[The role of immunologic response in chronic allograft rejection]

Chronic allograft rejection is an active immunologic and inflammatory process leading to graft failure. It is associated with many disorders evidencing increased reactivity of the host against graft alloantigens. Among the most important ones are: de novo synthesis of antibodies against HLA class I and II, immunoglobin deposits on vascular endothelial and tubular basement membrane, C4d complement deposits in peritubular capillaries, increased proliferation of lymphocytes in response to mismatched HLA-DR, and elevated expression of cytokines on infiltrating mononuclears and tubular cells. Prevention of chronic rejection comprises of transplanting undamaged organs, avoidance of acute rejection, incorporation of medicines inhibiting remodelling of vascular wall into therapy, and elimination of factors accelerating graft damage. In case of humoral chronic rejection suppression of humoral arm immune response is required. Early diagnosis and effective suppression of antibody production may allow to avoid progression of allograft failure.