Kidney Transplantation: Mechanisms of Rejection and Acceptance

We describe the molecular and cellular mechanisms believed to be responsible for the rejection of renal allografts, including acute T cell–mediated rejection, acute antibody-mediated (humoral) rejection, rejection mediated by the innate immune system, and chronic rejection. We present mechanisms of graft acceptance, including accommodation, regulation, and tolerance. Studies in animals have replicated many pathologic features of acute and chronic rejection. We illuminate the pathogenesis of human pathology by reflection from experimental models.