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id="toc-Hyperacute_rejection" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hyperacute_rejection"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Hyperacute rejection</span> </div> </a> <ul id="toc-Hyperacute_rejection-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Acute_rejection" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Acute_rejection"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2</span> <span>Acute rejection</span> </div> </a> <ul id="toc-Acute_rejection-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Chronic_rejection" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Chronic_rejection"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.3</span> <span>Chronic rejection</span> </div> </a> <ul id="toc-Chronic_rejection-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Rejection_due_to_non-adherence" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Rejection_due_to_non-adherence"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Rejection due to non-adherence</span> </div> </a> <ul id="toc-Rejection_due_to_non-adherence-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Rejection_detection" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Rejection_detection"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Rejection detection</span> </div> </a> <ul id="toc-Rejection_detection-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Rejection_treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Rejection_treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Rejection treatment</span> </div> </a> <button aria-controls="toc-Rejection_treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Rejection treatment subsection</span> </button> <ul id="toc-Rejection_treatment-sublist" class="vector-toc-list"> <li id="toc-Immunosuppressive_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Immunosuppressive_therapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Immunosuppressive therapy</span> </div> </a> <ul id="toc-Immunosuppressive_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Antibody-based_treatments" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Antibody-based_treatments"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Antibody-based treatments</span> </div> </a> <ul id="toc-Antibody-based_treatments-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Blood_transfer" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Blood_transfer"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Blood transfer</span> </div> </a> <ul id="toc-Blood_transfer-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Marrow_transplant" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Marrow_transplant"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.4</span> <span>Marrow transplant</span> </div> </a> <ul id="toc-Marrow_transplant-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Gene_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Gene_therapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.5</span> <span>Gene therapy</span> </div> </a> <ul id="toc-Gene_therapy-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Transplant rejection</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. 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href="https://an.wikipedia.org/wiki/Ref%C3%BAs_de_transplante" title="Refús de transplante – Aragonese" lang="an" hreflang="an" data-title="Refús de transplante" data-language-autonym="Aragonés" data-language-local-name="Aragonese" class="interlanguage-link-target"><span>Aragonés</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%9E%D1%82%D1%85%D0%B2%D1%8A%D1%80%D0%BB%D1%8F%D0%BD%D0%B5_%D0%BD%D0%B0_%D1%82%D1%80%D0%B0%D0%BD%D1%81%D0%BF%D0%BB%D0%B0%D0%BD%D1%82%D0%B0%D0%BD%D1%82" title="Отхвърляне на трансплантант – Bulgarian" lang="bg" hreflang="bg" data-title="Отхвърляне на трансплантант" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Rebuig_de_trasplantament" title="Rebuig de trasplantament – Catalan" lang="ca" hreflang="ca" data-title="Rebuig de trasplantament" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Transplantation#Immunreaktionen" title="Transplantation – German" lang="de" hreflang="de" data-title="Transplantation" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%91%CF%80%CF%8C%CF%81%CF%81%CE%B9%CF%88%CE%B7_%CE%BC%CE%BF%CF%83%CF%87%CE%B5%CF%8D%CE%BC%CE%B1%CF%84%CE%BF%CF%82" title="Απόρριψη μοσχεύματος – Greek" lang="el" hreflang="el" data-title="Απόρριψη μοσχεύματος" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%B1%D8%AF_%D9%BE%DB%8C%D9%88%D9%86%D8%AF" title="رد پیوند – Persian" lang="fa" hreflang="fa" data-title="رد پیوند" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Rejet_de_greffe" title="Rejet de greffe – French" lang="fr" hreflang="fr" data-title="Rejet de greffe" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%9D%B4%EC%8B%9D%EA%B1%B0%EB%B6%80%EB%B0%98%EC%9D%91" title="이식거부반응 – Korean" lang="ko" hreflang="ko" data-title="이식거부반응" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%8F%D6%80%D5%A1%D5%B6%D5%BD%D5%BA%D5%AC%D5%A1%D5%B6%D5%BF%D5%A1%D5%BF%D5%AB_%D5%B4%D5%A5%D6%80%D5%AA%D5%B8%D6%82%D5%B4" title="Տրանսպլանտատի մերժում – Armenian" lang="hy" hreflang="hy" data-title="Տրանսպլանտատի մերժում" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Penolakan_transplantasi" title="Penolakan transplantasi – Indonesian" lang="id" hreflang="id" data-title="Penolakan transplantasi" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Rigetto_di_trapianto" title="Rigetto di trapianto – Italian" lang="it" hreflang="it" data-title="Rigetto di trapianto" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%93%D7%97%D7%99%D7%99%D7%AA_%D7%90%D7%99%D7%91%D7%A8" title="דחיית איבר – Hebrew" lang="he" hreflang="he" data-title="דחיית איבר" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Afstoting_(geneeskunde)" title="Afstoting (geneeskunde) – Dutch" lang="nl" hreflang="nl" data-title="Afstoting (geneeskunde)" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E6%8B%92%E7%B5%B6%E5%8F%8D%E5%BF%9C" title="拒絶反応 – Japanese" lang="ja" hreflang="ja" data-title="拒絶反応" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Odrzucanie_przeszczepu" title="Odrzucanie przeszczepu – Polish" lang="pl" hreflang="pl" data-title="Odrzucanie przeszczepu" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Rejei%C3%A7%C3%A3o_de_transplante" title="Rejeição de transplante – Portuguese" lang="pt" hreflang="pt" data-title="Rejeição de transplante" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A0%D0%B5%D0%B0%D0%BA%D1%86%D0%B8%D1%8F_%D0%BE%D1%82%D1%82%D0%BE%D1%80%D0%B6%D0%B5%D0%BD%D0%B8%D1%8F_%D1%82%D1%80%D0%B0%D0%BD%D1%81%D0%BF%D0%BB%D0%B0%D0%BD%D1%82%D0%B0%D1%82%D0%B0" title="Реакция отторжения трансплантата – Russian" lang="ru" hreflang="ru" data-title="Реакция отторжения трансплантата" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Hylkiminen" title="Hylkiminen – Finnish" lang="fi" hreflang="fi" data-title="Hylkiminen" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Avst%C3%B6tning" title="Avstötning – Swedish" lang="sv" hreflang="sv" data-title="Avstötning" 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For the condition in which transplanted cells attack the recipient's cells, see <a href="/wiki/Graft-versus-host_disease" title="Graft-versus-host disease">Graft-versus-host disease</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Transplant rejection</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Lung_transplant_rejection_-_high_mag.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Lung_transplant_rejection_-_high_mag.jpg/220px-Lung_transplant_rejection_-_high_mag.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Lung_transplant_rejection_-_high_mag.jpg/330px-Lung_transplant_rejection_-_high_mag.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Lung_transplant_rejection_-_high_mag.jpg/440px-Lung_transplant_rejection_-_high_mag.jpg 2x" data-file-width="4272" data-file-height="2848" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data"><a href="/wiki/Micrograph" title="Micrograph">Micrograph</a> showing <a href="/wiki/Lung_transplant" class="mw-redirect" title="Lung transplant">lung transplant</a> rejection. Lung <a href="/wiki/Biopsy" title="Biopsy">biopsy</a>. <a href="/wiki/H%26E_stain" title="H&E stain">H&E stain</a>.