HLA in Transplantation

This chapter is about kidney and bone marrow transplantation, a therapy that is routinely used in our hospitals to correct a failure of different organs. It contains a historical perspective starting from the middle of the last century. I have included this topic in the book because of the significant impact of HLA compatibility in the survival of a grafted organ or a bone marrow. The important role of immunosuppression to fight allograft rejection is also included in this chapter, with special emphasis on the discovery of “cyclosporine” that improved the rate of survival of kidney allograft and is nowadays used in the treatment of different autoimmune diseases. This chapter also describes the variety of bone marrow transplants that are currently performed in different types of leukaemia and lymphoma. Several international organizations in the United States and Europe have been created to share donated kidneys and bone marrow with high degree of HLA compatibility. The identification of bone marrow stem cell precursors by monoclonal antibodies helped to develop novel protocols of treatment leading to colonization and replacement of all leucocyte populations in the transplanted patients. I have included also in this chapter the list of the different “Human Leucocyte Differentiation Antigen Workshops” that took place following the discovery of the method of “monoclonal antibody” production by Köhler and Milstein in 1975. This technology contributed to the progress in transplantation with applications in other medical areas such as pathology and internal medicine. Gerhard Köhler and Cesar Milstein received the Nobel Prize in 1984.