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.
HLA Rejection NK cell Management
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