</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Immunology" title="Immunology">Immunology</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="/wiki/Immunosuppressive_drugs" class="mw-redirect" title="Immunosuppressive drugs">Immunosuppressive drugs</a></td></tr></tbody></table> <p><b>Transplant rejection</b> occurs when <a href="/wiki/Organ_transplant" class="mw-redirect" title="Organ transplant">transplanted</a> tissue is rejected by the recipient's <a href="/wiki/Immune_system" title="Immune system">immune system</a>, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of <a href="/wiki/Immunosuppressant_drugs" class="mw-redirect" title="Immunosuppressant drugs">immunosuppressant drugs</a> after transplant.<sup id="cite_ref-pmid11158412_1-0" class="reference"><a href="#cite_note-pmid11158412-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Types">Types</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=1" title="Edit section: Types"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Transplant rejection can be classified into three types: hyperacute, acute, and chronic.<sup id="cite_ref-:6_2-0" class="reference"><a href="#cite_note-:6-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> These types are differentiated by how quickly the recipient's immune system is activated and the specific aspect or aspects of immunity involved.<sup id="cite_ref-:0_3-0" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Hyperacute_rejection">Hyperacute rejection</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=2" title="Edit section: Hyperacute rejection"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><b>Hyperacute rejection</b> is a form of rejection that manifests itself in the minutes to hours following transplantation.<sup id="cite_ref-:1_4-0" class="reference"><a href="#cite_note-:1-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> It is caused by the presence of pre-existing <a href="/wiki/Antibody" title="Antibody">antibodies</a> in the recipient that recognize <a href="/wiki/Antigen" title="Antigen">antigens</a> in the donor organ.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> These antigens are located on the endothelial lining of blood vessels within the transplanted organ and, once antibodies bind, will lead to the rapid activation of the <a href="/wiki/Complement_system" title="Complement system">complement system</a>.<sup id="cite_ref-:2_6-0" class="reference"><a href="#cite_note-:2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Irreversible damage via thrombosis and subsequent graft necrosis is to be expected.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Tissue left implanted will fail to work and could lead to high fever and malaise as the immune system acts against foreign tissue.<sup id="cite_ref-:4_8-0" class="reference"><a href="#cite_note-:4-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/ABO-incompatible_transplantation" title="ABO-incompatible transplantation">ABO-incompatible transplantation</a></div> <p>Graft failure secondary to hyperacute rejection has significantly decreased in incidence as a result of improved pre-transplant screening for antibodies to donor tissues.<sup id="cite_ref-:1_4-1" class="reference"><a href="#cite_note-:1-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> While these preformed antibodies may result from prior transplants, prior blood transfusions, or pregnancy, hyperacute rejection is most commonly from antibodies to <a href="/wiki/ABO_blood_group_system" title="ABO blood group system">ABO blood group</a> antigens.<sup id="cite_ref-:2_6-1" class="reference"><a href="#cite_note-:2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Consequently, transplants between individuals with differing ABO blood types is generally avoided though may be pursued in very young children (generally under 12 months, but often as old as 24 months)<sup id="cite_ref-West_2001_9-0" class="reference"><a href="#cite_note-West_2001-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> who do not have fully developed immune systems.<sup id="cite_ref-pmid21836514_10-0" class="reference"><a href="#cite_note-pmid21836514-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Shortages of organs and the morbidity and mortality associated with being on transplant waitlists has also increased interest in ABO-incompatible transplantation in older children and adults.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Acute_rejection">Acute rejection</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=3" title="Edit section: Acute rejection"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Histocompatibility" title="Histocompatibility">Histocompatibility</a></div> <p><b>Acute rejection</b> is a category of rejection that occurs on the timescale of weeks to months, with most episodes occurring within the first 3 months to 1 year after transplantation.<sup id="cite_ref-:2_6-2" class="reference"><a href="#cite_note-:2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:4_8-1" class="reference"><a href="#cite_note-:4-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Unlike hyperacute rejection, acute rejection is thought to arise from two distinct immunological mechanisms as <a href="/wiki/Lymphocyte" title="Lymphocyte">lymphocytes</a>, a subset of white blood cells, begin to recognize antigens on transplanted organ/graft.<sup id="cite_ref-:10_12-0" class="reference"><a href="#cite_note-:10-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> This recognition occurs due to the <a href="/wiki/Major_histocompatibility_complex" title="Major histocompatibility complex">major histocompatibility complex</a> (MHC), which are proteins on cell surface that are presented to the T-cell receptor found on <a href="/wiki/T_cell" title="T cell">T-cells</a>.<sup id="cite_ref-:3_13-0" class="reference"><a href="#cite_note-:3-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> In humans, this is known as the human leukocyte antigen (HLA) system<sup id="cite_ref-:3_13-1" class="reference"><a href="#cite_note-:3-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> and over 17,000 HLA alleles or genetic variants have been described such that it is extremely uncommon for any two people to have identical alleles.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Other non-HLA proteins, known as minor histocompatibility antigens, do exist but generally are unable to cause acute rejection in and of themselves unless a multitude of non-HLA proteins are mismatched.<sup id="cite_ref-:5_15-0" class="reference"><a href="#cite_note-:5-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> As such, HLA matching (in addition to matching ABO groups) is critical in preventing acute rejection.<sup id="cite_ref-:9_16-0" class="reference"><a href="#cite_note-:9-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p>This process of recognition by T-cells can happen directly or indirectly and lead to acute cellular and acute humoral rejection respectively.<sup id="cite_ref-:2_6-3" class="reference"><a href="#cite_note-:2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Direct allorecognition is a phenomenon within transplant immunology where the <a href="/wiki/Dendritic_cell" title="Dendritic cell">dendritic cells</a>, which are the body's <a href="/wiki/Antigen-presenting_cells" class="mw-redirect" title="Antigen-presenting cells">antigen-presenting cells</a> (APCs), migrate from <i>donor</i> tissue to <a href="/wiki/Lymphoid_tissue" class="mw-redirect" title="Lymphoid tissue">lymphoid tissue</a> (<a href="/wiki/Lymphoid_follicles" class="mw-redirect" title="Lymphoid follicles">lymphoid follicles</a> and <a href="/wiki/Lymph_nodes" class="mw-redirect" title="Lymph nodes">lymph nodes</a>) in the <i>recipient</i> and present their MHC peptides to recipient lymphocytes.<sup id="cite_ref-:8_17-0" class="reference"><a href="#cite_note-:8-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> In comparison, indirect allorecognition is more analogous to how foreign antigens are recognized by the immune system.<sup id="cite_ref-:7_18-0" class="reference"><a href="#cite_note-:7-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Dendritic cells of the <i>recipient</i> come across peptides from donor tissue whether in circulation, lymphoid tissue, or in donor tissue itself.<sup id="cite_ref-:7_18-1" class="reference"><a href="#cite_note-:7-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Since not the result of direct antigen presentation, these may not necessarily be intact MHC molecules but instead other proteins that are deemed different enough from recipient may engender a response.<sup id="cite_ref-:7_18-2" class="reference"><a href="#cite_note-:7-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> This process leads to the priming of T-cells to respond to the peptides secondarily going forward.