虽然实际年龄可以被精确定义，但高龄的临床表现在不同个体中以不同的方式和不同的发生率发生。观察到的高龄表型可能反映了几种生物衰老机制的叠加，随着世界应对人口老龄化，这些机制越来越受到关注。即使在免疫系统内，也有多种与年龄相关的生物机制在发挥作用，包括端粒功能障碍、表观遗传失调、免疫衰老程序和线粒体功能障碍。这些生物学机制与临床综合征相关，例如导致短端粒综合征（STS）的端粒功能障碍，并且最佳的患者管理可能需要识别基于生物学的衰老综合征。在肺移植的临床背景下，选择的免疫老化机制尤其明显。事实上，STS 越来越被认为是肺移植的适应症。与此同时，移植的压力可能会引发常见的衰老表型，因为同种异体肺移植面临着强大的免疫反应，相对于其他实体器官，需要更高水平的免疫抑制和相关毒性。肺移植加剧的与年龄相关的病症包括骨髓抑制、疱疹病毒感染、肝硬化、低丙种球蛋白血症、虚弱和癌症风险。本综述旨在剖析免疫衰老的分子机制，并描述其在肺移植背景下的临床表现。虽然这些机制更有可能在肺移植的背景下显现，但这种基于机制的免疫衰老临床综合征方法与老年医学具有广泛的相关性。© 2024 Kapse、Budev、Singer 和 Greenland。

While chronologic age can be precisely defined, clinical manifestations of advanced age occur in different ways and at different rates across individuals. The observed phenotype of advanced age likely reflects a superposition of several biological aging mechanisms which have gained increasing attention as the world contends with an aging population. Even within the immune system, there are multiple age-associated biological mechanisms at play, including telomere dysfunction, epigenetic dysregulation, immune senescence programs, and mitochondrial dysfunction. These biological mechanisms have associated clinical syndromes, such as telomere dysfunction leading to short telomere syndrome (STS), and optimal patient management may require recognition of biologically based aging syndromes. Within the clinical context of lung transplantation, select immune aging mechanisms are particularly pronounced. Indeed, STS is increasingly recognized as an indication for lung transplantation. At the same time, common aging phenotypes may be evoked by the stress of transplantation because lung allografts face a potent immune response, necessitating higher levels of immune suppression and associated toxicities, relative to other solid organs. Age-associated conditions exacerbated by lung transplant include bone marrow suppression, herpes viral infections, liver cirrhosis, hypogammaglobulinemia, frailty, and cancer risk. This review aims to dissect the molecular mechanisms of immune aging and describe their clinical manifestations in the context of lung transplantation. While these mechanisms are more likely to manifest in the context of lung transplantation, this mechanism-based approach to clinical syndromes of immune aging has broad relevance to geriatric medicine.© 2024 Kapse, Budev, Singer and Greenland.