There is a Road, No Simple Highway: Envisioning a Path to Better Long-Term Organ Transplant Survival

The current half-life of a transplanted organ has not improved in a very long time. Historical reports on the causes of allograft failure have pointed to a plethora of contributing issues. However, in recent years, alloantibody-mediated injury has emerged as the major cause of allograft loss. As such, one road to advance transplant is to address this problem. There is a hope that new treatments can minimize the impact of alloantibody-mediated injury just as T-cell directed therapies developed over the last few decades have minimized the impact of T-cell mediated rejection on allograft survival. However, these new therapies are at least a few years away. While we are unsure how to treat alloantibodies, we can certainly do a better job at preventing them. This review will discuss the current data surrounding alloantibody-mediated injury and how prevention of alloantibodies may be one way to advance transplantation.