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Background  Older age at organ transplantation is associated with increased risk of infection and malignancy but reduced risk of cellular rejection. De novo donor-specific anti-HLA antibodies ( dn DSA), are key biomarkers associated with reduced long-term allograft survival, yet there is a lack of data focusing on age-associated changes.    Methods  Development of  dn DSA was restrospectively analyzed in all subjects who received a kidney transplant at the University Hospital Zurich between 01/2006 and 02/2015. Follow up continued until 03/2016. The incidence of  dn DSA in different age categories was compared with special focus on the extremes of age: children < 10 years ( n  = 19) and adults ≥60 years of age ( n  = 110).    Results  Incidence of  dn DSA gradually decreased with age, with older recipients having a significantly lower risk (HR 0.21,  p  = 0.0224) compared to pediatric recipients. Cumulative incidence of  dn DSA at 2, 5 and 10 years was 6.2, 9.1 and 36% in the older recipients versus 5.3, 29.5 and 47.1% in pediatric recipients. Median time to development of  dn DSA was similar (older 720 days, min 356, max 3646 days; children 1086 days, min 42, max 2474 days). Annual incidence was highest within the first two years after transplantation in the older recipients and peaked in years two to four in pediatric recipients.  Dn DSA were predominantly class II. More  dn DSA were observed with cyclosporine as compared to tacrolimus.    Conclusion  Older kidney transplant recipients have a lower risk of developing  dn DSA than pediatric recipients, pointing towards reduced humoral immune reactivity with increasing age. This observation raises the question of adjustment in immunosuppression.    Electronic supplementary material  The online version of this article (10.1186/s12979-019-0149-8) contains supplementary material, which is available to authorized users.

Age-associated decrease in de novo donor-specific antibodies in renal transplant recipients reflects changing humoral immunity