The search for immunosuppressive therapies to induce tolerance in organ transplantation

Organ transplantation has become a major therapeutic option for patients with irreversible organ diseases. Immunosuppressive agents are usually required to prevent allograft rejection in patients who undergo an organ transplantation. Such drugs suppress both specific and nonspecific immunity, and render the recipient more susceptible to both infection and malignancy. Therefore, the development of more effective and less toxic immunosuppressive agents could improve the clinical outcomes of organ transplant recipients. Since the early days of clinical and experimental liver transplantation, it has been known that the liver is less likely to be rejected in comparison to other organs and may be tolerogenic even across a fully allogeneic MHC barrier in some specific cases. Spontaneous acceptance of liver allografts has been observed in several species. Orthotopic liver transplantation (OLT) in certain rat strains is accepted without immunosuppressive agents and serum from post-OLT recipients displays immunosuppressive activity. Attempts have been made to identify the immunosuppressive factors that are present in post-OLT serum to elucidate the mechanism of immunological tolerance and to discover novel immunosuppressive agents for potential use in organ transplantation. In this review we will focus on established and recent findings in the identification of immunosuppressive factors in a rat tolerogenic OLT model. The most recent therapeutic methods in organ transplantation and future prospects will be discussed.