Study of immunological mechanisms during successful withdrawal of immunosuppression after living donor liver transplantation

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This study aims to clarify the mechanisms of clinical tolerance, to identify indicators for safe withdrawal of immunosuppression, and to increase the number of patients free from immunosuppression. Patients free from immunosuppression after living liver transplantation (IS free patients) were investigated, such as Th1 & Th2 cytokines, regulatory T cells. 1) IS free patients showed donor specific hypo-response in MLR and the Th1 cytokines were down regulated in IS free patients compared with third party MLR. 2) There was no specific feature in cytokine gene expression in liver biopsy tissue in IS free patients. 3) The serum of IS free patients showed nonspecific suppression in MLR but we could not isolate and identify the substance yet. 4) The number of CD4+/CD25+ cells and γ/δ TCR+ T cells were increased in IS free patients compared with healthy people. 5) In clinical, over 900 patients underwent living donor liver transplantation in our institution and the number of patients completely free from immunosuppression was increased from 15 in 1998 to 49 in 2002 and other 36 patients were under weaning protocol. We continue to study cellar factors as the most possible indicators for IS withdrawal.