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Organ-specific differences in achieving tolerance

Madariaga, Maria Lucia L.a; Kreisel, Danielb; Madsen, Joren C.a,c

Current Opinion in Organ Transplantation: August 2015 - Volume 20 - Issue 4 - p 392–399
doi: 10.1097/MOT.0000000000000206
TOLERANCE INDUCTION: Edited by Joren C. Madsen

Purpose of review When it comes to tolerance induction, kidney allografts behave differently from heart allografts that behave differently from lung allografts. Here, we examine how and why different organ allografts respond differently to the same tolerance induction protocol.

Recent findings Allograft tolerance has been achieved in experimental and clinical kidney transplantation. Inducing tolerance in experimental recipients of heart and lung allografts has, however, proven to be more challenging. New protocols being developed in nonhuman primates based on mixed chimerism and cotransplantation of tolerogenic organs may provide mechanistic insights to help overcome these challenges.

Summary Tolerance induction protocols that are successful in patients transplanted with ‘tolerance-prone’ organs such as kidneys and livers will most likely not succeed in recipients of ‘tolerance-resistant’ organs such as hearts and lungs. Separate clinical trials using more robust tolerance protocols will be required to achieve tolerance in heart and lung recipients.

aCenter for Transplantation Science, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts

bDivision of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri

cDivision of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence to Joren C. Madsen, MD, DPhil, WHT-05-510C, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA. Tel: +1 617 726 6506; e-mail:

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