The Sensitized Patient Awaiting Heart Transplantation

Abstract

The humoral theory of transplantation states that antibodies cause the rejection of allografts. This hypothesis was first proposed in the early twentieth century, when efforts were made to produce antibodies against tumors. However, it was soon realized that the antibodies were produced against transplant antigens present on transplantable tumors, not against the tumor-specific antigens. Development of inbred mouse subsequently allowed identification of the transplant antigens determined by the H-2 locus of mice [1]. The analogous human leukocyte antigen (HLA) system was established by discovery of antibodies against leukocytes in multiple transfused patients [2] and analysis of lymphocytotoxic alloantibodies made by pregnant women, directed against mismatched paternal antigens of the fetus [3, 4]. The HLA antibodies were then found to cause rejection of kidneys [5]. Antibodies appeared in almost all patients after rejection of kidneys.