<sup id="cite_ref-:6_2-1" class="reference"><a href="#cite_note-:6-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> A third semi-direct pathway has been described in which recipient APCs present fully intact donor MHCs,<sup id="cite_ref-:8_17-1" class="reference"><a href="#cite_note-:8-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> yet its relative contribution to acute rejection is not as well understood.<sup id="cite_ref-:5_15-1" class="reference"><a href="#cite_note-:5-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>Acute cellular rejection occurs following direct allorecognition of mismatched donor MHC by <a href="/wiki/Cytotoxic_T_cell" title="Cytotoxic T cell">cytotoxic T-cells</a> that begin to secrete <a href="/wiki/Cytokine" title="Cytokine">cytokines</a> to recruit more lymphocytes as well as cause apoptosis or cell death directly.<sup id="cite_ref-:1_4-2" class="reference"><a href="#cite_note-:1-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:2_6-4" class="reference"><a href="#cite_note-:2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> The greater the difference in MHC between donor and recipient, the more cytotoxic T-cells are recruited to damage the graft,<sup id="cite_ref-:2_6-5" class="reference"><a href="#cite_note-:2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> which may be seen via biopsy in solid organ transplants, with increased lymphocyte infiltration indicative of more severe acute cellular rejection.<sup id="cite_ref-:5_15-2" class="reference"><a href="#cite_note-:5-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Acute humoral rejection is a process usually initiated by indirect allorecognition arising from recipient <a href="/wiki/T_helper_cell" title="T helper cell">helper T-cells</a>.<sup id="cite_ref-:2_6-6" class="reference"><a href="#cite_note-:2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> These helper T-cells have a crucial role in the development of B-cells that can create donor-specific antibodies.<sup id="cite_ref-:1_4-3" class="reference"><a href="#cite_note-:1-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> The antibodies deposit themselves within the donor graft and lead to activation of the complement cascade alongside antibody-mediated cytotoxicity with <a href="/wiki/Neutrophil" title="Neutrophil">neutrophils</a>, a type of white blood cell separate from lymphocytes, predominantly infiltrating into tissues.<sup id="cite_ref-:2_6-7" class="reference"><a href="#cite_note-:2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Barring genetically identical twins, acute rejection is to be expected to some degree.<sup id="cite_ref-:9_16-1" class="reference"><a href="#cite_note-:9-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Rates of clinically significant acute rejection that could endanger transplant have decreased significantly with the development of immunosuppressive regimens. Using kidney transplants as an example, rates of acute rejection have declined from >50% in the 1970s to 10-20%.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Singular episodes of acute rejection, when promptly treated, should not compromise transplant; however, repeated episodes may lead to chronic rejection.<sup id="cite_ref-:9_16-2" class="reference"><a href="#cite_note-:9-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Chronic_rejection">Chronic rejection</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=4" title="Edit section: Chronic rejection"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Transplant_glomerulopathy_-_very_high_mag.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5e/Transplant_glomerulopathy_-_very_high_mag.jpg/220px-Transplant_glomerulopathy_-_very_high_mag.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5e/Transplant_glomerulopathy_-_very_high_mag.jpg/330px-Transplant_glomerulopathy_-_very_high_mag.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/5e/Transplant_glomerulopathy_-_very_high_mag.jpg/440px-Transplant_glomerulopathy_-_very_high_mag.jpg 2x" data-file-width="4272" data-file-height="2848" /></a><figcaption> <a href="/wiki/Micrograph" title="Micrograph">Micrograph</a> showing a <a href="/wiki/Glomerulus" title="Glomerulus">glomerulus</a> with changes characteristic of a transplant glomerulopathy. <a href="/wiki/Transplant_glomerulopathy" title="Transplant glomerulopathy">Transplant glomerulopathy</a> is considered a form of chronic antibody-mediated rejection. <a href="/wiki/PAS_stain" class="mw-redirect" title="PAS stain">PAS stain</a>.</figcaption></figure> <p><b>Chronic rejection</b> is an insidious form of rejection that leads to graft destruction over the course of months, but most often years after tissue transplantation.<sup id="cite_ref-:10_12-1" class="reference"><a href="#cite_note-:10-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> The mechanism for chronic rejection is yet to be fully understood, but it is known that prior acute rejection episodes are the main clinical predictor for the development of chronic rejection.<sup id="cite_ref-:2_6-8" class="reference"><a href="#cite_note-:2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> In particular, the incidence increases following severe or persistent acute rejection, whereas acute rejection episodes with return to function back to baseline do not have major effects on graft survival.<sup id="cite_ref-:11_20-0" class="reference"><a href="#cite_note-:11-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Chronic rejection is generally thought of as being related to either vascular damage or parenchymal damage with subsequent fibrosis.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> While it is unknown the exact contribution of the immune system in these processes, the indirect pathway of allorecognition and the associated antibody formation seems to be especially involved.<sup id="cite_ref-:2_6-9" class="reference"><a href="#cite_note-:2-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Chronic rejection has widely varied effects on different organs. At 5 years post-transplant, 80% of lung transplants, 60% of heart transplants and 50% of kidney transplants are affected, while liver transplants are only affected 10% of the time.<sup id="cite_ref-:11_20-1" class="reference"><a href="#cite_note-:11-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Therefore, chronic rejection explains long-term morbidity in most lung-transplant recipients,<sup id="cite_ref-pmid15667618_23-0" class="reference"><a href="#cite_note-pmid15667618-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid14621118_24-0" class="reference"><a href="#cite_note-pmid14621118-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> the median survival roughly 4.7 years, about half the span versus other major organ transplants.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> Airflow obstruction not ascribable to other cause is labeled <a href="/wiki/Bronchiolitis_obliterans" title="Bronchiolitis obliterans">bronchiolitis obliterans</a> <a href="/wiki/Syndrome" title="Syndrome">syndrome</a> (BOS), confirmed by a persistent drop—three or more weeks—in <i>forced expiratory volume</i> (FEV<sub>1</sub>) by at least 20%.<sup id="cite_ref-pmid17347496_26-0" class="reference"><a href="#cite_note-pmid17347496-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> First noted is infiltration by <a href="/wiki/Lymphocytes" class="mw-redirect" title="Lymphocytes">lymphocytes</a>, followed by <a href="/wiki/Epithelium" title="Epithelium">epithelial cell</a> injury, then inflammatory lesions and recruitment of <a href="/wiki/Fibroblasts" class="mw-redirect" title="Fibroblasts">fibroblasts</a> and <a href="/wiki/Myofibroblasts" class="mw-redirect" title="Myofibroblasts">myofibroblasts</a>, which proliferate and secrete proteins forming scar tissue.<sup id="cite_ref-pmid16799090_27-0" class="reference"><a href="#cite_note-pmid16799090-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> A similar phenomenon can be seen with liver transplant wherein fibrosis leads to jaundice secondary to the destruction of bile ducts within the liver, also known as vanishing bile duct syndrome.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Rejection_due_to_non-adherence">Rejection due to non-adherence</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=5" title="Edit section: Rejection due to non-adherence"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>One principal reason for transplant rejection is non-adherence to prescribed immunosuppressant regimens. This is particularly the case with adolescent recipients,<sup id="cite_ref-pmid22248250_29-0" class="reference"><a href="#cite_note-pmid22248250-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> with non-adherence rates near 50% in some instances.