Immunotolerance in liver transplantation: A primer for the clinician

Juanita Pérez-Escobar, Jose Victor Jimenez, Erika Faride Rodríguez-Aguilar, Maximiliano Servín-Rojas, Jesus Ruiz-Manriquez, Luisa Safar-Boueri, Eduardo Carrillo-Maravilla, Miquel Navasa, Ignacio García-Juárez*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

The use of immunosuppressive medications for solid organ transplantation is associated with cardiovascular, metabolic, and oncologic complications. On the other hand, the development of graft rejection is associated with increased mortality and graft dysfunction. Liver transplant recipients can withdraw from immunosuppression without developing graft injury while preserving an adequate antimicrobial response - a characteristic known as immunotolerance. Immunotolerance can be spontaneously or pharmacologically achieved. Contrary to the classic dogma, clinical studies have elucidated low rates of true spontaneous immunotolerance (no serologic or histological markers of immune injury) among liver transplant recipients. However, clinical, serologic, and tissue biomarkers can aid in selecting patients in whom immunosuppression can be safely withdrawn. For those who failed an immunosuppression withdrawal trial or are at high risk of rejection, pharmacological interventions for immunotolerance induction are under development. In this review, we provide an overview of the mechanisms of immunotolerance, the clinical studies investigating predictors and biomarkers of spontaneous immunotolerance, as well as the potential pharmacological interventions for inducing it.

Original languageEnglish (US)
Article number100760
JournalAnnals of Hepatology
Volume28
Issue number1
DOIs
StatePublished - Jan 1 2023

Keywords

  • Graft rejection
  • Immune system
  • Outcomes

ASJC Scopus subject areas

  • Hepatology

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