Cytolytic molecules in rejection

PURPOSE OF REVIEW: Acute and chronic rejection are major problems in clinical transplantation. Rejection is largely mediated by natural killer (NK) and T cells that use cytolytic molecules, including perforin, granzymes, granulysin, and Fas ligand, to eliminate the allograft. The purpose of this review is to inform the reader of recent advances in our understanding of the roles of cytolytic molecules in rejection and their potential as biomarkers of rejection. RECENT FINDINGS: Although it is well accepted that T cells are the major effector cells in acute rejection, there is an increasing recognition that cells of the innate immune system, and in particular NK cells, also play a major role in allograft rejection. SUMMARY: Both NK cells and cytotoxic T cells contribute to acute rejection. The major molecules involved include perforin, granzymes, granulysin, and Fas ligand. Molecular profiles that include these and other molecules may allow better management of organ allograft recipients.