<sup id="cite_ref-pmid22248250_29-1" class="reference"><a href="#cite_note-pmid22248250-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p><p>A pilot study conducted by Michael O. Killian PhD from Florida State University and Dr. Dipankar Gupta from University of Florida published in April 2022 in <i>Pediatric Transplantation</i> <sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> studied the acceptability and feasibility of an asynchronous directly observed therapy mobile health application among adolescent heart transplant recipients. Patients in the study utilized emocha Health's digital medication adherence program which included asynchronous video messages and chat messages exchanged with a care team. Patients completing the study achieved a 90.1% adherence rate. The researchers noted that further randomized trials are required to confirm the initial findings. However, the results were very promising considering few options exist to support pediatric patients in taking their medications.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (May 2024)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Rejection_detection">Rejection detection</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=6" title="Edit section: Rejection detection"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Diagnosis of acute rejection relies on clinical data—patient signs and symptoms but also calls on laboratory data such as <a href="/wiki/Peripheral_blood_cell" class="mw-redirect" title="Peripheral blood cell">blood</a> or even tissue <a href="/wiki/Biopsy" title="Biopsy">biopsy</a>. The laboratory pathologist generally seeks three main <a href="/wiki/Histology" title="Histology">histological</a> signs: (1) infiltrating <a href="/wiki/T_cells" class="mw-redirect" title="T cells">T cells</a>, perhaps accompanied by infiltrating <a href="/wiki/Eosinophils" class="mw-redirect" title="Eosinophils">eosinophils</a>, <a href="/wiki/Plasma_cells" class="mw-redirect" title="Plasma cells">plasma cells</a>, and <a href="/wiki/Neutrophils" class="mw-redirect" title="Neutrophils">neutrophils</a>, particularly in telltale ratios, (2) structural compromise of tissue anatomy, varying by tissue type transplanted, and (3) injury to blood vessels. Tissue biopsy is restricted, however, by sampling limitations and risks/complications of the invasive procedure.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Cellular <a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">magnetic resonance imaging</a> (MRI) of immune cells <a href="/wiki/Radiolabeling" class="mw-redirect" title="Radiolabeling">radiolabeled</a> <i>in vivo</i> might—similarly to <a href="/wiki/Gene_expression_profiling" title="Gene expression profiling">Gene Expression Profiling (GEP)</a>—offer noninvasive testing.<sup id="cite_ref-pmid21305593_34-0" class="reference"><a href="#cite_note-pmid21305593-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Rejection_treatment">Rejection treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=7" title="Edit section: Rejection treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-More_citations_needed_section plainlinks metadata ambox ambox-content ambox-Refimprove" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><a href="/wiki/File:Question_book-new.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/50px-Question_book-new.svg.png" decoding="async" width="50" height="39" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/75px-Question_book-new.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/100px-Question_book-new.svg.png 2x" data-file-width="512" data-file-height="399" /></a></span></div></td><td class="mbox-text"><div class="mbox-text-span">This section <b>needs additional citations for <a href="/wiki/Wikipedia:Verifiability" title="Wikipedia:Verifiability">verification</a></b>.<span class="hide-when-compact"> Please help <a href="/wiki/Special:EditPage/Transplant_rejection" title="Special:EditPage/Transplant rejection">improve this article</a> by <a href="/wiki/Help:Referencing_for_beginners" title="Help:Referencing for beginners">adding citations to reliable sources</a> in this section. Unsourced material may be challenged and removed.</span> <span class="date-container"><i>(<span class="date">June 2020</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <p>Hyperacute rejection manifests severely and within minutes, and so treatment is immediate: removal of the tissue. Acute rejection is treated with one or several of a few strategies. Despite treatment, rejection remains a major cause of transplant failure.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> Chronic rejection is generally considered irreversible and poorly amenable to treatment—only retransplant generally indicated if feasible—though inhaled <a href="/wiki/Ciclosporin" title="Ciclosporin">ciclosporin</a> is being investigated to delay or prevent chronic rejection of lung transplants. </p> <div class="mw-heading mw-heading3"><h3 id="Immunosuppressive_therapy">Immunosuppressive therapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=8" title="Edit section: Immunosuppressive therapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A short course of high-dose <a href="/wiki/Corticosteroids" class="mw-redirect" title="Corticosteroids">corticosteroids</a> can be applied, and repeated. <i>Triple therapy</i> adds a <a href="/wiki/Calcineurin_inhibitor" class="mw-redirect" title="Calcineurin inhibitor">calcineurin inhibitor</a> and an <a href="/wiki/Anti-proliferative_agent" class="mw-redirect" title="Anti-proliferative agent">anti-proliferative agent</a>. Where calcineurin inhibitors or steroids are contraindicated, <a href="/wiki/MTOR" title="MTOR">mTOR inhibitors</a> are used. </p><p><b>Immunosuppressive drugs</b>: </p> <ul><li><a href="/wiki/Corticosteroids" class="mw-redirect" title="Corticosteroids">Corticosteroids</a> <ul><li><a href="/wiki/Prednisolone" title="Prednisolone">Prednisolone</a></li> <li><a href="/wiki/Hydrocortisone" title="Hydrocortisone">Hydrocortisone</a></li></ul></li> <li><a href="/wiki/Calcineurin" title="Calcineurin">Calcineurin</a> inhibitors <ul><li><a href="/wiki/Ciclosporin" title="Ciclosporin">Ciclosporin</a></li> <li><a href="/wiki/Tacrolimus" title="Tacrolimus">Tacrolimus</a></li></ul></li> <li>Anti-proliferatives <ul><li><a href="/wiki/Azathioprine" title="Azathioprine">Azathioprine</a></li> <li><a href="/wiki/Mycophenolic_acid" title="Mycophenolic acid">Mycophenolic acid</a></li></ul></li> <li><a href="/wiki/MTOR" title="MTOR">mTOR</a> inhibitors <ul><li><a href="/wiki/Sirolimus" title="Sirolimus">Sirolimus</a></li> <li><a href="/wiki/Everolimus" title="Everolimus">Everolimus</a></li></ul></li></ul> <div class="mw-heading mw-heading3"><h3 id="Antibody-based_treatments">Antibody-based treatments</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=9" title="Edit section: Antibody-based treatments"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Antibody specific to select immune components can be added to immunosuppressive therapy. The <a href="/wiki/Monoclonal_antibody" title="Monoclonal antibody">monoclonal</a> anti-T cell antibody <a href="/wiki/OKT3" class="mw-redirect" title="OKT3">OKT3</a>, once used to prevent rejection, and still occasionally used to treat severe acute rejection, has fallen into disfavor, as it commonly brings severe <a href="/wiki/Cytokine_release_syndrome" title="Cytokine release syndrome">cytokine release syndrome</a> and late <a href="/wiki/Post-transplant_lymphoproliferative_disorder" title="Post-transplant lymphoproliferative disorder">post-transplant lymphoproliferative disorder</a>. (OKT3 is available in the <a href="/wiki/United_Kingdom" title="United Kingdom">United Kingdom</a> for named-patient use only.) </p><p><b>Antibody drugs</b>: </p> <ul><li>Monoclonal anti-IL-2Rα receptor antibodies <ul><li><a href="/wiki/Basiliximab" title="Basiliximab">Basiliximab</a></li> <li><a href="/wiki/Daclizumab" title="Daclizumab">Daclizumab</a></li></ul></li> <li>Monoclonal anti-IL-6R receptor antibodies <ul><li><a href="/wiki/Tocilizumab" title="Tocilizumab">Tocilizumab</a></li></ul></li> <li>Polyclonal anti-T-cell antibodies <ul><li><a href="/wiki/Anti-thymocyte_globulin" title="Anti-thymocyte globulin">Anti-thymocyte globulin</a> (ATG)</li> <li><a href="/wiki/Anti-lymphocyte_globulin" title="Anti-lymphocyte globulin">Anti-lymphocyte globulin</a> (ALG)</li></ul></li> <li>Monoclonal anti-CD20 antibodies <ul><li><a href="/wiki/Rituximab" title="Rituximab">Rituximab</a></li></ul></li></ul> <div class="mw-heading mw-heading3"><h3 id="Blood_transfer">Blood transfer</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=10" title="Edit section: Blood transfer"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Cases