The transplanted organ is a continous source of HLA alloantigens that can induce a rejection response at any time after transplantation. Both direct and indirect alloactivation pathways are important in the generation of donor-specific cell-mediated cytotoxicity and delayed-type hypersensitivity-like mechanism off allograft rejection. Conversely, the the continuous presence of small numbers of donor APC (referred to as microchemerism) may promote and maintain allograft tolerance, rather than transplantation rejection.
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