Liver transplantation immunology: Immunosuppression, rejection, and immunomodulation

免疫抑制 医学 肝移植 免疫学 人口 免疫系统 移植 肝病 内科学 环境卫生
作者
Aldo J. Montaño‐Loza,Manuel Rodríguez‐Perálvarez,G.-P. Pageaux,Alberto Sánchez‐Fueyo,Sandy Feng
出处
期刊:Journal of Hepatology [Elsevier BV]
卷期号:78 (6): 1199-1215 被引量:62
标识
DOI:10.1016/j.jhep.2023.01.030
摘要

Outcomes after liver transplantation have continuously improved over the past decades, but long-term survival rates are still lower than in the general population. The liver has distinct immunological functions linked to its unique anatomical configuration and to its harbouring of a large number of cells with fundamental immunological roles. The transplanted liver can modulate the immunological system of the recipient to promote tolerance, thus offering the potential for less aggressive immunosuppression. The selection and adjustment of immunosuppressive drugs should be individualised to optimally control alloreactivity while mitigating toxicities. Routine laboratory tests are not accurate enough to make a confident diagnosis of allograft rejection. Although several promising biomarkers are being investigated, none of them is sufficiently validated for routine use; hence, liver biopsy remains necessary to guide clinical decisions. Recently, there has been an exponential increase in the use of immune checkpoint inhibitors due to the unquestionable oncological benefits they provide for many patients with advanced-stage tumours. It is expected that their use will also increase in liver transplant recipients and that this might affect the incidence of allograft rejection. Currently, the evidence regarding the efficacy and safety of immune checkpoint inhibitors in liver transplant recipients is limited and cases of severe allograft rejection have been reported. In this review, we discuss the clinical relevance of alloimmune disease, the role of minimisation/withdrawal of immunosuppression, and provide practical guidance for using checkpoint inhibitors in liver transplant recipients.
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