refractory to immunosuppressive or antibody therapy are sometimes treated with photopheresis, or extracorporeal photoimmune therapy (ECP), to remove antibody molecules specific to the transplanted tissue. </p> <div class="mw-heading mw-heading3"><h3 id="Marrow_transplant">Marrow transplant</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=11" title="Edit section: Marrow transplant"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Bone_marrow_transplant" class="mw-redirect" title="Bone marrow transplant">Bone marrow transplant</a> can replace the transplant recipient's immune system with the donor's, and the recipient accepts the new organ without rejection. The marrow's <a href="/wiki/Hematopoietic_stem_cells" class="mw-redirect" title="Hematopoietic stem cells">hematopoietic stem cells</a>—the reservoir of <a href="/wiki/Stem_cells" class="mw-redirect" title="Stem cells">stem cells</a> replenishing exhausted blood cells including <a href="/wiki/White_blood_cells" class="mw-redirect" title="White blood cells">white blood cells</a> forming the immune system—must be of the individual who donated the organ or of an <a href="/wiki/Identical_twin" class="mw-redirect" title="Identical twin">identical twin</a> or a <a href="/wiki/Cloning" title="Cloning">clone</a>. There is a risk of <a href="/wiki/Graft-versus-host_disease" title="Graft-versus-host disease">graft-versus-host disease</a> (GVHD), however, whereby mature <a href="/wiki/Lymphocytes" class="mw-redirect" title="Lymphocytes">lymphocytes</a> entering with marrow recognize the new host tissues as foreign and destroy them. </p> <div class="mw-heading mw-heading3"><h3 id="Gene_therapy">Gene therapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=12" title="Edit section: Gene therapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Gene_therapy" title="Gene therapy">Gene therapy</a> is another method that can be used. In this method, the genes that cause the body to reject transplants would be deactivated. Research is still being conducted, and no gene therapies are being used to date to treat patients.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> Current research tends to focus<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (January 2022)">citation needed</span></a></i>]</sup> on Th1 and Th17 which mediate allograft rejection via the <a href="/wiki/Cyclophosphamide#Mechanism_of_action" title="Cyclophosphamide">CD4</a> and CD8 <a href="/wiki/T-cell_receptor" title="T-cell receptor">T cells</a>.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=13" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Graft-versus-host_disease" title="Graft-versus-host disease">Graft-versus-host disease</a></li> <li><a href="/wiki/Graft-versus-tumor_effect" title="Graft-versus-tumor effect">Graft-versus-tumor effect</a></li> <li><a href="/wiki/Immunosuppression" title="Immunosuppression">Immunosuppression</a></li> <li><a href="/wiki/Transplant_engineering" title="Transplant engineering">Transplant engineering</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Transplant_rejection&action=edit&section=14" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-pmid11158412-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid11158412_1-0">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFFrohnFrickePuchtaKirchner2001" class="citation journal cs1">Frohn C, Fricke L, Puchta JC, Kirchner H (February 2001). <a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fndt%2F16.2.355">"The effect of HLA-C matching on acute renal transplant rejection"</a>. <i>Nephrology, Dialysis, Transplantation</i>. <b>16</b> (2): 355–360. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fndt%2F16.2.355">10.1093/ndt/16.2.355</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11158412">11158412</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nephrology%2C+Dialysis%2C+Transplantation&rft.atitle=The+effect+of+HLA-C+matching+on+acute+renal+transplant+rejection&rft.volume=16&rft.issue=2&rft.pages=355-360&rft.date=2001-02&rft_id=info%3Adoi%2F10.1093%2Fndt%2F16.2.355&rft_id=info%3Apmid%2F11158412&rft.aulast=Frohn&rft.aufirst=C&rft.au=Fricke%2C+L&rft.au=Puchta%2C+JC&rft.au=Kirchner%2C+H&rft_id=https%3A%2F%2Fdoi.org%2F10.1093%252Fndt%252F16.2.355&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransplant+rejection" class="Z3988"></span></span> </li> <li id="cite_note-:6-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-:6_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:6_2-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMoreauVareyAnegonCuturi2013" class="citation journal cs1">Moreau A, Varey E, Anegon I, Cuturi MC (November 2013). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808773">"Effector mechanisms of rejection"</a>. <i>Cold Spring Harbor Perspectives in Medicine</i>. <b>3</b> (11): a015461. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1101%2Fcshperspect.a015461">10.1101/cshperspect.a015461</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808773">3808773</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24186491">24186491</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cold+Spring+Harbor+Perspectives+in+Medicine&rft.atitle=Effector+mechanisms+of+rejection&rft.volume=3&rft.issue=11&rft.pages=a015461&rft.date=2013-11&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3808773%23id-name%3DPMC&rft_id=info%3Apmid%2F24186491&rft_id=info%3Adoi%2F10.1101%2Fcshperspect.a015461&rft.aulast=Moreau&rft.aufirst=A&rft.au=Varey%2C+E&rft.au=Anegon%2C+I&rft.au=Cuturi%2C+MC&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3808773&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransplant+rejection" class="Z3988"></span></span> </li> <li id="cite_note-:0-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-:0_3-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMoreauVareyAnegonCuturi2013" class="citation journal cs1">Moreau A, Varey E, Anegon I, Cuturi MC (November 2013). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808773">"Effector mechanisms of rejection"</a>. <i>Cold Spring Harbor Perspectives in Medicine</i>. <b>3</b> (11): a015461. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1101%2Fcshperspect.a015461">10.1101/cshperspect.a015461</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808773">3808773</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24186491">24186491</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cold+Spring+Harbor+Perspectives+in+Medicine&rft.atitle=Effector+mechanisms+of+rejection&rft.volume=3&rft.issue=11&rft.pages=a015461&rft.date=2013-11&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3808773%23id-name%3DPMC&rft_id=info%3Apmid%2F24186491&rft_id=info%3Adoi%2F10.1101%2Fcshperspect.a015461&rft.aulast=Moreau&rft.aufirst=A&rft.au=Varey%2C+E&rft.au=Anegon%2C+I&rft.au=Cuturi%2C+MC&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3808773&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransplant+rejection" class="Z3988"></span></span> </li> <li id="cite_note-:1-4"><span class="mw-cite-backlink">^ <a href="#cite_ref-:1_4-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:1_4-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-:1_4-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-:1_4-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFChang2021" class="citation book cs1">Chang YC (2021-01-01). "The surgical and immunosuppressive basis for infections in the pediatric solid organ transplant recipient". In Steinbach WJ, Green MD, Michaels MG, Danziger-Isakov LA (eds.). <i>Pediatric Transplant and Oncology Infectious Diseases</i>. Philadelphia: Elsevier. pp. 1–9.e3. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FB978-0-323-64198-2.00010-5">10.1016/B978-0-323-64198-2.00010-5</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-323-64198-2" title="Special:BookSources/978-0-323-64198-2"><bdi>978-0-323-64198-2</bdi></a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:228907807">228907807</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=The+surgical+and+immunosuppressive+basis+for+infections+in+the+pediatric+solid+organ+transplant+recipient&rft.btitle=Pediatric+Transplant+and+Oncology+Infectious+Diseases&rft.place=Philadelphia&rft.pages=1-9.e3&rft.pub=Elsevier&rft.date=2021-01-01&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A228907807%23id-name%3DS2CID&rft_id=info%3Adoi%2F10.1016%2FB978-0-323-64198-2.00010-5&rft.isbn=978-0-323-64198-2&rft.aulast=Chang&rft.aufirst=YC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransplant+rejection" class="Z3988"></span></span> </li> <li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHarmon2010" class="citation book cs1">Harmon WE (2010-01-01). 