Rejection After ABO-Incompatible Organ Transplantation

Abstract

Antigen variety, especially HLA discrepancies between the recipients and donors, can cause rejection reaction, which is a complex and hazardous immunological reaction involving multiple cell- and antibody-mediated processes. Similarly for ABOi transplants, previous studies have confirmed that minimization of HLA mismatch is a key to the success of solid organ transplant (Holgersson et al., Transplantation 84:S48–S50, 2007). Allograft rejections are similar to other immunological responses except they are mainly mediated by alloreactive T cells that specifically recognize alloantigen and exert their destructive functions through direct cytotoxicity, NK cell-mediated cytotoxicity, ADCC, complement activation, a variety of pro-inflammatory cytokines, etc. (Holgersson et al., Transplantation 84:S48–S50, 2007 and Subramanian et al., Int J Immunogenet 39:282–290, 2012).

Due to the different underlying mechanisms, rejection reactions can be classified as described in the following chapters and vary on their clinical manifestations as well as managements.