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Grand Rounds
September 15, 1999

The Future of Organ and Tissue TransplantationCan T-Cell Costimulatory Pathway Modifiers Revolutionize the Prevention of Graft Rejection?

Author Affiliations

Author Affiliations: Navy Medical Research Center, NIDDK/Navy Transplantation and Autoimmunity Branch (Drs Harlan and Kirk), and the Uniformed Service University of the Health Sciences (Dr Harlan), Bethesda, Md; and the Organ Transplant Service, Walter Reed Army Medical Center, Washington, DC (Dr Kirk).


Grand Rounds at the Clinical Center of the National Institutes of Health Section Editors: John I. Gallin, MD, the Clinical Center of the National Institutes of Health, Bethesda, Md; David S. Cooper, MD, Contributing Editor, JAMA .

JAMA. 1999;282(11):1076-1082. doi:10.1001/jama.282.11.1076

Transplantation therapies have revolutionized care for patients with end-stage organ (kidney, liver, heart, lung, and pancreatic β-cell) failure, yet significant problems persist with treatments designed to prevent graft rejection. Antirejection therapies are not always effective, must be taken daily, and are both expensive and associated with well-known toxic effects. Recent advances have suggested that the immune system has more self-regulatory capability than previously appreciated. In this review, we discuss immune system function and new therapeutic agents that modify so-called costimulatory receptor signaling to support transplant function without generally suppressing the immune system.