Endothelial cells in organ transplantation: Friends or foes?

Vascular endothelial cells are the first interface between donor and recipient in organ transplantation. Endothelial cells and smooth muscle cells are key actors of acute and chronic rejection processes in organ allografting, but they also have the capacity to protect themselves from allograft-induced injury. Recent advances in our understanding of the precise mechanisms leading to endothelial dysfunction or, on the contrary, to endothelial protection, suggest that therapeutic interventions targeting endothelial cells could improve allograft survival and have even raised the question of whether such manipulations can be considered with a view to inducing immunological tolerance.