Joanna Schaenman1, Deena Goldwater2. 1. Department of Medicine, Division of Infectious Diseases. 2. Department of Medicine, Divisions of Geriatrics and Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Abstract
PURPOSE OF REVIEW: The aim of this review is to describe the latest investigations into the immunobiology of aging and the potential impact on outcomes after mechanical circulatory support implantation and heart transplantation. This information is relevant given the growing numbers of older patients with heart failure undergoing evaluation for mechanical circulatory support device (MCSD) or heart transplantation. RECENT FINDINGS: A host of aging-associated aspects of immune dysfunction have been described in the general population including T-cell senescence, exhaustion, and terminal dedifferentiation, as well as impaired function of innate immune cells. Another important consequence of T-cell senescence is inflammation, which is known to have a strong relationship with both heart failure and frailty in older patients. Recent data on the association between T-cell and monocyte phenotypes as well as evaluation of gene expression and adverse outcomes after MCSD suggests the potential value of immunologic assessment of MCSD and heart transplant candidates and recipients. Measurement of physical frailty represents another avenue for patient evaluation that may complement immunologic assessment. Determination of immune dysfunction and frailty prior to transplantation may have implications for choice of induction and dosing of maintenance immunosuppression. SUMMARY: As the age of transplant and MCSD candidates and recipients continues to increase, it is important for providers to recognize the potential impact of aging-associated immune dysfunction and how it may influence candidate selection, postintervention monitoring, and adjustment of immunosuppression.
PURPOSE OF REVIEW: The aim of this review is to describe the latest investigations into the immunobiology of aging and the potential impact on outcomes after mechanical circulatory support implantation and heart transplantation. This information is relevant given the growing numbers of older patients with heart failure undergoing evaluation for mechanical circulatory support device (MCSD) or heart transplantation. RECENT FINDINGS: A host of aging-associated aspects of immune dysfunction have been described in the general population including T-cell senescence, exhaustion, and terminal dedifferentiation, as well as impaired function of innate immune cells. Another important consequence of T-cell senescence is inflammation, which is known to have a strong relationship with both heart failure and frailty in older patients. Recent data on the association between T-cell and monocyte phenotypes as well as evaluation of gene expression and adverse outcomes after MCSD suggests the potential value of immunologic assessment of MCSD and heart transplant candidates and recipients. Measurement of physical frailty represents another avenue for patient evaluation that may complement immunologic assessment. Determination of immune dysfunction and frailty prior to transplantation may have implications for choice of induction and dosing of maintenance immunosuppression. SUMMARY: As the age of transplant and MCSD candidates and recipients continues to increase, it is important for providers to recognize the potential impact of aging-associated immune dysfunction and how it may influence candidate selection, postintervention monitoring, and adjustment of immunosuppression.
Authors: Charles F A de Bourcy; Cesar J Lopez Angel; Christopher Vollmers; Cornelia L Dekker; Mark M Davis; Stephen R Quake Journal: Proc Natl Acad Sci U S A Date: 2017-01-17 Impact factor: 11.205
Authors: Mara A McAdams-DeMarco; Hao Ying; Alvin G Thomas; Fatima Warsame; Ashton A Shaffer; Christine E Haugen; Jacqueline M Garonzik-Wang; Niraj M Desai; Ravi Varadhan; Jeremy Walston; Silas P Norman; Dorry L Segev Journal: Transplantation Date: 2018-10 Impact factor: 4.939
Authors: Gustavo Campos Ramos; Anne van den Berg; Vânia Nunes-Silva; Johannes Weirather; Laura Peters; Matthias Burkard; Mike Friedrich; Jürgen Pinnecker; Marco Abeßer; Katrin G Heinze; Kai Schuh; Niklas Beyersdorf; Thomas Kerkau; Jocelyne Demengeot; Stefan Frantz; Ulrich Hofmann Journal: Proc Natl Acad Sci U S A Date: 2017-03-02 Impact factor: 11.205
Authors: George A Heberton; Michael Nassif; Andrew Bierhals; Eric Novak; Shane J LaRue; Brian Lima; Shelley Hall; Scott Silvestry; Susan M Joseph Journal: Am J Cardiol Date: 2016-08-12 Impact factor: 2.778
Authors: Xiaobo Yang; Josep Lupón; Maria T Vidán; Caleb Ferguson; Paloma Gastelurrutia; Phillip J Newton; Peter S Macdonald; Héctor Bueno; Antoni Bayés-Genís; Jean Woo; Erik Fung Journal: J Am Heart Assoc Date: 2018-12-04 Impact factor: 5.501