RESUMEN
UNLABELLED: Several studies have shown that some liver transplant recipients may tolerate immunosuppression withdrawal. Mechanisms and biomarkers of tolerance are not well known. METHODS: Twenty-four LT patients with immunosuppression side-effects underwent progressive immunosuppression withdrawal. Peripheral lymphocyte populations and secretion of cytokines were analyzed at baseline and during withdrawal until tolerance (n = 15) or rejection (n = 9), as well as 3 months after tolerance achievement or rejection resolution (as follow-up). Immunological markers were compared among groups. RESULTS: The percentages of CD3+CD4+ cells progressively decreased in both groups. CD3+CD8+ cells gradually increased in tolerant patients. B lymphocytes gradually decreased in tolerant and initially in non-tolerant patients, reverting at rejection. Regulatory T cells progressively increased until rejection in non-tolerants, decreasing to basal levels after renewing immunosuppression; no significant changes were found in tolerant patients. The percentages and absolute counts of natural killer cells significantly increased in both groups, being more evident in tolerant patients. The secretion of several cytokines was higher in non-tolerant patients when rejection was diagnosed. CONCLUSIONS: The greater increase of natural killer cells in tolerant patients suggests their potential role in the tolerance phenomenon.
Asunto(s)
Citocinas/metabolismo , Trasplante de Hígado , Subgrupos Linfocitarios/inmunología , Síndrome de Abstinencia a Sustancias/diagnóstico , Linfocitos T Reguladores/inmunología , Antígenos CD/metabolismo , Estudios de Seguimiento , Humanos , Tolerancia Inmunológica , Pruebas Inmunológicas , Inmunofenotipificación , Terapia de Inmunosupresión/efectos adversos , Monitoreo Fisiológico , Síndrome de Abstinencia a Sustancias/etiología , Privación de TratamientoRESUMEN
La constante actualización en el campo del trasplante hepático llevó a la celebración de la III Reunión de consenso de la Sociedad Española de Trasplante Hepático. En ella se debatió acerca de 3 temas actuales y de gran interés clínico: el trasplante en pacientes con cirrosis hepática por virus C, trasplante hepático de donante vivo y la evaluación de la calidad de los injertos hepáticos. También se abordó un tema de gran interés para las unidades de trasplante hepático: la evaluación de su calidad (AU)
The constant updating in the field of liver transplant led to the holding of the III Consensus Meeting of the Spanish Liver Transplant Association. Three current topics of great clinical interest were debated during this meeting; transplant in patients with liver cirrhosis due to hepatitis C, live donor liver transplant and the evaluation of the quality of liver grafts. A subject of great interest to Liver Transplant Units was also discussed: the assessment of their quality (AU)
Asunto(s)
Humanos , Trasplante de Hígado/tendencias , Hepatitis C Crónica/cirugía , Sociedades Médicas/normas , Donadores Vivos/provisión & distribución , Tolerancia al TrasplanteRESUMEN
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