Contemporary Strategies and Barriers to Transplantation Tolerance

The purpose of this review is to discuss immunologic tolerance as it applies to solid organ transplantation and to identify barriers that hinder the achievement of this long-term goal. First, the definition of tolerance and an introduction of mechanisms by which tolerance exists or can be achieved will be discussed. Next, a review of contemporary attempts at achieving transplant tolerance will be described. Finally, a discussion of the humoral barriers to transplantation tolerance and potential ways to overcome these barriers will be presented. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Address all correspondence and requests for reprints to: Stuart J. Knechtle, MD, Executive Director, Duke Transplant Center, 207 Research Dr., Jones 365, Durham, NC 27710, U.S.A. Phone: 919-613-9687; Fax: 919-684-8716; E-mail: stuart.knechtle@dm.duke.edu. Jean Kwun, DVM, PhD, Duke Transplant Center, 207 Research Dr., Jones 362, Durham, NC 27710, U.S.A. Phone: 919-668-6792; Fax: 919-684-8716; E-mail: jean.kwun@duke.edu (SJK and JK share the corresponding authorship for this work) Disclosure: The authors declare no conflicts of interest. Funding: The work in this paper is supported in part by grants: NIH U19 AI051731 (S.K.), NIH 1U19AI131471 (S.K.) and AHA Enduring Hearts Foundation Research Award 15SDG25710165 (J.K.). Author Contribution B.E. conceived the idea and wrote the manuscript. P.S. conceived the idea, wrote the manuscript, and devised the figure. K.F. and J.Y. participated in manuscript cowriting and critical revision. J.K. and S.K. conceived the idea and wrote the manuscript. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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