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The direct and indirect pathways of allo-sensitisation. In the direct pathway, donor-derived MHC complexes, presented by donor-derived ‘passenger’ dendritic cells (antigen-presenting cells or APCs), are recognised directly by recipient T cells. In the indirect pathway, host APCs take up immunogenic proteins from apoptotic graft cells and present donor-derived processed peptides on host MHC to host T cells. MHC, major histocompatibility complex; APC, antigen presenting cell.
