Ageing is an emerging topic in organ transplantation. An increasing number of marginal grafts from older donors are being utilized for transplantation. Older organs are frequently allocated to elderly recipients who represent the fastest growing patient population on the waiting list.

Donor age impairs the ability for tissue repair and may render older organs more immunogenic. In contrast, ageing of the immune system („immunosenescence“) has a significant influence on the T-cell responses, thereby decreasing the risk of acute rejection. Investigating the effects of advanced donor and recipient age on the immune response after transplantation seems critical in order to avoid under – or overimmunosuppression. Although less well understood, immunosenescence and organ age specific aspects of injury and repair may likely affect tolerance protocols.

The influence of ageing on both graft quality and the post-transplant immune response will become increasingly important for improving long-term graft and patient outcome and establishing clinical tolerance protocols.