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Review
. 2023 Jun 19;12(12):4130.
doi: 10.3390/jcm12124130.

Pathophysiology of Rejection in Kidney Transplantation

Christina L Tamargo  1 , Sam Kant  2
Affiliations
Review

Pathophysiology of Rejection in Kidney Transplantation

Christina L Tamargo et al. J Clin Med. .

Abstract

Kidney transplantation has been the optimal treatment for end-stage kidney disease for almost 70 years, with increasing frequency over this period. Despite the prevalence of the procedure, allograft rejection continues to impact transplant recipients, with consequences ranging from hospitalization to allograft failure. Rates of rejection have declined over time, which has been largely attributed to developments in immunosuppressive therapy, understanding of the immune system, and monitoring. Developments in these therapies, as well as an improved understanding of rejection risk and the epidemiology of rejection, are dependent on a foundational understanding of the pathophysiology of rejection. This review explains the interconnected mechanisms behind antibody-mediated and T-cell-mediated rejection and highlights how these processes contribute to outcomes and can inform future progress.

Keywords: T-cell-mediated rejection; allograft rejection; antibody-mediated rejection; kidney transplant; transplant immunology.

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Conflict of interest statement

The authors have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Mechanisms of T cell priming and activation. APC, antigen-presenting cell; MHC, major histocompatibility complex; TCR, T cell receptor. Created with Biorender.
Figure 2
Figure 2
Mechanisms of B cell maturation and antibody formation. APC, antigen-presenting cell; BCR, B cell receptor; MHC, major histocompatibility complex; TCR, T cell receptor. Created with Biorender.
See this image and copyright information in PMC

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