T cells are the major barrier to the transplantation of organs between other than genetically identical twins. The basis for immune rejection lies in the incredible heterogeneity among humans in histocompatibility genes and proteins. Rejection can be managed somewhat by careful histocompatibility matching of donor and recipient, and with drugs that suppress T cell function, but permanent acceptance of transplants has yet to be achieved. This chapter examines how T cells detect transplants as foreign, and the mechanisms they use to reject them. A close study of these processes may suggest better strategies for ensuring transplant survival.
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