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Spontaneous and induced tolerance for liver transplant recipients
Published Web Location
http://ovidsp.tx.ovid.com/sp-3.24.1b/ovidweb.cgi?QS2=434f4e1a73d37e8c00586f3002aa4aac1c2342ae3ed7291362647240354ee11cc02b7b845cbd768246b1a4add7ab0e4ab2319f57df3bdbd06ffc14ffcfffc9893c96e92a49da59dcb571aae370d66e647be0827dd3cdba6d05edfbc9772aafa44716151b5590e44d2bf7d6b90fd068d055d21763feaf6e4270d7082d088c6681f545306d521df1bc42793b3ce8a5a33edc25bf24bea92641bcf86a536e553e0f6a110274989f18c0b82e9d4fa31629240b4450eafee5a41c103b35c14dbc6780c3fd82a7eb03d0a9f8e18791d7e3043e9403c9a0b209bce24409acc75bccd17No data is associated with this publication.
Abstract
Purpose of review
Transformative medical and surgical advances have remarkably improved short-term survival after liver transplantation. There is, however, pervasive concern that the cumulative toxicities of modern immunosuppression regimens severely compromise both quality and quantity of life for liver transplant recipients. The inherently tolerogenic nature of the liver offers the tantalizing opportunity to change the current paradigm of nonspecific and lifelong immunosuppression. Safe minimization or discontinuation of immunosuppression without damage to the liver allograft is an attractive strategy to improve long-term survival after liver transplantation.Recent findings
Recent prospective, multicenter clinical trials have demonstrated that immunosuppression can be safely withdrawn from selected liver transplant recipients with preservation of allograft histology. These successes have spurred multiple avenues of investigation to identify peripheral blood and/or tissue biomarkers and delineate mechanisms of tolerance. Concomitant advances in the ability to expand regulatory T cells in the laboratory have spawned clinical trials to facilitate immunosuppression minimization and/or discontinuation.Summary
This review will delineate the unique liver immunobiology that has driven the recent clinical trials to unmask spontaneous tolerance or induce tolerance for liver transplant recipients. The emerging results of these trials over the next 5 years hold promise to reduce the burden of lifelong immunosuppression and thereby optimize the long-term health of liver transplant recipients.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.