Withdrawal of Immunosuppression after Liver Transplantation

Life-long immunosuppression (IS) has always been considered the traditional approach in the management of transplant recipients to protect the hepatic graft from rejection. The liver is a tolerogenic organ with impressive immune regulatory mechanisms that maintain local and systemic immune tolerance to antigens, as well the capability to trigger effective immune responses against pathogens. The King's College team identified independent factors that were associated with sustained IS withdrawal: non-autoimmune liver disease; fewer donor—recipient human leucocyte antigen mismatches; and no previous acute rejection episode. From the reported data it is clear that it is possible safely to reduce and even discontinue IS therapy in up to 40% of selected liver allograft recipients. The identification of tolerance biomarkers is of central importance, in order to be able to develop a protocol that can be applied to all suitable patients.