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Kidney Transplant II: Surgical Procedure01:26

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Updated: Jun 23, 2026

In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients
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Clinical operational tolerance after solid organ transplantation.

P Di Cocco1, L Bonanni, M D'Angelo

  • 1Transplant Unit, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.

Transplantation Proceedings
|May 23, 2009
PubMed
Summary

Clinical operational tolerance (COT) after solid organ transplantation (SOT) allows normal graft function without immunosuppression, improving quality of life. Achieving COT remains challenging, especially for kidney and lung transplants, necessitating new cell-based strategies.

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Published on: May 2, 2013

Area of Science:

  • Transplantation immunology
  • Graft acceptance
  • Immunosuppression minimization

Background:

  • Clinical operational tolerance (COT) signifies normal graft function post-solid organ transplantation (SOT) without immunosuppression.
  • COT offers significant benefits, including reduced side effects and enhanced patient quality of life.
  • While achievable in liver recipients, COT remains difficult in kidney and lung transplant patients.

Purpose of the Study:

  • To review the current status of clinical operational tolerance in solid organ transplantation.
  • To highlight the challenges and potential strategies for inducing COT.
  • To emphasize the need for novel approaches beyond molecular protocols.

Main Methods:

  • Review of existing literature on clinical operational tolerance in SOT.
  • Analysis of reported cases and challenges in achieving COT across different organ types.
  • Discussion of current limitations in molecular tolerogenic protocols.

Main Results:

  • COT is well-established in stable liver transplant recipients.
  • Successful COT cases are rare in kidney and lung transplantation.
  • Mechanisms underlying COT are not fully understood.
  • Current molecular strategies have limitations for widespread COT induction.

Conclusions:

  • Achieving clinical operational tolerance is a major goal in SOT but remains challenging.
  • Cell-based strategies represent a promising avenue for future COT induction.
  • Further research is needed to elucidate COT mechanisms and develop effective induction protocols.