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Spontaneous and induced tolerance for liver transplant recipients

Feng, Sandy

Current Opinion in Organ Transplantation: February 2016 - Volume 21 - Issue 1 - p 53–58
doi: 10.1097/MOT.0000000000000268
TOLERANCE INDUCTION: Edited by Kadiyala V. Ravindra and Esma S. Yolcu
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Purpose of review Transformative medical and surgical advances have remarkably improved short-term survival after liver transplantation. There is, however, pervasive concern that the cumulative toxicities of modern immunosuppression regimens severely compromise both quality and quantity of life for liver transplant recipients. The inherently tolerogenic nature of the liver offers the tantalizing opportunity to change the current paradigm of nonspecific and lifelong immunosuppression. Safe minimization or discontinuation of immunosuppression without damage to the liver allograft is an attractive strategy to improve long-term survival after liver transplantation.

Recent findings Recent prospective, multicenter clinical trials have demonstrated that immunosuppression can be safely withdrawn from selected liver transplant recipients with preservation of allograft histology. These successes have spurred multiple avenues of investigation to identify peripheral blood and/or tissue biomarkers and delineate mechanisms of tolerance. Concomitant advances in the ability to expand regulatory T cells in the laboratory have spawned clinical trials to facilitate immunosuppression minimization and/or discontinuation.

Summary This review will delineate the unique liver immunobiology that has driven the recent clinical trials to unmask spontaneous tolerance or induce tolerance for liver transplant recipients. The emerging results of these trials over the next 5 years hold promise to reduce the burden of lifelong immunosuppression and thereby optimize the long-term health of liver transplant recipients.

Abdominal Transplant Fellowship, University of California San Francisco, San Francisco, California, USA

Correspondence to Sandy Feng, MD, PhD, Professor of Surgery in Residence, Director, Abdominal Transplant Fellowship, University of California San Francisco, 505 Parnassus Avenue, M-896, San Francisco, CA 94143-0780, USA. Tel: +1 415 353 8725; fax: +1 415 353 8709; e-mail: sandy.feng@ucsfmedctr.org

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