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Review
. 2009 Oct;23(4):191-8.
doi: 10.1016/j.trre.2009.06.002. Epub 2009 Jul 22.

The role of antibodies in transplantation

Alexander T Chang  1 , Jeffrey L Platt
Affiliations
Review

The role of antibodies in transplantation

Alexander T Chang et al. Transplant Rev (Orlando). 2009 Oct.

Abstract

For the past 40 years, T cells have been considered the primary threat to the survival of allografts. However, antibodies can induce severe vascular disease of organ transplants, and this disease, particularly "antibody-mediated" rejection, has become a major clinical challenge. Not only do antibodies cause rejection, the rejection caused by antibodies resists treatment by conventional drug regimens. On the other hand, antibodies can induce a condition in which grafts seemingly resist antibody-mediated injury, which is accommodation. In this communication, we discuss the role of antibodies in the diagnosis and pathogenesis of rejection and accommodation, and suggest what we considered the major gaps in knowledge and directions research into this subject might productively take.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1. Mechanisms of graft vascularization
Isolated cellular grafts are vascularized entirely by in-growth of recipient blood vessels (top). Free tissue grafts are vascularized partly by the in-growth of recipient blood vessels and partly by the spontaneous anastomosis of graft and host capillaries (middle). Organ grafts are vascularized by the surgical anastomosis, the graft itself being supplied by donor vasculature (bottom).
Figure 2
Figure 2. The impact of antibodies on the outcome of transplantation
(a) Organ transplantation can lead to one or more of the conditions listed in this figure. The conditions are shown according to the time of occurrence after transplantation. Hyperacute rejection occurs within 24 hours of reperfusion and is caused usually by antibodies already present in the recipient at the time of transplantation. Antibody mediated rejection (also known as humoral or vascular rejection) occurs days, weeks or months after transplantation and is caused at least most of the time by antibodies produced after transplantation. Accommodation refers to acquired resistance of a transplant to humoral injury. Accommodation may be induced by anti-donor antibodies. Chronic rejection may be caused by antibodies in some cases. (b) Tissue or cell transplants are subject to failure caused by primary non-function or by cellular rejection but usually not to injury caused by antibodies.
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