Transplantation

Abstract

Transplantation had long been considered before becoming a common practice in the twentieth century. Today, with ever‐increasing knowledge of graft rejection by the immune system, a number of different cells, tissues or organs can be successfully transplanted with effective immunosuppressive therapy to prevent the recipient immune system from targeting and destroying the transplant. Nevertheless, the adverse side effects of immunosuppressive therapy and the limited availability of transplantable organs necessitie the development of other therapies as bridging therapies for transplantation, to support organ function or offer a viable alternative to transplantation.

Key Concepts

  • Organ transplantation is a successful therapy for end‐stage organ failure.
  • Genetic differences between the donor and recipient result in graft rejection by the recipient's immune system.
  • Most transplantation requires immunosuppressive therapy.
  • Immunosuppressive therapy is limited by serious side effects.
  • The shortage of organs for transplantation requires the development of alternative therapies to treat organ failure.

Keywords: allorecognition; transplant; MHC; immunosuppressive therapy; T‐cell

Figure 1. HLA region of chromosome 6. The HLA (human leukocyte antigen) region is the most diverse in the human genome and HLA class I and II are largely responsible for antigenic mismatches between the donor and recipient that result in rejection of the transplanted graft.
Figure 2. Direct and indirect allorecognition. Direct allorecognition occurs when donor‐derived dendritic cells leave the graft and migrate to the transplant recipients' lymph nodes. CD4+ and CD8+ T cells recognise the donor HLA (light blue) as foreign and mount an adaptive immune response against the graft (a). Indirect allorecognition occurs when dead graft cells are internalised by recipient dendritic cells. These cells present peptide antigen derived from the graft cells' HLA and present them to CD4+ and CD8+ T cells (b).
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References

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Further Reading

Anand J, Singh SK, Antoun DG, et al. (2015) Durable mechanical circulatory support versus organ transplantation: past, present, and future. BioMed Research International 2015: 849571.

Lazaryan A, Weisdorf DJ, DeFor T, et al. (2016) Risk factors for acute and chronic graft‐versus‐host disease after allogeneic hematopoietic cell transplantation with umbilical cord blood and matched sibling donors. Biology of Blood and Marrow Transplantation 22 (1): 134–140.

Nassereddine S, Rafei H, Elbahesh E and Tabbara I (2017) Acute graft versus host disease: a comprehensive review. Anticancer Research 37 (4): 1547–1555.

Safa K, Riella LV and Chandraker A (2013) Beyond calcineurin inhibitors: emerging agents in kidney transplantation. Current Opinion in Nephrology and Hypertension 22 (6): 689–697.

Wadström J, Ericzon BG, Halloran PF, et al. (2017) Advancing transplantation: new questions, new possibilities in kidney and liver transplantation. Transplantation 101 (Suppl 2S): S1–S41.

WHO http://www.who.int/topics/transplantation/en/ (accessed March 2017).

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How to Cite close
Smith, Peter L(Jan 2018) Transplantation. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0001246.pub3]