Germani Giacomo, Rodriguez-Castro Kryssia, Russo Francesco Paolo, Senzolo Marco, Zanetto Alberto, Ferrarese Alberto, Burra Patrizia
Giacomo Germani, Kryssia Rodriguez-Castro, Francesco Paolo Russo, Marco Senzolo, Alberto Zanetto, Alberto Ferrarese, Patrizia Burra, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy.
World J Gastroenterol. 2015 Jan 28;21(4):1061-8. doi: 10.3748/wjg.v21.i4.1061.
The evaluation of the immunosuppression state in liver transplanted patients is crucial for a correct post-transplant management and a major step towards the personalisation of the immunosuppressive therapy. However, current immunological monitoring after liver transplantation relies mainly on clinical judgment and on immunosuppressive drug levels, without a proper assessment of the real suppression of the immunological system. Various markers have been studied in an attempt to identify a specific indicator of graft rejection and graft acceptance after liver transplantation. Considering acute rejection, the most studied markers are pro-inflammatory and immunoregulatory cytokines and other proteins related to inflammation. However there is considerable overlap with other conditions, and only few of them have been validated. Standard liver tests cannot be used as markers of graft rejection due to their low sensitivity and specificity and the weak correlation with the severity of histopathological findings. Several studies have been performed to identify biomarkers of tolerance in liver transplanted patients. Most of them are based on the analysis of peripheral blood samples and on the use of transcriptional profiling techniques. Amongst these, NK cell-related molecules seem to be the most valid marker of graft acceptance, whereas the role CD4+CD25+Foxp3+ T cells has still to be properly defined.
评估肝移植患者的免疫抑制状态对于正确的移植后管理至关重要，也是免疫抑制治疗个体化的重要一步。然而，目前肝移植后的免疫监测主要依赖临床判断和免疫抑制药物水平，而没有对免疫系统的实际抑制情况进行适当评估。人们已经研究了各种标志物，试图找到肝移植后移植物排斥和移植物存活的特定指标。考虑到急性排斥反应，研究最多的标志物是促炎和免疫调节细胞因子以及其他与炎症相关的蛋白质。然而，这些标志物与其他情况有相当大的重叠，只有少数得到了验证。标准肝脏检查由于其低敏感性和特异性以及与组织病理学结果严重程度的弱相关性，不能用作移植物排斥的标志物。已经进行了多项研究来确定肝移植患者免疫耐受的生物标志物。其中大多数基于外周血样本分析和转录谱分析技术的应用。其中，NK细胞相关分子似乎是移植物存活最有效的标志物，而CD4+CD25+Foxp3+T细胞的作用仍有待明确界定。
