物衰老生物标志物。
