Transplantation tolerance; myth or reality?

Area of Science:

• Transplantation immunology
• Organ transplantation
• Immunosuppression therapy

Background:

• Organ transplantation is a standard therapy for end-stage organ failure.
• Lifelong immunosuppression is necessary to prevent graft rejection but causes significant morbidity, including infections and malignancies.
• Chronic graft attrition leads to graft loss within 7-10 years despite current strategies.

Purpose of the Study:

• To review the progress made in achieving transplant tolerance.
• To discuss the challenges and future directions in the pursuit of transplant tolerance.

Main Methods:

• This is an editorial discussing the current state of research and clinical practice in transplant tolerance.
• It synthesizes existing knowledge and expert opinion on the topic.

Main Results:

• Transplant tolerance, defined as stable allograft function without immunosuppression and intact host immunity, is the ultimate goal.
• Despite 60 years of research, true transplant tolerance remains elusive, often referred to as "Mackenna's gold."

Conclusions:

• Significant progress has been made, but transplant tolerance is not yet a clinical reality.
• Further research is crucial to overcome barriers and achieve a state of no immunosuppression in transplant recipients.
• Achieving transplant tolerance promises to revolutionize organ transplantation by eliminating immunosuppression-related complications and improving long-term graft survival.