Transplantation, Innate Alloimmunity: The Primary Allograft Injury Leads to Alloimmune-Mediated Allograft Rejection

The rediscovery of innate immunity appears to have revolutionized not only basic immunology but transplant immunology as well. Walter Land described in his new monograph the emerging role of innate immunity in organ transplantation. "We are confident that this book will change the scientific and practical viewpoints of transplantologists in their day-to-day work," the Editor, Mehmet Haberal, comments.

Land outlines modern notions in immunology claiming that the innate immune defense system is not only directed against pathogen-mediated tissue injury but against any tissue injury, including allograft injury. In this context, the author emphasizes that, during the last decade, accumulating experimental and clinical evidence has been published in favor and support of his original "Injury Hypothesis" holding that it is the primary allograft injury that - in addition to its foreignness - induces innate immune pathways leading to alloimmune-mediated allograft rejection, and contributing to the development of alloatherosclerosis and allofibrosis as major pathohistological features of chronic allograft dysfunction. Accordingly, in this book, Walter Land has collected and meticulously described a wealth of supporting evidence that have recently led to those revolutionizing notions in transplant medicine.

The book is presented in eight chapters headed

- Early appreciation in the 1990s: The injured allograft as an acutely inflamed organ and the first clues to the existence of innate immunity
- Oxidative allograft injury revisited at the beginning of the new milennium
- Oxidative injury-induced, damage associated molecular pattern molecules and their pattern recognition receptors
- Role of pattern recognition receptors in mediating oxidative tissue injury via activation of dendritic cells, innate lymphocytes, and T lymphocytes
- Experimental and clinical findings in direct and indirect support of the existence of innate alloimmunity
- Chronic allograft dysfunction: a model disease of innate immunity
- Immunosuppressive strategies in light of innate alloimmunity
- Innate alloimmunity and blood coagulation

The book closes up with an optimistic Epilogue: "I firmly believe that allograft injury-induced pathways and processes of innate immunity are not only critical for the induction and direction of the adaptive alloimmune response, leading to allograft rejection, but also for the induction and direction of allotolerance, allowing discontinuation of maintenance immunosuppression in successfully transplanted patients."