Skip to main content

Immunology of Organ Transplantation

  • Chapter
  • First Online:
Pathology of Solid Organ Transplantation

Abstract

The major hurdle to successful transplantation is immune-mediated rejection, a process that has been partially prevented through the use of potent immunosuppressive medications. Understanding the basis of transplant immunology is required to comprehend the role of the tissue typing laboratory in managing potential transplant recipients to understand the mechanisms of immunosuppression and to be able to appropriately detect and diagnose acute or chronic rejection. The goal of this chapter is to give general overview of the components of the immune system, recognition of alloantigen, and cellular and humoral immune response, focusing on those aspects that are important to understand the logic behind the clinical use of immunosuppressive drugs. We then outline clinically relevant organ specific differences and clinical applications of transplant immunology.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Abbas, A.K., Lichtman, A.H., Pillai, S.: Introduction to the immune system. William R Schmitt (ed) In: Cellular and Molecular Immunology, 6th ed. Saunders/Elsevier, Philadelphia (2007)

    Google Scholar 

  2. Ansari, M.J., Sayegh, M.H.: Clinical transplantation tolerance: the promise and challenges. Kidney Int. 65, 1560–1563 (2004)

    Article  PubMed  Google Scholar 

  3. Baid, S., Saidman, S.L., Tolkoff-Rubin, N., et al.: Managing the highly sensitized transplant recipient and B cell tolerance. Curr. Opin. Immunol. 13, 577–581 (2001)

    Article  CAS  PubMed  Google Scholar 

  4. Banasik, M., Klinger, M.: Chronic allograft nephropathy–immunologic and nonimmunologic factors. Ann. Transplant. 11, 7–10 (2006)

    PubMed  Google Scholar 

  5. Bray, R.A., Nickerson, P.W., Kerman, R.H., et al.: Evolution of HLA antibody detection: technology emulating biology. Immunol. Res. 29, 41–54 (2004)

    Article  CAS  PubMed  Google Scholar 

  6. Chalermskulrat, W., Neuringer, I.P., Schmitz, J.L., et al.: Human leukocyte antigen mismatches predispose to the severity of bronchiolitis obliterans syndrome after lung transplantation. Chest 123(6), 1825–1831 (2003)

    Article  PubMed  Google Scholar 

  7. Clarkson, M.R., Sayegh, M.H.: T-cell costimulatory pathways in allograft rejection and tolerance. Transplantation 15, 555–563 (2005)

    Article  Google Scholar 

  8. Croft, M., Dubey, C.: Accessory molecule and costimulation requirements for CD4 T cell response. Crit. Rev. Immunol. 17, 89–118 (1997)

    CAS  PubMed  Google Scholar 

  9. Delves, P.J., Roitt, I.M.: The immune system. first of two parts. N Engl J. Med. 6, 37–49 (2000)

    Google Scholar 

  10. Delves, P.J., Roitt, I.M.: The immune system. second of two parts. N Engl J. Med. 13, 108–117 (2000)

    Google Scholar 

  11. Doran, T.J., Geczy, A.F., Painter, D., et al.: A large, single center investigation of the immunogenetic factors affecting liver transplantation. Transplantation 15, 1491–1498 (2000)

    Article  Google Scholar 

  12. Dyer, P.A., Johnson, R.W., Martin, S., et al.: Evidence that matching for HLA antigens significantly increases transplant survival in 1001 renal transplants performed in the northwest region of England. Transplantation 48, 131–135 (1989)

    Article  CAS  PubMed  Google Scholar 

  13. Festenstein, H., Doyle, P., Holmes, J.: Long-term follow-up in london transplant group recipients of cadaver renal allografts. the influence of HLA matching on transplant outcome. N Engl J. Med. 2, 7–14 (1986)

    Article  Google Scholar 

  14. Gebel, H.M., Bray, R.A., Nickerson, P.: Pre-transplant assessment of donor-reactive, HLA-specific antibodies in renal transplantation: contraindication vs. risk. Am. J. Transplant. 3, 1488–1500 (2003)

