Study on the tolerance induction after liver transplantation

活体供体肝移植（LRLT）可能比尸体移植具有一定的免疫学优势。本研究的目的是分析单一中心对110名儿童和成人患者进行LRLT的经验，并特别参考接受者的免疫反应。我们回顾了110例连续行LRLT患者的医疗记录。分析移植前协变量与患者和移植物存活的关系。精算患者/移植物生存率分别为1年、3年和5年。分析同种异体移植术后急性和慢性排斥反应的类型和发生率。此外，我们还研究了围手术期血清细胞因子水平和肝脏细胞因子mRNA表达情况。精算1年、3年和5年患者和移植物存活率分别为88%、85%和85%。Log-rank检验表明，abc相容性预测患者生存率，而患者年龄、基础疾病、患者临床状态、供受体关系、供体年龄和移植物体积/标准肝体积比不能预测患者生存率。人白细胞抗原匹配不是影响排斥发生率的因素。血清白细胞介素-6、8、12、15水平升高与同种异体移植排斥反应一致。在eb病毒相关的移植后淋巴细胞增生性疾病患者中，可停止免疫抑制剂，血清白细胞介素-10水平升高。控制Th1/Th2细胞因子平衡，阻断共刺激信号是克服肝移植后免疫后遗症的关键。

It has been expected that living-related donor liver graft transplantation (LRLT) might have some immunological advantages over cadaveric transplantation. The objective of this study was to analyze a single center's experience with 110 LRLT in pediatric and adult patients with special reference to immunological response in the recipients.The medical records of 110 consecutive patients who underwent LRLT were reviewed. The relationship between pretransplant covariates and patient and graft survival was analyzed. Actuarial patient/graft survival rates were determined at 1, 3 and 5 years. The type and incidence of posttransplant complications including acute and chronic allograft rejection were analyzed. In addition, the perioperative profiles of serum cytokine levels as well as cytokine mRNA expression in the liver were investigated.The 1-, 3-, and 5-year actuarial patient and graft survival rates were 88%, 85%, and 85%, respectively. Log-rank test demonstrated that ABC-compatibility predicted patient survival rate, whereas patient age, underlying disease, patient's clinical status, donor-recipient relation, donor age and graft volume/standard liver volume ratio did not. Human leukocyte antigen matching was not the factor affecting the incidence of rejection. Interleukin-6, 8, 12, 15 levels in the serum were elevated in accordance with allograft rejection In the patients with Epstein-Barr virus related posttransplant lymphoproliferative disorder where the cessation of immunosuppressant is possible, serum interleukin-10 level was elevated.The control of Th1/Th2 cytokine balance as well as the blockade of costimulatory signaling are the keys to overcome immunological sequelae after liver transplantation.