Operational tolerance is not always permanent: A 10-year prospective study in pediatric liver transplantation recipients.

Autor: Wozniak LJ; Pediatric Gastroenterology, Hepatology, and Nutrition David Geffen School of Medicine at UCLA Los Angeles California USA Division of Liver and Pancreas Transplantation, Department of Surgery David Geffen School of Medicine at UCLA Los Angeles California USA Department of Pathology and Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles California USA Immunogenetics Center University of California, Los Angeles (UCLA)Los Angeles California USA., Venick RS, Naini BV, Scapa J, Hickey MJ, Rossetti M, Korin Y, Reed EF, Farmer DG, Busuttil RW, Vargas JH, McDiarmid SV
Jazyk: angličtina
Zdroj: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2022 Oct; Vol. 28 (10), pp. 1640-1650. Date of Electronic Publication: 2022 May 17.
DOI: 10.1002/lt.26474
Abstrakt: Immunosuppression withdrawal can be safely performed in select liver transplantation recipients, but the long-term outcomes and sustainability of tolerance have not been well studied. We completed a 10-year prospective, observational study of 18 pediatric liver transplantation recipients with operational tolerance to (1) assess the sustainability of tolerance over time, (2) compare the clinical characteristics of patients who maintained versus lost tolerance, (3) characterize liver histopathology findings in surveillance liver biopsies; and (4) describe immunologic markers in patients with tolerance. Comparator patients from two clinical phenotype groups termed "stable" and "nontolerant" patients were used as controls. Of the 18 patients with operational tolerance, the majority of patients were males (n = 14, 78%) who were transplanted for cholestatic liver disease (n = 12, 67%). Median age at transplantation was 1.9 (range, 0.6-8) years. Median time after transplantation that immunosuppression had been discontinued was 13.1 (range, 2.9-22.1) years. As many as 11 (61%) maintained tolerance for a median of 10.4 (range, 1.9-22.1) years, whereas 7 (39%) lost tolerance after a median of 3.2 (range, 1.5-18.6) years. Populations of T regulatory cells (%CD4 + CD25 hi CD127 lo ) were significantly higher in patients with tolerance (p = 0.02). Our results emphasize that spontaneous operational tolerance is a dynamic and nonpermanent state. It is therefore essential for patients who are clinically stable off immunosuppression to undergo regular follow-up and laboratory monitoring, as well as surveillance biopsies to rule out subclinical rejection.
(© 2022 American Association for the Study of Liver Diseases.)
Databáze: MEDLINE
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