Review article
https://doi.org/10.21860/medflum2020_245217
Immunobiology of kidney transplantation and mechanisms of immunosuppressive drugs
Stela Živčić-Ćosić
; Klinički bolnički centar Rijeka, Medicinski fakultet Sveučilišta u Rijeci, Hrvatska
Zlatko Trobonjača
; Medicinski fakultet Sveučilišta u Rijeci, Hrvatska
Abstract
The immune system comprises the nonspecific (natural) immune response and the specific (aquired) immunity that has adaptively developed against foreign antigens. AB0-compatible kidney allotransplantation primarily stimulates a specific immune response against peptide antigens presented on donor cells by major histocompatibility complex (MHC) encoded molecules. The immune response begins with alloantigen recognition by T lymphocytes, i.e. the T-cell receptor interaction with peptide antigens presented by antigen-presenting cells, and the costimulatory receptor interaction with its ligand on the antigen-presenting cell. Both signals are necessary for T lymphocytes to enter the cell cycle, then intracellular signalling leads to the activation of genes and secretion of cytokines. Activated T lymphocytes migrate to the allograft where they induce an acute inflammatory response. They act directly cytotoxic and provide help to B lymphocytes for antibody production, and for delayed-type hypersensitivity responses induced by macrophages. Alloantigen-dependent and independent factors contribute to effector mechanisms which lead to allograft rejection. Remarkable advances in the field of immunobiology and immunogenetics have enhanced the safety and improved outcome after kidney transplantation. It is very important to early detect and prevent allograft rejection. With currently available immunosuppressive drugs, severe T-cell mediated rejection has become a rare event. The most common cause of graft failure is chronic rejection mediated by antibodies directed against donor HLA antigens. Herein, we review the mechanisms of cell- and antibody-mediated rejection, site of action of immunosuppressive drugs and recent development of treatment strategies aiming at further improvement of patient and graft survival.
Keywords
allograft rejection; HLA complex; kidney transplantation; transplantation immunobiology
Hrčak ID:
245217
URI
Publication date:
1.12.2020.
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