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"43 - Pediatric Renal Transplantation". In Himmelfarb J, Ikizler TA (eds.). <i>Chronic Kidney Disease, Dialysis, and Transplantation</i> (Fourth ed.). 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Genetics</i>. <b>18</b> (5): 309–326. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fnrg.2017.12">10.1038/nrg.2017.12</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/28286337">28286337</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:2222755">2222755</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nature+Reviews.+Genetics&rft.atitle=Transplant+genetics+and+genomics&rft.volume=18&rft.issue=5&rft.pages=309-326&rft.date=2017-05&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A2222755%23id-name%3DS2CID&rft_id=info%3Apmid%2F28286337&rft_id=info%3Adoi%2F10.1038%2Fnrg.2017.12&rft.aulast=Yang&rft.aufirst=JY&rft.au=Sarwal%2C+MM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransplant+rejection" class="Z3988"></span></span> </li> <li id="cite_note-38"><span class="mw-cite-backlink"><b><a href="#cite_ref-38">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBagleyIacomini2003" class="citation journal cs1">Bagley J, Iacomini J (April 2003). <a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fsj.gt.3302020">"Gene therapy progress and prospects: gene therapy in organ transplantation"</a>. <i>Gene Therapy</i>. <b>10</b> (8): 605–611. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fsj.gt.3302020">10.1038/sj.gt.3302020</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12692588">12692588</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gene+Therapy&rft.atitle=Gene+therapy+progress+and+prospects%3A+gene+therapy+in+organ+transplantation&rft.volume=10&rft.issue=8&rft.pages=605-611&rft.date=2003-04&rft_id=info%3Adoi%2F10.1038%2Fsj.gt.3302020&rft_id=info%3Apmid%2F12692588&rft.aulast=Bagley&rft.aufirst=J&rft.au=Iacomini%2C+J&rft_id=https%3A%2F%2Fdoi.org%2F10.1038%252Fsj.gt.3302020&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransplant+rejection" class="Z3988"></span></span> </li> <li id="cite_note-39"><span class="mw-cite-backlink"><b><a href="#cite_ref-39">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGiannoukakisThomsonRobbins1999" class="citation journal cs1">Giannoukakis N, Thomson A, Robbins P (September 1999). <a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fsj.gt.3300981">"Gene therapy in transplantation"</a>. <i>Gene Therapy</i>. <b>6</b> (9): 1499–1511. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fsj.gt.3300981">10.1038/sj.gt.3300981</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10490759">10490759</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gene+Therapy&rft.atitle=Gene+therapy+in+transplantation&rft.volume=6&rft.issue=9&rft.pages=1499-1511&rft.date=1999-09&rft_id=info%3Adoi%2F10.1038%2Fsj.gt.3300981&rft_id=info%3Apmid%2F10490759&rft.aulast=Giannoukakis&rft.aufirst=N&rft.au=Thomson%2C+A&rft.au=Robbins%2C+P&rft_id=https%3A%2F%2Fdoi.org%2F10.1038%252Fsj.gt.3300981&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransplant+rejection" class="Z3988"></span></span> </li> <li id="cite_note-40"><span class="mw-cite-backlink"><b><a href="#cite_ref-40">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFYuanPaez-CortezSchmitt-KnosallaD'Addio2008" class="citation journal cs1">Yuan X, Paez-Cortez J, Schmitt-Knosalla I, D'Addio F, Mfarrej B, Donnarumma M, et al. (December 2008). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605226">"A novel role of CD4 Th17 cells in mediating cardiac allograft rejection and vasculopathy"</a>. <i>The Journal of Experimental Medicine</i>. <b>205</b> (13): 3133–3144. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1084%2Fjem.20081937">10.1084/jem.20081937</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605226">2605226</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/19047438">19047438</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Experimental+Medicine&rft.atitle=A+novel+role+of+CD4+Th17+cells+in+mediating+cardiac+allograft+rejection+and+vasculopathy&rft.volume=205&rft.issue=13&rft.pages=3133-3144&rft.date=2008-12&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2605226%23id-name%3DPMC&rft_id=info%3Apmid%2F19047438&rft_id=info%3Adoi%2F10.1084%2Fjem.20081937&rft.aulast=Yuan&rft.aufirst=X&rft.au=Paez-Cortez%2C+J&rft.au=Schmitt-Knosalla%2C+I&rft.au=D%27Addio%2C+F&rft.au=Mfarrej%2C+B&rft.au=Donnarumma%2C+M&rft.au=Habicht%2C+A&rft.au=Clarkson%2C+MR&rft.au=Iacomini%2C+J&rft.au=Glimcher%2C+LH&rft.au=Sayegh%2C+MH&rft.au=Ansari%2C+MJ&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2605226&rfr_id=info%3Asid%2Fen.wikipedia.org%3ATransplant+rejection" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External 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href="https://icd.who.int/browse10/2019/en#/T86">T86</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D006084">D006084</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000815.htm">000815</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" 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title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Hypersensitivity_disease_by_cause" title="Special:EditPage/Template:Hypersensitivity disease by cause"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Hypersensitivity_and_autoimmune_diseases" style="font-size:114%;margin:0 4em"><a href="/wiki/Hypersensitivity" title="Hypersensitivity">Hypersensitivity</a> and <a href="/wiki/Autoimmune_disease" title="Autoimmune disease">autoimmune diseases</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Type_I_hypersensitivity" title="Type I hypersensitivity">Type I</a>/<a href="/wiki/Allergy" title="Allergy">allergy</a>/<a href="/wiki/Atopy" title="Atopy">atopy</a><br />(<a href="/wiki/Immunoglobulin_E" title="Immunoglobulin E">IgE</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Foreign</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Allergic_asthma" class="mw-redirect" title="Allergic asthma">Allergic asthma</a></li> <li><a href="/wiki/Allergic_urticaria" class="mw-redirect" title="Allergic urticaria">Allergic urticaria</a></li> <li><a href="/wiki/Allergic_rhinitis" title="Allergic rhinitis">Allergic rhinitis</a> (Hay fever)</li> <li><a href="/wiki/Anaphylaxis" title="Anaphylaxis">Anaphylaxis</a></li> <li><a href="/wiki/Atopic_dermatitis" title="Atopic dermatitis">Atopic dermatitis</a></li> <li><a href="/wiki/Food_allergy" title="Food allergy">Food allergy</a> <ul><li>common allergies include: <a href="/wiki/Egg_allergy" title="Egg allergy">Egg</a></li> <li><a href="/wiki/Milk_allergy" title="Milk allergy">Milk</a></li> <li><a href="/wiki/Peanut_allergy" title="Peanut allergy">Peanut</a></li> <li><a href="/wiki/Seafood_allergy" class="mw-redirect" title="Seafood allergy">Seafood</a></li> <li><a href="/wiki/Soy_allergy" title="Soy allergy">Soy</a></li> <li><a href="/wiki/Tree_nut_allergy" title="Tree nut allergy">Tree nut</a></li> <li><a href="/wiki/Wheat_allergy" title="Wheat allergy">Wheat</a></li></ul></li> <li><a href="/wiki/Side_effects_of_penicillin" title="Side effects of penicillin">Penicillin allergy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Autoimmune</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Autoimmune_urticaria" title="Autoimmune urticaria">Autoimmune urticaria</a></li> <li><a href="/wiki/Eosinophilic_esophagitis" title="Eosinophilic esophagitis">Eosinophilic esophagitis</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Type_II_hypersensitivity" title="Type II hypersensitivity">Type II</a>/<a href="/wiki/Antibody-dependent_cellular_cytotoxicity" title="Antibody-dependent cellular cytotoxicity">ADCC</a><br /> <ul><li><ul><li><a href="/wiki/Immunoglobulin_G" title="Immunoglobulin G">IgG</a></li> <li><a href="/wiki/Immunoglobulin_M" title="Immunoglobulin M">IgM</a></li></ul></li></ul></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Foreign</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <li><a href="/wiki/Hemolytic_disease_of_the_newborn" title="Hemolytic disease of the newborn">Hemolytic disease of the newborn</a></li> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Autoimmune</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cytotoxicity" title="Cytotoxicity">Cytotoxic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Autoimmune_hemolytic_anemia" title="Autoimmune hemolytic anemia">Autoimmune hemolytic anemia</a></li> <li><a href="/wiki/Bullous_pemphigoid" title="Bullous pemphigoid">Bullous pemphigoid</a></li> <li><a href="/wiki/Goodpasture_syndrome" title="Goodpasture syndrome">Goodpasture syndrome</a></li> <li><a