Overview:

‘Accommodation’ refers to a vascularized transplant that has acquired resistance to antibody-mediated rejection. The phenomenon was first described after clinical ABO-incompatible (ABOi) renal transplantation in the 1980s and is recognised as a common outcome in this context today. Platt and Bach defined three potential mechanisms to explain accommodation, of which the development of endothelial cell cytoprotection is the most studied. Although much is known about how accommodation arises in animal models and there are reliable ways to induce it, little is known about how it arises after clinical ABOi transplantation, there is no way to induce it clinically and most importantly there is no dependable way of recognising when it has occurred. In this talk, I will review recent progress in this area and highlight how accommodation could be of benefit, alongside other strategies, to prolong the life of human transplanted organs.