Transplantation immunology 2003: simplified approach.
Transplantation has been performed clinically for four decades and has become the standard of care for end-stage organ failure. Understanding of the immunobiology of transplantation has made tremendous advances, but knowledge still lags behind the clinical use. As a result, nonspecific immunosuppression remains the standard therapy. This article presents an overview of current knowledge of the immunobiology of solid organ transplantation, with emphasis on T-cell activation (antigen presentation, CoS) and cellular allograft (transplantation) immunity. The molecular events of T-cell activation, with some emphasis on the sites of action of modern immunosuppression, are reviewed. A simplified approach to understanding the immunobiology and strategy of maintenance immunosuppression is discussed. Key early and late steps in T-cell activation and the sites of action of immunosuppressive agents are reviewed. The required cellular interactions for the alloresponse and the targets of biologic agents used in transplants are reviewed. Special considerations for the immunology in neonates, infants, and children as recipients are provided. Understanding the immunobiology of transplantation is key to making decisions about children with transplants, developing better protocols, and creating tolerance in the future.
Pietra
Biagio A
BA
Division of Cardiology, Department of Pediatrics, The Children's Hospital, 1056 East 19th Avenue, Box B-100, Denver, CO 80212, USA. bill.pietra@uchsc.edu
D017951:Antigen Presentation; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D002648:Child; D002985:Clinical Protocols; D003602:Cytotoxicity, Immunologic / Q000276:immunology; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008285:Major Histocompatibility Complex / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology; D014181:Transplantation Immunology / Q000276:immunology; D023001:Transplantation Tolerance
D007166:Immunosuppressive Agents