    Article  PubMed  Google Scholar 

  15. Gould, D.S., Auchincloss, H.: Direct and indirect recognition: the role of MHC antigens in graft rejection. Immunol. Today 20, 77–82 (1999)

    Article  CAS  PubMed  Google Scholar 

  16. Gundlach, M., Schmidt, P., Hell, K., et al.: The influence of major histocompatibility complex subloci differences on graft rejection in small-bowel transplantation. Transplant. Proc. 22, 2474–2475 (1990)

    CAS  PubMed  Google Scholar 

  17. Hale, D.A.: Basic transplantation immunology. Surg. Clin. N. Am. 86, 1103–1125 (2006). v

    Article  PubMed  Google Scholar 

  18. Izcue, A., Coombes, J.L., Powrie, F.: Regulatory T cells suppress systemic and mucosal immune activation to control intestinal inflammation. Immunol. Rev. 212, 256–271 (2006)

    Article  CAS  PubMed  Google Scholar 

  19. Klein, J., Sato, A.: The HLA system. first of two parts. N Engl J. Med. 7, 702–709 (2000)

    Google Scholar 

  20. Klein, J., Sato, A.: The HLA system. second of two parts. N Engl J. Med. 14, 782–786 (2000)

    Google Scholar 

  21. Lakkis, F.G.: Transplantation tolerance: a journey from ignorance to memory. Nephrol. Dial. Transplant. 18, 1979–1982 (2003)

    Article  CAS  PubMed  Google Scholar 

  22. Lakkis, F.G., Arakelov, A., Konieczny, B.T., et al.: Immunologic ‘ignorance’ of vascularized organ transplants in the absence of secondary lymphoid tissue. Nat. Med. 6, 686–688 (2000)

    Article  CAS  PubMed  Google Scholar 

  23. Le Bas-Bernardet, S., Hourmant, M., Valentin, N., et al.: Identification of the antibodies involved in B-cell crossmatch positivity in renal transplantation. Transplantation 27, 477–482 (2003)

    Article  Google Scholar 

  24. London, C.A., Lodge, M.P., Abbas, A.K.: Functional responses and costimulator dependence of memory CD4+ T cells. J. Immunol. 1, 265–272 (2000)

    Google Scholar 

  25. Malaise, J., Berney, T., Morel, P., et al.; EUROSPK Study Group: Effect of HLA matching in simultaneous pancreas-kidney transplantation. Transplant. Proc. 37, 2846–2847 (2005)

    Article  Google Scholar 

  26. Mezrich, J.D., Benjamin, L.C., Sachs, J.A., et al.: Role of the thymus and kidney graft in the maintenance of tolerance to heart grafts in miniature swine. Transplantation 27, 1663–1673 (2005)

    Article  Google Scholar 

  27. Newell, K.A., Larsen, C.P.: Toward transplantation tolerance: a large step on a long road. Am. J. Transplant. 6, 1989–1990 (2006)

    Article  CAS  PubMed  Google Scholar 

  28. Niv, Y., Mor, E., Tzakis, A.G.: Small bowel transplantation–a clinical review. Am. J. Gastroenterol. 94, 3126–3130 (1999)

    CAS  PubMed  Google Scholar 

  29. Opelz, G., Wujciak, T.: The influence of HLA compatibility on graft survival after heart transplantation. the collaborative transplant study. N Engl J. Med. 24, 816–819 (1994)

    Article  Google Scholar 

  30. Opelz, G., Wujciak, T., Dohler, B., et al.: HLA compatibility and organ transplant survival. Collaborative transplant study. Rev. Immunogenet. 1, 334–342 (1999)

    CAS  PubMed  Google Scholar 

  31. Pearl, J.P., Parris, J., Hale, D.A., et al.: Immunocompetent T-cells with a memory-like phenotype are the dominant cell type following antibody-mediated T-cell depletion. Am. J. Transplant. 5, 465–474 (2005)

    Article  CAS  PubMed  Google Scholar 

  32. Pietra, B.A., Wiseman, A., Bolwerk, A., et al.: CD4 T cell-mediated cardiac allograft rejection requires donor but not host MHC class II. J. Clin. Invest. 106, 1003–1010 (2000)

