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From immunosuppression to tolerance.

David H Adams1, Alberto Sanchez-Fueyo2, Didier Samuel3

  • 1Centre for Liver Research and NIHR Biomedical Research Unit in Liver Disease, University of Birmingham and Queen Elizabeth Hospital, Edgbaston Birmingham B152TT, United Kingdom.

Journal of Hepatology
|April 29, 2015
PubMed
Summary
This summary is machine-generated.

Liver transplantation survival has improved due to better immunosuppression, but long-term management requires balancing rejection prevention with therapy side effects. Future strategies aim for personalized immunosuppression and graft tolerance.

Keywords:
Calcineurin inhibitorsImmune toleranceImmunosuppressionmTOR inhibitors

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Area of Science:

  • Hepatology
  • Transplantation Immunology
  • Clinical Medicine

Background:

  • Liver transplantation is a key treatment for end-stage liver disease.
  • Improved surgical, anesthetic, and post-transplant care have enhanced survival rates.
  • Effective immunosuppression is crucial for preventing graft rejection and ensuring long-term success.

Purpose of the Study:

  • To review current liver transplant immunosuppression strategies.
  • To discuss the challenges of acute and chronic rejection.
  • To explore future directions in immunosuppression and achieving graft tolerance.

Main Methods:

  • Review of current literature on liver transplantation and immunosuppression.
  • Analysis of rejection rates and post-transplant complications.
  • Discussion of evolving immunosuppressive drug protocols and tolerance induction strategies.

Main Results:

  • Current immunosuppression protocols, primarily calcineurin inhibitors (CNI) with steroids and other agents, have reduced acute (10-40%) and chronic (<5%) rejection rates.
  • Long-term survivors may develop atypical rejection due to under-immunosuppression.
  • Post-transplant complications related to immunosuppression necessitate protocol adjustments to protect renal function and prevent cancer and metabolic syndrome.

Conclusions:

  • Achieving full graft tolerance is rare, with only 20% of patients successfully weaned off immunosuppression.
  • Future immunosuppression will be personalized, focusing on graft protection, reducing recurrence, and minimizing therapy-related complications.
  • Strategies promoting stable long-term immunological tolerance are essential for advancing liver transplantation outcomes.