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Kidney transplantation has always been the clinical and pathological context for designing and developing novel therapeutic strategies in the whole field of transplantation. The possibility of dialysis as a parachute offers the benefit of a certain free space to initiate and propose new treatment options. The ...

Kidney transplantation has always been the clinical and pathological context for designing and developing novel therapeutic strategies in the whole field of transplantation. The possibility of dialysis as a parachute offers the benefit of a certain free space to initiate and propose new treatment options. The fine balance between immunosuppression and immune regulation remains the fil rouge that represents the challenge of the new millennium for dedicating the greatest resources and the most reasonable investments in this strategic area to cope with serious organ failure.

Over the last few decades, research has explored several relationships between the various players regulating the microenvironment of the immune response. The key pathways activated during the rejection process have been identified, while the role of immune regulation in preventing this activation has expanded. Furthermore, the impact of diet, microbiota, and exercise on the immune homeostasis of transplanted organs is being increasingly recognized. Integration of all these complex systems ultimately influences transplant outcomes.

In terms of the immune complex of solid organ transplantation, this emergent knowledge is progressively allowing us to translate the immunology of solid organ transplantation into a series of targeted actions that, taken together, have the potential to drive the immune response towards specific and selective treatments.
Three main problems still have to be faced. The first lies in the actions required to prevent allograft recognition, the second regards the measures to counteract acute or chronic immune rejection when the host immune system identifies non-self-epitopes of the transplanted organ, including therapeutic interventions and measures such as microbiota/diet manipulation. Lastly, efforts to promote selective immune regulation/tolerance towards the transplanted organ are highly needed. This Research Topic aims to focus attention on the state of advance of these three research lines.

We welcome the submissions of Original Research, Review, Mini-review, Perspectives, Clinical Trial, and Case Report articles focusing on, but not limited to, the following topics related to the Kidney Transplantation:
• Allograft rejection
• Cellular rejection
• Antibody-mediated rejection (AMR)
• Reprogramming of the immune system
• Tolerogenic/immune regulatory strategies
• Therapies for kidney transplantation (e.g., Cell therapy, Drug combination therapy)
• Donor specific antibodies (DSA)
• Innate Immunity in kidney transplantation
• Allorecognition and tracking of antigen-specific cellular immunity
• Environmental factors modulating alloimmunity (eg. diet, exercise, microbiota)
• Xenotransplantation

Topic Editor Flavio Vincenti received financial support from Angion Biomedica Corp., Astellas Pharma US, Inc., Pfizer, Novartis Pharmaceuticals, Egenesis, Horizon, Veloxis, Merck, Eledon, Quell Bio, Sangamo. The other Topic Editor declares no competing interests.

Keywords: Transplantation, Rejection, Immunosuppressive agents, Immune regulation, Biological agents, Antibodies and antigens, Target therapy, Cell therapy, Novel small molecule agents, Drug combination therapy, Donor specific antibodies


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