RT Book, Section
A1 Griffith, Bartley P.
A2 Cohn, Lawrence H.
SR Print(0)
ID 55929236
T1 Chapter 63. Immunobiology of Heart and Heart-Lung Transplantation
T2 Cardiac Surgery in the Adult, 4e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-163310-9
LK accesssurgery.mhmedical.com/content.aspx?aid=55929236
RD 2024/04/25
AB This  chapter  on  the  immunology  of  transplantation  is  a  refreshed  effort  designed  to  promote  a  foundation  for  understanding  the  basic  transplant  immunologic  fundamentals  necessary  for  competency  in  caring  for  heart  and  lung  transplant  recipients.  Although  surgeons  must  acquire  the  technical  expertise  to  perform  these  often  demanding  surgeries  safely,  the  recipients'  well-being  additionally  benefits  from  a  surgical  team  well  versed  in  basic  transplant  immunology.  Comfort  in  treating  patients  who  receive  immunosuppressive  therapies,  both  conventional  and  innovative,  requires  familiarity  with  the  nonsurgical  language  of  transplantation.  The  goal  of  this  chapter  is  to  squeeze  the  essentials1  into  an  understandable  short  text.  The  knowledge  gained  should  permit  surgeons  to  read  immunology-tilted  manuscripts  with  better  understanding  and  thus  make  better  decisions  in  treating  their  own  patients.  The  core  features  of  this  alloresponse  and  new  science  are  presented  with  some  specific  references  to  hearts  and  lungs  so  that  the  surgeon  participating  in  the  care  of  thoracic  organ  recipients  can  more  easily  build  an  understanding  of  the  complex  and  evolving  science.  The  material  is  organized  to  reflect  a  unifying  theory  of  the  immune  response  that  determines  the  fate  of  an  allograft  and  most  often  the  heart  or  lung  recipient  as  well.  This  includes:  (1)  histocompatibility;  (2)  activation  of  alloresponse  T  lymphocytes  and  T-cell–mediated  rejection  (TMR);  (3)  antibody-mediated  rejection  (AMR);  (4)  the  underappreciated  immune  pathways,  natural  killer  (NK)  cells,  and  memory  lymphocytes;  and  (5)  immune  plus  gene  monitoring.  The  text  will  clarify  acute,  cell-mediated,  hyperacute,  and  chronic  rejection  pathways  (Fig.  63-1).