Transplantation immunology
A. M. VanBuskirk, D. J. Pidwell, P. W. Adams and C. G. Orosz
The practice of clinical and experimental transplantation continues to
evolve at a rapid pace. To appreciate the current transplant practices, it
is first necessary to review transplant immunology in its proper context,
ie, as a component of the complex series of events that promote the repair
of damaged tissues. These processes are generally categorized as
inflammation, immunity, and tissue repair/reinforcement. In general, there
are 3 forms of graft rejection: hyperacute, acute, and chronic rejection.
All 3 forms of graft rejection represent pathologic consequences of one or
more of these repair-related processes. The various graft rejection
responses also illustrate several complex immunologic principles that need
to be considered. These include the definition of an alloantigen, the
structure and function of major histocompatibility complex molecules, and
the behavior of antigen-presenting cells and alloreactive T cells. This
review combines these concepts and principles into a discussion of the 3
forms of graft rejection, each of which is addressed at the level of
histopathology, pathobiology, incidence, and clinical strategies.
