Monitoring the operationally tolerant liver allograft recipient

作者：Castellaneta Antonino; Thomson Angus W; Nayyar Navdeep; de Vera Michael; Mazariegos George V^*

来源：Current Opinion in Organ Transplantation, 2010, 15(1): 28-34.

DOI：10.1097/MOT.0b013e328334269a

• biomarkers
• immune monitoring
• microarray analysis
• tolerance registry
• transplant tolerance

Purpose of review
A fundamental goal in transplantation is the establishment of allograft function without ongoing immunosuppression. Robust allograft tolerance has been established in experimental transplantation models, whereas clinical operational tolerance has been described most frequently following human liver transplantation.
Recent findings
Clinical assessment of tolerance has been limited to laboratory evaluation of organ function. Additional tools include graft monitoring through biopsy and blood sampling for biomarker analysis. Current biomarkers under assessment in recent years include dendritic cell subsets, regulatory T cells, antidonor antibodies, and gene polymorphisms. Emerging microarray analysis that is being prospectively validated will also be reviewed. A further tool in the characterization of the tolerant patient will be the accurate enrollment of such patients into a multicenter registry that will prospectively follow the natural history of the patient withdrawn from immunosuppression and help facilitate the entry of interested patients to mechanistic and immune monitoring trials. The International Solid Organ Transplant Tolerance Registry (www.transplant-tolerance.org) will be briefly described.
Summary
Effective biomarker characterization of the operationally tolerant liver allograft recipient would allow earlier, well tolerated, prospective drug withdrawal with the goal of extending the potential benefits of drug minimization to an increasing number of patients in a more predictable fashion.

• 出版日期2010-2