Tolerance protocol of living kidney transplant for developing countries through basic strategy of lymphocyte depletion

Figure 1 The mechanisms of tolerance and rejection. A: In fetal life, T-lymphocyte response as the clonal deletion of auto reactive T-lymphocytes in the thymus to the fetal antigens so that the organism is rendered self-tolerant to self-antigens, whereas after birth these changes to the state of clonal proliferation on exposure to exogenous antigens; B: In presence of allograft the immune reactive T-lymphocytes and subsequently B-lymphocytes, carry out the process of immune response and rejection as carried out by hematologic immune cells. Suppression of this mechanism leads to graft maintenance; C: Possible tolerance inducing strategies. APC: Antigen presenting cell; CD: Cluster differentiation; T-eff: T-effector; T-reg: T-regulator lymphocyte; CTLA4: Cytotoxic T-lymphocyte associated antigen 4; mAb: Monoclonal antibody; CAR-T: Chimeric antigen receptor encoded T-reg cell.

Figure 2 The tolerance protocol methodology for low immunogenic living kidney transplantation. A: Selection of Living donor and low immunogenic recipient; B: Sequence of peri-transplant protocol for B lymphocyte depletion, followed by transplantation and induction of immunosuppression. Subsequently, migration to tolerance regime.