Granot E, Loewenthal R, Jakobovich E, Gazit E, Sokal E, Reding R
Pediatric Department, Kaplan Medical Center, Rehovot, Israel.
Pediatr Transplant. 2012 Feb;16(1):E1-4. doi: 10.1111/j.1399-3046.2010.01378.x. Epub 2010 Aug 31.
We report long-term (seven yr) immunological tolerance in a 16-yr-old boy, to a liver allograft donated by his father following a bone marrow transplant at age 2.5 yr from the same donor. The bone marrow transplant was complicated by severe GVHD leading to liver failure and the ensuing need for a liver transplant, performed under planned avoidance of immunosuppression. At one wk post-transplant, although a liver biopsy was histologically compatible with acute rejection, favorable clinical and biochemical evolution precluded initiating immunosuppressive therapy, thus highlighting the need for caution when interpreting early histological changes so that administration of unnecessary immunosuppression can be avoided. Induction of tolerance in transplant recipients remains an elusive goal. In those patients who had received conventional bone marrow transplants and had endured the consequences of GVHD, development of macrochimerism may allow immunosuppression-free solid organ transplantation from the same donor.
我们报告了一名16岁男孩对肝脏同种异体移植的长期（7年）免疫耐受情况。该肝脏移植供体为其父亲，而在他2.5岁时曾接受过来自同一供体的骨髓移植。骨髓移植并发严重移植物抗宿主病（GVHD），导致肝功能衰竭，随后需要进行肝脏移植，此次肝脏移植是在计划避免免疫抑制的情况下进行的。移植后1周，尽管肝脏活检在组织学上与急性排斥反应相符，但良好的临床和生化进展使免疫抑制治疗未被启动，这突出表明在解读早期组织学变化时需谨慎，以免进行不必要的免疫抑制治疗。诱导移植受者产生耐受仍然是一个难以实现的目标。在那些接受过传统骨髓移植并承受过GVHD后果的患者中，大嵌合体的形成可能使来自同一供体的实体器官移植无需免疫抑制。