href="/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome" title="Guillain–Barré syndrome">Guillain–Barré syndrome</a></li> <li><a href="/wiki/Immune_thrombocytopenic_purpura" title="Immune thrombocytopenic purpura">Immune thrombocytopenic purpura</a></li> <li><a href="/wiki/Pemphigus_vulgaris" title="Pemphigus vulgaris">Pemphigus vulgaris</a></li> <li><a href="/wiki/Rheumatic_fever" title="Rheumatic fever">Rheumatic fever</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">"<a href="/wiki/Hypersensitivity#Type_V" title="Hypersensitivity">Type V</a>"/<a href="/wiki/Receptor_(biochemistry)" title="Receptor (biochemistry)">receptor</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Graves%27_disease" title="Graves' disease">Graves' disease</a></li> <li><a href="/wiki/Myasthenia_gravis" title="Myasthenia gravis">Myasthenia gravis</a></li> <li><a href="/wiki/Pernicious_anemia" title="Pernicious anemia">Pernicious anemia</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Type_III_hypersensitivity" title="Type III hypersensitivity">Type III</a><br />(<a href="/wiki/Immune_complex" title="Immune complex">Immune complex</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Foreign</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Arthus_reaction" title="Arthus reaction">Arthus reaction</a></li> <li><a href="/wiki/Farmer%27s_lung" title="Farmer's lung">Farmer's lung</a></li> <li><a href="/wiki/Henoch%E2%80%93Sch%C3%B6nlein_purpura" title="Henoch–Schönlein purpura">Henoch–Schönlein purpura</a></li> <li><a href="/wiki/Cutaneous_small-vessel_vasculitis" title="Cutaneous small-vessel vasculitis">Hypersensitivity vasculitis</a></li> <li><a href="/wiki/Acute_proliferative_glomerulonephritis" title="Acute proliferative glomerulonephritis">Post-streptococcal glomerulonephritis</a></li> <li><a href="/wiki/Reactive_arthritis" title="Reactive arthritis">Reactive arthritis</a></li> <li><a href="/wiki/Serum_sickness" title="Serum sickness">Serum sickness</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Autoimmune</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Lupus" title="Lupus">Lupus</a></li> <li><a href="/wiki/Rheumatoid_arthritis" title="Rheumatoid arthritis">Rheumatoid arthritis</a></li> <li><a href="/wiki/Subacute_bacterial_endocarditis" title="Subacute bacterial endocarditis">Subacute bacterial endocarditis</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Type_IV_hypersensitivity" title="Type IV hypersensitivity">Type IV</a>/<a href="/wiki/Cell-mediated_immunity" title="Cell-mediated immunity">cell-mediated</a><br />(<a href="/wiki/T_cell" title="T cell">T cells</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Foreign</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Allergic_contact_dermatitis" title="Allergic contact dermatitis">Allergic contact dermatitis</a></li> <li><a href="/wiki/Mantoux_test" title="Mantoux test">Mantoux test</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Autoimmune</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Coeliac_disease" title="Coeliac disease">Coeliac disease</a></li> <li><a href="/wiki/Giant_cell_arteritis" title="Giant cell arteritis">Giant cell arteritis</a></li> <li><a href="/wiki/Hashimoto%27s_thyroiditis" title="Hashimoto's thyroiditis">Hashimoto's thyroiditis</a></li> <li><a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">Multiple sclerosis</a></li> <li><a href="/wiki/Postorgasmic_illness_syndrome" title="Postorgasmic illness syndrome">Postorgasmic illness syndrome</a></li> <li><a href="/wiki/Reactive_arthritis" title="Reactive arthritis">Reactive arthritis</a></li> <li><a href="/wiki/Type_1_diabetes" title="Type 1 diabetes">Type 1 diabetes</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Graft-versus-host_disease" title="Graft-versus-host disease">GVHD</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Transfusion-associated_graft-versus-host_disease" title="Transfusion-associated graft-versus-host disease">Transfusion-associated graft-versus-host disease</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Unknown/<br />multiple</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Foreign</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypersensitivity_pneumonitis" title="Hypersensitivity pneumonitis">Hypersensitivity pneumonitis</a> <ul><li><a href="/wiki/Allergic_bronchopulmonary_aspergillosis" title="Allergic bronchopulmonary aspergillosis">Allergic bronchopulmonary aspergillosis</a></li></ul></li> <li><a href="/wiki/Latex_allergy" title="Latex allergy">Latex allergy</a> (I+IV)</li> <li><a class="mw-selflink selflink">Transplant rejection</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Autoimmune</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Addison%27s_disease" title="Addison's disease">Autoimmune adrenalitis</a></li> <li><a href="/wiki/Autoimmune_hepatitis" title="Autoimmune hepatitis">Autoimmune hepatitis</a></li> <li><a href="/wiki/Autoimmune_polyendocrine_syndrome" title="Autoimmune polyendocrine syndrome">Autoimmune polyendocrine syndrome</a> <ul><li><a href="/wiki/Autoimmune_polyendocrine_syndrome_type_1" title="Autoimmune polyendocrine syndrome type 1">APS1</a></li> <li><a href="/wiki/Autoimmune_polyendocrine_syndrome_type_2" title="Autoimmune polyendocrine syndrome type 2">APS2</a></li></ul></li> <li><a href="/wiki/Sj%C3%B6gren_syndrome" title="Sjögren syndrome">Sjögren syndrome</a></li> <li><a href="/wiki/Autoimmune_disease" title="Autoimmune disease">Systemic autoimmune disease</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Organ_transplantation" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Organ_transplantation" title="Template:Organ transplantation"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Organ_transplantation" title="Template talk:Organ transplantation"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Organ_transplantation" title="Special:EditPage/Template:Organ transplantation"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Organ_transplantation" style="font-size:114%;margin:0 4em"><a href="/wiki/Organ_transplantation" title="Organ transplantation">Organ transplantation</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Types</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Allotransplantation" title="Allotransplantation">Allotransplantation</a> <ul><li><a href="/wiki/ABO-incompatible_transplantation" title="ABO-incompatible transplantation">ABOi</a></li></ul></li> <li><a href="/wiki/Autotransplantation" title="Autotransplantation">Autotransplantation</a></li> <li><a href="/wiki/Xenotransplantation" title="Xenotransplantation">Xenotransplantation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Transplantable_organs_and_tissues" title="Transplantable organs and tissues">Organs and tissues</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bone_grafting" title="Bone grafting">Bone</a></li> <li><a href="/wiki/Hematopoietic_stem_cell_transplantation" title="Hematopoietic stem cell transplantation">Bone marrow</a></li> <li><a href="/wiki/Brain_transplant" title="Brain transplant">Brain</a></li> <li><a href="/wiki/Corneal_transplantation" title="Corneal transplantation">Corneal</a></li> <li><a href="/wiki/Eye_transplantation" title="Eye transplantation">Eye</a></li> <li><a href="/wiki/Face_transplant" title="Face transplant">Face</a></li> <li><a href="/wiki/Hand_transplantation" title="Hand transplantation">Hand</a></li> <li><a href="/wiki/Head_transplant" title="Head transplant">Head</a></li> <li><a href="/wiki/Heart_transplantation" title="Heart transplantation">Heart</a></li> <li><a href="/wiki/Heart%E2%80%93lung_transplant" title="Heart–lung transplant">Heart–lung</a></li> <li><a href="/wiki/Intestine_transplantation" title="Intestine transplantation">Intestine</a></li> <li><a href="/wiki/Kidney_transplantation" title="Kidney transplantation">Kidney</a></li> <li><a href="/wiki/Liver_transplantation" title="Liver transplantation">Liver</a></li> <li><a href="/wiki/Lung_transplantation" title="Lung transplantation">Lung</a></li> <li><a href="/wiki/Pancreas_transplantation" title="Pancreas transplantation">Pancreas</a> <ul><li><a href="/wiki/Islet_cell_transplantation" title="Islet cell transplantation">islet cell</a></li></ul></li> <li><a href="/wiki/Penis_transplantation" title="Penis transplantation">Penis</a></li> <li><a href="/wiki/Skin_grafting" title="Skin grafting">Skin</a></li> <li><a href="/wiki/Spleen_transplantation" title="Spleen transplantation">Spleen</a></li> <li><a href="/wiki/Thymus_transplantation" title="Thymus transplantation">Thymus</a></li> <li><a href="/wiki/Uterus_transplantation" title="Uterus transplantation">Uterus</a></li> <li><a href="/wiki/Vaginal_transplantation" title="Vaginal