15. The Immune System in Liver Transplantation: Rejection vs. Tolerance

  1. James Neuberger DM, FRCP2,
  2. James Ferguson MD, FRCPE3 and
  3. Philip N. Newsome PhD, FRCPE4
  1. Palak J. Trivedi and
  2. Nick D. Jones

Published Online: 19 JUL 2013

DOI: 10.1002/9781118675915.ch15

Liver Transplantation: Clinical Assessment and Management

Liver Transplantation: Clinical Assessment and Management

How to Cite

Trivedi, P. J. and Jones, N. D. (2013) The Immune System in Liver Transplantation: Rejection vs. Tolerance, in Liver Transplantation: Clinical Assessment and Management (eds J. Neuberger, J. Ferguson and P. N. Newsome), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118675915.ch15

Editor Information

  1. 2

    Associate Medical Director, Organ Donation and Transplantation, NHS Blood and Transplant, Bristol; Honorary Consultant Physician, Queen Elizabeth Hospital, Birmingham, UK

  2. 3

    Consultant Hepatologist, Queen Elizabeth Hospital, Birmingham, UK

  3. 4

    Head of Cell Therapy, Senior Lecturer in Hepatology and Consultant Transplant Hepatologist, Centre for Liver Research and Birmingham NIHR Liver Biomedical Research Unit, Institute of Biomedical Research, The Medical School, University of Birmingham; Queen Elizabeth Hospital, Birmingham, UK

Author Information

  1. University of Birmingham, Birmingham, UK

Publication History

  1. Published Online: 19 JUL 2013

ISBN Information

Print ISBN: 9781118277386

Online ISBN: 9781118675915

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Keywords:

  • antigen-presenting cell;
  • HLA;
  • liver transplant;
  • microchimerism;
  • regulatory T-cell;
  • rejection;
  • tolerance

Summary

After solid organ transplantation, rejection is mediated by recipient leucocytes, and less frequently via preformed antibodies directed against donor antigens. Although transplantation of MHC histo-incompatible tissues elicits a strong cytopathic T-cell-dependent immune response to donor tissue, HLA incompatibility itself does not have a bearing on long-term liver allograft survival. As a result, liver allografts have long been considered to be ‘immunologically privileged' due to an enhanced degree of tolerogenicity compared to other solid organ transplants (e.g. renal transplants). This is evidenced by the lower frequency of rejection episodes despite positive T-cell cross-matches as well as a low incidence of graft loss due to rejection. Moreover, it is increasingly recognised that the tolerogenic nature of the liver allograft may allow withdrawal of immunosuppression in carefully selected individuals.