Conflict of interest: I am a major shareholder and Chairman of One Lambda, one of the companies that sells antibody testing kits. My publications in the humoral theory predate the formation of the company by 25 years.
Humoral Theory of Transplantation
Article first published online: 28 MAY 2003
American Journal of Transplantation
Volume 3, Issue 6, pages 665–673, June 2003
How to Cite
Terasaki, P. I. (2003), Humoral Theory of Transplantation. American Journal of Transplantation, 3: 665–673. doi: 10.1034/j.1600-6143.2003.00135.x
- Issue published online: 28 MAY 2003
- Article first published online: 28 MAY 2003
- Received 13 November 2002, revised 26 December 2002 and accepted for publication 13 February 2003
According to the humoral theory of transplantation, antibodies cause allograft rejection. Publications are cited showing that antibodies: (1) cause hyperacute kidney rejection, (2) lead to C4d deposits associated with early kidney graft failures, (3) are a good indicator of presensitization leading to early acute rejections, (4) were present in 96% of 826 patients who rejected a kidney graft, (5) are associated with chronic rejection in 33 studies of kidney, heart, lung and liver grafts, and (6) in three studies, appeared in the circulation BEFORE evidence of bronchiolitis obliterans in lung transplants, and BEFORE kidney rejection. In addition, a prospective cooperative study of 1629 patients in 24 centers demonstrated that antibodies foretold subsequent failures after a follow-up period of 6 months (p = 0.05). The specificity of antibodies detected in the serum of rejecting patients were often not donor specific, presumably because they were absorbed by the rejecting organ.
If the humoral theory is accepted, even provisionally, transplanted patients who have antibodies could be treated with immunosuppression until the antibodies disappear to determine whether chronic rejection can be blocked. If successful, in patients who do not have antibodies, immunosuppression could be reduced until antibodies appear.