transplantation">Vagina</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Graft_(surgery)" title="Graft (surgery)">Medical grafting</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bone_grafting" title="Bone grafting">Bone grafting</a></li> <li><a href="/wiki/Skin_grafting" title="Skin grafting">Skin grafting</a></li> <li><a href="/wiki/Vascular_bypass" title="Vascular bypass">Vascular bypass</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Organ_donation" title="Organ donation">Organ donation</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Non-heart-beating_donation" title="Non-heart-beating donation">Non-heart-beating donation</a></li> <li><a href="/wiki/Organ_procurement" title="Organ procurement">Organ procurement</a></li> <li><a href="/wiki/Organ_trade" title="Organ trade">Organ trade</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Complications</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Graft-versus-host_disease" title="Graft-versus-host disease">Graft-versus-host disease</a></li> <li><a href="/wiki/Post-transplant_lymphoproliferative_disorder" title="Post-transplant lymphoproliferative disorder">Post-transplant lymphoproliferative disorder</a></li> <li><a class="mw-selflink selflink">Transplant rejection</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Transplant networks<br />and government<br /> departments</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Eurotransplant" title="Eurotransplant">Eurotransplant</a></li> <li><a href="/wiki/Gift_of_Life_Marrow_Registry" title="Gift of Life Marrow Registry">Gift of Life Marrow Registry</a></li> <li><a href="/wiki/Human_Tissue_Authority" title="Human Tissue Authority">Human Tissue Authority</a></li> <li><a href="/wiki/LifeSharers" title="LifeSharers">LifeSharers</a></li> <li><a href="/wiki/National_Marrow_Donor_Program" title="National Marrow Donor Program">National Marrow Donor Program</a></li> <li><a href="/wiki/National_Organization_for_Organ_and_Tissues_Donation_and_Transplantation_(Lebanon)" title="National Organization for Organ and Tissues Donation and Transplantation (Lebanon)">NOD-Lb</a></li> <li><a href="/wiki/National_Transplant_Organization" title="National Transplant Organization">National Transplant Organization</a></li> <li><a href="/wiki/NHS_Blood_and_Transplant" title="NHS Blood and Transplant">NHS Blood and Transplant</a></li> <li><a href="/wiki/Trillium_Gift_of_Life_Network" title="Trillium Gift of Life Network">Trillium Gift of Life Network</a></li> <li><a href="/wiki/United_Network_for_Organ_Sharing" title="United Network for Organ Sharing">United Network for Organ Sharing</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Advocacy<br /> organizations</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anthony_Nolan" title="Anthony Nolan">Anthony Nolan</a></li> <li><a href="/wiki/Blood_Cancer_UK" title="Blood Cancer UK">Blood Cancer UK</a></li> <li><a href="/wiki/DKMS" title="DKMS">DKMS</a></li> <li><a href="/wiki/Halachic_Organ_Donor_Society" title="Halachic Organ Donor Society">Halachic Organ Donor Society</a></li> <li><a href="/wiki/Kidney_Foundation_of_Canada" title="Kidney Foundation of Canada">Kidney Foundation of Canada</a></li> <li><a href="/wiki/National_Kidney_Foundation" title="National Kidney Foundation">National Kidney Foundation</a></li> <li><a href="/wiki/ORGANIZE" title="ORGANIZE">ORGANIZE</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Joint societies</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/American_Society_of_Nephrology" title="American Society of Nephrology">American Society of Nephrology</a></li> <li><a href="/wiki/American_Society_of_Transplantation" title="American Society of Transplantation">American Society of Transplantation</a></li> <li><a href="/wiki/Canadian_Society_of_Transplantation" title="Canadian Society of Transplantation">Canadian Society of Transplantation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Countries</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Organ_transplantation_in_China" title="Organ transplantation in China">Organ transplantation in China</a> <ul><li><a href="/wiki/Organ_harvesting_from_Falun_Gong_practitioners_in_China" title="Organ harvesting from Falun Gong practitioners in China">harvesting from Falun Gong</a></li></ul></li> <li><a href="/wiki/Organ_donation_in_India" title="Organ donation in India">Organ donation in India</a> <ul><li><a href="/wiki/Gurgaon_kidney_scandal" title="Gurgaon kidney scandal">Gurgaon kidney scandal</a></li></ul></li> <li><a href="/wiki/Organ_transplantation_in_Israel" title="Organ transplantation in Israel">Organ transplantation in Israel</a></li> <li><a href="/wiki/Organ_transplantation_in_Japan" title="Organ transplantation in Japan">Organ transplantation in Japan</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">People</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Heart</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Christiaan_Barnard" title="Christiaan Barnard">Christiaan Barnard</a></li> <li><a href="/wiki/James_Hardy_(surgeon)" title="James Hardy (surgeon)"> James D. Hardy</a></li> <li><a href="/wiki/Adrian_Kantrowitz" title="Adrian Kantrowitz">Adrian Kantrowitz</a></li> <li><a href="/wiki/Richard_Lower_(surgeon)" title="Richard Lower (surgeon)">Richard Lower</a></li> <li><a href="/wiki/Norman_Shumway" title="Norman Shumway">Norman Shumway</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Kidney</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/J._Hartwell_Harrison" title="J. Hartwell Harrison">J. Hartwell Harrison</a></li> <li><a href="/wiki/John_P._Merrill" title="John P. Merrill">John P. Merrill</a></li> <li><a href="/wiki/Joseph_Murray" class="mw-redirect" title="Joseph Murray">Joseph Murray</a></li> <li><a href="/wiki/Elizabeth_Ward_(British_campaigner)" title="Elizabeth Ward (British campaigner)">Elizabeth Ward</a></li> <li><a href="/wiki/Michael_Woodruff" title="Michael Woodruff">Michael Woodruff</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Liver</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Fikri_Alican" title="Fikri Alican">Fikri Alican</a></li> <li><a href="/wiki/James_Hardy_(surgeon)" title="James Hardy (surgeon)"> James D. Hardy</a></li> <li><a href="/wiki/Thomas_Starzl" title="Thomas Starzl">Thomas Starzl</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Lung</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Fikri_Alican" title="Fikri Alican">Fikri Alican</a></li> <li><a href="/wiki/Joel_D._Cooper" title="Joel D. Cooper">Joel D. Cooper</a></li> <li><a href="/wiki/Vladimir_Demikhov" title="Vladimir Demikhov">Vladimir Demikhov</a></li> <li><a href="/wiki/James_Hardy_(surgeon)" title="James Hardy (surgeon)"> James D. Hardy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Pancreas</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Richard_C._Lillehei" title="Richard C. Lillehei">Richard C. Lillehei</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Penis</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Andr%C3%A9_van_der_Merwe" title="André van der Merwe">André van der Merwe</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alexis_Carrel" title="Alexis Carrel">Alexis Carrel</a></li> <li><a href="/wiki/Jean-Michel_Dubernard" title="Jean-Michel Dubernard">Jean-Michel Dubernard</a></li> <li><a href="/wiki/Donna_Mansell" title="Donna Mansell">Donna Mansell</a></li> <li><a href="/wiki/Bruce_Reitz" title="Bruce Reitz">Bruce Reitz</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/List_of_organ_transplant_donors_and_recipients" title="List of organ transplant donors and recipients">List of organ transplant donors and recipients</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related topics</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Biomedical_tissue" title="Biomedical tissue">Biomedical tissue</a></li> <li><a href="/wiki/Edmonton_protocol" title="Edmonton protocol">Edmonton protocol</a></li> <li><a href="/wiki/Eye_bank" title="Eye bank">Eye bank</a></li> <li><a href="/wiki/Immunosuppressive_drug" title="Immunosuppressive drug">Immunosuppressive drugs</a></li> <li><a href="/wiki/Lung_allocation_score" title="Lung allocation score">Lung allocation score</a></li> <li><a href="/wiki/Machine_perfusion" title="Machine perfusion">Machine perfusion</a></li> <li><a href="/wiki/Total_body_irradiation" title="Total body irradiation">Total body irradiation</a></li> <li><a href="/wiki/Frankenstein%27s_monster" title="Frankenstein's monster">Frankenstein's monster</a></li></ul> </div></td></tr></tbody></table></div>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1" alt="" width="1" height="1" style="border: none; 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