Zhou Ai-Wei, Jin Jing, Liu Yuan
Department of Liver Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
Department of Nursing, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
World J Gastroenterol. 2024 Apr 7;30(13):1791-1800. doi: 10.3748/wjg.v30.i13.1791.
Liver transplantation (LT) has become the most efficient treatment for pediatric and adult end-stage liver disease and the survival time after transplantation is becoming longer due to the development of surgical techniques and perioperative management. However, long-term side-effects of immunosuppressants, like infection, metabolic disorders and malignant tumor are gaining more attention. Immune tolerance is the status in which LT recipients no longer need to take any immunosuppressants, but the liver function and intrahepatic histology maintain normal. The approaches to achieve immune tolerance after transplantation include spontaneous, operational and induced tolerance. The first two means require no specific intervention but withdrawing immunosuppressant gradually during follow-up. No clinical factors or biomarkers so far could accurately predict who are suitable for immunosuppressant withdraw after transplantation. With the understanding to the underlying mechanisms of immune tolerance, many strategies have been developed to induce tolerance in LT recipients. Cellular strategy is one of the most promising methods for immune tolerance induction, including chimerism induced by hematopoietic stem cells and adoptive transfer of regulatory immune cells. The safety and efficacy of various cell products have been evaluated by prospective preclinical and clinical trials, while obstacles still exist before translating into clinical practice. Here, we will summarize the latest perspectives and concerns on the clinical application of cellular strategies in LT recipients.
肝移植（LT）已成为治疗小儿和成人终末期肝病最有效的方法，并且由于手术技术和围手术期管理的发展，移植后的生存时间正变得更长。然而，免疫抑制剂的长期副作用，如感染、代谢紊乱和恶性肿瘤，正受到越来越多的关注。免疫耐受是指肝移植受者不再需要服用任何免疫抑制剂，但肝功能和肝内组织学仍保持正常的状态。移植后实现免疫耐受的方法包括自发耐受、操作性耐受和诱导性耐受。前两种方式不需要特定干预，而是在随访期间逐渐停用免疫抑制剂。迄今为止，尚无临床因素或生物标志物能够准确预测哪些人适合移植后停用免疫抑制剂。随着对免疫耐受潜在机制的认识，已开发出许多策略来诱导肝移植受者产生耐受。细胞策略是诱导免疫耐受最有前景的方法之一，包括造血干细胞诱导的嵌合现象和调节性免疫细胞的过继转移。各种细胞产品的安全性和有效性已通过前瞻性临床前和临床试验进行了评估，但在转化为临床实践之前仍存在障碍。在此，我们将总结细胞策略在肝移植受者临床应用方面的最新观点和关注点。
