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The Role of Complement in Transplantation

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Book cover The Complement System

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Abstract

Organ transplantation is an established therapy for patients with end-stage organ disease. In the past years, a growing understanding of physiology and pathophysiology, refinement of tissue typing, better surgical techniques and more effective immunosuppressive strategies has progressively favoured prolonged graft survival. However, still a significant proportion of grafts fail within the first months and years after transplantation because of a progressive and irreversible immune response of the recipient. The pathogenesis of graft rejection comprises complex immunological and non-immunological mechanisms. Humoral as well as cell-mediated immune reactions have been implicated in graft rejection. Although primarily driven by T-cell response the role of complement activation in acute graft rejection has become evident in recent years. Here, modern complement analysis as an integral part of posttransplantation monitoring may contribute to early recognition of impeding graft rejection. Hyperacute graft rejection is a rare occurrence in the clinic. It may occur immediately after allotransplantation due to preexisting blood group directed or anti-HLA antibodies. In xentransplantation, hyperacute rejection is a major barrier to organ survival. The binding of pre-existing, so-called natural antibodies, mostly of the IgM class, to donor cells leads to fulminant activation of the complement and clotting systems with rapid loss of graft function. Therapeutic substitution of appropriate complement regulators appears to be a reasonable approach to reduce undesirable complement-mediated inflammatory reactions in the grafted organ.

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  1. Institute of Immunology, University of Heidelberg, Germany

    Michael Kirschfink

  2. Institute of Immunology, Rikshospitalet University Hospital, Oslo, Norway

    Tom Eirik Mollnes

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  1. Walter Reed Army Institute of Research, Silver Spring, MD

    Janos Szebeni

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Kirschfink, M., Mollnes, T.E. (2004). The Role of Complement in Transplantation. In: Szebeni, J. (eds) The Complement System. Springer, Boston, MA. https://doi.org/10.1007/1-4020-8056-5_18

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