Transplantation immunology. Clinical aspects.

ALTHOUGH transplantation of tissues is very artificial biologically, therapeutically it has provided a successful approach to management of functional failure of a variety of organs or systems. Renal transplantation is practiced widely in many centers throughout the world for patients with chronic renal failure for whom a suitable donor is available. Transplantation of bone marrow is becoming more widely practiced for aplastic anemia, immunodeficiency, and a variety of cancers, especially leukemia, as increasing numbers of centers for this procedure are created (see chapter 21). Transplantation of heart, liver, endocrine tissue, skin, lung, bone, and nonviable tissues is also practiced, but to a lesser extent, and is beyond the scope of this primer. TYPES OF GRAFTS Four types of transplants or grafts are recognized according to the genetic relationship between the donor and recipient (Table 19-1). An allograft is one transplanted between genetically nonidentical members of the same species, eg, all