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 .
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.
Harlan DM, Kirk AD. The Future of Organ and Tissue TransplantationCan T-Cell Costimulatory Pathway Modifiers Revolutionize the Prevention of Graft Rejection?. JAMA. 1999;282(11):1076–1082. doi:10.1001/jama.282.11.1076