CYTOKINES AND ADHESION MOLECULES IN CHRONIC REJECTION

Despite the increasing short-term success of clinical transplantation during recent years, many allografts, regardless of organ type, contin ue to be lost over the long term due to chronic rejection, despite imp rovements in immunosuppression and better patient management. Thus, as a long-term answer to an irreversible disease process, organ transpla ntation has not lived up to its potential. Although the host mechanism s leading to the process remain obscure, the progressive morphological changes evolving in the afflicted organs are well understood. Chronic rejection has long been thought to be an antibody-mediated event, as immunoglobulins and other circulating proteins are often associated wi th areas of vascular damage. It is becoming more clear, however, that a whole array of host defense factors, primarily, cytokines, lymphokin es and adhesion molecules, are of critical importance in the process. This review summarizes various cytokines and their individual function s as well as adhesion molecules potentially involved in aspects of imm une responsiveness, and placed in the context of chronic rejection.