Fifty Shades of Transplantation Tolerance: Beyond a Binary Tolerant/Non-Tolerant Paradigm

AbstractPurpose of ReviewIt has long been considered that tolerance in a transplant recipient is a binary all-or-none state: either the graft is accepted without immunosuppression identifying the recipient as tolerant, or the recipient rejects the graft and is not tolerant. This tolerance paradigm, however, does not accurately reflect data emerging from animal models and patients and requires revision.Recent FindingsIt is becoming appreciated that there may be different gradations in the quality of transplantation tolerance based on underlying cellular mechanisms of immunological tolerance, and that individuals may enhance the robustness of their state of transplant tolerance by strengthening or combining different cellular mechanisms. Furthermore, evidence suggests that even if tolerance is lost, the loss may be only temporary, and in some circumstances, tolerance can be restored.SummaryShifting our focus from an all-or-nothing tolerance paradigm to one with many shades may help us better understand how tolerance operates, and how this state may be tracked and enhanced for better patient outcomes.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research