Transplantation faces an unprecedented shortage of organs available for transplantation, resulting in longer waiting times and transplant candidates on the waiting list dying before getting a transplant. This dramatic situation triggered the search for new approaches and innovations to increase the donor pool, such as extending the acceptance criteria concerning donor age or organ transplantation across blood group barriers. Herein, leading experts detailed the immunological and molecular concepts behind the successful clinical translation of these strategies. Organ rejection remains a constant challenge and transplantation tolerance is still elusive as the current paradigm aims for immunosuppression rather than immune modulation. Two contributions in this issue review two different molecular paradigms in harnessing the immunologic response after transplantation. The interplay between the intestinal innate and adaptive immunity is particularly intricate and the intestine remains the organ with the highest rate of acute rejection after transplantation. Experts in the field summarized both time-honored and recent knowledge in intestinal preservation and tolerance in intestinal transplantation with potential for further basic and translational research.
Keywords: blood groups; immunobiology; intestine; organ transplantation.