Thus far, we have described the molecular basis of allo-antigen recognition and the cells involved in the recognition of and responses to allografts. We now turn to a consideration of the effector mechanisms responsible for the immunologic rejection of allografts. In different experimental models and in clinical transplantation, allo-reactive CD4+ and CD8+ T cells and alloantibodies have been shown to be capable of mediating allograft rejection. These different immune effectors cause graft rejection by different mechanisms (Fig. 16-8), and all three effectors may contribute to rejection concurrently.
For historical reasons, graft rejection is classified on the basis of histopathologic features or the time course of rejection after transplantation rather than on the basis of immune effector mechanisms. Based on the experience of renal transplantation, the histopathologic patterns are called hyperacute, acute, and chronic (see Fig. 16-8). These patterns are associated with different dominant immune effector mechanisms.
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