Immune Landscape in Kidney Transplantation

Kidney transplantation is the optimal treatment for end-stage renal failure patients. However, its long-term survival rate remains relatively low, with immune rejection being a crucial risk factor. In recent years, notable progress has been made in the study of the immune regulation network in kidney transplantation. The key roles and molecular mechanisms of diverse immune cells in rejection have been gradually clarified. Innate immune components (such as neutrophils, macrophages, natural killer cells, etc.) activate inflammatory signals via pattern recognition receptors and collaborate with the complement system and platelets to mediate early graft damage. In adaptive immunity, T/B cell subsets drive donor-specific immune responses through direct/indirect recognition pathways, forming the core effector mechanism of immune rejection. We retrieved relevant articles from databases such as PubMed and Web of Science using keywords including "kidney transplantation" and "immunity", focusing on the most recent research published in the past decade. Articles were screened and evaluated based on high scientific standards regarding research quality and relevance. This review centers on the dynamic interaction network between innate and adaptive immunity after kidney transplantation. It systematically elaborates the roles of various immune cell subsets throughout the rejection process and further explores the application prospects of xenogeneic kidney transplantation, immune monitoring techniques, and precision individualized immunotherapy, all with the aim of exploring new directions for future kidney transplantation immunology research.