Transplantation

This chapter outlines the relevant principles of basic transplant immunology, immunosuppression and rejection. The process of organ donation, allocation and transplant recipients are described. Transplantation of the heart and lungs, kidney, pancreas and islet, liver and small bowel are detailed.

A Short History of Skin Grafting in Burns: From the Gold Standard of Autologous Skin Grafting to the Possibilities of Allogeneic Skin Grafting with Immunomodulatory Approaches

Due to groundbreaking and pioneering developments in the last century, significant improvements in the care of burn patients have been achieved. In addition to the still valid therapeutic standard of autologous split-thickness skin grafting, various commercially available skin substitutes are currently available. Significant progress in the field of tissue engineering has led to the development of promising therapeutic approaches. However, scientific advances in the field of allografting and transplant immunology are of great importance. The achievement of various milestones over the past decades has provided thought-provoking impulses in the field of skin allotransplantation. Thus, biologically viable skin allotransplantation is still not a part of the clinical routine. The purpose of this article is to review the achievements in burn surgery with regards to skin allotransplantation in recent years.

Transplant Immunology: Basic Immunology and Clinical Practice

Engraftment of a transplanted organ into an allogeneic host triggers a cascade of immunologic responses in the host that are designed to facilitate graft rejection. Modern donor-to-host matching techniques and immunosuppression protocols have successfully tempered this natural immune response so that graft survival has dramatically improved. However, optimizing graft survival by precisely downregulating the host response to graft rejection while preserving host immune defenses against pathologic and infectious agents remains poorly understood and elusive in current clinical practice. This review discusses transplant immunology with respect to host versus graft and the basis of allorecognition, as well as clinical management of the transplanted allograft. Figures show human leukocyte antigen (HLA), direct allorecognition, T cell receptor and CD3, T cell–associated second messenger signaling pathway, CD8 molecules directly ligating class I HLAs and CD4 molecules directly binding HLA class II, detection of alloantibodies by enzyme-linked immunosorbent assay or flow cytometry, recipient-donor crossmatch, histopathology of kidney allograft with antibody-mediated rejection, and an algorithm for assessment and management of renal allograft rejection. This review contains 9 figures, 6 tables and 61 references. Keywords: Transplantation, immunology, human leukocyte antigen, crossmatch, donor, acute rejection, chronic rejection

Transplant Immunology: Basic Immunology and Clinical Practice

Engraftment of a transplanted organ into an allogeneic host triggers a cascade of immunologic responses in the host that are designed to facilitate graft rejection. Modern donor-to-host matching techniques and immunosuppression protocols have successfully tempered this natural immune response so that graft survival has dramatically improved. However, optimizing graft survival by precisely downregulating the host response to graft rejection while preserving host immune defenses against pathologic and infectious agents remains poorly understood and elusive in current clinical practice. This review discusses transplant immunology with respect to host versus graft and the basis of allorecognition, as well as clinical management of the transplanted allograft. Figures show human leukocyte antigen (HLA), direct allorecognition, T cell receptor and CD3, T cell–associated second messenger signaling pathway, CD8 molecules directly ligating class I HLAs and CD4 molecules directly binding HLA class II, detection of alloantibodies by enzyme-linked immunosorbent assay or flow cytometry, recipient-donor crossmatch, histopathology of kidney allograft with antibody-mediated rejection, and an algorithm for assessment and management of renal allograft rejection. This review contains 9 figures, 6 tables and 61 references. Keywords: Transplantation, immunology, human leukocyte antigen, crossmatch, donor, acute rejection, chronic rejection

Transplant Immunology: Basic Immunology and Clinical Practice

Engraftment of a transplanted organ into an allogeneic host triggers a cascade of immunologic responses in the host that are designed to facilitate graft rejection. Modern donor-to-host matching techniques and immunosuppression protocols have successfully tempered this natural immune response so that graft survival has dramatically improved. However, optimizing graft survival by precisely downregulating the host response to graft rejection while preserving host immune defenses against pathologic and infectious agents remains poorly understood and elusive in current clinical practice. This review discusses transplant immunology with respect to host versus graft and the basis of allorecognition, as well as clinical management of the transplanted allograft. Figures show human leukocyte antigen (HLA), direct allorecognition, T cell receptor and CD3, T cell–associated second messenger signaling pathway, CD8 molecules directly ligating class I HLAs and CD4 molecules directly binding HLA class II, detection of alloantibodies by enzyme-linked immunosorbent assay or flow cytometry, recipient-donor crossmatch, histopathology of kidney allograft with antibody-mediated rejection, and an algorithm for assessment and management of renal allograft rejection. This review contains 9 figures, 6 tables and 61 references. Keywords: Transplantation, immunology, human leukocyte antigen, crossmatch, donor, acute rejection, chronic rejection

Immunological Characteristics and Management of Kidney Transplantation

Kidney transplantation (KT) is the best way to improve the quality of life and survival of patients with end-stage renal disease. However, after KT the adaptive immune system plays important roles in the development of rejection via multiple pathways. Accordingly, the suppression or modulation of these pathways is key to allograft survival. Advances in our understanding of the immunology related to KT with the development of immunosuppressants have reduced the rate of acute rejection and improved short-term transplant outcomes. Nonetheless, <i>de novo</i> donor-specific antibodies and subsequent chronic rejection continue to be responsible for the poor long-term survival of transplanted patients. In addition, the morbidity and mortality rates in patients returning to dialysis after graft failure are high. Better long-term outcomes following KT require innovative treatment strategies that include a focus on de novo antibodies. Here, we review basic transplant immunology as well as the diagnostic tools and medications that contribute to successful KT. We also provide an update on newly developed immunosuppressants.