    Article  CAS  PubMed  Google Scholar 

  33. Pihlgren, M., Dubois, P.M., Tomkowiak, M., et al.: Resting memory CD8+ T cells are hyperreactive to antigenic challenge in vitro. J. Exp. Med. 1, 2141–2151 (1996)

    Article  Google Scholar 

  34. Saiki, T., Ezaki, T., Ogawa, M., et al.: In vivo roles of donor and host dendritic cells in allogeneic immune response: cluster formation with host proliferating T cells. J. Leukoc. Biol. 69, 705–712 (2001)

    CAS  PubMed  Google Scholar 

  35. Sayegh, M.H., Turka, L.A.: The role of T-cell costimulatory activation pathways in transplant rejection. N Engl J. Med. 18, 1813–1821 (1998)

    Google Scholar 

  36. Schulman, L.L., Weinberg, A.D., McGregor, C., et al.: Mismatches at the HLA-DR and HLA-B loci are risk factors for acute rejection after lung transplantation. Am. J. Respir. Crit. Care Med. 157, 1833–1837 (1998)

    CAS  PubMed  Google Scholar 

  37. Schulman, L.L., Weinberg, A.D., McGregor, C.C., et al.: Influence of donor and recipient HLA locus mismatching on development of obliterative bronchiolitis after lung transplantation. Am. J. Respir. Crit. Care Med. 163, 437–442 (2001)

    CAS  PubMed  Google Scholar 

  38. Sheldon, S., Yonan, N.A., Aziz, T.N., et al.: The influence of histocompatibility on graft rejection and graft survival within a single center population of heart transplant recipients. Transplantation 27, 515–519 (1999)

    Article  Google Scholar 

  39. Smith, J.D., Rose, M.L., Pomerance, A., et al.: Reduction of cellular rejection and increase in longer-term survival after heart transplantation after HLA-DR matching. Lancet 18, 1318–1322 (1995)

    Article  Google Scholar 

  40. Starzl, T.E., Murase, N., Abu-Elmagd, K., et al.: Tolerogenic immunosuppression for organ transplantation. Lancet 3, 1502–1510 (2003)

    Article  Google Scholar 

  41. Starzl, T.E., Zinkernagel, R.M.: Transplantation tolerance from a historical perspective. Nat. Rev. Immunol. 1, 233–239 (2001)

    Article  CAS  PubMed  Google Scholar 

  42. Sumitran-Holgersson, S.: HLA-specific alloantibodies and renal graft outcome. Nephrol. Dial. Transplant. 16, 897–904 (2001)

    Article  CAS  PubMed  Google Scholar 

  43. Terasaki, P.I., Ozawa, M.: Predicting kidney graft failure by HLA antibodies: a prospective trial. Am. J. Transplant. 4, 438–443 (2004)

    Article  CAS  PubMed  Google Scholar 

  44. van den Berg, J.W., Hepkema, B.G., Geertsma, A., et al.: Long-term outcome of lung transplantation is predicted by the number of HLA-DR mismatches. Transplantation 15, 368–373 (2001)

    Article  Google Scholar 

  45. Viola, A., Lanzavecchia, A.: T cell activation determined by T cell receptor number and tunable thresholds. Science 5, 104–106 (1996)

    Article  Google Scholar 

  46. Welsh, R.M., Selin, L.K.: No one is naive: the significance of heterologous T-cell immunity. Nat. Rev. Immunol. 2, 417–426 (2002)

    CAS  PubMed  Google Scholar 

  47. West, L.J., Pollock-Barziv, S.M., Dipchand, A.I., et al.: ABO-incompatible heart transplantation in infants. N Engl J. Med. 15, 793–800 (2001)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Barbara Murphy .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer Berlin Heidelberg

About this chapter

Cite this chapter

Gurkan, S., Schröppel, B., Murphy, B. (2009). Immunology of Organ Transplantation. In: Liapis, H., Wang, H. (eds) Pathology of Solid Organ Transplantation. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79343-4_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-79343-4_1

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-79342-7

  • Online ISBN: 978-3-540-79343-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics