ALLO- AND AUTOIMMUNITY: Edited by Denis GlotzAlloimmune-induced intragraft lymphoid neogenesis promotes B-cell tolerance breakdown that accelerates chronic rejectionSicard, Antoine; Chen, Chien-Chia; Morelon, Emmanuel; Thaunat, OlivierAuthor Information aHospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie Clinique bINSERM U1111, Centre International de Recherche en Infectiologie (CIRI), Ecole Normale Supérieure de Lyon, CNRS cUniversité Lyon 1, Lyon, France Correspondence to Olivier Thaunat, MD, PhD, Service de Néphrologie, Médecine de Transplantation et d’Immunologie Clinique, Hôpital Edouard Herriot, 5 Place d’Arsonval, Lyon, France. Tel: +33 4 72 11 02 29; fax: +33 4 72 11 02 71; e-mail: [email protected] Current Opinion in Organ Transplantation: August 2016 - Volume 21 - Issue 4 - p 368-374 doi: 10.1097/MOT.0000000000000329 Buy Metrics Abstract Purpose of review Antibody-mediated rejection (AMR) has emerged as a leading cause of allograft loss in solid organ transplantation. A better understanding of AMR immunopathology is a prerequisite to improve its management. Recent findings The prevalent dogma considers that AMR is the consequence of a thymo-dependent B-cell response against donor-specific polymorphic antigens (mainly mismatched human leukocyte antigen molecules). Nevertheless, antibodies directed against nonpolymorphic antigens expressed by the graft are also generated during chronic rejection and can contribute to allograft destruction. This implies that a breakdown of self-tolerance occurs during chronic rejection. Accumulating evidence suggests that this event occurs inside the ectopic ‘tertiary’ lymphoid tissue that develops within rejected allografts. Thus, AMR should be viewed as a complex interplay between allo- and autoimmune humoral responses. Summary The interplay between allo- and autoimmune humoral responses in chronic rejection highlights several unmet medical issues like better diagnosis tools are needed to screen recipients for nonhuman leukocyte antigen alloantibodies and autoantibodies, therapeutic strategies shall aim at blocking the response against alloantigens but also the breakdown of self-tolerance that occurs within tertiary lymphoid tissue. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.