Immunology of Transplant Protocols

Abstract

The development of immunosuppressive medications to control the alloimmune response against donor Human leukocyte antigens (HLA) has permitted the transplantation of many solid organs as well as the treatment of graft versus host disease in bone marrow transplantation. The experience gained with these now routine therapies for end stage organ disease has led to protocols for composite tissue transplantation with grafts containing multiple organ types, such as skin, muscle, nerve, and bone. Successful transplant of limbs, face, and larynx has ushered in a new stage in the progress of clinical transplantation with identification of newly characterized interactions between the immune system and the allograft. The expanding number of clinically successful composite tissue transplants has increased the likelihood for subspecialists not in the traditional fields of nephrology, hepatology, pulmonology, or cardiology to encounter patients taking immunosuppressive medications. Therefore, it is useful to have a basic understanding of the rationale for and complications of therapies including these medications.

Cellular activation pathways and interaction networks in vascularized composite allotransplantation

“…Yet, this groundbreaking reconstructive biotechnology is also associated with challenges, mainly owing to the strong rejection response that invariably occurs following transplantation. VCAs are composed of a variety of tissue types, including, but not limited to, skin, mucosa, blood vessels, lymphatics, nerves, muscle, and bone, with suspected varying degrees of antigenicity between the tissues ( 4 ). To ensure graft survival, patients are usually maintained on high doses of systemic immunosuppression with potentially severe long-term side effects ( 5 ).…”