ABSTRACT
This chapter begins with a summary of the history of solid organ transplantation. It then details the prevention of rejection by careful matching of donor and recipient. The various types of rejection are described (hyperacute, acute, chronic, antibody mediated) with a focus on the pathophysiology behind them. Often touted as the “holy grail” in clinical transplantation, operational tolerance is the concept of allowing for organ immunosuppression while keeping the global immune system intact. The various therapies used to impact the three key signaling pathways in T-cell activation are grouped by mechanism of action, and their effects are described. Effective long-term immunosuppression is inevitably associated with a state of immune incompetence, which leads to infections and neoplasia. The most common of these are summarized along with a description of the pathophysiology and treatment of graft-versus-host disease. Finally, the chapter ends with a description of the attempts to induce tolerance, initially with blood transfusions and later with bone marrow transplants.
