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Review
. 1998 Sep;19(5):441-55.
doi: 10.1023/a:1009924907775.

Transplantation tolerance, microchimerism, and the two-way paradigm

T E Starzl  1 , A J Demetris
Affiliations
Review

Transplantation tolerance, microchimerism, and the two-way paradigm

T E Starzl et al. Theor Med Bioeth. 1998 Sep.
No abstract available

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Figures

Figure 1
Figure 1
(Upper panels) One-way paradigm in which transplantation is conceived as involving a unidirectional immune reaction: (left) host-versus-graft (HVG) with whole organs and (right) graft-versus-host (GVH) with bone marrow or other hematopoietic transplants. (Lower panels) Two-way paradigm in which transplantation is seen as a bidirectional and mutually cancelling immune reaction that is (left) predominantly HVG with whole organ grafts, and (right) predominantly GVH with bone marrow grafts.
Figure 2
Figure 2
Comtemporaneous host versus graft (HVG) and graft versus host (GVH) reactions in the two-way paradigm as applied to organ transplantation. Following the initial interaction, the evolution of non-reactivity of each leukocyte population to the other is seen as a predominantly low-grade stimulatory state that may wax and wane, rather than one of absolute or irreversible clonal deletion.
Figure 3
Figure 3
The mirror image of Figure 2 after bone marrow transplantation to a recipient who has undergone cytoablation.
Figure 4
Figure 4
The continuum of chimerism from observations of Ray Owen in Freemartin cattle (77) to the present. Chimerism was incorrectly discounted as a factor in organ allograft acceptance from about 1960 until the discovery in 1992 of microchimerism in organ recipients.,
See this image and copyright information in PMC

Comment in

References

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    1. Billingham R, Brent L, Medawar P. Quantitative studies on tissue transplantation immunity. III. Actively acquired tolerance. Phil Trans R Soc Lond (Biol) 1956;239:357–412. - PMC - PubMed
    1. Starzl TE, Demetris AJ. Transplantation milestones: Viewed with one- and two-way paradigms of tolerance. JAMA. 1959;46:876–879. - PMC - PubMed
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