Pediatric Hepatology and Liver Transplantation
Pediatric Hepatology and Liver Transplantation
复制标题
小儿肝病学和肝移植
DOI：
10.1007/978-3-319-96400-3_36
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Feng S
中科院分区：
文献类型：
--
作者：
Feng S
长期以来，肝脏一直被认为是所有移植的实体器官中最具“耐受性”的。这最初是基于超过半个世纪前的观察，即肝脏同种异体移植物与其他器官不同，在某些猪种中自发接受，而不需要任何免疫抑制。自从这些开创性的观察以来，已经发现了许多关于肝脏的解剖学和生物学的证据，证明了其致耐受性的性质并阐明了潜在的机制。临床医生已经吸取了这些教训，因此，已经尝试尽量减少甚至完全停止免疫抑制。已经发表了多个单中心报告和一些关于免疫抑制剂停药的前瞻性、多中心临床试验，清楚地证明了原则性证据：在高度选择的成人和儿童肝移植受者中，确实存在自发耐受。在完全没有免疫抑制的情况下，肝移植物可以在短期和中期内继续发挥功能，具有稳定的生化和非常重要的组织学特征。具有临床定义的耐受性和不耐受性表型的患者的可用性支持了相当大的努力来鉴定可靠预测耐受性的生物标志物。虽然已经提出了几个，只有一个组织为基础的生物标记物显示出足够的承诺，值得前瞻性测试的效用，以增加安全性和成功的尝试退出。自发耐受的存在也促使试验在既存和新生成人肝移植受者中诱导耐受。目前的方法集中在制造的细胞产品的管理，最常见的自体调节性T细胞的各种制剂，提供供体特异性免疫调节的前景。在接下来的十年中，肝移植界可以期待更多地了解自发和诱导耐受以及耐受的生物标志物和潜在机制。
The liver has long been viewed as the most “tolerogenic” of all solid organs transplanted. This was initially based on observations made more than half a century ago that liver allografts, unlike other organs, are spontaneously accepted across certain strains of pigs without the need for any immunosuppression. Since these seminal observations, much has been discovered about the liver’s anatomy and biology that evidences its tolerogenic nature and elucidates the underlying mechanisms. Clinicians have assimilated these lessons, and, as a result, there have been attempts to minimize and even completely discontinue immunosuppression. Multiple single center reports and a few prospective, multicenter clinical trials of immunosuppression withdrawal have been published, clearly demonstrating proof-of-principle: among highly selected adult and pediatric liver transplant recipients, spontaneous tolerance does exist. Liver allografts can continue to function, in the short- and mid-term, well with stable biochemical and, very importantly, histological profiles in the complete absence of immunosuppression. The availability of patients with clinically defined phenotypes of tolerance and non-tolerance has supported considerable efforts to identify a biomarker reliably predictive of tolerance. Although several have been suggested, only one—a tissue-based biomarker—has shown sufficient promise to merit prospective testing for utility to increase the safety and success of attempted withdrawal. The existence of spontaneous tolerance has also motivated trials to induce tolerance in both pre-existing and de novo adult liver transplant recipients. Current approaches center on administration of manufactured cellular products, most often various preparations of autologous regulatory T cells that offer the prospect of donor-specific immunomodulation. In the upcoming decade, the liver transplant community can look forward to learning much more about both spontaneous and induced tolerance as well as biomarkers and underlying mechanisms of tolerance.
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影响因子：
4.9
作者：
Selmi C;De Santis M;Gershwin ME
通讯作者：
Gershwin ME
儿科患者的 IgG4 硬化性胆管炎
影响因子：
4.2
作者：
Danya Rosen;S. Thung;Shari Sheflin;Joanne Lai;Ally Rosen;R. Arnon;Jaime Chu
通讯作者：
Jaime Chu
影响因子：
25.7
作者：
Reilly, Norelle R.;Lebwohl, Benjamin;Hultcrantz, Rolf;Green, Peter H. R.;Ludvigsson, Jonas F.
通讯作者：
Ludvigsson, Jonas F.
肝毛细血管病：韩国首例病例报告。
影响因子：
3.3
作者：
G. Choe;Hyun Soon Lee;J. Seo;Jong;S. Lee;Kee Seon Eom;J. Chi
通讯作者：
J. Chi
DOI：
10.1186/1546-0096-10-34
发表时间：
2012-09-20
期刊：
Pediatric rheumatology online journal
影响因子：
--
作者：
Patwardhan A;Rennebohm R;Dvorchik I;Spencer CH
通讯作者：
Spencer CH