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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
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Operational tolerance after liver transplantation.

Giuseppe Orlando1, Shay Soker, Kathryn Wood

  • 1Transplantation Research Immunology Group, Nuffield Department of Surgery, University of Oxford, Headington, Oxford OX3 9DU, UK. gorlando@wfubmc.edu

Journal of Hepatology
|April 28, 2009
PubMed
Summary

Achieving an immunosuppression-free state after liver transplantation (LT) is possible in a significant portion of patients. This study suggests clinical operational tolerance (COT) is attainable for more LT recipients than previously thought.

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Area of Science:

  • Transplantation immunology
  • Gastroenterology
  • Immunology

Background:

  • The ultimate goal in transplantation is an immunosuppression-free (IS-free) state.
  • Clinical operational tolerance (COT) is rare in solid organ transplantation but observed in liver transplantation (LT).
  • Current physician belief suggests COT is unattainable for most LT recipients due to safety concerns and study limitations.

Purpose of the Study:

  • To challenge the prevailing belief that clinical operational tolerance (COT) is out of reach for most liver transplant (LT) recipients.
  • To present evidence supporting the feasibility of achieving a stable, IS-free state after LT.
  • To encourage a re-evaluation of current attitudes towards IS minimization in LT.

Main Methods:

  • Review of existing global data on clinical operational tolerance (COT) after liver transplantation (LT).
  • Analysis of factors influencing the achievement of COT, including patient selection and study design.
  • Evaluation of the safety and stability of IS-free states in LT recipients.

Main Results:

  • Worldwide experience shows COT can be safely achieved in approximately 25% of selected LT individuals.
  • Success in achieving COT is independent of donor/recipient immunology, age, indication, follow-up duration, or chimerism.
  • Growing evidence indicates a permanent IS-free state is achievable in LT recipients with non-immune mediated liver diseases.

Conclusions:

  • The established belief that COT is unattainable for the majority of LT recipients may no longer be justified.
  • A significant proportion of LT recipients can achieve a stable and permanent immunosuppression-free state.
  • Further research and clinical practice should explore and support IS minimization strategies in LT.