  Solid organ transplantation across the allogeneic barrier, pioneered by
Thomas Starzl, has by now become a common medical procedure. Unfortunately, the
number of donor organs lost due to transplant arteriosclerosis (chronic
rejection), remains significant and unchanged for decades. We argue that
designation of transplant arteriosclerosis as chronic rejection, and its
classification as a delayed long-lasting reaction of recipient immune effectors
against donor alloantigens have given us a wrong impression that we have
identified the necessary cause/pathogenesis of the tissue pathology. However,
whatever treatment options we have in the anti-rejection toolbox, despite their
success in treating classical rejection, do not work for the transplant
arteriosclerosis. Yet, the scientific community has continued to conceptualize
and approach the pathology within the alloimmunity model. Due to unproductive
research from the alloimmunity and rejection 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 language we chose to name the disease has
restricted our cognitive ability to solve the problem. While the initial
perception of the transplant arteriosclerosis 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 the delayed arterial pathology of donor organs
using all available knowledge on alloimmunity and rejection, we must finally
disassociate the former from the latter. The only way to start this
uncomfortable 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.
