Clinical Immune Tolerance in Liver Transplantation: Present and Future.
10.7599/hmr.2014.34.4.197
- Author:
Gyu Seong CHOI
1
Author Information
1. Division of transplantation, Department of Surgery, Samsung Medical Center, School of Meidicine Sunkyunkwan University, Seoul, Korea. medi9370@gmail.com
- Publication Type:Review
- Keywords:
Liver Transplantation;
Immune Tolerance;
End Stage Liver Disease
- MeSH:
Animals;
Carcinoma, Hepatocellular;
Chimerism;
End Stage Liver Disease;
Fatigue;
Humans;
Immune System;
Immune Tolerance*;
Immunosuppression;
Immunosuppressive Agents;
Liver;
Liver Diseases;
Liver Transplantation*;
Living Donors;
T-Lymphocytes, Regulatory;
Tissue Donors
- From:Hanyang Medical Reviews
2014;34(4):197-201
- CountryRepublic of Korea
- Language:English
-
Abstract:
Liver transplantation is the most effective treatment for end-stage liver diseases (ESLD) with satisfactory clinical results and so is considered as the treatment of choice for ESLD and early hepatocellular carcinoma with cirrhotic liver. Unfortunately, adverse effects of life-long immunosuppression prevent the development of alternative strategies to achieve better long-term outcome. Achieving clinical operational tolerance is one of the ultimate goals in the clinical transplantation field. Around 15% of liver transplantation recipients develop spontaneous operational tolerance after immunosuppression withdrawal, and the percentage may be even higher in pediatric living donor liver transplantation recipients. One of the possible explainable mechanisms is a T cell fatigue from large amount of antigen loaded. Despite continuing progress, clinical operational tolerance is still rare in liver transplantation. Reprogramming the recipient immune system by creating chimerism and utilizing regulatory cell therapies are among the newer promising means to achieve clinical liver transplantation tolerance in the future. In animal studies, administration of donor specific regulatory T cells allows a prolonged survival without immunosuppressive agents. In this review, proposed mechanisms for clinical tolerance will be offered and current experimental trial will be introduced.
