arXiv2024
Solid organ transplantation has by now become a common medical procedure. Owing to the introduction of new immunosuppressive drugs, the allograft loss due to acute rejection has been reduced significantly over time. Tragically, the number of donor organs lost due to allograft vasculopathy (AV), generally named chronic vascular rejection or chronic rejection, has remained significant and unchanged for decades. We argue that designation of AV as chronic rejection, and its classification as a delayed long-lasting reaction of recipient immune effectors against donor alloantigens have given us the wrong impression that we have identified the necessary cause of the disease. However, whatever treatment options we have in the anti-rejection toolbox, despite their success in treating acute rejection, do not work for AV. Yet, the scientific community has continued to conceptualize and approach AV within the alloimmunity and rejection model. Due to unproductive research from the alloimmunity perspective, the number of transplanted hearts lost due to this pathology today is almost the same as it was fifty years ago. We believe that this phenomenon falls under the rubric of linguistic relativity, and that the language we chose to name the disease has restricted our cognitive ability to solve the problem. While the initial perception of the AV as chronic rejection was logical and scientific, the subsequent experience revealed that such perception and approach have been fruitless, and likely are incorrect. Considering our tragic failure to prevent and treat allograft vasculopathy using all available knowledge on alloimmunity and rejection, we must finally disassociate the former from the latter. A good way to start this process is to change the words we are using; particularly, the words we chose to name the disease. We have to step out of the alloimmunity rejection box